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  1. 26
    043958

    Health, ethics and human values.

    Bankowski Z; Gutteridge F

    WORLD HEALTH. 1987 Jun; 9-11.

    The Council for International Organizations of Medical Sciences (CIOMS), a nongovernmental organization, arranges conferences with the World Health Organization (WHO) and UNESCO on new developments in biology and medicine to explore their social, ethical, moral, administrative, economic, and legal implications. The objective is to create international and interdisciplinary forums where the scientific and lay communities can express their views on topics of immediate concern, unhampered by administrative, political, or other considerations. The primary objectives of the Round Table Conference held in Athens in 1987 were: to identify and compare the ethical content of selected health policy issues from the perspectives of different national, cultural, and religious settings; to examine the interaction of ethical factors and other determinants of health policy in the policymaking process; to explore ways to assist countries in dealing with the interaction of ethics and health policymaking; and to evaluate the usefulness of this kind of dialogue. The conference proposed 3 approaches: an examination of the practical problems of making policy decisions; an examination of a series of case studies; and an examination of the fundamental values underlying the interaction of health policy, ethics, and human values underlying the interaction of health policy, ethics, and human values by considering the meanings which life, suffering, and death hold for a number of the world's principal religions and ideologies. WHO's principal theme for this and the next decade -- the goal of health for all by the year 2000 -- was identified as a central issue in considering health policy, ethics, and human values. Participants reviewed 5 case studies, chosen as being of interest to both developed and developing countries: the allocation of resources for primary health care; public policy and hereditary disease; care of low birth weight infants; health care of the elderly; and organ substitution therapy. The discussion highlighted some of the paradoxes in today's approaches to the problems. It was agreed that there should be continued collaborative followup of the issues discussed and that a mechanism should be established that would support regional groupings in a continued inquiry into issues of regional interest. CIOMS will serve as the organizing focal point.
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  2. 27
    034916

    Breastfeeding--a life-saver in the Third World.

    Arton M

    MIDWIVES CHRONICLE. 1985 Jul; 98(1170):200-1.

    At the April meeting of the World Health Organization (WHO), experts in occupational health concluded that there is no evidence to justify the exclusion of women from any type of employment. Yet, they simultaneously underscored the need for conditions in places of work to be adapted to women, and in particular to those women employed in manual work, whether agriculture or manufacture. This was WHO's 1st meeting on the subject of health and the working woman. According to the experts, anatomical and physiological differences between men and women should not limit job opportunities. As more and more women enter the work force, machines need to be redesigned to take into account the characteristics of working women. In industries where strength is a requirement, e.g., mining, a certain level of body strength and size should be established and applied to both sexes. Also recommended were measures to protect women of childbearing age, who form the majority of women in the work force, against the hazards of chemicals -- gases, lead, solder fumes, sterilizing agents, pesticides -- and other threats to health deriving from the work places. Chemicals or ionizing radiation absorbed into the body could lead to mutagenicity, not only of women but also of men. In cases where a woman has conceived, mutagenicity could mean fetal death, or, where damage is done to sperm or ovum, lead to congenital malformation and to leukemia in newborns. Solvents so absorbed could appear in breast milk, thus poisoning the baby. Ionizing radiation, used in several industrial operations, also has been linked to breast cancer. As women increasingly take jobs that once used to be done solely by men, more needs to be known about the hazards of their health and of the psychosocial implications of long working hours. The following were included among recommendations made to increase knowledge and to protect health: that epidemiological studies be conducted in the risk of working women as well as more research on the effects of chemicals on pregnant workers; that working women be allowed to breastfeed children for at least 6 months at facilities set up at work places; and that information and health education programs be carried out to alert women against occupational health hazards.
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  3. 28
    201302

    Rural development: a select bibliography, 1987.

    United Nations. Economic and Social Commission for Asia and the Pacific [ESCAP]

    Bangkok, Thailand, United Nations Economic and Social Commission for Asia and the Pacific, 1988. v, 133 p. (ESCAP Library Bibliographical Series No. D. 11)

    This 486-item bibliography is compiled from materials selected from the computerized ESCAP Bibliographic Information System data base. The bibliography includes monographs, documents, and serial articles received in the ESCAP Library and the libraries of some other UN agencies during 1987. Contents are arranged under 7 broad subjects widely used among rural development staff and researchers: agriculture; application of science and technology; health and social services; human resources development and institutions; industrial development; physical infrastructure, natural resources and environment; and policies and planning. Author, title, and geographic area indexes appear after the bibliography.
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  4. 29
    044175
    Peer Reviewed

    Infant feeding in the Third World.

    Ebrahim GJ

    POSTGRADUATE MEDICAL JOURNAL. 1986; 62(724):93-6.

    Breastfeeding has been on the decline in the 3rd world for the past 20 years or so. Modernization has been blamed, yet in the industrialized nations of Sweden, Britain, and the US, women play significant roles in the labor force, are active in professional and public life, and in most Western nations the educated women and those from the professional and upper classes are most likely to breastfeed their babies. Regarding milk substitutes, many products unacceptable in the Western market are on sale in developing nations. In the absence of strong governmental controls, consumer pressure, and professional vigilance, bottle feeding is taken lightly with disasterous consequences. 3 main dangers have been identified: those arising from the nonavailability of protective substances of breast milk to the infant; those arising from the contamination of the feed in a highly polluted environment of poverty and ignorance of simple principles of hygiene; and those arising from overdilution of feeds on the account of the costs of the baby foods. Market forces and competition led the manufacturers of baby foods to stake their claims to the markets of the 3rd world, and almost all of them adopted undesirable promotional methods. The ensuing uproar led to an International Code of Ethics being adopted at the 33rd world Health Assembly under the auspices of the World Health Organization. Although the matter should have rested there, some manufacturers developed their own codes and have persuaded governments to adopt alternative codes. The present situation with regard to infant feeding in the 33rd world should be considered in the context of the international developments identified and also in light of several social and demographic processes. At the current rates of growth in population up to 80% of humanity will be living in the 3rd world by the end of the 20th century. The 2nd demographic phenomenon of social and political significance is the unprecedented increase in the growth of the urban population with national health and social services failing to respond adequately to the challenge of this growth. In many developing countries national planners and economists are beginning to look upon human milk as an important national resource, and the need for a network of services to ensure the nutrition and health of pregnant and lactating women is obvious and is recognized internationally. With regard to the question of adequacy of breast milk, there are many gaps in knowledge. Each community needs to be studied separately, and those involved in scientific research in 1 environment should resist the temptation of extrapolating the results to communities and societies with a different set of circumstances.
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  5. 30
    200337

    Health and the family life cycle: selected studies on the interaction between mortality, the family and its life cycle.

    Germany, Federal Republic of. Bundesinstitut fur Bevolkerungsforschung; World Health Organization [WHO]

    Wiesbaden, Federal Republic of Germany, Federal Institute for Population Research, 1982. 503 p.

    The family is the basic unit of society within which reproductive behavior, socialization patterns, and relations with the community are determined. The concept of the family life cycle provides an important frame of reference for the study of the history of a family traced through its various stages of development. The World Health Organization has developed a comprehensive program relating to the statistical aspects of the interrelationships between health and the family. The main objectives are: 1) to clarify the basic conceptual issues involved and to develop a family life cycle model; 2) to explore the statistical aspects of family-oriented health demography research; 3) to test and apply the methodology to the study of populations at different socioeconomic levels; and 4) to set forth some implications of the findings for social policy, health demography research, and the generation of a database for such studies. Demography research on the family consequences of mortality changes should not be limited to the study of their effect on the size and structure of the family, but should also deal with the impact on the timing of events and the life cycle as a dynamic phenomenon that is subject to change. This publication is from the 1981 Final Meeting on Family Life Cycle Methodology. The background documents fall into 3 main topics: 1) conceptual and methodological issues, 2) review of available evidence on the interaction between mortality and the family life cycle; and 3) case studies.
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  6. 31
    038176

    Growing up in a changing world. Part two: youth organizations and family life education: ideas into action.

    Fordham J

    London, England, International Planned Parenthood Federation, Programme Development Dept., 1985. 107 p.

    This publication, Part 2 of "Growing up in a Changing World," was produced by the International Planned Parenthood Federation at the request of the Informal Working Group on Family Life Education. It provides practical guidelines for organizations that want to incorporate family life education into their program. Whereas Part 1 focused on the concept of family life education, Part 2 provides concrete material on training and project activities. A basic training program for youth leaders should include specific content areas in family life education and the use of participatory learning methods so leaders can organize educational activities for other young people in the community. The training should cover the communication process and give youth leaders practice in organizing group discussions. Project planning, management, and evaluation are also important aspects of leadership training. The activities suggested in this publication are all participatory in approach and based on the belief that people learn best through activities in which their own knowledge and experience are valued. The descriptions of activities include the following components: introduction, objectives, materials, time, preparation, and procedure. Of importance is assessment of the suitability of these sample activities for use with specific groups of young people. In considering suitability, 3 factors should be kept in mind: 1) there may be opposition by parents or religious leaders to subjects concerned with sex education and family planning, and ways should be sought to overcome this resistance; 2) activities must be appropriate to the learning abilities, characteristics, and circumstances of the target population; and 3) speical care is needed when developing or adapting activities for use with young people who are illiterate.
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  7. 32
    040246

    The ethical, political and medical consequences of the new reproductive technologies.

    PLANNED PARENTHOOD IN EUROPE: REGIONAL INFORMATION BULLETIN. 1986 Autumn; 15(2):3-13.

    This paper, prepared for European planned parenthood associations, reviews the range of political and ethical reactions to new reproductive technologies. Planned parenthood federations are committed to ensure that women and human living material are protected both from unethical scientific manipulation and exploitation for profit and that candidates for infertility treatment are given appropriate counseling. Within these limits, research into the causes and treatment of infertility has been encouraged. On the other hand, so-called pro-life forces challenge research in this area on the grounds that the sanctity of human life may be violated. A more recent development has been the emergence of feminist opposition to reproductive research on the grounds that it threatens to lead to the expropriation of women as childbearers. The potential removal of reproduction from people is viewed as a further devaluation of women's status and concern is voiced that pre-embryo screening may take the form of benign eugenics. Feminists further argue that in vitro fertilization services are disproportionately available to white, middle-class women. Finally, it is feared that the incorporation of sex preselection into the population programs of Third World countries will become possible as a logical extension of current importation to developing countries of chemical contraceptives (eg Depo-Provera) regarded as unsuitable for use in the US. In the face of such arguments, both from pro-life and feminist forces, planned parenthood federations are urged to be clear about potential uses and abuses of the new reproductive technologies.
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  8. 33
    200354

    Mortality and health issues: review of current situation and study guidelines.

    United Nations. Economic and Social Commission for Asia and the Pacific [ESCAP]

    Bangkok, Thailand, United Nations, Economic and Social Commission for Asia and the Pacific, 1985. iv, 112 p. (Asian Population Studies Series No. 63.)

    Over the past 3 decades, most of the countries in the Economic and Social Commission for Asia and the Pacific (ESCAP) region have witnessed unprecedented declines in mortality--a phenomenon that has resulted in a remarkable increase in their population size. This paper documents the results of an ESCAP and World Health Organization study to analyze the trends and patterns of mortality in the region, taking into consideration the variability in levels and trends, as well as their antecedents and consequences. Long term objectives are: 1) to investigate the dynamics of mortality change by examining mortality trends in relation to other demographic processes, 2) to examine the implication of observed mortality trends and patterns for existing developmental programs, and 3) to provide a scientific basis for the formulation of intervention policies aimed at the reduction of mortality in the region. The advent of vaccines, major public health programs, effective vector control, antibiotics, and chemotherapeutics are the responsible factors for the sustained transition of mortality after the 1940s and 1950s. The study is divided into 3 phases: 1) phase 1 to be completed by late February 1985; 2) phase 2 to be completed by June 1985; and 3) phase 3 to be completed by January 1986. Background papers address the following issues: 1) the implications of mortality trends and patterns for economic, health, and social welfare planning; 2) future outlook of the mortality situation and mortality projections; and 3) methodological aspects of the study of biological and socioeconomic correlates of mortality.
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  9. 34
    038831
    Peer Reviewed

    Excerpts from the WHO Code for the Marketing of Breast-Milk Substitutes.

    World Health Organization [WHO]

    BIRTH. 1985 Winter; 12(4):243-4.

    This article sets forth excerpts from the World Health Organization (WHO) Code for the Marketing of Breastmilk Substitutes. The purpose of these guidelines is to ensure that infant formula is not marketed or distributed in ways that interfere with the protection and promotion of breastfeeding. It is specified that informational and educational materials dealing with infant feeding practices should include clear material on the following points: 1) the benefits and superiority of breastfeeding, 2) maternal nutrition in preparation for breastfeeding, 3) the negative effect on breastfeeding of the introduction of partial bottlefeeding, 4) the difficulty of reversing the decision not to breastfeed, and 5) the proper use of infant formula. Materials on infant formula should include the social and financial implications of its use, the health hazards of inappropriate foods, and the health hazards of unnecessary or improper use of infant formula. Donations of educational equipment or materials by manufacturers or distributors of infant formula should be made only at the request of the appropriate government authority and should be distributed only through the health care system. There should be no advertising or other promotion to the general public of infant formula products. Manufacturers should not provide samples of products to pregnant women or mothers, and there should be no point-of-sale advertising or giving of samples or gifts. No health care facility may be used for the purpose of promoting infant formula, and health care workers are expected to encourage and protect breastfeeding. Information provided to health professionals by manufacturers and distributors of infant formula should be restricted to scientific and factual matters and should not imply that bottlefeeding is equivalent or superior to breastfeeding.
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  10. 35
    039522
    Peer Reviewed

    [Record of the second meeting of the WHO Collaborating Centers on AIDS] Deuxieme reunion des centres collaborateurs de l'OMS pour le SIDA: memorandum d'une reunion de l'OMS.

    BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1986; 64(2):221-31.

    Participants at the 2nd meeting of World Health Organization (WHO) collaborating centers on AIDS (acquired immune deficiency syndrome) held in Geneva in December 1985 reported on progress since the 1st meeting in September 1985 and made a number of recommendations for future action in the areas of information, education, and prevention; reference reactants and tests of anti-HTLV-III antibodies; epidemiologic evaluation; and research on vaccines and antiviral agents. It was recommended that ministries of health, education, and social services provide the public with timely and accurate information on AIDS, that physicians, nurses, and similar personnel inform the ill and the public about AIDS and its prevention, and that school age children and young people be informed about AIDS and how to avoid infection. Systems of registration of AIDS cases should be implemented in order to provide the WHO and member states with data on the international level. Standardization and availability of serologic tests is also required. Instructions for avoiding infection should be provided for health personnel and others caring for AIDS patients, for individuals providing personal services to the public, and to ensure adequate methods of disinfection. Instructions for preventing AIDS should discuss sexual and parenteral transmission as well as perinatal transmission. Specific recommendations for education and family placement for children with AIDS have already been published. Instructions should be provided for prisons and similar estabilshments. Requiring international travellers to provide certificates attesting to their AIDS-free status is not justified as a preventive measure. The significant existing demand for reference reactants including human serums with anit-HTLV-III antibodies and controls is being addressed by several institutes in different countries, but it would be premature to furnish reference reactants other than serums. The WHO collaborating centers should furnish materials for purposes of training in diagnostic techniques. Existing tests for diagnosis and confirmation should be imporved and new tests should be developed, with particular attention to simple methods appropriate for use in developing countries. It will be necessary to establish international biological standards for the HTLV-III virus, but the required specifications are not yet known. Technical cooperation and epidemiological evaluation must be planned separately, based on the different prevalence of infections and technical expertise of different countries. A clinical definition of AIDS is needed for countries lacking resources needed to apply the Centers for Disease Control/WHO definition. Surveillance methods and laboratories can be installed with WHO assistance, to help evaluate the extent of AIDS infection in different countries. Later technical cooperation in the areas of continued surveillance and laboratory capacities will depend on results of the initial evaluation in each country. Research is currently underway in several countries of possible vaccines and drugs. Careful preclinical studies should be done to evaluate the toxicity of an agent before clinical studies are conducted. Convenient animal models should be sought for future research. 3 annexes to this report specify methods of disinfection; general principles of preventing transmission of the AIDS virus through parenteral exposure or following donation of organs, sperm, or other tissue; and a proposed definition of clinical cases of AIDS.
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  11. 36
    205134

    The World Bank Population, Health and Nutrition Department, Policy and Research Division fiscal year 1986-1988 work program.

    World Bank. Population, Health and Nutrition Department

    [Unpublished] [1986]. iii, 9, 5 p.

    This note presents the work program of the Policy and Research Division of the World Bank Population, Health, and Nutrition Department for the fiscal years 1988. Although this note was prepared mainly for internal review purposes in the department and in the Bank, it has been circulated outside the Bank to increase awareness of the department policy and research activities. This note 1) lists department staff, 2) gives a brief overview of the department's work, 3) relates the history of the department, and 4) describes the department's activities by objectives. The department's objectives comprise 1) population, 2) population in Sub-Saharan Africa, 3) health, 4) pharmaceuticals, 5) nutrition, 6) intersectoral links, and 7) poverty alleviation. The principal population activities include work on the role of the private sector in family planning, incentives for small family size, cost-effective approaches to the delivery of family planning services, and a population lending review. Work on population in Sub-Saharan Africa centers on adolescent fertility and spatial population distribution. The work program in health reviews health financing and the cost-effectiveness of alternative health interventions. Research on pharmaceuticals examines a range of potential policy interventions on the demand and supply side. A nutrition paper is being prepared on the cost-effectiveness of nutrition interventions, especially as part of primary health care. Intersectoral issues include the links between population, health, and nutrition on one hand and other sectors, such as agriculture and education on the other hand. Work on poverty alleviation examines the extent to which population, health, and nutrition projects should reach out to poor client groups. Research activities in each of these 7 areas are described. An annex lists recent staff papers on these subjects.
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  12. 37
    038364

    IPPF involvement in the International Youth Year: a progress report.

    International Planned Parenthood Federation [IPPF]

    [London, England], IPPF, 1986 Jan 31. 5, 13 p.

    This report provides a brief description of the International Planned Parenthood Federation's (IPPF) involvement in and contributions to International Youth Year (IYY). IYY reinforced an IPPF priority program area for the 1980s--meeting the needs of young people--and all member family planning associations were encouraged to establish links with IYY national coordinating committees. IPPF was also instrumental in the formation of a nongovernmental Working Group on Family Life Education comprised of representatives from a range of organizations involved in youth work and is preparing a resource book on family life education for these groups. The guidelines for action for IYY, prepared by a United Nations Advisory Committee in which IPPF was a major participant, urge governments to promote culturally appropriate family life education, encourage young people and their organizations to be active in the implementation of population programs, promote social policies to strengthen the family, encourage community education to counteract adolescent pregnancy, and ensure that family life and sex education are available to young people. Where necessary, family planning information and services can be made available to adolescents within a country's sociocultural context. There is a need to sustain the global interst in youth concerns generated by IYY and to translate into action the recommendations and resolutions on youth that were developed. It is essential that such action consider factors such as the promotion and protection of the rights and responsibilities of young people, sensitivity to local traditions, identification and mobilization of local resources, interagency cooperation, and involvement of young people in decision making. The document concludes with progress reports from 30 countries on family planning association activities in support of IYY.
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  13. 38
    034877

    Toward 2000: the quest for universal health in the Americas.

    Acuna HR

    Washington, D.C, Pan American Health Organization, 1983. x, 145 p. (Scientific Publication No. 435)

    This document, prepared by the Pan American Health Organization (PAHO), reviews health in the Americas in the period 1905-47, provides a more detailed assessment of progress in the health sector during the 1970s, and then outlines prospects for the period 1980-2000 in terms of meeting the goal of health for all by the year 2000. The main feature of this goal is its comprehensiveness. Health is no longer viewed as a matter of disease, but as a social outcome of national development. Attainment of this goal demands far-reaching socioeconomic changes, as well as revision of the concepts underlying national health systems. It seems likely that the coming period in Latin America and the Caribbean will be characterized by intense urban concentration and rapid industrialization, with a trend toward increasing heterogeneity. If current development trends continue, the gap in living standards between urban and rural areas will widen due to sharp differences in productivity. Regionally based development planning could raise living standards and reduce inequalities. In the type of development expected, the role of social services is essential. It will be necessary to determine whether the objective is to provide the poor with access to services that are to be available to all or to provide special services for target groups. The primary health care strategy must be applicable to the entire population, not just a limited program to meet the minimal needs of the extreme poor. Pressing issues regarding health services in the next 2 decades include how to extend their coverage, increase and strengthen their operating capacity, improve their planning and evaluation, increase their efficiency, and improve their information systems. Governments and ministries must be part of effective infrastructures in which finance, intersectoral linkages, community participation, and intercountry and hemispheric cooperation have adequate roles. One of PAHO's key activities must be systematic monitoring and evaluation of strategies and plans of action for attaining health for all.
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  14. 39
    034948

    World plan of action for the implementation of the objectives of the International Women's Year: a summarized version.

    United Nations. Department of International Economic and Social Affairs. Centre for Social Development and Humanitarian Affairs

    New York, New York, United Nations, 1976. 43 p.

    This booklet's objective is to bring the World Plan of Action for the Implementation of the Objectives of the International Women's Year to a wide audience. The 1st section focuses on national action -- overall national policy, national machinery and national legislation, funding, and minimum objectives to be realized by 1980. The 2nd section covers specific areas for national action: international cooperation and the strengthening of international peace; political participation; education and training; employment and related economic roles; health and nutrition; the family in modern society; population; housing and related facilities; and other social questions. The subsequent 4 sections deal with the following: research, data collection and analysis; mass media; international and regional action; and review and appraisal. A major focus of the Plan is to provide guidelines for national action for the 10-year period up to 1985 which the Generaly Assembly, at its 30th session, proclaimed as the Decade for Women: Equality, Development and Peace. Its recommendations are addressed primarily to governments and to all public and private institutions, political parties, employers, trade unions, nongovernmental organizations, women's and youth groups and all other groups, and the mass communication media. Governments are urged to establish short, medium, and longterm targets and objectives to implement the Plan. The following are among the objectives envisaged as a minimum to be achieved by 1980: literacy and civic education should be significantly increased, especially among rural women; coeducational, technical, and vocational training should be available in both industrial and rural areas; equal access at every level of education, including compulsory primary school education, should be ensured; employment opportunities should be increased, unemployment reduced, and discriminatory employment conditions should be eliminated; infrastructural services should be established and increased, where necessary, in both rural and urban areas; legislation should be introduced, where necessary, to ensure women of voting and electoral rights, equal legal capacity, and equal employment opportunities and conditions; there should be more women in policymaking positions locally, nationally, and internationally; more comprehensive measures for health education, sanitation, nutrition, family education, family planning, and other welfare services should be provided; and equal exercise of civil, social, and political rights should be guaranteed.
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  15. 40
    034419

    The United Nations Decade for Women: an end and a beginning.

    Who Chronicle. 1985; 39(5):163-70.

    The World Conference to appraise the achievements of the UN Decade for Women was held in Nairobi, Kenya during July 1985 and was attended by 6000 delegates. In preparation for the Nairobi conference, the Director General of the World Health Organization (WHO) issued a report analyzing the situation regarding women, health, and development and drawing attention to the special health needs of women as well as to the key roles that women play in promoting health and development. Accurate, adequate, and relevant information is essential if appropriate action is to be taken, and much of WHO's efforts during the Decade focused on collecting such information. According to the Director General's report, women's contribution to development is underestimated and their potential is grossly underestimated. Their health status also is conditioned by factors such as employment, education, and social status. Ultimately, women's participation in health and development may even depend on equitable access to economic resources and political power. Thus, the report stresses that it is imperative not to view the health aspects in isolation. The status society accords women is closely linked to their reproductive function. Yet, despite this vital function, girls are valued less than boys in many countries. Nowhere is the inequity in women's status more apparent than in their economic situation. A study on the training and utilization of traditional birth attendants was carried out in the Eastern Mediterranean Region, and 3 Member States were then assisted in launching national training programs. In the Eastern Mediterranean Region, WHO collaborated with countries in pilot projects for the early detection and treatment of cervical and breast cancer. Legislative and policy issues relative to the welfare of women also have been studied. Among the subjects coverd have been the protection of working mothers, measures governing the minimum legal age of marriage, and harmful traditional practices. The grassroots organizations are the primary focus of WHO's strategy for involving women's organizations in primary health care since they serve the poor and the powerless and their goal is usually to satisfy the immediate needs of their members. WHO has initiated a multinational study on women as providers of health care, in which 17 Member States have participated. The Joint WHO/UNICEF Nutrition Support Program, initiated in 1982, supports action to improve the nutritional status of women and children.
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  16. 41
    034275

    Health crisis in Ethiopia: a Third World syndrome [editorial]

    Nurhussein MA; Leonidas JR

    Journal of the National Medical Association. 1985 Dec; 77(12):963-5.

    The goal of "Health for All by the Year 2000," adopted by the World Health Organization, will be pure rhetoric if all sectors involved are not sensitized to the problem of famine in many countries in Africa and other 3rd world nations. The medical profession should be made aware of this goal, both on national and international fronts. The case of Ethiopia is discussed as a valid example of a "diseased third world," focusing on the famine, other medical problems, and the health system. The last emperor of Ethiopia, Haile Selassie, was swept away by the 1974 revolution. The major cause of his downfall was the 1973 famine, which the emperor wanted to conceal from the outside world. A military government took over, espousing Marxist ideology and aligning itself with the Soviet Union. Famine has been endemic for decades; the last famine in 1973 claimed over 300,000 lives. The country never totally recovered from the effects of that drought, and as early as 1981-82, major relife organizations were warned of another looming crisis. Some of the causes of the current crisis include the absence of rain for 3 consecutive years that paralyzed agriculture, poor and primitive farming practices, and deforestation. It is estimated that the land area covered by forest has dropped from 16 to 3.1% over the last 20 years. This has adversely affected the moisture-retentive capacity of the soil. Other man-made contributory factors are the civil war, the resulting dislocation of the population, and administrative mismanagement. 10 million people now face starvation; 300,000 have already died, and 1000 per day continue to die. The attention of the international community is justifiably focused on the immediate task of providing food. Yet, the full medical aspect of the famine and its consequences have not been adequately handled. Assuming that international aid will effectively prevent further loss of life, the survivors will face a host of health problems, epidemics in particular. Most of the feeding camps and various refugee centers are overcrowded; elementary sanitary facilities are lacking. There is a critical shortage of vaccines and other medical supplies. The vast majority of the Ethiopian population suffers from various preventable communicable diseases. The leading 10 causes of morbidity diagnosed in 1976 were venereal diseases, helminthiasis, bacillary and amebic dysentery, gastroenteritis, leprosy, malaria, tuberculosis, schistosomiasis, trachoma, and influenza. WHO reports that health expenditures represent only 5.7% of the total budget and that only 20% of the population are vaccinated against smallpox, yellow fever, DPT (diptheria, pertussis, tetanus), measles, tuberculosis, and polio.
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  17. 42
    033882

    The Joint WHO/UNICEF Nutrition Support Programme.

    Gurney M

    World Health. 1985 Nov; 13-15.

    In November 1980, Dr. Halfdan Mahler, Director-General of the World Health Organization (WHO), and James Grant, head of the UN Children's Fund (UNICEF), drafted a joint program to improve the nutritional status of children and women through developmental measures based on primary health care. The government of Italy agreed to fund in full the estimated cost of US$85.3 million. When a tripartite agreement was signed in Rome in April 1982, the WHO/UNICEF Joint Nutrition Support Program (JNSP) came into being. It was agreed that resources would be concentrated in a number of countries to develop both demonstrable and replicable ways to improve nutrition. Thus far, projects are underway or are just starting in 17 countries in Africa, Asia, Latin America, and the Caribbean. In most of these countries, infant and toddler mortality rates are considerably higher than the 3rd world averages. Program objectives include reducing infant and young child diseases and deaths and at the same time improving child health, growth, and development as well as maternal nutrition. These objectives require attention to be directed to the other causes of malnutrition as well as diet and food. JNSP includes nutrition and many other activities, such as control of diarrhea. The aim of all activities is better nutritional status leading to better health and growth and lower mortality. Feeding habits and family patterns differ from 1 country to another as do the JNSP country projects. Most JNSP projects adopt a multisectoral approach, incorporating varied activities that directly improve nutritional status. Activities involve agriculture and education as well as health but are only included if they can be expected to lead directly to improved nutrition. A multisectoral program calls for multisectoral management and involves coordination at all levels -- district, provincial, and national. This has been one of the most difficult things to get moving in many JNSP projects, yet it is one of the most important. Community participation is vital to all projects. Its success can only be judged as the projects unfold, but early experiences from several countries are encouraging.
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  18. 43
    033825

    The Expanded Program on Immunization in the Americas: a review.

    Bulletin of the Pan American Health Organization. 1985; 19(3):307-14.

    The basis for the Pan America Health Organization/World Health Organization Expanded Program on Immunization (EPI) is provided by a resolution (WHA27.57) adopted by the World Health Assembly in May 1974. The program's longterm objectives include: to reduce morbidity and mortality from diphtheria, whooping cough, tetanus, measles, tuberculosis, and poliomyelitis by providing immunization services directed against those disease for every child in the world by 1990; to promote countries' self-reliance in the delivery of immunization services within the context of comprehensive health services; and to promote regional self-reliance in matters of vaccine production and quality control. The EPI, which requires a longterm commitment to continued immunization activities, is an essential element of PAHO/WHO's strategy to achieve health for all by the year 2000. Immunization coverage has been included among the indicators which will be used to monitor the success of that strategy at regional and global levels. As of April 1985, available country reports showed that immunization coverage in the Americas had improved considerably since the EPI was launched in 1977. In 1978, for example, only a very small proportion of the children under 1 year of age (less than 10%) outside the US and Canada lived in countr ies where 50% immunization coverage with the EPI vaccines had been attained for this age group. By 1984, over 55% of these children were living in countries where at least 50% infant coverage with DPT and measles vaccines had been attained, and over 80% were living in countries where at least 50% infant coverage with polio vaccine had been attained. Immunization coverage generally improved between 1980-84, especially in the 12 smaller countries of the subregion with populations of less than 130,000. In the period since EPI training activities were initiated in early 1979 through the end of 1984, it is estimated that at least 15,000 health workers attended EPI workshops. Over 12,000 EPI training modules were distributed in the Region. In 1983 and 1984, the Cold Chain Regional Focal Point held special training workshops on cold chain equipment maintenance and repair in Bolivia, Colombia, and Nicaragua; technicians were also trained in Brazil. In Northern America, Canada, the US, and Mexico have the ability to produce all the EPI vaccines, and the first 2 are self-sufficient. Most countries have made notable strides in improving and expanding the cold chain, although cold chain failures have been identified through investigation of vaccine failures. During its 6 years of operation, PAHO's EPI Revolving Fund has placed vaccine orders worth over US$19 million. At present, all countries in the region are receiving adequate quantities of vaccines to cover their target populations.
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  19. 44
    033658

    Targets for health for all. Targets in support of the European regional strategy for health for all.

    World Health Organization [WHO]. Regional Office for Europe

    Copenhagen, Denmark, WHO, Regional Office of Europe, 1985. x, 201 p.

    This book sets out the fundamental requirements for people to be healthy, to define the improvements in health that can be realized by the year 2000 for the peoples of the European Region of the World Health Organization (WHO), and to propose action to secure those improvements. Its purposes are as follows: propose improvements in the health of the people in order to achieve health for all by the year 2000; indicate where action is called for, the extent of the collective effort required, and the lines along which it should be directed; provide a tool for countries and the Region to Monitor progress toward the goal and revise their course of action if necessary. The targets proposed are intended to indicate the improvements that could be expected if all the will, knowledge, resources, and technology already available were pooled in the pursuit of a common goal. The target levels set are based on historical trends in the fields concerned, their expected future evolution, and the knowledge available on the probable effects of intervention. These levels are intended to inspire and motivate Member States when they are determining their own priorities, targets, and capabilities and thus the degree to which they can contribute to reaching the regional targets. The base year for all the targets in 1980. The year 2000 is the completion data retained for all targets related to health improvements. Targets related to lifestyles, the environment and care respectively have 1990 or 1995 as their date of completion unless specific problems justify the allocation of a later year. Targets embodying measures to bring about the changes in research and health development support should be reached before 1990. The aim is to give people a positive sense of health so that they can make full use of their physical, mental, and emotional capacities. A well informed, well motivated, and actively participating community is a key element to the attainment of the common goal. The focus of the health care system should be on primary health care -- meeting the basic health needs of each community through services provided as close as possible to where people live and work, readily accessible and acceptable to all, and based on full community participation. Health problems transcend national frontiers.
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  20. 45
    033365

    United Nations Children's Fund: report of the Executive Board (15-26 April 1985).

    UNICEF. Executive Board

    New York, New York, United Nations, 1985. v, 58 p. (Economic and Social Council Official Records, 1985. Supplement No. 10; E/1985/31; E/ICEF/1985/12)

    The major decisions of the UN Children's Fund Executive Board in their 1985 session were to: approve several new program recommendations and endores a major emergency assistance program for several African countries; approve initiatives to accelerate the implementation of child survival and development actions, particularly towards the goal of achieving universal immunization of children against 6 major childhood diseases by 1990; adopt a comprehensive policy framework for UN International Children's Emergency Fund (UNICEF) programs concerning women; approve UNICEF revised budget estimates for 1984-85 and budget estimates for 1986-87; and make a number of decisions on ways to improve the administration and the role of the Board. The Board members both reported on and heard evidence of the encouraging results of recent efforts to implement national child survival and development programs. Reports of the successful immunization campaigns in Burkina Faso, Colombia, El Salvador, and Nigeria were welcomed, along with the news that half a million children were saved during the year through the use of oral rehydration therapy. Stronger efforts were encouraged to improve results in the areas of breastfeeding and growth monitoring. Implementation issues in connection with child survival and development actions were a continuing focus of Board attention during the session. The accelerated implementation of child survival and development actions was accorded the highest priority in approving the medium-term plan for 1984-88. The Board also adopted a resolution that sought to draw the attention of world leaders, during their observance of the 40th anniversary of the UN, to the importance of reaffirming their commitment to accelerate the implementation of the child survival and development resolution and realizing universal immunization by 1990. Delegations commended the results of the World Health Organization/UNICEF joint nutrition support program but noted that malnutrition among women and children appeared to be increasing. Water supply and sanitation activities were encouraged, and the Board stressed that those actions should be linked with health and hygiene education. The Board endorsed the report on recent UNICEF activities in Africa. Many delegations spoke in support of the increased aid to Africa. Major emphasis was given to linking emergency responses with ongoing UNICEF programs. The Board approved new multi-year commitments from general resources totalling $303,053,422 for 28 country and interregional programs and noted 32 projects totaling $223,215,000 to be funded from specific-purpose contributions. The Board stressed the importance of ensuring that child survival and development actions were integrated with continuing efforts in other of UNICEF action. The Board approved a commitment of $252,550,443 for the budget for the biennium 1986-87.
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  21. 46
    033067

    Tobacco--its role in the economy and the health of African countries.

    Who Chronicle. 1985; 39(3):104-6.

    In Africa the issue of smoking and health is complicated by the fact that in many countries tobacco is grown commercially and is relied upon to bring in foreign exchange through export, of revenue for the government if sold on the home market. Consequently, in some nations the ministries of health and of agriculture are working at cross purposes. This contradiction is recognized in the report issued recently of a World Health Organization (WHO) seminar on smoking and health organized for English-speaking Member States of the WHO African Region, and held in Zambia. In opening the seminar, the prime minister of Zambia, Mr. N. Mundia, stated that governments had an obligation to educate people on the risks involved in the use of tobacco but that this could pose a moral dilemma where tobacco production made an apparently significant contribution to the economy. Additionally, he warned that developing countries are considered valuable markets by tobacco companies and stressed that if the promotion of tobacco products by such companies represented a threat "to the health of our people, we cannot let it happen." This point was endorsed by Mr. W.C. Mwambazi, the National WHO Program Coordinator who stated that smoking was on the increase in many developing countries as a result of unscrupulous marketing practices by cigarette manufacturers and that smoking was a major threat to the realization of health for all by the year 2000. Aspects of smoking and health that have special relevance for Africa are emphasized in the report. The few studies carried out in Africa tend to confirm findings from the developed world that smoking increases the risk of cancer and coronary heart disease. Not only is tobacco smoked in Africa, but it is chewed and taken as snuff, and these uses also entail a risk to health. Case studies included in the report show that transnational tobacco companies take full advantage of the present lack of legislation in most African countries on the promotion and use of tobacco. Health hazards are the primary reason why smoking controls are needed, but there are also economic arguments. Tobacco cultivation requires land that could otherwise be used for the production of much needed food. Curing tobacco leaves requires vast amounts of heat that is generated by burning either expensive (and usually imported) oil or timber, the consumption of which ultimately leads to deforestation, soil erosion, and desertification. Although tobacco may be cultivated primarily as an export crop, the country of origin rarely escapes the health hazards of smoking and their economic consequences, including increased cost of health care and absenteeism from work. According to the report, control measures should include the following: data collection; public information and education; and legislation. The report proposes that a functional committee on smoking control be established in the ministry of health to work especially within the primary health care machinery.
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  22. 47
    030588

    After Mexico: NGOs and the follow-up to the International Conference on Population. Summary report of the Fourth Annual NGO/UNFPA Consultation on Population in New York (March 6, 1985).

    Cassidy K

    New York, New York, UN Non-Governmental Liaison Service, 1985. 50 p.

    This Summary Report of the Fourth Annual Nongovernmental Organizations/UN Fund for Population Activities (NGO/UNFPA) contains the following: an opening statement of David Poindexter, Director, Communication Centre of the Population Institute; a presentation devoted to opportunities for action by Bradman Weerakoon, Secretary General, International Planned Parenthood Federation (IPPF); a discussion of global population realities by Sheldon Segal, Director, Population Sciences of the Rockefeller Foundation; panel discussions on the topic of patterns of NGO action; reports from workshop groups (environment, development and population; role and status of women; health and population; reproduction and the family; population policies and funding; population and children; population and youth; and population and aging); a report on financing global population programs, given by Barbara Hertz, Senior Economist, World Bank; discussion of the implementation of the Mexico mandate, Rafael M. Salas, Under Secretary-General of the UN and Executive Director of the UNFPA; recommendations of the Mexico City Conference which refer to the NGO role in followup; and some background material. Recommendations of the workshop groups for ongoing NGO action in the field of population include: linkages between environment, development, and population to be more carefully delineated; the need for the voice of women to be heard at all levels by those formulating population policies and for the status of women to be considered by all as essential to the population issue; couples to be offered a full range of contraceptive choices; all family members to have access to reproductive health information, sex education, and family planning services; organizations to look for multiple sources of funding and to become less reliant on a single source of funding for population and health related activities; support of programs which promote women's development; governments to prepare youth better for their roles within their own countries; and the leadership role of the elderly to be facilitated and utilized in the areas of education, communication, and influencing policies at the village, regional, national, and international level.
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  23. 48
    030026

    Development, life-styles, population and environment in Latin America.

    United Nations. Economic Commission for Latin America and the Caribbean

    In: Population, resources, environment and development. Proceedings of the Expert Group on Population, Resources, Environment and Development, Geneva, 25-29 April 1983, [compiled by] United Nations. Department of International Economic and Social Affairs. New York, New York, United Nations, 1984. 403-32. (Population Studies No. 90; ST/ESA/SER.A/90; International Conference on Population, 1984)

    Relying on empirical work done by the Economic Commission for Latin America (ECLA), this paper illustrates how the demographic dynamics of Latin America in the last 2 decades and the environmental problems being faced by the people of the region are related to the specific productive structures and consumption patterns which, to different degrees depending on the country, prevailed during that time and are now even more widespread in Latin America. Analysis of the population/styles of development/life styles/environment relationships in Latin America provides some useful guidelines for future action in the field. The dominance of a development style in which transnational corporations play a key role demonstrates that many apparently local manifestations of the problems of population, resources, environment, and development have their cause elsewhere, in distant centers or decision making, or in a process triggered by someone else. A critical part of the interplay of these relationships in future years is likely to occur in the industrialized countries. This is so because of the global reach of many of their domestic and international policies and also because they act as centers which diffuse worldwide patterns and systems of production and consumption, transnational life styles, technologies, and so forth. What occurs in the developing countries is not likely to have such great influence worldwide, though in many instances it will be of critical importance for their domestic development. Everywhere, integrated/systems thinking, planning, policy, and decision making are a prerequisite for dealing with these interrelationships. In this context, different specific population policies will have a critical role to play. The remaining problem is that decision makers still need to learn how to think and act in an integrated and systematic manner. The gap between the desired schemes, models, and plans and the real world tends to be considerable. There are a number of things that could be undertaken internationally and by the UN system to fill the gap, and these are identified.
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  24. 49
    030024

    Population, resources and environment and prospects for socio-economic development.

    Mangahas M

    In: Population, resources, environment and development. Proceedings of the Expert Group on Population, Resources, Environment and Development, Geneva, 25-29 April 1983, [compiled by] United Nations. Department of International Economic and Social Affairs. New York, New York, United Nations, 1984. 359-81. (Population Studies No. 90; ST/ESA/SER.A/90; International Conference on Population, 1984)

    This discussion focuses on the prospective impact of population growth, within the context of global constraints on resources and the environment, on certain basic conditions of socioeconomic development, i.e., food, education, health, housing, and income distribution. A table presents a basic summary of world demographic conditions as of 1980. About 3/4 of the world population of 4.4 billion is in the less developed countries. The population of these countries grows at an annual rate of about 3 1/2 times that of the more developed countries. Compared to the latter, the LDCs' birthrate is more than double, and its total fertility rate is nearly 2 1/2 times as large. The problem of hunger and undernutrition is serious, and continued population growth only makes the task of dealing with it more difficult over time. According to the US Presidential Commission on World Hunger (1980), 1 out of every 8 persons in the world is malnourished, and the number is rising. Poverty is the root cause of undernutrition. The rate of growth of food production has been slightly above that of population. The influence of population growth on food demand has been far greater than that of income growth. New sources of growth in food supply do not portend to be as readily available as before. In some ways current demographic trends will tend to improve the education, health, and housing (EHH) capital. Parents will be able to afford schooling for their children more easily because of later marriages, wider spacing of children, and fewer children. Lower fertility will make for fewer health risks particularly to mothers and infants. The problem of providing basic services for a rapidly growing population could be made more manageable by concentrating more on the human than on the material linkages between inputs and outputs, between the capital formers and the formed home capital. Population growth helps to perpetuate poverty by restraining the growth of wages. There has been a widening gap in per capita income between the richest and the poorest countries and between the middle income and the poorest. The burden of population growth is lessened through any means that raises factor productivity. 1 means would be the removal of conventions restricting the use of any factor below full capacity.
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  25. 50
    030023

    Interrelationships between population, resources, environment and development.

    UNESCO

    In: Population, resources, environment and development. Proceedings of the Expert Group on Population, Resources, Environment and Development, Geneva, 25-29 April 1983, [compiled by] United Nations. Department of International Economic and Social Affairs. New York, New York, United Nations, 1984. 351-8. (Population Studies No. 90; ST/ESA/SER.A/90; International Conference on Population, 1984)

    The Man and the Biosphere (MAB) Program within the UN Educational, Scientific and Cultural Organization (UNESCO) offers an ideal framework for pilot projects to study, at a microscale, the complicated interrelationships that exist between an area's population problems and its developmental and environmental problems. An underlying reason for initiating the MAB was the evidence that the pressures of population growth and movement and the demands of development had placed stress on human/environment relationships. A 1st pilot project was carried out in Fiji on population-resources-environment interrelations during 1974-77. The main objectives were to reduce gaps in existing knowledge, to elaborate a set of reference information and guidelines for planners, decision makers and research workers, and to develop further the methodological tools needed for tackling problems in this area. In light of the Fiji experience, the collaboration of the UN Fund for Population Activities (UNFPA) and UNESCO has continued with the implementation of a 2nd-stage project on population, development, and environment interactions in the eastern Caribbean (1979-81). The 2 MAB pilot projects can be regarded as 2 successful efforts which advanced knowledge and methodology in general, but the task of building up a vast program of similar studies covering an array representative of the major environmental and development conditions in the 3rd world still needs to be tackled. Planning for a longer range future provides for action which may not be justifiable in the context of short-term planning. Such action includes the allocation of heavy initial investments to build up the infrastructure necessary for ensuring a sustainable energy system or to provide for ecological stability and the husbanding of natural resources to ensure the sustainable productive capacity of renewable resources. It is necessary to develop integrative approaches and to consider sociocultural factors in development planning. Considerations of a conceptual and methodological nature are identified.
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