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Demography India. 1984 Jan-Dec; 13(1-2):153-67.The threshold hypothesis shares with transition theory the basic assumption that a decline in fertility is interrelated with a decline in mortality and change in the social, economic, and cultural conditions of the population. However, threshold theory fails to formulate a causal chain between fertility and the other variables and its application at the aggregate country level is limited by intracountry heterogeneity in cultural and social variables. Problematic is the fixing of the timing for a country of a decline in fertility to be inferred from the fact that some indicators of development have reached the threshold zone while others have not. This paper attempts to develope a combined index for socioeconomic development on the basis of data from 12 countries of the ESCAP region of South East Asia. Variables included were life expectancy at birth, infant mortality rate, adult female literacy, percentages of females economically active, GNP per capita, and percentage urban population. In 1970, 3 of the countries analyzed had a crude birth rate below 25, 6 countries had a rate between 25-40, and 3 had a rate above 40. The lowest value of the index recorded for countries of low fertility (crude birth rate below 25) and the highest value recorded for countries of high fertility (above 40) are taken as the threshold zones for the overall index. The number of countries in the threshold range increased from 5 in 1970 to 8 in 1975. With the increase in the index value, a reduction in the fertility level was noted. In contrast, where socioeconomic development was slow, fertility showed little change. Policy makers could use this system to assess which indicator could be pushed through to raise the overall index of development so as to effect a decline in fertility.
Population and Development Review. 1984; 10(2):353-9.Thise comments and remarks were fomulated in 1974 during a panel discussion which was part of the program for the Population Tribune, a nongovernmental meeting, organized in parallel with the 1st UN World Population Conference at Bucharest. The panelists discussed the ways in which they expected the deliberations of a similarly conceived international conference, taking place 10 years after Bucharest, would differ from those of the 1974 meeting. The author prefaces his comments by clarifying his own position: population change is nnot the determinant of economic and social development. 5 major differences between the future policy debates and those at Bucharest are identified, explored and critically judged. The next Conference's deliberations will be characterised by a greatly increased understanding and appreciation of what its topic is supposed to be, of what the population problem really is and of what population policy is about. The author argues that the present conference did not deal with these issues in a satisfactory fashion. He maintains that there has been a failure to identify the structure of the population problem: an inconsistency between collective and individual interest. The principle to be adopted by governments is to analyze their own situation, identify their problems and act according to their best interest. The principles are the same whether a country is developed or developing. A 2nd major difference will be an increased understanding and appreciation that population policies should be guided by a search for improvement and optimization. A 3rd important difference will be increased demographic sophistication of the participants, to overcome the mechanistic and naive interpretation of the development-fertility link. A 4th difference is the expectation that, by 1984, the economic sophistication in discussing problems of development will have been greatly increased, which will facilitate constructive discussions of economic-demographic interrelations. A final change expected for 1984 would manifest itself in a calmer yet more helpful stance of the developed countries with respect to the developing world in demographic matters. Ultimately, the solutions must be local, rather than global.
Assessment and implementation of health care priorities in developing countries: incompatible paradigms and competing social systems.
Social Science and Medicine. 1984; 19(4):373-84.This paper addresses conceptual issues underlying the assessment and implementation of health care priorities in developing countries as practiced by foreign development agencies coping with a potentially destabilizing unmet social demand. As such, these agencies mediate the gap between existing health care structures patterned around the narrow needs of the ruling classes and the magnitude of public ill-health which mass movements strive to eradicate with implications for capitalism at large. It is in this context that foreign agencies are shown to intervene for the reassessment and implementation of health care priorities in developing countires with the objective of defending capitalism against the delegitimizing effects of its own development, specifically the persistence of mass disease. Constrained by this objective, the interpretations they offer of the miserable state of health prevailing in developing countries and how it could be improved remains ideological: it ranges between "stage theory" and modern consumption-production Malthusiansim. Developing countries are entering into a new pattern of public health which derives from their unique location in the development of capitalism, more specifically in the new international division of labor. Their present position affects not only the pattern and magnitude of disease formation but also the effective alleviation of mass disease without an alteration in the mode of production itself. In the context of underdevelopment, increased productivity is at the necessary cost of public health. Public health improvement is basically incompatible with production-consumption Malthusianism from which the leading "Basic Needs" orientation in the assessment and implementation of health care priorities derives. Marx said that "countries of developing capitalism suffer not only from its development but also from its underdevelopment." (author's modified)