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The global eradication of smallpox. Final report of the Global Commission for the Certification of Smallpox Eradication, Geneva, December 1979.
Geneva, Switzerland, WHO, 1980. 122 p. (History of International Public Health No. 4)The Global Commission for the Certification of Smallpox Eradication met in December 1978 to review the program in detail and to advise on subsequent activities and met again in December 1979 to assess progress and to make the final recommendations that are presented in this report. Additionally, the report contains a summary account of the history of smallpox, the clinical, epidemiological, and virological features of the disease, the efforts to control and eradicate smallpox prior to 1966, and an account of the intensified program during the 1967-79 period. The report describes the procedures used for the certification of eradication along with the findings of 21 different international commissions that visited and reviewed programs in 61 countries. These findings provide the basis for the Commission's conclusion that the global eradication of smallpox has been achieved. The Commission also concluded that there is no evidence that smallpox will return as an endemic disease. The overall development and coordination of the intensified program were carried out by a smallpox unit established at the World Health Organization (WHO) headquarters in Geneva, which worked closely with WHO staff at regional offices and, through them, with national staff and WHO advisers at the country level. Earlier programs had been based on a mass vaccination strategy. The intensified campaign called for programs designed to vaccinate at least 80% of the population within a 2-3 year period. During this time, reporting systems and surveillance activities were to be developed that would permit detection and elimination of the remaining foci of the disease. Support was sought and obtained from many different governments and agencies. The progression of the eradication program can be divided into 3 phases: the period between 1967-72 when eradication was achieved in most African countries, Indonesia, and South America; the 1973-75 period when major efforts focused on the countries of the Indian subcontinent; and the 1975-77 period when the goal of eradication was realized in the Horn of Africa. Global Commission recommendations for WHO policy in the post-eradication era include: the discontinuation of smallpox vaccination; continuing surveillance of monkey pox in West and Central Africa; supervision of the stocks and use of variola virus in laboratories; a policy of insurance against the return of the disease that includes thorough investigation of reports of suspected smallpox; the maintenance of an international reserve of freeze-dried vaccine under WHO control; and measures designed to ensure that laboratory and epidemiological expertise in human poxvirus infections should not be dissipated.
Report of the evaluation of UNFPA assistance to the National Family Planning and Sex Education Programme of Costa Rica.
[Unpublished] 1980 Mar. 89 p.This report of the evaluation of UN Fund for Population Activities (UNFPA) assistance to Costa Rica's National Family Planning and Sex Education Program covers the following: 1) project dimension and purpose of the evaluation, scope and methodology of the evaluation, composition of the mission, and constraints; 2) background information; 3) 1974-77 family planning/sex education program (overview, immediate objectives, strategy, activities and targets, and institutional framework); 4) planned and actual inputs and rephasing in 1978-79; 5) family planning activities (physical facilities and types of services provided, recruitment of new users, continuation of users within the program, distribution of contraceptive supplies, sterilizations, and indicators of program impact); 6) training and supervision; 7) education, information, and communication (formal and nonformal education, educational activities in the clinics, and the impact of the nonformal educational program); 8) maternal and child health (maternal health indicators, cytological examinations, and infant mortality); 9) program evaluation and research; 10) population policy; 11) program administration; 12) some general conclusions regarding the performance of the program; and 13) the program beyond 1979. UNFPA evaluations are independent, in depth analyses, prepared and conducted by the Office of Evaluation, usually with the assistance of outside consultants. The process of analysis used in the evaluation follows a logical progression, i.e., that which underlines the original program design. Evaluation assessment includes an analysis of inputs and outputs, an investigation of the interrelationship among activities, an indication of the effectiveness of activities in achieving the objectives, and an assessment of duplication of activities or lack of coverage and the effect of this on realization of the objectives. The program was able to expand the coverage of family planning activities but has been unsuccessful in having a population policy established. The number of hospitals, health centers, and rural health posts providing family planning services was tripled in the 1974-77 period. The program could not achieve its targets in number of new users, and it recruited in 1977, only 11% of the total population of the country, against the 20% planned. It has been estimated that between 1973-77 around 231,200 births or 44.4% of those possible had been averted. Training and supervision has been a weak area of the program. A large number of professors have been trained in sex education, but no evaluation has been undertaken of the likely impact of this trained staff at the school level. The information, education, and communication (IEC) program has been successful in taking information and education to the population on family planning/sex education concerns but less successful in motivating the political groups to formulate a population policy.
Bangkok, ILO Regional Office for Asia and the Pacific, 1980. 64 p.The chapters included in this resource book for trainers, prepared for a regional audience, present those topics that are most relevant in an organized sector population/family welfare education program, i.e., a program directed to any group of workers which can be approached through an appropriate organizational channel. This book has been prepared with the trainers of instructors in mind, i.e., for those who are going to help prepare the actual factory level instructors to become efficient in family welfare education. It is most important that trainers and instructors in a family welfare education program appreciate the fact that the program is directed to explaining the relationships between the pressure of the labor supply and the well-being of the worker's family. Following an introductory chapter, the chapters of this volume present the following: objectives of International Labor Organization (ILO) Population/Family Welfare Education Program; population concepts and factors affecting population growth (population concepts and factors affecting population growth); population growth and employment; family welfare, living standards, and population change; communication in population/family welfare education; and methods of contraception. The basic objective of most ILO-designed country population education programs is to facilitate the understanding of population and family welfare factors in so far as they affect the working conditions and quality of life of the workers. The programs are generally designed to encourage active involvement and participation of the regular members of the labor force. Implicit in the objectives is the motivation to the acceptance of family planning as a means of fertility regulation. The implementation of a program at the plant level is generally a combination of work undertaken by a trainer and volunteer motivators. The trainer can present the case for family planning welfare through various mediums, and the motivators follow up by talking to colleagues either individually or in small groups.
Geneva, Switzerland, WHO, 1980. 290 p.This Sixth Report on the World Health Situation tries to bring out the main ideas on health and health care issues and how to deal with them that arose during the 1973-1977 period. The primary sources of information used in the preparation of the report were the following: information routinely passed on by Member Governments to the World Health Organization (WHO); country reviews specially submitted by Member Governments for the Sixth Report; information routinely collected by other organizations of the United Nations system; and information for the reference period collected by WHO on an "ad hoc" basis to meet specific policy and program requirements. A background chapter focuses on general considerations, population, food and nutrition, education, social changes, economic trends, employment, poverty, health-related behavioral factors, evaluation of development progress and data needs, and policy issues. Subsequent chapters examine health status differentials, health action, research, and the outlook for the future in terms of demographic prospects, social and economic aspects, health status trends, health manpower supply and demand, and world health policies. Most significant during the 1973-1977 period was the explicit recognition of the view that health development is a reflection of conscious political, social, and economic policy and planning rather than merely an outcome (or by-product) of technology. The goal of "health for all by the year 2000" expresses the political commitment of health services and the agencies responsible for them to a "new Health order." Primary health care is the most important vehicle for achieving this new health order. The most important social trends during the report period are reflected in the still low and in some areas worsening nutritional level of the majority of the population. The overall picture with regard to mortality continues to be mixed, with a few notable cases of marked decline and many of continuing unspectacular decline. The data on morbidity are even less reliable than those on mortality, but it appears that there has been a significant increase or resurgence of certain communicable diseases. There is evidence of decreasing dependence on physicians in some parts of the world and a related strengthening of various paramedical and auxiliary groupings. Some of the important new health programs are to be found in the area of family health. The overall role and importance of primary health care are emphasized in many parts of the report. There are some specific indications of ways in which primary health care activities are being integrated with the more traditional activities of the health sector.
Population Bulletin of the United Nations Economic Commission For Western Asia. 1980 Jun; 18:65-80.The United Nations Population Division has been preparing world population estimates and projections by region since 1951, by country since 1958, and by sex and age for each country since 1968. The latest revision of the projections was prepared in 1978. The 2 basic methods of preparing population projections are mathematical and component, and the component methods are most widely used at present, by both national governments and the United Nations. Before projections are prepared, the base data must be evaluated and adjusted. In the UN projections, the assumptions imply that orderly progress will be made and that there will be no catastrophes such as famines and epidemics during the projection period. The projectins are prepared in 4 variants--"medium", "high," "low," and "constant." A major source of uncertainty in populations arises from the problem of estimating future fertility. Changes in fertility affect the age distribution and the total population size more than changes in mortality. At the UN, mortality assumptions are initially made in terms of life expectancy at birth and then in terms of age-sex patterns of probabilities of survival corresponding to different life expectancy levels at birth. Some of the results of the 1978 revision of the medium variant of the estimates and projections are shown in table form. The world total population of 4,033,000,000 in 1975 is projected to reach 6,199,000,000 by the year 2000. Among the major areas and regions of the world, the most rapid population growth for the future is projected for the Arab countries, Africa and Latin America. Of the 2 Arab regions, North Africa and Southwest Asia, Southwest Asia is expected to have the higher rate of growth because of assumed continued immigration. Within the Arab regions, there has been an increasing diversity in the rate of population growth. This divergence is expected to narrow with assumed decreased migration rates during the 1980s.
United Nations/World Health Organization Meeting on Socio-Economic Determinants and Consequences of Mortality, Mexico City, 19-25 June 1979.
Population Bulletin. 1980; (13):60-74.The objectives of the United Nations/World Health Organization (WHO) Meeting on Socioeconomic Determinants and Consequences of Mortality, held in Mexico City in June 1979, were the following: to review the knowledge of differential mortality and to identify gaps in the understanding of its socioeconomic determinants and consequences; to discuss the methodological and technical problems associated with data collection and analysis; to consider the policy implications of the findings presented and to promote studies on the implications of socioeconomic differentials in mortality on social policy and international development strategies; to formulate recommendations and guidelines for the utilization of the 1980 round of population censuses for in-depth studies of mortality differentials; and to stimulate national and international research on differential mortality. Participants discussed the state of knowledge of socioeconomic differentials and determinants of mortality and described the socioeconomic measures available, the methods of data collection and analysis used, and the findings themselves. A number of characteristics had been employed in the study of differential mortality, and these could be grouped under the following headings: occupation; education; housing; income, wealth; family size; and place of residence. The techniques or methods used to analyze mortality were direct and indirect methods, and these are examined. Inequalities in mortality were found to be closely associated with inequalities in social and economic conditions. Any effort to reduce or remove those inequalities would have to be based on a clear understanding of their causes and interrelationships in order to succeed. Participants indicated a desire to see a resurgence of mortality research, and some research suggestions are outlined.
Progress of work, 1979-1980, of the Department of International Economic and Social Affairs in the field of population: report of the Secretary-General.
New York, UN, 1980 Nov 18. 20 p. (E/CN.9/349)A progress report of work performed during the 1979-1980 period by the Department of International Economic and Social Affairs in the field of population is presented. Covered in the report are activities of the Secretariat in the analysis of demographic trends and structure, demographic estimates and projections, fertility and family planning, population and development, population policy, monitoring and review and appraisal of the World Population Plan of Action. Also included are other continuing activities of the Secretariat. During the period covered by the report, efforts continued to carry out the program adopted by the Commission and the General Assembly. Mortality studies were reinstated along with urbanization studies, the scope of work in international migration was expanded, and new projections were prepared of total population, its sex-age structure, its urban-rural distribution, and the number of households and families. Additional work was carried out on analysis of World Fertility Survey data and of factors affecting acceptance of family planning programs. Also continued was the investigation of the relationships between social and economic factors and the components of demographic change. Under continuous study was the policy implications of the changing world population. Studies in population development and studies analyzing population policies were predominant in this 3rd round of monitoring of population trends and policies.
Recommendations of the Meeting on Socio-economic Determinants and Consequences of Mortality: report of the Secretary-General.
New York, UN, 1980 Dec 8. 12 p. (E/CN.9/352)This document contains the recommendations of the Meeting on Socioeconomic Determinants and Consequences of Mortality, organized by the Population Division and the World Health Organization. The meeting was held June 19-25, 1979 in Mexico City. The participants developed and adopted a set of recommendations for future research and action in the following areas: data collection and processing; methodological and substantive research activities, international coordination, training and data dissemination, and funding of future research and training activities. The recommendations are presented to the Population Commission for its consideration and appropriate action, within the context of the future work program in population. Dissemination of information on results of national studies on mortality and its differentials should be part of an international information-exchange system. Suitable mechanisms at the international and national levels should be set up to establish such a system. Governments should make mortality and social class data available to private research organizations whenever possible. Since mortality had received low priority in the allocation of funds for research and training, the Meeting called upon bilateral and multilateral funding agencies in population and public health to rectify that deficiency.
Action by the United Nations to implement the recommendations of the World Population Conference, 1974: monitoring of population trends and policies: concise report on monitoring of population trends.
New York, UN, 1980 Dec 16. 30 p. (E/CN.9/347)Included in this document is a concise report presented to the Population Commission on the findings of the 3rd round of monitoring of world population trends as requested by the Economic and Social Council in resolution 1979/33. The findings are summarized in terms of the recent levels and trends of demographic variables and their differentials. Attention is directed to the socioeconomic determinants and consequences of these levels and trends. The relationships between population and development are reviewed. Such aspects are included as economic disparities associated with socio-demographic development and the relations between fertility, mortality and socioeconomic variables in developing countries. There appears to be increasing evidence that a movement towards fertility decline in underway in the developing countries and that the trend towards moderation in the rate of growth of world population is continuing. The annual rate of growth of the world population may decline to 1.5% by the end of the 20th century, from 1.7 at this time and 2.0% over 15 years ago. The decline is small, and its significance lies primarily in its persistence and anticipated acceleration. Otherwise, substantial population increase, primarily in many of the developing countries, will persist and continue to be among the major factors influencing the present and future of humanity. The decline in the birthrate of the developing countries was mostly brought about by declines in China and in several East-Asian, South-Asian and Latin American countries. Besides the initial fertility decline in the developing countries, another primary feature of the present demographic situation is the continuing fertility decline in the developed countries.
Intercom. 1980 May; 8(5):1, 12-15.Africa's growing population problems and the role of family planning in Africa were described. Population growth in Africa is accelerating more rapidly than in any other region of the world and population pressures on the continent are just beginning to emerge. The current population of Africa is 472 million and constitutes 10% of the world's population. Most countries in Africa are just entering the early phase of the demographic transition. Mortality rates are declining but the birth rates remain high. Africa's growth rate increased from 2% to 3% from 1955-1980. In sub-Saharan Africa vital statistics are not available for many of the countries and population estimates are based on inadequate data. Fertility is high in the region and the average woman has 6-7 children. Population problems in the region are masked to some extent because population density is still relatively low; however, land pressures are beginning to mount as overgrazed, deforested, eroded, and exhausted land areas increase. Per capita food production is declining by 1.4% annaually due in part to the outdated transportation and marketing systems which characterize many of the sub-Saharan countries. In many of these sub-Saharan countries there is a lack of interest in family planning and some governments have pronatalist population policies. Family planning is viewed by some Africans as an attempt on the part of Westerners to suppress the native population. National governments often hesitate to establish family planning programs for fear that these will be interpreted as veiled attempts to reduce the political influence of opposing tribal groups. Most family planning activities in sub-Saharan countries are financially supported by private and international organizations. Major contributors in 1979 were UNFPA, which provided $18 million primarily for the collection of demographic data, and IPPF, which spent $7.5 million on family planning programs. Other organizations providing assistance are 1) the Pathfinders, 2) the Population Council, and 3) the Family Planning International Assistance. USAID provides direct funding and also funds bilateral and regional programs through individual governments.
WHO CHRONICLE. 1980 Jan; 34(1):9-15.The need for data on socioeconomic differentials in morality and the difficulties encountered in collecting this type of data are discussed, and mortality research priorities for both developing and developed countries are suggested. Socioeconomic factors have an impact on mortality, and mortality levels vary not only by country, but within each country by social class. In recent years mortality levels have declined in most countries; however, differences in mortality levels between social classes have probably increased. Although data on socioeconomic differentials in mortality is needed to adequately access the health status and health needs of a country, mortality data, especially in developing countries, is limited. In developing countries, vital registration systems must either be established or greatly improved. Until these systems are improved, mortality data will have to be collected mainly by survey techniques. The scope of maternal and infant mortality surveys should be expanded to include data on all types of mortality. National survey capabilities should be improved by establishing training programs for survey personnel. WHO could coordinate and direct these mortality data collection efforts. In developed countries, data collection is generally adequate, and the emphasis should be placed on developing better analytical tools for processing existing data. Despite the lack of mortality data in developing countries, it is known that differences in mortality levels between social classes could be reduced by improving: 1) community based preventive healt,h care systems and 2) sanitary conditions.