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  1. 1
    Peer Reviewed

    Health in an unequal world.

    Marmot M

    Lancet. 2006 Dec 9; 368(9552):2081-2094.

    William Harvey was born in Folkestone on April 1, 1578. He was educated at the King's School, Canterbury, Gonville, and Caius College, Cambridge, and the University of Padua, graduating as doctor of arts and medicine in 1602. He became a Fellow of the Royal College of Physicians in 1607 and was appointed to the Lumleian lectureship in 1615. In the cycles of his Lumleian lectures over the next 13 years, Harvey developed and refined his ideas about the circulation of the blood. He published his conclusions in 1628 in Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus, which marks the beginning of clinical science. In it, Harvey considered the structure of the heart, arteries, and veins with their valves. By carefully devised experiments and supported by the demonstration of the unidirectional flow of the blood in the superficial veins of his own forearm, he established that the blood circulated, and did not ebb and flow as had been believed for more than 1000 years. (excerpt)
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  2. 2

    Trip report, Burundi, 21 - 24 July 1987.

    Ben Salem B

    [Unpublished] 1987. 7 p.

    During the July 21-24 trip to Burundi, discussions were held about possible Association for Voluntary Surgical Contraception (AVSC) assistance in creating a training center at the University Hospital which could serve as a site for training medical personnel from Burundi and other French-speaking African nations. Practical training is urgently needed at this time to allow health personnel to feel comfortable about dispensing a wide range of contraceptive methods/information. A great need exists for the training of nurses in IUD insertion and for copper-T commodities. Family planning method acceptance is growing steadily: the number is said to double every 6 months. As yet, voluntary surgical contraception plays a minor role and is available only at a limited number of centers. As previously reported, several donors, including the UN Fund for Population Assistance, World Bank, and the African Development Bank, are involved in activities/proposals related to maternal/child health and family planning. The major objective of AVSC assistance to the Ministry of Public Health is to increase access to VSC by integrating quality services into ongoing maternal/child health/family planning activities in 4 regional referral hospitals. The project is expected to last for 4 years with a total budget of slightly over $200,000. During this visit, the basics were worked out for a program in which AVSC would provide assistance for training 10 physicians/year in minilap (both postpartum and interval) using local anesthesia. Trainees would be residents and interns and, if possible, physicians from government facilities. It is hoped that a training program document can be developed for presentation at the December 1987 meeting of AVSC's International Committee. The site visit was useful to the effort of moving the pending project with the Ministry of Public Health along and for discussing possible cooperation with the University Hospital. Program success is likely for several reasons: the Ministry of Public Health generally is favorable and supportive; chances for "institutionalization" are good; the basic hospital infrastructure is sound; and the rising demand for VSC is recognized by health officials and service providers.
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  3. 3

    But some are more essential than others] Action Programme on Essential Drugs and Vaccines.

    Lauridsen E

    World Health. 1984 Jul; 3-5.

    In 1977 the World Health Organization (WHO) began a peaceful revolution in international public health by asking a group of experts which drugs were really necessary to take care of most health problems. The conclusion was that about 200 drugs and vaccines could be considered essential in good medical practice. Most of them were of proven efficacy, with well-known therapeutic properties, and most were no longer protected by patent rights and could be mass produced at a reasonable cost to patients. The Model List of Essential Drugs, although revised twice since 1977, has needed only minor adjustments and is still limited to about 220 essential drugs and vaccines. More than 80 countries in the 3rd world have adapted the model list to their requirements. Country experience demonstrates that using a limited number of essential drugs poses no threat to public health. In response to problems of drug supply and drug use in developing countries, country application of the philosophy of essential drugs has become the centerpiece of a global program designed to make sure that a limited number of essential drugs of good quality are available at prices that poorer patients can afford. A strategy, drawn up toward the end of the 1970s and which eventually became the Action Program on Essential Drugs and Vaccines, addresses the complexity of the world of pharmaceutical products and their utilization. It focuses on essential drug availability in primary health care. If a limited number of essential drugs cannot be delivered on a regular basis to rural areas and the poorer sections of cities, the whole strategy of health for all by the year 2000 will face a partial or even total failure. The Action Program on Essential Drugs and Vaccines is becoming a worldwide effort, with many partners involved. Countries decide for themselves on the pharmaceutical policy they want to follow. Many have chosen an essential drug policy and some have accelerated their programs with external technical and financial collaboration. Physicians and other health workers who prescribe, and dispensing pharmacists, are obvious partners for the Action Program. New information and training must be provided for students of medicine, pharmacy, and pharmacology before an improvement in the fine art of prescribing medicine can be expected. Patients, supported by better information and follow-up, should also accept more responsibility for their own use of drugs.
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  4. 4


    Menes RJ

    Washington, D.C., U.S. Office of International Health, Division of Planning and Evaluation, 1976. 144 p. (Syncrisis: the dynamics of health, XIX)

    This report uses available statistics to examine health conditions in Senegal and their interaction with socioeconomic development. Background data are presented, after which population, health status, nutrition, environmental health, health infrastructure, facilities, services and manpower, national health policy and planning, international organizations, and the Sahel are discussed. Diseases such as malaria, measles, tuberculosis, trachoma and venereal diseases are endemic in Senegal, and high levels of infant and childhood mortality exist throughout the country but especially in rural areas. Diarrhea, respiratory infections, and neonatal tetanus contribute to this mortality and are evidence of the poor health environment, and lack of basic services including nutrition assistance, health education, and potable water. Nutrition in Senegal appears to be good in general, but seasonal and local variations sometimes produce malnutrition. Lowered fertility rates would reduce infant and maternal mortality and morbidity and might slow the present decline in per capita food intake. At present the government of Senegal has no population policy and almost no provisions for family planning services. Health services are inadequate and inefficient, with shortages of all levels of health manpower, poor planning, and overemphasis on curative services.
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  5. 5


    Loomis SA

    Washington, D.C., U.S. Office of International Health, Division of Planning and Evaluation, 1976. 92 p. (Syncrisis: the dynamics of health, XVII)

    This article uses available statistics to analyze health conditions in Bangladesh and their impact on the country's socioeconomic development. Background information on the country is first given, after which population characteristics, health status, nutrition, national health policy and adminstration, health services and programs, population programs, environmental sanitation, health sector resources, financing of health care and donor assistance are examined. Bangladesh's 3% annual population increase is expected to increase already great population pressure and to have a negative impact on the health status of the population. Although reliable health statistics are lacking, infant mortality is estimated at 140 per 1000, 40% of all deaths occur in the 0-4 age group, and maternal mortality is high. Infectious diseases exacerbated by malnutrition are the main causes of death. 4 key factors are responsible for the general malnutrition: 1) rapidly growing population, 2) low per capita income, 3) high incidence of diarrheal diseases, and 4) dietary practices that restrict nutrient intake. Most of the population has access only to traditional health services, and medical education is hospital oriental and curative, with minimal emphasis on public health. The level of environmental sanitation is extremely low.
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  6. 6

    Yozgat MCH/FP Project: Turkey country report.

    Coruh M

    [Unpublished] 1979. Paper prepared for the Technical Workshop on the Four Country Maternal and Child Health/Family Planning Projects, New York, Oct. 31-Nov. 2, 1979. (Workshop Paper No. 2) 10 p.

    An integrated health care system which combined the maternal/child health with other services was undertaken in the Yozgat Province of Turkey from 1972-77. The objective was to train midwives in MCH/FP and orient their activities to socialization. The first 2 years of the program was financed by UNFPA. 52 health stations were completed and 18 more are under construction. The personnel shortage stands at 33 physicians, 21 health technicians, 30 nurses, and 67 midwives. Yozgat Province is 75% rural and has about a 50% shortage of roads. The project was evaluated initially in 1975 and entailed preproject information studies, baseline health practices and contraceptive use survey, dual record system, and service statistics reporting. The number of midwives, who are crucial to the program, have increased from an average 115 in 1975 to 160 in 1979. Supervisory nurses are the link between the field and the project managers. Their number has decreased from 17 to 6. Until 1977 family planning service delivery depended on a handful of physicians who distributed condoms and pills. The Ministry of Health trained women physicians in IUD insertions. The crude death rate in 1976 was 13.2/1000; the crude birth rate was 42.7/1000. The crude death rate in 1977 was 14.8/1000; birth rate, 39.9/1000. Common child diseases were measles, enteritis, bronchopneumonia, otitis, and parasitis.
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  7. 7

    Health care or medical care [editorial]

    Buri R

    Public Health Reviews. 1982 Jul-Dec; 10(3-4):223-7.

    Throughout the world and particularly in the developing and underdeveloping countries the health situation is less than satisfactory. In their report O'Mahoney and Dahlqvist listed 31 countries as being the least developed and with an average life expectancy of 45 years and 200/1000 children born dying within a year. With a world population of 4 billion people, 10 countries in the World Health Organization (WHO) South East Asian region alone have a population of about 1 billion. The common enemies of the population of this region are hunger, poverty, and ignorance. The health problems which are responsible for high morbidity and mortality are protein energy malnutrition, which aggravates the already prevalent common infectious diseases, and gastrointestinal infections due to bacteria and parasites. Tuberculosis, malaria, and acute hemorrhagic fever also require attention. The situation is worsened by very high birthrates (30-40/1000), resulting in high population growth rates (1.8-3.0%) in many countries in this region. The impact of medical care on health, not to mention health coverage, is only temporary. Health depends on a simple effective system within a community whose members are alert to their own health, since the number of professional medical personnnel will never suffice. Health is as much everyone's right as everyone's responsibility. It is essential to gear the education of the health professionals to the true needs of the people. The public requires a new kind of physician who is willing to attack the health needs of a total population and is committed to preventing, promoting, and rehabilitating as well as curing. Physicians need to be concerned with socioeconomic and health problems, and students must be trained to function as members of a larger group of health personnel, i.e., of a health care team. At the 30th World Health Assembly, held in May 1977, it was resolved that primary social target of WHO and its member states should be the attainment by the year 2000 of a level of health that will allow all the worlds' citizens to lead socially and economically productive lives. Essential elements for health as suggested by the Director General of WHO include: adequate food and housing; adequate supply of safe drinking water; suitable waste disposal; maternal and child health and family planning; immunization against major infectious diseases; prevention and control of locally endemic diseases; appropriate treatment of common diseases and injuries; health education; and the provision of essential drugs. These are guidelines; each individual country has to work out its own strategies.
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  8. 8

    Keeping in touch by two-way radio.

    Hudson HE; Forsythe V; Burns SG

    World Health Forum. 1983; 4(2):157-61.

    In developing countries, the delivery of basic health care services is often hampered by communications problems. A pilot project in Guyana, involving 2-way radio in 9 medex (medical extension) locations, was funded by USAID (United States Aid for International Development). A training manual was prepared, and a training workshop provided the medex workers with practical experience in using the radios. The 2-way radios have facilitated arrangements for the transport of goods, hastened arrangements for leave, and shortened delays in correspondence and other administrative matters. Communication links enable rural health workers to treat patients with the advice of a doctor and allow doctors to monitor patient progress. Remote medex workers report that regular radio contacts with their colleagues have lessened their sense of isolation, boosted their morale, and helped build their confidence. 1 important element of the project was the training given to the field workers in proper use of the radio and in basic maintenance. Another key to the success of the system appears to be the strength and professionalism of the medex organization itself. Satellite systems may eventually prove to be the most cost effective means of providing rural telephone and broadcasting services and may also be designed to include dedicated medical communications networks at very little additional cost.
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  9. 9

    Family planning and fragmented services: some lessons from history.

    Aries NR

    [Unpublished] [1983]. 26 p.

    The basis of reproductive control is a woman's ability to consider the matter as an integrated part of her life. Despite this reality, there exists a contradiction in the organization and provision of women's reproductive health care. Services are fragmented between a number of programs and providers, providing a piecemeal approach to care. This paper explains the causes of such fragmentation and argues the need for an integrated system around women's reproductive health services. The modern fragmentation is related to the definition of health care put forward by the medical profession in the 19th century and the continued response of advocacy groups to this definition. By reviewing this history and examining the relation of birth control to other reproductive services, it is possible to understand the current political stalemate which surrounds women's health services. The fragmentation of reproductive health care occurred in the 19th century. During that period, women-dominated networks of care gave way to a male-dominated system for treating disease. The medical profession most profoundly influenced this process. In its push to establish professional dominance, reproduction was transformed so that a distinction was made between birthing and pregnancy prevention. Male physicians controlled the former while the antiabortion and obscenity laws made the latter unlawful. Women's reproductive health services have never been an accepted part of medicine, and therefore never integrated into the health care delivery system. Current attacks are to a large extent similar to those experienced by those birth control advocates who organized in response to the Comstock law. Women who distributed birth control literature in the early 1900s were jailed. Clinics were closed in the 1920s and 1930s. Physicians working for Planned Parenthood affiliates were harassed by local medical societies in the 1950s. In the 1960s and early 1970s clinics were the site of pickets who charged them with practicing genocide. The form has changed, and clinics are now faced with federal cutbacks and regulations. The intent remains the same. These actions are designed to discourage clients from seeking and utilizing services because family planning is not considered an integral part of medical practice. This history also teaches that the strategies that were successful in the past may not be as effective in the future. The strategy needed now is one of intergration. Services are vulnerable because they are provided independently of each other. They could be better protected if the various reproductive health organizations formed alliances and coalitions. In this way it would become more difficult to single out a specific services because it would be an integral part of a comprehensive program. Administrative initiatives have failed because fragmentation is deeply entrenched in the history of medicine and health service delivery.
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