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New York, New York, UNICEF, . 42 p.In the last 12 months, world-wide support has been gathering behind the idea of a revolution which could save the lives of up to 7 million children each year, protect the health and growth of many millions more, and help to slow down world population growth. This document summarizes case studies which illustrate the techniques which make this revolution possible. These techniques are: oral rehydration therapy (ORT); growth monitoring; expanded immunization using newly improved vaccines to prevent the 6 main immunizable diseases which kill an esitmated 5 million children a year and disable 5 million more (measles, whooping cough, neonatal tetanus, polio, diphtheria and tuberculosis); and the promotion of scientific knowledge about the advantages of breastfeeding and about how and when an infant should be given supplementary foods. Results are summarized from Guatemala, Papua New Guinea, Brazil, Egypt, Indonesia, Barbados, the Philippines, Nicaragua and Honduras, Malawi, China, Nepal, Bangladesh, Colombia, and Ethiopia. The impact of economic recession and female education on childrens' health is discussed, and basic statistics for developed and underdeveloped countries are given.
Lancet. 1984 Jan 7; 1(8367):23-4.The epidemic of tobacco smoking is quickly spreading to developing countries with the encouragement of UK- and US-based companies. A 1983 World Health Organization (WHO) report catalogues the evidence that the smoking diseases have already arrived in the developing countries. High death rates for lung cancer are reported from India, China, Hong Kong, and Cuba, and in the Bantu of Natal. Coronary heart disease associated with cigarette smoking is a major feature in India, Pakistan, and the Philippines. Perinatal mortality rates are doubled in Bangladesh women who smoke. WHO makes a strong appeal for effective change. The question is whether governments and health ministries will face up to this challenge any more than they did to 2 earlier WHO reports on smoking. Developing countries are now urged to give high priority to smoking control activities. Although malnutrition and infectious diseases may seem to be more pressing, only action now can prevent their exacerbation by smoking-related diseases. Each country should establish a central agency with responsibility for smoking control action. Special steps should be taken to safeguard the health of children through educational programs. The sale of cigarettes to minors should be prohibited. Particular attention should be paid to traditional smoking materials as a cause of ill health, and advertising and promotion of tobacco products should be banned. Where tobacco is a commercial crop, every attempt should be made to reduce its role in the national economy and to investigate alternative use of land and labor. The UK bears considerable responsibility for the present situation. Yet, far from discouraging exports to developing countries, the reverse is true. Britain offers no overseas assistance for anti-smoking programs. Instead, it has provided funds for the development of tobacco industries. Individual doctors in Britain can provide an example by pressing for smoking control policies in all hospitals and health service premises. They can voice their concern at the activities of the tobacco companies both at home and abroad, and they can consider the propriety of holding tobacco shares either themselves or via the universities or institutions with which they are associated.
Washington, D.C., World Bank, 1984. 13 p.An overview of the global economy is provided, with particular attention to the 3rd world, and focusing on 4 economic issues that deserve priority in 1984 and for some years to come: improving economic policy and performance in the industrial countries; liberalizing trade; reviving international capital flows; and improving economic policy in the developing countries. According to the Organization for Economic Cooperation and Development, the industrial countries as a group are likely to achieve economic growth of 3.5% in 1984, up from 2.25% in 1983 and negative growth in 1982. The World Bank estimate is that the developing countries will average growth of 3-3.5% in 1984, up from less than 1% in 1983 and less than 2% in 1982. Yet, since population is growing more than 2% a year in the developing countries, average per capita income actually fell in 1982-83 and will increase only modestly in 1984. Economic conditions vary greatly among the developing countries. 1 priority issue, clearly, is improved economic policies and performance in the industrial countries so that they can translate their current recovery into sustained and noninflationary growth. To move from recovery into a sustained period of economic expansion, the industrial countries need to create an environment conducive to structural change. Sustained and rapid growth will require further liberalization of international trade, and this is another priority issue. Barriers to trade must be reduced, including trade between the industrial and developing countries. Trade with developing countries is vitally important to the industrial countries. For the developing countries, growing exports to the industrial countries are essential for the recovery of growth and credit worthiness. For the world's low income countries, particularly sub-Saharan Africa, effective programs of official development assistance are essential. So the World Bank will continue to urge governments to increase their International Development Association (IDA) contributions. Strengthening IDA will be difficult, but it is essential. The slump in commercial bank lending and direct investment, along with very slow growth in official lending and development assistance, has forced the developing countries to cut imports. Looking ahead, it is expected that most developing countries will continue to be able to import more than they export and that the negative net transfers for medium- and longterm lending from private sources will continue to decline gradually. The debt crisis has had a most damaging effect on the private sector in the developing world. Developing countries must pursue economic policy reform urgently and tenaciously, for it is absolutely fundamental to the resumption of their economic and social progress.
A critique of the ideological and political positions of the Willy Brandt report and the WHO Alma Ata declaration.
Social Science and Medicine. 1984; 18(6):467-74.This article analyzes the Willy Brandt Commission Report and the WHO Alma Ata Declaration within the socioeconomic and political context that determined them, and makes a critique of the ideological and political assumptions that both documents make. Through an assumingly apolitical and technological-administrative discourse, both documents reproduce the major positions upheld by the hegemonic development establishments of the Western world which view the improvement of primary health services as the "key" to achieving health for all by the year 2000. Abundant empirical evidence exists to show that most improvements in health have been due to changes in economic, social and political structures rather than in the health sector. To suggest that the Alma Ata recommendations (which list interventions to be undertaken in health, education, and food production) are apolitical, in that they make no reference to political systems within which they function, is to assume that the structural determinants of society have no bearing on the effectiveness of the individual interventions. This type of presentation is itself political and misleading and is thus the main weakness of the report. A new understanding of what health and health struggles are should lead the WHO of the future to focus on: 1) concrete assistance to the liberation movements in their struggles against institutionalized violence and disease. (The reality is that other U.N. agencies are providing such assistance already.); 2) analysis of the structural constraints to health and the class and other forms of resistance to basic change; 3) change of all existing staff and consultant structures to better reflect the huge diversity of views on health, breaking with the dominant medical ideology; and 4) research and storage of information on the international mobility of capital and labor and its possible implications for health.
International consultation of NGOs on population issues in preparation of the 1984 United Nations International Conference on Population: report of the consultation.
[Unpublished] . 83 p.196 individuals from 44 countries, representing national and international non-governmental organizations, bilateral agencies and intergovernmental organizations attended the consultation. The purposes of the consultation were: 1) to provide an overview of the contributions of non-governmental organizations to the implementation of the World Population Plan of Action through a wide range of population and population related programs carried out since the Plan was adopted in 1974; 2) to explore what non-governmental organizations believe needs to be done in the world population field during the balance of the century; 3) to prepare for participation in the January 1984 Conference Preparatory Committee meeting and in the Conference itself to be held in August 1984; and 4) to provide suggestions for activities of national affiliates relative to the 1984 Conference. This report provides a synopsis of the plenary sessions and their recommendations. Addresses by numerous individuals covered the following topics: the creative role of non-governmental organizations (NGOs) in the population field; vital contributions of NGO's to the implementation of the world population plan of action; the family; population distribution and migration; population, resources, environment and international economic crisis; mortality and health; and NGO prospects for the implementation of the world population plan of action.
[Unpublished] 1984 May 3. Presented at the 1984 Annual Meeting of the Population Association of America, Minneapolis, Minnesota, May 3-5, 1984. 26 p.The paper summarizes the health strategy of the US Agency for International Development (AID). The goal of the strategy is to assist developing countries to 1) reduce mortality among infants and young children, and 2) to reduce disease and disability among selected population groups. The main strategy elements include: 1) improved and expanded use of available technologies; 2) development of new and improved technologies; and 3) strengthening human resource and institutional capability. A more in-depth look is taken at how AID implements its strategy in Asia emphasizing the primary goal of infant mortality reduction. The paper provides a demographic overview of the 9 AID-assisted Asian countries. A summary of AID's program support in Asia showing levels and trends by subcategory is provided. Particular attention is paid to projects supporting selective primary care. Finally, the paper discusses the difficulties of implementing the strategy in Asia and speculates on the chances for success. (author's)
In: United Nations. Department of International Economic and Social Affairs. Population projections: methodology of the United Nations. New York, N.Y., United Nations, 1984. 25-32. (Population Studies, No. 83; ST/ESA/SER.A/83)The United Nations population projection assumptions are statements of expected trends in fertility, mortality and migration in the world. In every assessment, each of the 3 demographic components is unambiguously specified at the national level for each of the 5-year periods during the population interval (1950-2025). The approach used by the UN in preparing its projections is briefly summarized. At the general level, the analyst relies on available information of past events and current demographic levels and differentials, the demographic trends and experiences of similar countries in the region and his or her informed interpretations of what is likely to occur in the future. One common feature of the UN population projections that guides the analyst in preparing the assumptions is the general conceptual scheme of the demographic transition, or the socio-economic threshold hypothesis of fertility decline. As can be observed from the projected demographic trends reported in this paper, population stabilization at low levels of fertility, mortality and migration is the expected future for each country, with the only important differences being the timing of the stabilization. Irrespective of whether the country is developed, with very low fertility (for example, the Federal Republic of Germany or Japan), or developing with high fertility (such as, Bangladesh or the Syrian Arab Republic), it is assumed that fertility will arrive at replacement levels in the not too distant future. Serious alternative theories or hypotheses of population change, such as declining population size, are not only very few in number, but they tend to be somewhat more unacceptable and inconvenient to the demographic analyst as well as being considerably less palatable to goverments.
World Smoking and Health. 1984 Spring; 9(1):4-6.An Expert Committee met in World Health Organization Headquarters in Geneva in November 1982 to discuss Smoking Control Strategies in Developing Countries. They reviewed the harmful health effects of different types of tobacco which characterized developing countries and the adverse effects of tobacco use on their economics due to smoking related diseases and higher smokers' work absenteeism. It advised on the objectives of smoking control programs, including data collection; education and information; legislation; smoking cessation; the role of medical, political, social, and religious leaders; the role of WHO, UN agencies, and nongovernmental organizations; research on smoking behavior; and evaluation of program efficacy. In addition, the Committee provided guidance on how to counteract tobacco industry arguments. More than a million people worldwide die prematurely each year because of cigarette smoking. In developed countries smoking is generally understood to cause lung cancer, coronary heart disease, chronic bronchitis, and other respiratory disorders. Major campaigns have been launched to reduce the rate of smoking. The public in most developing countries are unaware of the dangers, and no educational, legislative, or other measures are being taken to combat the smoking epidemic. The Committee called for firm steps to be taken to prevent this unnecessary modern epidemic. The incidence of tobacco related diseases is increasing in developing countries. Many of the developing countries have cigarettes on sale with high yields of tar and nicotine. Tobacco cultivation has spread to about 120 countries, becoming a substantial source of employment and creating new vested interests. Overall, the costs outweigh the "benefits." Tobacco taxes may be Politically comfortable," that is, easy to administer and generally acceptable to smokers, but these taxes do not contribute to national wealth but merely redistribute wealth. They cannot offset the economic losses caused by tobacco production and use: health service expenditures on smoking related diseases, disablement and work absenteeism, domestic and forest fires, use of scarce fule to cure tobacco, and reduced food production. Action against smoking can be inexpensive yet effective. Health warnings can be placed on cigarette packets, and legislation can be enacted to put an end to the double standards in marketing practices, whereby cigarettes of the same brand carrying health warnings in developed countries are marketed without these warnings in developing countries. Recommendations issued to governments and public health authorities in developing countries are listed.
BMJ. British Medical Journal. 1984 May 26; 288(6430):1611-2.In response to an article on disease among children in the Third World, the author of this letter outlines the efforts of the World Health Organization (WHO) to both alleviate disease in delveloping countries and promote an approach to health suited to current realities in these countries. WHO has become increasingly aware that the diseases affecting the Third World can be eradicated only through a broad, integrated approach that places health in the wider context of social and economic development. WHO has adopted a primary health care strategy to tackle the control of tropical diseases and the reduction of mortality and morbidity among Third World children. Central to this approach is the use of appropriate health technology and the participation of families and communities in the health services. A primary health care orientation further addresses theproblem of how Third World countries can best allocate scarce health resources. In its specific action programs such as control of diarrheal diseases and immunization, WHO aims to help countries and communities to improve their own health. It is the application of existing knowledge thatis needed in the Third World, not new knowledge or technology.
Evaluation of the Population Council's International Awards Program on the Determinants of Fertility.
[Unpublished] 1984. 51 p.This evaluation of the effectiveness of the International Awards Program on the Determinants of Fertility, administered by the Population Council and funded by the US Agency for International Development, Office of Population, addresses 8 aspects of the Awards Program: the review process, solicitation and development proposals, orientation of approved projects, AID's role in the Awards Program, management, dissemination, and funding. Also considered is AID's potential role in population policy research. Recommendations are made about AID's role in social science research on population, the participation of the Population Council in such research, and specific aspects of the present program. It is concluded that AID should continue to support social science research which focuses on the determinants of fertility in developing countries and which is relevant to population policies in developing countries. This research should be administered by an independent organization. AID should also commission an account of social science research projects which have been important in providing direction for population policies. The Population Council is best suited to direct a program on the determinants of fertility in developing countries and a continuation of the present awards program should be administered by them. In order to improve the contribution of social science research, it is recommended that the Council take steps to increase the pool of applicants for the Awards Program and establish regular contact with AID regional population officers. The Council should also prepare plans for the dissemination of results of projects supported by the Awards Program. Finally, it is recommended that AID and the Council try to coordinate future data collection activities with the research activities supported by the Council's Awards Program.
In: United Nations. Department of International Economic and Social Affairs. Population projections: methodology of the United Nations. Papers of the United Nations Ad Hoc Expert Group on Demographic Projections, United Nations Headquarters, 16-19 November 1981. New York, United Nations, 1984. 15-6. (Population Studies No. 83; ST/ESA/SER.A/83)As the UN demographic estimates and projections cover all the developed and developing countries, special problems are encountered in data collection and evaluations. The responsibility for the UN projections rests primarily with the Population Division, but the results are the product of collaboration by all responsible offices within the UN system. This is 1 of the strengths of the UN population projections, yet there are numerous problems concerning those projections. Aside from the perpetual difficulties with collection and estimation of basic demographic indicators from incomplete data, all of which must be continuously undertaken, there are 8 major problems which have become more important in recent years and concern the current UN demographic projections. The 1st problem is the question of meeting the needs of the users who are the researchers, the planners, and the policymakers. The 2nd problem is that significant improvement can be made in the methodologies with, on the 1 hand, the prodigious advances in calculation devices and research techniques and on the other, a better knowledge of the economic and social context of demographic variables. The 3rd major problem in the component method of projections of fertility, which continues to be the most influential component to the future population of most nations. Another component of projection, mortality, has become a pressing issue in the field of projection as well. Knowledge of mortality in the third world is highly fragmentary. The 5th problematic issue is urbanization and city growth. There are severe problems with data comparability and projection methods. Sixth, for several developing and developed countries international migration plays a significant role in their population growth. More problematic than estimating the current net numbers of migrants is formulating assumptions about future patterns of international migration. Seventh, thus far demographic projections have largely been based on the demographic theory of transition, which appears to continue to be useful for developing countries. Yet, the demographic transition models are affected by a wider variety of trajectories than anticipated. Finally, no one has been able to explain clearly the major simultaneous movements of fertility of the developed countries. The question of obvious policy significance is what will happen in the future.
Who Chronicle. 1984; 38(2):76-81.An early objective of the World Health Organization's (WHO) traditional medicine program was to promote a realistic approach to the subject. The realism with which countries around the world, both developed and developing, examine their own traditional practices suggests that progress is being made towards this goal. The current challenge is to pursue action along 3 lines: evaluation, integration, and training. In traditional medicine it is necessary to separate myth from reality so that valid practicies and remedies can be distinguished from those that are patently ineffective and/or unsafe. Thus, WHO will continue to promote the development, teaching, and application of analytical methods that can be used to evaluate the safety and efficacy of various elements of traditional medicine. Action need not await the results of formal evaluation. Efforts can be initiated now to synthesize traditional and modern medicine. Several countries have attempted such a synthesis. For example, medical curricula in China include elements of Chinese medicine such as acupuncture, moxibustion, manipulation and massage, relaxation, and herbal medicine. A critical training need is to incorporate in the curricula of conventional health workers certain traditional practices and remedies that have been evaluated and proven safe and effective. Traditional practitioners also require training. They need to be provided with additional skills. It is essential to make practitioners of traditional medicine allies rather than competitors. The training of traditional birth attendants in aseptic delviery techniques and simple antenatal and postpartum care provides a good example of the possibilities that exist for collaboration between the traditional and modern health care sectors. In the past 2 years WHO has carried out numerous activities in the field of traditional medicine. For example, among the activities coordinated by WHO headquarters was the continuing search for indigenous plants for fertility regulation in men and women. In 1983, WHO collaboration centers for traditional medicine continued to strengthen national efforts in research and development. A prerequisite for the success of primary health care is the availability and use of suitable drugs. It is reasonable for decision makers to identify locally available plants or plant extracts that could usefully be added to the national list of durgs or that could even replace some pharmaceutical preparations that need to be purchased and imported. NAPRALERT (for national products alert) is a computerized database derived primarily from scientific information gathered from the world literature on the chemistry, pharmacology, and ethnopharmacology of natural plant products. It can provide both a general profile on a designated plant and a profile on the biological effects of a chemical constituent thereof. A valuable feature of the NAPRALERT database is its ability to generate information on plants from a given geographical area.
Who Chronicle. 1984; 38(2):60-4.The International Drinking Water Supply and Sanitation Decade, 1981-90, which has a diversity of objectives, takes a different form in each country. What makes this decade different from previous actions for water and sanitation is the way in which the programs, projects, and services are to be conceived, planned, implemented, managed, operated, and maintained. The urban population to be covered by water and sanitation services, in the developing nations that have prepared plans for the Decade, is roughly between 280-290 million people. In rural areas, some 750 million people are to be provided with drinking water and around 300 million with sanitation facilities. The initial goal of 100% of the population to be provided with water and sanitation by 1990 is proving difficult to realize. Only a small proportion of developing nations have even planned for 100% coverage by 1990. The initial optimism arising from the declaration of the Decade and the expectations of increased aid has given way to realism in the face of the global recession and the scarcity of development capital. The Southeast Asia Region of the World Health Organization (WHO) covers 11 member countries with a combined population of over 1000 million people. Among the countries in Southeast Asia that have prepared Decade plans, the following populations are to be covered by 1990: urban water supply, 126 million; urban sanitation, 156 million; rural water supply, 585 million; and rural sanitation, 212 million. Such a challenge calls for a stock taking of the real issues in order to identify what action can be taken. The lack of up-to-date and comprehensive databases is a serious problem. The information system for the Decade should be and integral part of it, be timed to keep pace with it, and be developed from the lowest level. The annual investment needed during the Decade is estimated at over 4 times that prior to the Decade. The accepted strategy is to meet the minimum needs of the largest number of people as quickly as possible. Evan without financial constraints, the Decade would not reach its goals unless critical manpower and institutional problems were addressed forthwith. Efforts are needed to train engineers, other specialists, and staff in the subprofessional and artisan categories. Good management requires intersectoral coordination. A decentralized "bottom-up" approach is mandatory at the planning stage, with strong financial, administrative, and technical support for implementation. Technology must be relevant, cost effective, feasible, necessary, sufficient, and energy conserving. Communities benefiting from the Decade should be encouraged to participate in the decision making process to the maximum extent possible. Country specific studies should be conducted to document the hardships of women and activities should be designed to alleviate their burdens. The provision of sanitation lags far behind that of drinking water, and low cost technology options for excreta disposal must be adopted. The responsibility for operation and maintenance should be delegated to the lowest level and to the community, with technical support from higher levels.
Who Chronicle. 1984; 38(2):47-59.The 73rd session of the World Health Organization's (WHO) Executive Board met in January 1984 to review progress in implementing strategies for health for all by the year 2000, based on information emanating from the countries themselves. This monitoring function was assigned to the Board by the World Health Assembly in 1981 and calls for the Board to evaluate progress towards health for all at regular intervals and to report back to the Health Assembly. The 1st country reports together with comments of the regional committees and relevant information provided by theSecretariat were examined in November 1983 by the Board's Program Committee. Emphasis at this stage was placed on reviewing the relevance of national health policies to the attainment of health for all and the progress being made in implementing national strategies. Actual evaluation of the strategies will begin in 1985. As many of the country reports submitted were not as complete or as accurate as they could have been, the overall progress report submitted were not as complete or as accurate as they could have been, the overall progress report suffered from a lack of detailed and precise informattion on many important aspects that were crucial to national health for all strategies. Dr. Brandt, presenting the Program Committee's views, told the board that the report did indicate that a high level of political sensitization had occurred and that the political will to attain the goal of health for all existed in a large majorithy of the countries that had reported. The report indicated that to a large extent the Secretariat had met its responsibilities. It was the Member States that had to shoulder the responsibility and reaffirm their commitment by action. The Program Committee's progress report points to the existence of specific technical needs, particularly in national capability to carry out health policies. Among the areas requiring strengthening are information analysis and management, financial analysis, assessment of status of public information, competence in planning and management, effective involvement of relevant sectors in health, and measurement of intersectoral action for health. The Board urged Member States to give highest priority to the continuing monitoring and evaluation of their health for all strategies and to assume full responsibility for this process. In regard to the action program on essential drugs and vaccines, priority in the last 2 years has gone to training and manpower development, the dissemination of experience and information, cooperation in the procurement and production of essential drugs, technical cooperation among developing countries, and contracts with nongovernmental organizations and the pharmaceutical industry. During the far ranging discussion that ensued in the Executive Board, members addressed themselves in considerable detail to numerous aspects of the action program. The Board approved a new and carefully phased procedure for the review of substances to be recommended for international drug control.
[Unpublished] 1984. Presented at the 11th Annual NCIH International Health Conference: International Health and Family Planning: Controversy and Consensus, Arlington, Virginia, June 10-13, 1984. 2 p.Upon acceptance of the National Council of International Health's International Health Award, Ayele Foly discussed the methodology she has used to teach family health to village women in Africa. By training local village leaders to teach health care, nutrition, prevention of diseases, and family planning, the information is more easily accepted than if introduced from the outside. Some women were taught the Billings Ovulation Method to make them more aware of their reproductive process, but there is need for more sure contraceptive methods for village women. In the village of Dampion in northern Togo, a woman who was already growing soybeans and preparing them for her family led a workshop to train other women from neighboring villages to enrich their families' diets with soybeans. The villagers of Kati in southern Togo learned to eliminate a large part of the guinea worm problem by filtering their water through cloth, installing pumps in their village, and building new wells. Through visual aids produced by World Neighbors and demonstrations of the connection between guinea worm and stagnant pond water, the villagers were motivated to take responsibility for their own health.
New York, Foreign Policy Association, 1984. 160 p.This expanded voters' guide to important foreign policy issues facing the US is intended to provide voters, information they need to take part in the national foreign policy debate and reach their own informed conclusions. The approach is nonpartisan and impartial and the style is telegraphic. Each of the 18 topics includes a list of significant questions, a presentation of essential background, an outline of policy choices and the pros and cons of each, and a brief bibliography. The book covers 5 major themes: leadership, national security, economic and social issues, critical regions, and the UN. The chapters cover: 1) president, congress, and foreign policy; 2) the arms race and arms control; 3) defense budget and major weapons systems; 4) nuclear proliferation; 5) jobs and international trade; 6) oil and energy; 7) the international debt crisis; 8) immigration and refugees; 9) Soviet Union; 10) the Atlantic alliance; 11) Lebanon, the Arabs, and Israel; 12) the Iran-Iraq war; 13) Central America; 14) Japan; 15) China and Taiwan; 16) South Africa and Namibia; 17) Third World: population, food, and development; and 18) the US and the UN.
Asian-Pacific Population Programme News. 1984; 13(2):25-30.Differences between the Report of the UN World Population Conference and the Report of the Third Asian and Pacific Population Conference were discussed in reference to 1) the relative importance placed on family planning and development in lowering fertility levels, 2) the degree to which family planning and development programs should be integrated, and 3) setting family planning targets. The UN conference was held in Bucharest, Hungary, in 1974 and the Asian and Pacific Conference was held in Colomb, Sri Lanka in 1982. The relative importance of family planning and development on fertility was a major issue at the Bucharest conference. The World Population Plan for Action (WPPA) formulated at the Bucharest conference did not recommend family planning as a strategy for reducing fertility; instead, the WPPA recommended that countries interested in reducing fertility should give priority to development programs and urged developed countries to promote international equity in the use of world resources. In contrast, the Asia-Pacific Call for Action on Population and Development as formulated at the Colomb conference, strongly recommended both development and family planning programs as a means to reduce fertility. It urged governments to adopt strong family planning policies, to make family planning services available on a regular basis, and to educate and motivate their populations toward family planning. In regard to integration strategies, the WPPA called for integrating family planning programs and development programs wherever possible, and particularly recommended integrated delivery of family planning and health services. The Asia-Pacific Call for Action supported an integrated approach, but only in those situations where it was proven to be a workable approach, i.e., where it improved the efficiency of family planning services. Combining family planning and maternal and child health programs is known to be an advantageous approach, but the consequences of integrating family planning with other health programs and with development programs needs further study. The WPPA recommended that governments set targets for life expectancy and infant mortality, but it did not mention setting fertility targets or establishing an ideal family size. It did urge governments to create the type of socioeconomic conditions which would permit couples to have the number of children they desired and to space them in the manner they wished. The WPPA noted that substantial national effort would be required to reduce the birthrate to the UN projected rate of 30/1000 population in developing regions by 1985. The Asia-Pacific Call for Action urged countries to set specific targets which would make it possible for them to attain replacement level fertility in the year 2000. It will be interesting to observe the degree to which the Asian and Pacific countries will be able to influence the participants at the upcoming International Conference on Population to their way of thinking on these critical issues. A copy of the Asia-Pacific Call for Action on Population and Development is included in an annex to the article.
Draper Fund Report. 1984 Jun; (13):1-3.The UN International Conference on Population to be held in Mexico City in August 1984, responding to an unprecedented upsurge of interest in population over the last decade, offers developed and developing countries the opportunity to assess current and likely future population trends, to comment on programs and progress during the past 10 years, and to determine desirable future directions. More developing countries are reporting diminished declining fertility and family size in countries of widely varying ethnic, social, and economic makeup. Although it is likely that the future will bring a steadily declining rate of world population growth, culminating in stability, present trends indicate that it will take more than a century for world population to stabilize. Meanwhile growth continues. The developing world's annual average birthrate from1975-80 was twice as high as the developed world's. Also there are large areas, much of Latin America and most of Africa, where growth rates continue very high. Other areas, such as parts of Asia, do not follow the general declining trend despite trend despite, in some instances, a long history of population programs. Interest in population programs and demand for resources to support them are growing, but the population dimension is sometimes unrecognized in development planning. The experience of the last decade illustrates that population assistance can make a uniquely valuable contribution to national development when it is given in accord with national policies, is appropriate to local conditions and needs, and is delivered where it can make the most impact. Substantial evidence exists that women in the developing world undertand the risks of repeated pregrancy and would like to take steps to reduce them. It is evident that providers of family planning services are not yet sufficiently responsive to women's own perceptions of their needs and that the social and economic conditions which make family planning a reasonable option do not yet exist. Influxes of immigrants, short and long term, legal and illegal, create particular problems for receiving countries. It is important for sending countries to know what effect the absence of their nationals is having on the domestic economy and essential for receiving countries to consider the protection of the human rights of international migrants, including settlers, workers, undocumented migrants, and refugees. It is a particular responsibility of the industrialized nations to make careful use of limited resources and to ensure that their comsumption contributes to the overall balance of the environment. In most developing countries infectious and parasitic disease remains the primary cause of death, particularly among the young. Much of this toll is preventable. The International Conference on Population provides an opportunity to establish in broad terms the conditions and directions of future cooperation.
New York, New York University Press, 1984. 206 p.This volume assesses the programming experience of the United Nations Fund for Population Activities (UNFPA) from its establishment in 1969 through 1983, a period during which the Fund supported over 3500 projects in the developing world for a total expenditure exceeding US$1 billion. The objectives of the UNFPA are to assist governments in formulating and implementing a population policy and to promote a fuller understanding of the population aspect of development. The UNFPA has worked with both governments and nongovernmental organizations to implement population programs consistent with cultural values and socioeconomic factors, and its financing of research, training, and action programs has enabled many developing countries to move closer to self-reliance in the field of population. Part 1 of this volume describes the Fund's operational experience in the geographic regions it serves. Part II describes programming assistance in the areas of family planning; information, population education, and communication; data collection; demographic research, training, and population policy; and women, population, and development. Part III suggests future programming outlooks from the regional, substantive, and operational perspectives. Provision of easily accessible, affordable family planning services consistent with prevailing sociocultural norms and potential user preferences is 1 of the Fund's most urgent concerns for the coming period. Greater emphasis on the use of demographic data in development planning and the strengthening of management aspects of population programs are additional goals. Future strategies will have to acknowledge the changing techincal cooperations of developing countries and devise a system where countries can draw on local resources where possible but retain access to international expertise. Compatibility between development projects in health, education, and employment and those in the population field should be sought. An appendix to this volume summarizes the principal demographic indicators for all countries and regions of the world.
In: United Nations. Department of International Economic and Social Affairs. Population projections: methodology of the United Nations. New York, N.Y., United Nations, 1984. 60-6. (Population Studies, No. 83; ST/ESA/SER.A/83)This paper offers suggestions for guiding the next projection's exercise at the United Nations in light of third world life tables which, although severely limited, are believed to be relatively reliable. Of prime importance is the suggestion that expectation of life at birth in a number of less developed areas has begun to overtake and surpass the lower levels of such measures among the populations of developed countries. Although this is the 1st such occurrence on record, it is not likely to be reversed. A major implication of these patterns is that the causal linkages which have historically connected levels and patterns of socioeconomic development with those of mortality have become greatly attenuated. It is safe to say that major new causal mechanisms for reducing mortality have come into play which demographers have yet to comprehend adequately for purposes of projection. Another suggestion is to increase attention to the specific status and performance of national public-sector health programs (including water supply and sanitation) key factors affecting the onset and scale of mortality downtrends during the postwar decades. In addition, increasingly close attention needs to be paid to political disturbances, affecting health-care programs financing and associated delivery systems. With few exceptions, differences between female and male life expectancies at birth have been rising in the sample areas under review, implying that the gains over time for females have been higher than those for males. This directional pattern at both ages is remarkably similar to what has been found to hold with notable consistency among developed countries since 1920. Its prevalence suggests a bench-mark for checing the projected longevity differentials between males and females in the next UN exercise; at a minimum, these should be compared with past directions and magnitudes of change. Added or new attention should be given to comparisons between developed country and less developed country mortality measures; to how such measures vary by age at given points of time and shift by age over time; to sex differentials of both mortality levels and changes; and to the rapidly growing stocks of information becoming available on leading correlates of deaths, survival and morbidity rates. Such attention will enhance the quality, relevance and reliability of the future work of the UN on population projections.
[A possible objective from now to the year 2000: reduce infant mortality in the third world by half] Un objectif possible d'ici 1' an 2000: reduire de moitie la mortalite infantile dans les pays du tiers-monde
Hygiene Mentale. 1984 Jun; 3(2):41-9.Every day 40,000 children die throughout the world, most of them in developing countries. There is a close relationship between infant mortality, life expectancy at birth, the adult literacy rate and national income per capita. Why such huge differences between the infant mortality rate of 7/1000 (live births) in Sweden and 208 in Upper Volta? The 4 scourges which afflict developing countries: hunger (malnutrition), disease, ignorance and poverty are responsible for this state of affairs. The author suggests that coordinated action by governments and International Agencies should be taken to halve the infant mortality rate by the year 2000. He notes that in the past 3 mistakes were made which should not be repeated. The 1st was to improve the living conditions of the population. The green revolution in India provides a striking example of an important progress which benefited only the wealthier farmers. A 2nd mistake was to believe that only a medical approach reduces the infant mortality rate. A 3rd error was to overlook the importance of health education and not to seek the active participation of the people concerned. The author recalls that the International Union for Health Education carried out a sanitary and social program from 1975 to 1978 in Africa, south of the Sahara. To this effect, the IUHE had to find out what the people really wanted, whether they could be motivated to increase the welfare of the villagers by measures adapted to existing possibilities, and to study how the people could recruit health workers among the villagers and train them to create village health committees. 4 weapons used together should reduce the infant mortality rate by 1/2 in the developing world before the end of the century. They are: the promotion of breast feeding, the extended coverage of vaccinations, the early detection of malnutrition and the treatment at hoem of diarrheic diseases thanks to oral rehydration. (author's modified) (summaries in ENG, SPA)
Assessment and implementation of health care priorities in developing countries: incompatible paradigms and competing social systems.
Social Science and Medicine. 1984; 19(4):373-84.This paper addresses conceptual issues underlying the assessment and implementation of health care priorities in developing countries as practiced by foreign development agencies coping with a potentially destabilizing unmet social demand. As such, these agencies mediate the gap between existing health care structures patterned around the narrow needs of the ruling classes and the magnitude of public ill-health which mass movements strive to eradicate with implications for capitalism at large. It is in this context that foreign agencies are shown to intervene for the reassessment and implementation of health care priorities in developing countires with the objective of defending capitalism against the delegitimizing effects of its own development, specifically the persistence of mass disease. Constrained by this objective, the interpretations they offer of the miserable state of health prevailing in developing countries and how it could be improved remains ideological: it ranges between "stage theory" and modern consumption-production Malthusiansim. Developing countries are entering into a new pattern of public health which derives from their unique location in the development of capitalism, more specifically in the new international division of labor. Their present position affects not only the pattern and magnitude of disease formation but also the effective alleviation of mass disease without an alteration in the mode of production itself. In the context of underdevelopment, increased productivity is at the necessary cost of public health. Public health improvement is basically incompatible with production-consumption Malthusianism from which the leading "Basic Needs" orientation in the assessment and implementation of health care priorities derives. Marx said that "countries of developing capitalism suffer not only from its development but also from its underdevelopment." (author's modified)
New York, United Nations, 1984. 108 p. (Population Studies, No. 85; ST/ESA/SER.A/85)The 3 parts of this report on world, regional, and international developments in the field of population, present a summary of levels, trends, and prospects in mortality, fertility, nuptiality, international migration, population growth, age structure, and urbanization; consider some important issues in the interrelationships between economic, social, and demographic variables, with special emphasis on the problems of food supply and employment; and deal with the policies and perceptions of governments on population matters. The 1st part of the report is based primarily on data compiled by the UN Population Division. The 2nd part is based on information provided by the Food and Agriculture Organization of the UN (FAO) and the International Labor Organization (ILO), as well as that compiled by the Population Division. The final part is based on information in the policy data bank maintained by the Population Division, including responses to the UN Fourth Population Inquiry among Governments. In 1975-80 the expectation of life at birth for the world was estimated at 57.2 years for both sexes combined. The corresponding figure for the developed and developing regions was 71.9 and 54.7 years, respectively. In 1975-80 the birthrate of the world was estimated at 28.9/1000 population and the gross reproduction rate was 1.91. These figures reflect considerable decline from the levels attained 25 years earlier: a crude birthrate of 38/1000 population and a gross reproduction rate of 2.44. World population grew from 2504 million in 1950 to 4453 million in 1983. Of the additional 1949 million people, 1645 million, or 84%, accrued to the less developed countries. The impact of population growth on economic development and social progress is not well understood. The governments of some developing countries still officially welcome a rapid rate of population growth. Many other governments see cause for concern in the need for the large increases in social expenditure, particularly for health and education, that accompany a young and growing population. Planners are concerned that the rapidly growing supply of labor, compounded by a trend toward rapid urbanization, may exceed that which the job market is likely to absorb. In the developed regions the prospect of a declining, or an aging, population is also cause for apprehension. There is a dearth of knowledge as to the impact of policies for altering the consequences of these trends. Many policies have been tried, in both developed and developing countries, to influence population growth and distribution, but the consequences of such policies have been difficult to assess. Frequently this problem arises because their primary objectives are not demographic in character.
[Unpublished] 1984 Aug 13. 40 p. (E/CONF.76/L.3; M-84-718)This report of the International Conference on Population, held in Mexico City during August 1984, includes: recommendations for action (socioeconomic development and population, the role and status of women, development of population policies, population goals and policies, and promotion of knowledge and policy) and for implementation (role of national governments; role of international cooperation; and monitoring, review, and appraisal). While many of the recommendations are addressed to governments, other efforts or initiatives are encouraged, i.e., those of international organizations, nongovernmental organizations, private institutions or organizations, or families and individuals where their efforts can make an effective contribution to overall population or development goals on the basis of strict respect for sovereignty and national legislation in force. The recommendations reflect the importance attached to an integrated approach toward population and development, both in national policies and at the international level. In view of the slow progress made since 1974 in the achievement of equality for women, the broadening of the role and the improvement of the status of women remain important goals that should be pursued as ends in themselves. The ability of women to control their own fertility forms an important basis for the enjoyment of other rights; likewise, the assurance of socioeconomic opportunities on a equal basis with men and the provision of the necessary services and facilities enable women to take greater responsibility for their reproductive lives. Governments are urged to adopt population policies and social and economic development policies that are mutually reinforcing. Countries which consider that their population growth rates hinder the attainment of national goals are invited to consider pursuing relevant demographic policies, within the framework of socioeconomic development. In planning for economic and social development, governments should give appropriate consideration to shifts in family and household structures and their implications for requirements in different policy fields. The international community should play an important role in the further implementation of the World Population Plan of Action. Organs, organizations, and bodies of the UN system and donor countries which play an important role in supporting population programs, as well as other international, regional, and subregional organizations, are urged to assist governments at their request in implementing the reccomendations.
Development: Seeds of Change. 1984; 2:66-7.UN International Children's Emergency Fund (UNICEF) experience over the last 20 years suggests that successful development for poor people is not possible without substantial grassroots involvement. This is the experience both in the developing and in industrialized countries. In the 1960s it became increasingly clear to UNICEF that if programs were to succeed with the small and landless farmers and the urban slum dwellers, there was no possibility of finding enough money to meet needs of these people through governmental channels. It was equally clear that in most places the existing patterns of development andeconomic growth would not reach these people until the year 2000 or thereabots. It was this that led UNICEF to adopt its basic services approach in the late 1960s and early 1970s, which implied that the cost of the most needed basic health services, education, and water had to be reduced to manageable limits. At this stage UNICEF began to articulate the imperative of using paraprofessionals, the need for much greater use of technology that was appropriate to rural and slum areas, and the importance of involving the people in this effort. Looking at those low income countries which have managed to achieve longer life expectancy and higher literacy rates, they are all societies which have practiced much more people's participation in economic and social activities than most other countries. These 3 very different societies -- China, South Korea, and Sri Lanka -- all have had a rather unique degree of people's participation in the development process. Grassroots participation in development is a very important element in developing and in industrial countries. 1 example concerns the whole question of proper nutrition practices, the promotion of breastfeeding, and the problem of the infant formula code. It was the people's groups which picked up the research results in the 1960s, which showed that breastfeeding was a better and more nutritious way of feeding children. The 2nd example pertains to the US government recommendation of significant cuts in UNDP and UNICEF, and the refusal of Congress to give in to those cuts. In regard to the developing countries, over the last year it has increasingly become the consensus of international experts that a childrens' health revolutioon is possible. The conclusion was based upon the fact that there were 2 new sets of developments coming together that created this new opportunity: some new technological advances in the development of rural rehydration therapy; and the capacity to communicate with poor people. With the whole emphasis on the basic human needs of the last 10 years, and on primary health care in the last 5 years, literally millions of health auxiliaries and community workers have been trained, a group of people who, if a country can mobilize them, can provide a new form of access.