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PubMed2000

Vaccine procurement and self-sufficiency in developing countries.

This paper discusses the movement toward self-sufficiency in vaccine supply in developing countries (and countries in transition to new economic and political systems) and explains special supply concerns about vaccine as a product class. It traces some history of donor support and programmes aimed at self-financing, then continues with a discussion about self-sufficiency in terms of institutional capacity building. A number of deficiencies commonly found in vaccine procurement and supply in low- and middle-income countries are characterized, and institutional strengthening with procurement technical assistance is described. The paper also provides information about a vaccine procurement manual being developed by the United States Agency for International Development (USAID) and the World Health Organization (WHO) for use in this environment. Two brief case studies are included to illustrate the spectrum of existing capabilities and different approaches to technical assistance aimed at developing or improving vaccine procurement capability. In conclusion, the paper discusses the special nature of vaccine and issues surrounding potential integration and decentralization of vaccine supply systems as part of health sector reform.

Developing Countries↗
PubMed2004

Social inclusion/exclusion: dancing the dialectic.

The last decade has seen many of the 'community' concepts in health (community empowerment, community capacity) replaced by 'social' concepts (social capital, social cohesion). The continuous re-labelling of roughly similar phenomena may be a necessary stratagem to attract attention to the economic and power inequalities that arise from undisciplined markets. Social concepts also have an advantage over community ones by directing that attention to higher orders of political systems. The latest construct being wielded by health practitioners, researchers and policy-makers are the twinned concepts of social inclusion and social exclusion. These represent a conceptual sophistication over social capital and social cohesion. Like their predecessors, however, there are risks in their adoption without a critical examination of the premises that underpin them. For example, how can one 'include' people and groups into structured systems that have systematically 'excluded' them in the first place? The cautions expressed in this article do not dissuade use of the concepts. Their utility, however, particularly at a time when not only inequalities, but also their rate of growth, is increasing, requires careful questioning.

Cultural Diversity↗
PubMed1987

Genetics after Auschwitz.

The fast growth and flourishing of science and technology in a vacuum of values was instrumental in organizing the various genocide programmes in Nazi Germany. This use of science and scientists for both ideological and practical goals has been overlooked by most observers including the scientists themselves. Some reasons for this are discussed herein.

Biomedical Research↗
PubMed1988

Genocide and public health: German doctors and Polish Jews, 1939-41.

German doctors in the General Government played an important role in providing the medical rationalization for ghettoization and mass murder. Their desire to prevent the spread of disease to Germans led them to favour providing adequate health care for Poles. The same self-interest engendered their persistent advocacy of ghettoization for Jews, who were believed to be natural carriers of spotted fever. When ghetto conditions created a self-fulfilling prophecy of wide-spread disease, the doctors advocated tighter sealing of the ghettos. By late 1941, this self-induced threat to public health made the doctors receptive to a mass murder solution.

Communicable Diseases↗
PubMed2001

Multi-country comparison of plasma lipid relationship to years of schooling in men and women.

BACKGROUND: The association between coronary heart disease (CHD) and social status has differed among societies in strength and direction. As years of schooling is a major determinant of socioeconomic status and dyslipidaemia a major CHD determinant, the purpose of this investigation is to estimate the association of years of schooling with plasma lipids and lipoproteins among samples from five countries representing different cultures, socio-political systems and stages of economic development. METHODS: Men and women from Chinese, Polish, Russian, Israeli and US samples were studied. Years of schooling were analysed both as a multi-category ordinal variable and divided into two strata: less than the equivalent of high school and greater than or equal to high school equivalence. Fasting plasma cholesterol, low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol and triglycerides were compared across years of schooling strata within each country. Lipid levels were computed unadjusted and then adjusted for age and lipid risk factor variables. RESULTS: Total cholesterol, LDL cholesterol, and triglycerides varied directly with years of schooling in Chinese, Polish and Russian men, and in contrast varied inversely with years of schooling among US white men. The HDL cholesterol varied inversely with years of schooling for Chinese, Polish, and Russian men, but varied directly with years of schooling among US white men. The lipid differences between men of high versus low years of schooling were not explained by age, body mass index, smoking, alcohol consumption or blood pressure medication use. Findings were less consistent for women and for Israelis and US blacks of both genders. CONCLUSIONS: Lipid and lipoprotein levels consistent with atherogenicity varied directly with years of schooling in Chinese, Polish, and Russian samples. Opposite trends were present in US whites. These findings are consistent with a hypothesized influence of social status on CHD risk differing among populations in relation to stages in societal economic development.

Asia↗
PubMed1995

Occupational health in China: 'rising with force and spirit'.

Occupational health services in China occupy a much more central role in public life than they do in North America. The Communist ideology on which the People's Republic was built, and which it almost alone today defends, places an idealized concept of the worker at the centre of the economic, social and political system. The present system in China is a parallel, institutionally separate system of medical care and research on occupational disorders that is in some ways better provided for with resources than the general healthcare system. One of the issues facing China today is how to turn the priorities of this vast, elaborate and incompletely developed system of occupational health care away from the provision of medical care to workers made ill from workplace exposure and towards prevention of the exposures that made them ill in the first place. The prevalence of smoking and the intensity of passive smoke exposure in Chinese workplaces make this exposure one of the most deadly occupational hazards seen. This problem of health promotion can probably only be effectively approached in China by worksite programmes but these are not apparent.

China↗
PubMed1995

Vichy France and the continuity of medical nationalism.

This paper reviews the rise of medical nationalism and protectionism in France from the end of the nineteenth century through to the 1940s, with an emphasis on the Vichy period. It presents this nationalism as part of a continuity, showing its beginnings well before the coming of the Vichy government, its extremes under this government, and its continuation after the fall of the Vichy government, although retreating from its more extreme positions.

Civil Rights↗
PubMed1989

Asian medical education.

In order to address issues relating to medical education in Asia, consideration must be given to the many differences among Asian countries, including variations in sizes, populations, social and cultural backgrounds, histories, political systems, and stages of economic development. In most Asian countries, poverty is pervasive, and it is usually national in scope. This is often coupled with lack of government commitment to provide health facilities and health care for the entire population. Systems of medical education differ widely and are based mainly on those of the country of colonial domination; hence, the systems may reflect predominantly British, American, Japanese, or Dutch influence, among others. Although most medical schools in Asia have academic disciplines and admission standards similar to those of Western schools, there are sharp differences among countries in faculty salaries, faculty competence, academic standards, adequacy of staffing, and number of medical schools. Underlying conditions and influences that have contributed to the current status of medical education systems in Asia are discussed.

Asia, Southeastern↗
PubMed2006

Mental illness in U.S. Presidents between 1776 and 1974: a review of biographical sources.

Numerous historical accounts suggest the presence of mental illness in US Presidents, but no systematic review has been undertaken for all holders of this office. We reviewed biographical sources regarding mental illness in 37 US Presidents from 1776 to 1974. Material was extracted by one of the authors and given to experienced psychiatrists for independent review of the correspondence of behaviors, symptoms, and medical information in source material to DSM-IV criteria for Axis I disorders. Levels of confidence were given for each diagnosis. Eighteen (49%) Presidents met criteria suggesting psychiatric disorder: depression (24%), anxiety (8%), bipolar disorder (8%), and alcohol abuse/dependence (8%) were the most common. In 10 instances (27%), a disorder was evident during presidential office, which in most cases probably impaired job performance. Mental illness in heads of state is a topic deserving further attention. Methodological limitations of using biography to determine psychopathology are discussed.

Data Collection↗
PubMed1997

The production of diaspora: Algerian emigration from colonialism to neo-colonialism (1840-1970).

"This paper is part of a larger project investigating the production and regulation of North African immigrants in the greater Paris automobile industry. Its aims are twofold. First, to reverse the emphasis placed on immigrants in the receiving countries and to (re-)explore the historical production of Algerian emigration into metropolitan industry, more specifically within the automobile industry....Second, in adopting an ¿articulation of modes of production' (AMOP) narrative as an alternative to other Eurocentric approaches, the first part of this paper emphasizes the contradictory layering of various modes which have produced an Algerian colonial diaspora. The latter half of the paper argues that the history of post-independence Algeria confirms that emigration was reinforced through a complex neocolonial relationship during a period of rapid acceleration of Algerian migration to France."

Africa↗
PubMedDate not supplied

Bioethics and political ideology: the case of active voluntary euthanasia.

In different countries responses to important bioethical issues are different, as exemplified by the attitudes towards the voluntary and active forms of medical euthanasia. But why is this the case? My suggestion is that the roots of the variety are, to be considerable degree, ideological. The most important present-day political ideologies all have their roots in the prevailing doctrines of moral and social philosophy. In the paper these doctrines are outlined and the predicted response towards active voluntary euthanasia within each model is sketched. The conclusion reached is that while it would in some countries be dangerous to allow euthanasia in the prevailing circumstances, the solution is not to hinder the legalization process but to alter the circumstances.

Attitude↗
PubMed1998

Migration--a challenge to modern citizenship.

"I will treat the question of whether there is an inherent difficulty hindering the nation-state and its concept of citizenship from coping with the problem of migration.... I interpret democracy as a political form which bridges the gap between the premodern concept of republicanism, which inspires the idea of citizenship, and statehood (which tends to be hostile to the idea of citizenship).... I claim also that democracy is necessarily harmonious with citizenship...which then leads me to the consequences of this judgment for the problem of migration...."

Democracy↗
PubMed2005

Quality-controlled education in epileptology: experiences from Europe and possible developments for other regions.

As a consequence of the political system shift in Eastern Europe in the early 1990s, the new International League Against Epilepsy (ILAE) Commission on European Affairs (CEA) had to face the task of ensuring an equally good quality of epilepsy care across the whole region. A high standard of epileptologic education being the most important precondition for that, the decision was taken to make quality-controlled education a first priority. To reach this aim, an "European Epilepsy Academy" (Eurepa) was founded in 1996. Its activities comprise organization of its own educational courses, certification of other educational courses, responsibility for education at European Congresses, training of trainers in epilepsy (now 45 trainers from 27 countries), adoption of a curriculum to become a certified European epileptologist, establishment of a multinational educational network, and a "Website Academy" as a forum for discussion. In the first two years of its activity, the Academy received financial support from the ILAE (money generated by the European Congresses) but has since been self-supporting, with income from membership fees, participation fees at courses, and moderate support from pharmaceutical companies. The interest in the Academy is high, especially in those parts of Europe where epileptology was until recently not well developed. This should encourage other regional ILAE commissions to implement similar strategies, even if different regional structures will require variable regional approaches. Thus, in regions with long distances, it may be useful to include methods of distant learning and other specific features.

Academies and Institutes↗
PubMed2000

Political abuse of psychiatry.

The abuse of psychiatry in Nazi Germany 60 years ago was the abuse of the 'duty to care'. Its scale was enormous; 300,000 people were sterilized and 100,000 killed in Germany alone and many thousands further afield, mainly in eastern Europe. This episode occurred in a country with a high reputation for its medicine, including psychiatry, and for its interest in the ethics of medical research. The economic conditions which preceded the violent political upheaval had led to increasing concern about 'the burden on the State' of the mentally ill and disabled. These preoccupations are still with us today. There may still be lessons to be learnt from the Nazi episode.

Persons with Disabilities↗