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In: World Health Organization (WHO). The second ten years of the World Health Organization, 1958-1967. Geneva, Switzerland, WHO, 1968. 1-36.The health problems and developments in the 6 regions of WHO are summariezed with some reference to WHO's work during the decade. Demographic data show decreases in general and infant mortality and increases in the expectation of life at birth while preventable diseases, especially communicative diseases, such as malaria, yaws, and polio myelitis are decreasing. The last 10 years have been directed toward the development of long-term national plans for integrated health services. Plans such as the strengthening of maternal and child health services, the promotion and accelaration of education and training of all categories of staff from auxiliaries to postgraduates, and the development of epidemiological services, health laboratories, and health statistics have been undertaken. The plans also provide for promotion of environmental health with emphasis on sanitary engineering, education, and community water supply and sewerage projects in selected rural and urban areas.
Eugenics Quarterly. 1964 Mar; 11:11-29.Population policies of governments which specifically aim at reducin g rates of growth are a post-World War 2 phenomenon. Increasing understanding that high fertility hampers efforts at development is leading to consideration of national family planning programs in many countries of the world. Public opinion polls show that people in various parts of the world have an ideal family size and would act to limit their births to this ideal if they knew it were possible. The national population policies of India, Pakistan, and Korea are discussed. Malaysia, Hong Kong, Ceylon, Puerto Rico, and Barbados do not have national programs but have encouraged voluntary family planning programs. The status of selected other countries as to family planning attitudes and programs is mentioned. International action concerning population matters is also mentioned.
In: Burke, S., ed. Responsible parenthood. (Proceedings of a working group of the IPPF, Tunisia, November 1969.) London, International Planned Parenthood Federation, April 1970. p. 51-78The IPPF report on sex education in Britain is presented along with some remarks about the British educational practice in the field of sex and life education. Since educational administration in the United Kingdom is highly decentralized, only the main trends on what is taught and how and to which pupils are highlighted. Certain innovations in this area are being made, e.g., the Schools Council Humanities Project which involves the subject of human relationships as part of a more general educational curriculum. Attempts are being made to involve the parents in this area of school activities. Mass media is also involved. Television programs on sex education are in both planning and production stages. The IPPF report on sex education in Britain describes the educational scene in Britain. The report discusses the subject matter in terms of the actions at the central government, the local educational authority, and the nongovernmental levels. It also includes information on the findings of surveys in this field, and a more specific look at a survey into the sexual behavior of young people including their attitudes toward sex eduction. The central government has produced various reports indicating an awareness of the need for educating young people in sexual matters. The curriculum development and the role of the British Broadcasting Corporation are also discussed. At the local authority level, the schools are encouraged to incorporate sex education in their curriculum and make use of special agencies such as the Marriage Guidance Council.
In: Family planning and population programs. (Proceedings of the International Conference on Family Planning Programs, Geneva, August 1965.) Chicago, University of Chicago Press, 1966. p. 791-810Experts, working around the world and on different phases of family planning, reviewed what they believed the International Conference on Family Planning Programs, held in 1965, had accomplished and what main areas in the field still needed to be done. Sir Colville Deverell mentioned that the timing of the Conference seemed to be a turning point for the whole movement. There is finally general acceptance worldwide of the rightness of family planning, with only some Catholic and some Communist reservations remaining. As governments become more involved in family planning programs, voluntary agencies will still have the major job of creating favorable public opinion. A.F. Guttmacher felt that the World Health Organization should make abortion its primary problem for study. L. Baumgartner suggested that technical cooperation is necessary to develop mass solutions to family planning program problems. M. Tottie felt that the Conference marked a step forward in the goal of both healthy children and healthy parents. B.L. Raina felt that the sense of urgency noted in the Conference would result in a crusade for moderating fertility. E. Adil felt that the Conference proved family planning workability on a worldwide basis. N. Fisch saw the need for the development of research-minded administrators who will encourage researchers to accept administrative responsibility. T.I. Kim suggested 1) that the public health officer is the key factor in initiating national family planning programs, and 2) the desirability of adopting several contraceptive methods with emphasis on the IUD. S.C. Hsu believed the Conference provided new ideas and new information for dealing with mass family planning programs.
In: World Health Organization (WHO). Third report on the world health situation, 1961-1964. Geneva, Switzerland, WHO, April 1967. 28-35. (Official Records of the World Health Organization No. 155)The specific replies of 86 governments to the questionnaire for the Third Report are analyzed. The questionnaire asked for 3 things; 1) a description of the major public health problems still to be solved in order of magnitude; 2) how that assessment had been made; and 3) assignment of, where possible, priorities to the solving of the problems. The 46 problems cited fell into the following 10 major groups, listed in order of importance; environmental deficiencies, malaria, tuberculosis, malnutrition, helminthiases (including bilharziasis), communicable diseases (exclusive of malaria, tuberculosis and venereal diseases), chronic degenerative diseases and accidents, administrative and organizational deficiencies (including personnel deficiencies), venereal diseases, and mental health. Though the health record for each country was different, common patterns tended to emerge on a regional basis. The African region profile was drawn from the experience of 28 countries, and the general picture was of a region where effort needed to be concentrated on the control of communicable diseases, requiring large expenditures in basic sanitation, training of personnel and administrative and organizational improvements. In Canada and the U.S. the major problems were cardiovascular diseases, cancer, and accidents, and the organization and financing of health care services. The Central and South American and the Caribbean profile was drawn from the replies of 36 countries. Their problems in order of importance were: 1) malnutrition, 2) environmental deficiencies and diarrheal and venereal diseases, and 3) malaria. 7 countries in the Southeast Asia region provided information. Major problems there were environmental deficiencies, diarrheal diseases and dysentary, communicable diseases, and to a lesser extent population pressure. In the European region, priority was given to problems of administration and organization, followed fairly closely by cancer, cardiovascular disease, venereal diseases, tuberculosis, respiratory virus diseases, and infectious hepatitis. In the Eastern Mediterranean malaria and tuberculosis were the outstanding diseases and half the respondents had important administrative and organizational problems. In the Western Pacific, Australia, Japan, and New Zealand have problems comparable to those of the developed countries of Europe and North America. In the other countries in the region the emphasis was on communicable diseases with tuberculosis in the lead. Other problems mentioned that did not fit under 1 of the 10 headings were human rabies, alcoholism, dental health, and problems associated with urbanization and industrialization. Problems of population pressure and manpower deficiencies in the health field are also discussed on a regional basis.
In: Ross JA, ed. International encyclopedia of population. Vol. 1. New York, Free Press, 1982. 58-64.This discussion reviews the birth control movement over the period 1800-1952, highlighting the activities of many individuals and organizations. Early advocates of birth control in England included the Reverend Joseph Townsend, the freethinker and radical publisher Richard Carlile, and Francis Place, a social reformer and trade unionist credited with writing handbills on contraception that were first distributed to working class people in 1823. English birth control advocates reportedly gained their knowledge of contraceptive methods from France, where coitus interruptus and the sponge appear to have been widely used from the 1700s onward by all strata of society. America's 1st book on birth control was published in 1831 by Robert Dale Owen. Charles Knowlton, a Massachusetts physician, has been called America's 2nd birth control pioneer. He published "Fruits of Philosophy" in 1832, a treatise on contraceptive techniques that argued for birth control for social and medical reasons. During the mid-1800s interest in birth control grew slowly but steadily in Great Britain and the U.S. Charles Bradlaugh, a reformist publisher and freethinker, proposed the 1st Malthusian League in 1861. Birth control was termed Malthusianism from 1860 and the New Malthusianism and Neo-Malthusianism from the late 1870s. The dominant lasting social movements for birth control were based in England and the U.S., but physicians, scientists, and political economists in many European states were concerned with the subject. A turning point in open public discussion of birth control took place in England when prosecution of publishers of birth control booklets resulted in lively debate in the press. In outrage over the suppression of free speech and in support of the subject of birth control, Charles Bradlaugh and Annie Besant printed their own version of Knowlton's book and challenged the authorities to suppress its publication. The highly publicized case brought against Bradlaugh and Besant under the Obscene Publications Act of 1857 ended with victory for the defendants. In light of the trial publicity, the Malthusian League began to develop international connections. In the early 1900s activities of the national Malthusian leagues grew. The major force after World War 1 was Margaret Sanger who opened the 1st birth control clinic in the U.S. in 1916. Sanger founded several organizations devoted to promoting birth control. During the 1920s and the 1930s birth control activities began to spread throughout the U.S. There are significant parallels in the development of birth control in the U.S. and Great Britain. Marie Stopes may be considered as the British counterpart of Margaret Sanger. Stopes advocated birth control as a means of improving woman's control over her own body, as an aid to the fulfillment of marriage, and as a means to prevent excessive, unwanted childbearing. Economic, demographic, and social conditions after World War 2 stimulated renewed growth of the international birth control movement. Shortly after its establishement the UN began to pay attention to demographic issues, and the international ranks of those concerned with population as a problem swelled. The birth control movement has continued, but 1952 may be considered as a major turning point in its development. Many countries began to consider offering family planning services and to study population phenomena with a view toward reducing population growth rates.
In: Ross JA, ed. International encyclopedia of population. Vol. 1. New York, Free Press, 1982. 374-82.In the field of population, international assistance has a brief but spectacular history. Population activities covered by international assistance have been broadly classified by the UN organizations concerned into the following major subject areas: basic population data; population dynamics; population policy formulation, implementation, and evaluation; family planning; biomedical research; and communication and education. All of these areas involve a wide spectrum of data collection, training, research, communication, and operational activities. The UN began in the early 1950s to assist developing countries with census taking, training in demography, and studies on the relationships between population trends and social and economic factors. It also supported some action-oriented research activities. In 1958 Sweden became the 1st government to provide assistance to a developing country for family planning. The barriers that had handicapped the UN system in responding directly to the needs of developing nations for assistance in the population field, and particularly family planning, began to be lifted after the mid-1960s. Total international assistance for population activities amounted to only about $2 million in 1960 and $18 million in 1965. It increased to $125 million in 1970 and to an estimated net amount, excluding double counting, of around $450 million in 1979. The marked increase in population assistance is an indication of a growing commitment on the part of governments and international organizations to deal with the urgent population problems of the developing countries. More than 80 governments have at 1 time or another contributed to international population assistance, but the major shares come from fewer than 12 countries. The U.S., the largest contributor, spent around $182 million on population assistance in 1979, or 3.9% of its total development assistance. Sweden and Norway are the 2 largest donor governments after the U.S. By 1890, 121 developing countries, or nearly all, had received population assistance. Most of this number had received assistance from the UN Fund for Population Activities. About 47 developing countries also received assistance from bilateral donors. Almost all donors make their contributions to population assistance in grants, but a few governments also make loans available. From the limited data available, it appears that more and more developing countries are carrying increasing shares of the costs of their population programs. Most donors of population assistance continue to give high priority to support for family planning activities designed to achieve fertility reduction, health, social welfare, or other socioeconomic development objectives.
Geneva, Switzerland, WHO, 1982. 33 p. (WHO/HS/NAT.COM/82.373)This WHO publication contains information on the vital and health statistical activities engaged in by member countries between 1978-80. The information, received upon request by WHO, focused on the following issues: 1) changes in organization, function, and utilization of vital and health statistics information services; 2) work engaged in by the national committees on vital and health statistics or equivalent organizational bodies which coordinate and advise; and 3) current and newly undertaken activities and developments in such special areas as training and medical and health records. The U.S. section includes information on the National Center for Health Statistics, the National Committee on Vital and Health Statistics; cancer and tumor registries, and the Bureau of the Census. The countries in Europe with information included are: Finland, France, Federal Republic of Germany, Greece, Hungary, Netherlands, Norway, Portugal, Romania, Switzerland, and Turkey. Registers, national surveys, hospital morbidity, health status of populations, catalogues of official demographic and health statistics, training in health statistics, morbidity and mortality statistics, and birth statistics are some of the many activities engaged in by these countries. The Nordic Medical Statistics Commission (NOMESCO) is presented, an organization which was formed for the purpose of developing, coordinating, and standardizing health-related statistics in order to increase their inter-country use and comparability. Denmark, Finland, Iceland, Norway, and Sweden are represented and since 1978, NOMESCO has functioned under the Secretariat of the Minister Board of the Nordic Council with its own budget. Its working groups composed of experts from the participating countries are listed along with their appropriate subject area specializations. 13 conclusions arrived at by the Committee on "Planning of Information Services for Health, Decision-Simulation Approach" are presented. The final document should be useful to consumers and producers of such information in Scandinavian countries and it includes concrete examples of real life situations with definitions of system concept.
In: Ross JA, ed. International encyclopedia of population. Vol. 2. New York, Free Press, 1982. 578-82.This discussion of refugees reviews definitions, the various estimates of the number of refugees in the contemporary world, and the efforts to develop an international system of refugee rescue, relief, and resettlement. A refugee is defined as an individual who is seeking asylum in a foreign country. Asylum refers to protection granted or afforded by a state to an individual in its territory. At present international law and practice recognizes that each state has the right to grant asylum. The refugee has no recognized right of asylum vis-a-vis the state. Estimates of the number of refugees vary widely, depending on sources. 2 sets of refugee figures are presented in a table. 1 set focuses on the area of origin and the other on the area of asylum. In 1981, of the 12.6 million refugees, 8.1 million, or 64% were persons outside their country and the remaining 4.6 million or 36% were the estimated number of persons displaced within their own country. The majority of the estimated refugees (slightly more than 50%) were located in Africa. In 1981, Asia had about 2.2 million estimated refugees, 2 million of whom were outside their country. The Latin American refugees are widely dispersed. Of the 189,600 estimated for 1981, the largest group was in Mexico. The Middle East estimated total refugee populations increased from 3.3 to 3.6 million. Within the developing countries, the poorest bear a disproportionate burden. Since World War 1 there has been coordinated international attention directed to refugees. Before that time, the plight of refugees was seen as depending on a solution to the political problem that caused the displacement. The United Nations General Assembly passed a resolution in 1950 creating a United Nations High Commissioner for Refugees (UNHCR) to take over the legal protection of refugees and displaced persons from the International Refugee Organization, created in 1947. The UNHCR uses its "good offices," moral persuasion, and position as a politically neutral body focuses on humanitarian concerns. It negotiates with sending governments, countries of asylum, international relief organizations, voluntary agencies, and others to relieve suffering and to resettle refugees in their original country or elsewhere. International and national voluntary organizations and the governments in countries of asylum handle most of the actual care and resettlement of refugees. There is an increasing belief that refugee movements will be a permanent fact of international life.
World Health Forum. 1982; 3(2):236-8.Only 3 of Turkey's 44 socialized provinces have been able to meet the demand for midwives. Currently there are 28 midwifery colleges but there is widespread feeling that the midwife is not being adequately prepared for her role and is unable to provide the quality of services required under the present health system. The following are lacking: 1) task analysis, 2) sufficient supervision systems, 3) training curricula, 4) trained teachers, 5) postgraduate training facilities, and 6) teaching materials. To solve the last problem the Center for Medical Education Technology prepared a manual for midwives. A committee of professionals including midwives, nurses, pediatricians, gynecologist/obstetricians, educators, health administrators, family planning experts, and nutritionists collaborated in the effort. A problem-based approach was used and the role of the midwife as an agent for preventive measures and health communicator was stressed. The language of the text was kept simple and the contents were divided into 2 groups: maternal care/family planning and child care. The contents reflect the major health problems encountered by midwives: among children, disorders of the respiratory and digestive tracts, malnutrition and accidents, and among women, disorders relating to pregnancy and diseases of the urogenital tract as well as dental problems. Illustrations of processes inside the body are included. The manual is printed in type large enough to be read in poor light.
Population. 1982 Dec; 8(12):1.New population projects in 5 countries will be financed by Italy under an agreement by which project funds will be held in trust and admistered by UNFPA. The agreement will provide additional project funding for the 5 countries, Colombia, Ethiopia, Nicaragua, Peru and Somalia, over and above UNFPA ceilings. Similar agreements, known as "multi-bi" because they combine some of the features of both multilateral and bilateral assistance, have been made with Denmark, Finland, Netherlands, Norway and Sweden, which have made available over $US14 million. In addition, the OPEC (Organization of Petroleum Exporting Countries) Development Fund has provided $US1.5 million for projects in Pakistan. Multi-bi is an arrangement under which extra financing can be channelled to developing countries with maximum efficiency and minimum administrative cost. Projects prepared and agreed with governments, but which are beyond UNFPA's funding capabilities, are offered to donor governments which have funds available for population projects over and above their regular contribution to UNFPA. On acceptance, the projects are administered by UNFPA in the same way as the regular country program, but with special accounting and reporting provisions. This procedure has the advantage for donor countries of bypassing the costly and time-consuming processes of project preparation and approval and later of administration. For recipients the arrangement provides extra funding without additional administrative workload. Italy has already made available $US250,000 for population awareness programs in Africa through the African Information Network. Projects to be supported under the new agreement include mother and child health and family planning in Colombia, Nicaragua and Peru, communication support in Ethiopia, and the census planned for 1985 in Somalia. UNFPA was prepared a compendium of population projects offered for multi-bi support. Distributed in October, the listing includes some 66 projects in 31 countries totalling $US52.6 million. (full text)
Summary of significant findings from visits to United Kingdom, Sweden and Norway: September 22-30, 1982.
[Unpublished] 1982 Oct. 11 p.There were 2 objectives for the visits to UK, Sweden, and Norway: to discuss current policies relating to and for population and family planning programs, the current levels of funding for multilateral and bilateral programs for population, the relationship of population funding to other sectors of development aid, and the degree of public support for current policies and levels of funding; and to discuss possibilities for referring to these agencies Special Projects submitted to Population Crisis Committee (PCC) but which cannot be funded within the criteria or which have been funded in the initial stages but require more support for expansion or replication. Significant findings from these visits are summarized. All 3 agencies reported wide popular support for development assistance, including assistance in the solution of population problems. There is little debate on the kind of issues that arise in the US Congress and administration. UK officials attribute this to general public understanding of the need to raise standards of living in the 3rd world countries but also to the work of the British Parliamentary Committee on Population and Development. The 2 Scandinavian countries also testified to the popular support for development and population assistance which reflects itself in these governments and parliaments. There is some debate on priorities and levels of financing for particular countries, but these occur primarily within the party caucuses. Regarding levels of funding, it was gratifying to hear that all 3 countries, despite current economic problems, have increased funding for the International Planned Parenthood Federation (IPPF) and the UN Fund for Population Activities (UNFPA) in 1982 and project additional increases for 1983. Sweden will provide about US$10 million and Norway about US$6 million. These 2 countries are also increasing bilateral contributions to the health and population programs of a limited number of countries. Preference for multilateral channels over bilateral channels for population aid is most marked in UK where 77% of aid in this fiscal year will go through multilateral channels. The Norwegians are at about a 50-50 ratio and the Swedes at a 1/3 multilateral and a 2/3 bilateral. In all 3 visits, greater interest and favorable policies were found toward the use of NGO channels for population assistance. In addition to their contributions to IPPF which are directed toward the voluntary family planning associations, all 3 countries use nationally based private voluntary agencies to provide assistance to their counterparts in 3rd world countries.
[The demographic activities of the Council of Europe] Les activites demographiques du Conseil de l'Europe
Forum Statisticum. 1983 Mar; (19):63-86.The demographic activities of the Council of Europe are described. Consideration is given to the work of the Committee of Directors for Demographic Questions, the organization of conferences and seminars, and the work of the Parliamentary Assembly. Appendixes contain a list of demographic publications issued by the Council of Europe and a summary of the conclusions of the 1982 European Demographic Conference. (ANNOTATION)
London, England, IPPF, April 1983. 9 p. (IPPF Fact Sheet)Discusses the International Planned Parenthood Federation's (IPPF) position on the use of injectable contraceptives. The 2 currently available injectable contraceptives are depot medroxyprogesterone acetate (DMPA), which is marketed under the name Depo-Provera, and norethisterone acetate (NET-EN), sold as Noristerat or Norigest. Injectable contraceptives are highly effective, convenient, and have a long-acting effect which is an advantage. DMPA has been approved for contraceptive use in more than 80 developing and developed countries, and NEP-EN, a recent introduction, in 40 countries. After the contraceptive has been approved for domestic use, it is supplied by IPPF to those countries which request it. Injectables are also provided for contraceptive use by the World Health Organization (WHO) and the United Nations Fund for Population Activities (UNFPA). The current positions of the WHO and the IPPF are covered, as well as the positions of Britain, Sweden, and the United States. Criticisms of the injectable contraceptives and IPPF's position regarding these are also discussed. After taking the criticisms into account, IPPF concludes that there is not sufficient reason to change its current position on injectable contraceptives. It will continue to keep all methods under close and continuous review.
Infant and young child nutrition, including the nutritional value and safety of products specifically intended for infant and young child feeding and the status of compliance with and implementation of the International Code of Marketing of Breast-milk Substitutes: report by the Director-General.
Geneva, Switzerland, WHO, March 1983. 39 p.This report to the Health Assembly is presented in 3 parts: Part I--a summary of the present global nutritional situation with particular reference to infants and young children--is based on an initial reading of the results of national surveillance and monitoring activities in over 50 countries. Part II has been prepared in accordance with resolution WHA34.23 which requested the Director-General to report to the Assembly on steps taken to assess the changes that occur with time and under various climatic conditions in the quality, nutritional value and safety of products specifically intended for infant and young child feeding. Part III, in accordance with resolution WHA34.22, summarizes information provided by Member States on action being taken to give effect to the International Code of Marketing of Breast-milk Substitutes. It should be read in conjunction with section VI of the Director-General's progress report which informed the 35th World Health Assembly of action taken by WHO and its Member States in the field of infant and young child feeding. In light of the information on the implementation of the Code contained in these 2 reports, and in the absence of any suggestions from Member States for change, the Director-General considers that it would be premature, at this time, to propose any revision of the text of the Code, either its form or content. The Health Assembly's attention will be drawn, in future biennial progress reports on infant and young child feeding, to any development which may have a bearing on the International Code, in accordance with its Article 11.7 and resolution WHA33.32.
London, England, IPPF, Europe Region, 1982. 62 p.The final report of the Migrants and Planned Parenthood (MPP) Project, a cooperative effort between the European Region of International Planned Parenthood Federation (IPPF), Pro Familia, and other European Planned Parenthood Associations (PPA), is presented. Increasing contact with migrant clients stimulated Pro Familia to ask IPPF to evaluate existing family planning services for migrants and consider transnational coordination and sociopolitical action in this area. 13 countries were represented in this project: 4 donor countries (Italy, Portugal, Turkey, and Yugoslavia); 7 recipient countries (Belgium, Federal Republic of Germany, Luxembourg, Netherlands, Norway, Sweden, and the United Kingdom); and 2 through correspondence (France and Ireland). 2 questionnaires were administered. The 1st was aimed at detailing European migratory movements and the ethnicity of target groups in each country; the 2nd explored PPA attitudes toward migrant clients and the need for migrant-specific services. Project conclusions were based on a series of plenaries and sub working group meetings held during 1981-82. (Reports of these meetings are included as Appendices to the final report.) It is recommended that the MMP Project continue until a Regional Policy Statement can be produced. The Regional Council is requested to develop a handbook of general guidelines for migrant work and should nominate a nonsalaried regional migrant ombudsperson. Each PPA is requested to select a liaison person for migrant work. Other tasks proposed for PPAs include: personnel training, production of educational materials for migrants, and cooperation with migrant's organizations. Family planning and health should be integrated into general migrant services offered by other institutions. PPAs in donor countries should consider special programs for groups affected by migration, e.g., wives remaining behind and returning migrants. Discussions are to be held on how to reach illiterate migrants and develop wider channels of materials distribution. Future workshops may be scheduled to train family planning personnel to work with migrants. In terms of services, PPA personnel are warned that problems outside the scope of family planning are likely to be encountered in work with migrants. Attention should be given to making services more accessible. Possible measures include mobile clinics, domiciliary services, provision of interpreters, and child care. The need for sex segregation and use of female personnel is also stressed.
[Unpublished] 1983 Mar 1. 27 p. (IESA/P/ICP.1984/EG.II/30)The UN Fund for Population Activities (UNFPA), in extending assistance for population concerns, has pursued a multifaceted program of work in order to respond to the wide ranging needs of the developing countries it serves. This paper examines its assistance in the area of population distribution and migration, taking into account how both internal and international migration affect and are affected by trends in socioeconomic development. Some of the issues that surface under the rubric "population distribution, migration, and development" are summarized. UNFPA's assistance to activities in population distribution, migration, and development fall into 4 categories: data collection, research and analysis, policy formulation and planning, and awareness creation. UNFPA has supported data collection in order to improve knowledge of migratory movements. It has funded research on interrelationships between population distribution and socioeconomic factors. Much of this research has focused on the interplay between population movement and labor force opportunities. The strengthening of institutions and the training of personnel involved in work on population distribution, migration, and development have made up an important part of UNFPA's work in this area. Generally, UNFPA does not support action programs in this area. Within the context of a comprehensive redistribution program, UNFPA may provide assistance for those service programs within its mandate--family planning service, population information campaigns, and educational support for the execution of such schemes. Thus far UNFPA's assistance in the field of population distribution, migration, and development has totaled about US$15 million. Much of the research supported by UNFPA has attempted to clarify the interactions between the migration flows and economic opportunities and has sought to identify viable policy options that countries may pursue in order to bring about more satisfactory patterns of population distribution. The bulk of UNFPA assistance in Africa for population redistribution and migration has been for research activities in this field. Most countries of the Asian and Pacific region are predominantly concerned about rural urban migration and are committed to formulating policies aimed at correcting or at least reducing the dislocations attendant on unbalanced distribution of population. The concern with employment related migration is evident in several of the projects dealing wtih internal migration tha UNFPA supports in the Asia and Pacific region. Several of the projects that UNFPA has financed in the Latin American and Caribbean region involve providing information to rural populations about economic and social conditions in urban areas. UNFPA has sponsored a Conference on International Migration in the Arab world and is financing a study on migration trends in Southern Europe. In general, the interregional and global activities supported by UNFPA have focused on methodological issues, the creation of awareness, and the dissemination of information.
In: Connor E, Mullan F, ed. Community oriented primary care: new directions for health services delivery. Washington, D.C., National Academy Press, 1983. 250-7.Education of doctors for community oriented primary care (COPC) in the Netherlands is described. A basic doctor has 6 years of training and is prepared for further specialty training in general practice (currently only 1 year), clinical specialty (4-6 years), and social medicine (4 years). After high school, a weighted lottery is performed. Out of 6000 interested graduates, 1950 are placed in medical faculties. Only straight A students have a double chance. In 1970, the Dutch government started a new medical faculty that was community oriented and emphasized primary health care. For this, the educational system of this facility had to be different. A problem-oriented system was adopted. In 1974, an integrated innovative curriculum was started. The basic philosophy emphasizes a preference for orienting medical education to primary care. By the 5th and 6th year, students must acquire: 1) practical experience in solving primary care problems; and 2) the ability to recognize unusual problems and develop appropriate referral. During the 1st 4 years the problem-solving process is encountered; the problems must be increasingly complex; and the teaching program progresses from the general to the specific. The teaching program should begin with health problems and proceed to consider normal and abnormal functioning. The original arrangement for hospital internships is not yet feasible. It seems that hospital organization is too rigid to combine with a less department-linked program. Evaluation is mandatory. A theoretical final M.D. exam was designed. The World Health Organization (WHO) held a meeting at which key figures from 18 selected schools were brought together. From this meeting, it was agreed that a network would be developed linking schools. The network members met again and formulated objectives.
Population trends and issues, statement made at the Meeting of the Netherlands Association of Demographers, The Hague, Netherlands, 14 September, 1983.
New York, N.Y., UNFPA, . 7 p. (Speech Series No. 97)If world population is to stabilize by the end of the next century, it will be necessary to strengthen and sustain the downward trend in fertility already begun in most developing countries. Whatever reductions have been achieved in the rate of population growth are the result of fertility declines accompanied by moderate reduction in mortality. Added to the challenge of high birth, mortality and growth rates in some parts of the developing world, a number of issues of equal importance have emerged since the United Nations World Population Conference held in Bucharest in 1974. There are, for example, issues relating to aging, international and local migration, including urbanization, and the interrelationships between population, resources, the environment and development. Most of these problems have national as well as international dimensions. The Government of the Netherlands has taken important steps to alleviate some of these problems. For example, it considers that social and economic policy should constantly take in requirements resulting from changes in the age structure of the population. The Government has been a major donor to the United Nations Fund for Population Activities (UNFPA) since its inception and has contributed nearly US$105 million in 14 years.
The Bulgarian experience, statement made at the Special Convocation, Sofia State University, Sofia, Bugaria, 7 October, 1983.
New York, N.Y., UNFPA, . 5 p.Although world fertility has entered a perceptible period of decline heralding a deceleration in the rate of population growth, even with the current rate, which is about 1.7%/year, the world is still adding close to 78 million people to its population each year. This figure is estimated to rise to 89 million by the year 2000. A major concern confronting most developing countries at present is the integration of population factors into the development process. In this context, Bulgaria's progress in the twin fields of population and development provides an outstanding example of what can be achieved. Demographic development in the country since 1950 has been impressive. Although the bulk of transition in fertility and growth rate of population had occurred by 1950, the consistent improvement in health services has achieved at an early date what was sought by the World Population Plan of Action in its 2 quantified targets: lower infant mortality rates and longer life expectancy. A major reason for this success is the official policy in regard to the full integration of women into the development process. Internally, Bulgaria pursues a pronatalist policy. Within the context of Bulgaria's national goals of development objectives and human resource potential, this policy is understandable. Bulgaria's population program includes activities to reduce infant and child mortality, improve maternal health, augment reproductive health and increase marital fertility. The United Nations Fund for Population Activities, because of its respect for the sovereign rights of countries to determine their own population policies, has provided assistance for the implementation of this national program.
Universitas. 1983 Dec; 25(4):253-63.Unescos reports on the gap existing in mass media between the developed and the developing countries shows that in 1978 the 3rd world countries accounted for 70% of the world population, but only 22% of the published book titles, 9% of newsprint consumption, 18% of the radio receivers, and 12% of the television receivers. The contrast is more noticeable with the extremely marked urban rural gap in Central and South America, Africa, and Asia. Although illiteracy is "overleaped" by radio and television, in vast regions of the world participation in the "information-based society" does not go beyond a transistor radio of limited range. The progress in technological development might result in widening further the development gap between North and South in the field of information and communicaton. Research and development are possible almost only in the industrial countries and a few "threshold countries" such as India or Brazil. Satellites, cable networks, or networks of television transmitters confront most developing countries with unsolvable financing problems and human resources needs. While technology can make communications easier in many respects, nearly all developing countries areunable to establish the link to the information-based society with their own resources. Some theorists in North and South either negatethe need for such a link or question it. The international debate in recent years shows that the developing countries recognize both the apparent dangers and the great opportunities of the modern information and communication media: "drop out of the system" has changed to better participation, both in its products and in its control. The essence of the "media declaration" passed by the Unesco general conference in 1978 is a double commitment on the part of the member countries to the goal of a "free flow and a wider and better balanced dissemination of information" and to cooperation in the expedited building up of the inadequate structures in the developing countries. How this commitment is to be realized remains the most important issue for the future. In nearly all developing countries much needs to be done before a functioning media system which reaches all citizens and can be used by everyone is achieved. The Federal Republic of Germany, as a donor country and through government channels, political foundations, and nongovernment organizations, has given 1 billion deutsch marks for media aid to developing countries. The main emphasis is on the supply of equipment and material and on training and consultative assistance. For several years cooperation in the building of new agencies has been a priority, and it is hoped that this will continue so that the media declaration of 1978 can be kept.
In: Proceedings of the International Conference on Oral Rehydration Therapy, June 7-10, 1983, Washington, D.C., edited by Richard Cash. Washington, D.C., Agency for International Development [AID], Bureau for Science and Technology, 1983. 4-5. (International Conference on Oral Rehydration Therapy, 1983, proceedings)The Honorable Margaret Heckler, secretary of Health and Human Services, presents the goal of the conference--discussion of the remarkable potential of oral rehydration therapy and its importance to the health of infants and children throughout the world. The conference celebrates the scientific advances of recent years that give new hope for millions of children every year. Over 500 million episodes of diarrhea afflict infants in developing countries each year; each year, some 5 million children lose their lives to these diseases. In Europe, and in North America as well, diarrhea is the 6th most common cause of death among small children. At the turn of the century, mortality due to cholera was 60%. A scientist in Calcutta and 1 in Manila developed methods of intravenous therapy that reduced mortality dramatically to 20%. Treatment of the disease remained relatively unchanged until the middle of the century when work in Egypt and Asia resulted in a therapy method that reduced mortality for cholera to less than 1%. The crucial discovery of an effective cholera agent occurred in India in 1959. In 1962, scientists in Manila established the vital role of oral glucose in the absorption of sodium and water. The large-scale use of oral rehydration therapy was demonstrated in Dhaka and Calcutta in the 1960s, when 100s of cholera cases were managed under field conditions during a rural epidemic. A massive epidemic during a refugee crisis in 1971 was well-coped with by the Johns Hopkins group in Calcutta by treating 3700 patients over an 8-week period. This was one of the 1st large-scale uses of prepackaged materials for oral hydration, costing only US$750. In Dhaka and Calcutta in the early 1970s the critical discovery that noncholera diarrheal diseases could be treated with the oral rehydration therapy developed for cholera was made. The discovery of the role of glucose in accelerating the absorption of salt and water was underscored in the British journal "Lancet" as being potentially the most important medical advance of this century. A strong coalition of interest exists between governments and scientists of many nations as well as the international organizations to promote oral rehydration therapy. WHO, UNICEF, USAID and other agencies are playing an extremely important part in discovering how oral rehydration therapy can best be incorporated into broader health services, and how to prevent diarrheal diseases from occurring.
REVIEWS OF INFECTIOUS DISEASES. 1983 May-Jun; 5(3):452-9.This summary of the worldwide impact of measles discusses epidemiology, reported incidence, clinical severity, community attitudes toward measles, and the impact of immunization programs on measles. Measles, 1 of the most ubiquitous and persistent of human viruses, occurs regularly everywhere in the world except in very remote and isolated areas. Strains of measles virus from different counties are indistinguishable, and serum antibodies from diverse population have identical specificity. Yet, the epidemic pattern, average age at infection, and mortality vary considerably from 1 area to another and provide a contrasting picture between the developing and the developed countries. In the populous areas of the world, measles causes epidemics every 2-5 years, but in the rapidly expanding urban conglomerations in the developing world, the continuous immigration from the rural population provides a constant influx of susceptible individuals and, in turn, a sustained occurrence of measles and unclear epidemic curves. In the economically advanced nations, measles epidemics are closely tied to the school year, building up to a peak in the late spring and ceasing abruptly after the summer recess begins. Maternal antibody usually confers protection against measles to infants during the 1st few months of life. The total number of cases of measles reported to WHO for 1980 is 2.9 million. Considering that in the developing world alone almost 100 million infants are born yearly, that less than 20% of them are immunized against measles, and that various studies indicate that almost all nonimmunized children get measles, less than 3 million cases of measles in 1980 is a gross underestimate. There was adecrease in the global number of reported cases of measles during the 1979-80 period due primarily to the reduction in the number of cases in the African continent and, to a lesser extent, in Europe. It is premature to conclude that such a reported decline is real and that it reflects the beginning of a longterm trend. The contrast between the developed and the developing worlds is most marked in relation to the severity and outcome of measles. Case fatality rates of more than 20% have been reported from West Africa. It has been estimated that 900,000 deaths occur yearly in the developing world because of measles, but data available to WHO indicate that the global case fatality rate in the developing world approaches 2% (in contrast to 2/10,000 cases in the US), and the actal mortality may be greater than 1.5 million deaths per year. The advent of WHO's Expanded Program on Immunization has brought about an awareness of the measles problem. Whenever and wherever measles vaccine has been used effectively on a large scale, a marked reduction in the number of cases has been recorded.
Evaluation of WHO Special Programme of Research, Development and Research Training in Human Reproduction (HRP). 1. Task Force on Infertility.
In: Assessment of the WHO Special Programme of Research, Development and Research Training in Human Reproduction [HRP]. II. Task Force reports. Country reports, [compiled by] Sweden. Swedish Agency for Research Cooperation with Developing Countries [SAREC]. Stockholm, Sweden, SAREC, 1983 Apr.  p..To date, Sweden has provided the WHO Special Program of Research, Development, and Research Training in Human Reproduction (HRP) with 265 million Swiss Cr. A 2-part, in-depth assessment of selected aspects of HRP was thus undertaken to ensure that the program is indeed achieving its objectives and meeting the specific needs of developing countries rather than more global interests in technological advancement. The assessment was limited by the inability of the Swedish investigators to gain access to confidential, unpublished HRP documents. However, a review of infertility-related materials indicated that activities in this area are predominantly focused on developed countries. The situation in Third World countries, where both primary and secondary infertility are widespread, is not receiving the necessary attention. The topic of infertility itself is greatly overshadowed in developing countries by an emphasis on the control of fertility. A review of HRP activities in a specific Third World setting--Zambia--provided further evidence of a failure to ensure that the HRP is addressing the prevailing health research priorities in these countries. Although social realities, such a poverty and family size preferences, comprise major obstacles to family planning acceptance in Zambia, the HRP has concentrated its efforts on research into new contraceptive technologies--in keeping with its global agenda, rather than Zambia's. Any activities that have been initiated by HRP in Zambia have been located in isolation of the existing health service delivery system, making them an academic exercise at best. In general, HRP's work in Zambia appears to have actually weakened Zambian-based research capacity. This review suggests that Sweden's contribution to Zambia would have been better utilized had it been channeled directly on a bilateral basis rather than through the HRP.