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Washington, D.C., World Bank, 1992. xxvii, 133 p. (World Bank Country Study)In the early 1990s, the World Bank sent a team of specialists in demography, medicine, hospital administration, health policy, personnel, medical technology, and finance to China to examine the present health status of the population and to protect its future status. Before making any projections, however, they had to learn what demographic and epidemiologic factors would basically determine future health status. The main factors driving China's health transition included aging of the population; increased risk of developing chronic disease caused by changes in life style, dietary, environmental, and occupational risk factors; and changing morbidity and mortality patterns (i.e., shift from infectious to disabling and chronic diseases). The team mapped out specific strategies, which can indeed be achieved, to avert a health care crisis. The strategies revolved around a sustained effort of primary prevention of chronic diseases, especially circulatory diseases, which caused considerable premature mortality. The team illustrated how different formulas of total health expenditures would affect epidemiologic outcomes. The team learned that health care costs would probably increase due to unavoidable demographic trends (especially demographic aging), epidemiologic forces, and utilization and unit cost changes. Suggested primary prevention strategies alone would not be enough to control health expenditures to a level where feasible equity can be maintained. China must also greatly improve efficiency of hospital services, personnel, and technologies. The evaluation team concluded that the government needs to reassess policies for financing primary and preventive health services, the basis and conditions of insurance, and the role of prices and incentives in directing use and provision of services.
In: The population debate: dimensions and perspectives. Papers of the World Population Conference, Bucharest, 1974. Volume I. New York, New York, United Nations, 1975. 573-97. (Population Studies, No. 57; ST/ESA/SER.A/57)WHO presented a discussion on health trends and prospects in relation to population and development at the World Population Conference in Bucharest, Romania, in 1974. Even though many countries did not have available detailed results of 1970 population censuses, WHO was able to determine using the limited available data that both developing and developed countries could still make substantial reductions in death rates. This room for improvement was especially great for developing countries. Infectious diseases predominated as the cause of death in developing countries, while chronic diseases and accidents predominated in developed countries. Life expectancy at birth in developing countries was lower than that in developed countries (48.3-60.3 years vs. 70 years). Any life expectancy gains were likely to be slower after 1970 than during the 1950-1970 period. WHO claimed that by 2000 almost all of the population in developing and developed countries could reach a life expectancy of 60-65 years and 75-80 years, respectively. WHO stressed the complex interactions among population growth, health, and socioeconomic development. Specifically, an improved health status for both individuals and communities would promote socioeconomic development which in turn appeared to reduce natural increase. Some experts have expressed concern that investment in health services spurs population growth because they reduce mortality. Yet the child survival hypothesis indicated that a reduced infant mortality precedes increased demand for family planning methods and subsequent fertility decline. WHO concurred with the hypothesis and advocated that primary health services and family planning are critical to socioeconomic development. Indeed, family planning services should be integrated with maternal and child health services.