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World food resources and population: the narrowing margin.

This bulletin examines the narrowing margin between global food production and population growth. Between 1950 and 1971, world grain production nearly doubled and per capita production increased 31%. During the 1970s, gains in output barely kept pace with population growth, consumption/person declined in sub-Saharan Africa and parts of Asia, food prices were volatile, and over 100 food deficit countries came to depend on the exportable surplus of North America, now the only major grain exporting region. The world fish catch levelled off in the early 1970s and beef production, still dependent mainly on grassland grazing, levelled off in the mid-1970s. With little new land left to plow, satisfying increased food demand now depends on sharp increases in yields on existing crop land. Worldwide, this effort is hampered by loss of topsoil and irrigated land, conversion of cropland to nonfarm uses, rising energy costs, inefficient agrarian structures, particularly in the Soviet Union, the falling yield response to chemical fertilizers in agriculturally advanced countries, and the emerging competition between food and agriculturally based energy crops. Green Revolution successes in some developing countries deomonstrate that, given the right inputs, 3rd world farmers can increase crop yields dramatically. Feeding the world's poor also requires more equitable income and food distribution, including a reduction in the proportion of grain and fish consumed indirectly as livestock products by the affluent. Most important in meeting food needs on a finite planet is braking population growth. The author concludes that every effort should be made to stabilize world production at abour 6 billion by 2020, rather than 10.5 billion by 2110, as is now projected by the UN.

Agriculture↗

Selling to the moneyed masses.

Over the past decade, the distribution of household incomes has shifted so much that a much larger proportion of consumers now earn significantly higher-than-average incomes--while still falling short of being truly rich. As a result, what used to be a no-man's-land for new product introductions has in many categories become an extremely profitable "new middle ground." How can marketers capitalize on this new territory? The key, say the authors, is to rethink the positioning and design of offerings and the ways they can be brought to market. Take, for instance, how Procter & Gamble redefined the positioning map for tooth-whitening solutions. A decade ago, dental centers were popularizing expensive bleaching techniques that put the price of a professionally brightened smile in the 400 dollars range. At the low end, consumers also had the choice of whitening toothpastes that cost anywhere from 2 dollars to 8 dollars. P&G wisely positioned itself between the two ends, successfully targeting the new mass market with its 35 dollars Whitestrips. In product categories where it's clear the middle ground has already been populated, it's important for companies to design or redesign offerings to compete. An example is the Polo shirt. How do you sell a man yet another one after he's bought every color he wants? Add some features, and call it a golf shirt. Here, marketers have introduced designs based on the concept of "occasional use" in order to stand out. Finally, companies wishing to reach the "almost rich" can change how they go to market. Perhaps no mass retailer has made a stronger bid for the mass affluent than Target Stores, which has pioneered a focus the company itself characterizes as upscale discount. The strategy has made Target an everyday shopping phenomenon among well-heeled urbanites and prosperous professionals.

Consumer Behavior↗

Economics of health planning--Costa Rica as an example.

Costa Rica has been unusually successful in providing high levels of health for its people given its economic resources. It is proposed that there are two reasons for its success. Having no military, Costa Rica has had resources to invest in health care. Having a relatively equal income and education distribution and a democratic government, it has been able to provide health care widely rather than just to the elites. This paper examines production functions for health and possible directions for appropriate management of health as Costa Rica confronts the chronic disease pattern of the developed world.

Costa Rica↗

[Methods of study of the effects of modern administration (management) on the autonomy and satisfaction of physicians in clinical practice].

Marketing principles in health care delivery systems, reducing financial funds for health institutions and permanently increasing costs of medical equipment are responsible for the growing influence of management on physician's autonomy and working satisfaction. A questionnaire research was carried out in order to determine the best method of examination of this influence in Belgrade. All tested persons were medical doctors working in a primary health centers for 7 hours per day, who examined about 26 patients every day. More than a half of physician improved their knowledge by reading professional publications 6 hours per week. In spite of the fact that they all worked in the same institution, they expressed different opinions regarding the organisation. In the physicians' opinion clinical freedom and working satisfaction were at the high level, and partly connected with management practice. At the same time they were very unsatisfactory with personal income and budgetary distribution in the institution. It is evident that the method described in this article is useful in the analysis of the present situation related to management and physician's practice in the country.

Attitude of Health Personnel↗

[Financial protection in health: Mexico, 1992 to 2004].

OBJECTIVE: To document trends in financial protection in the health care system in Mexico between 1992 and 2004, applying a series of indicators that measure catastrophic and impoverishing health spending and the Index of Fairness in Financial Contributions. MATERIALS Y METHODS: This study uses the biannual time series of the Survey of Household Income and Expenditures (ENIGH) spanning the period 1992 to 2004. The methodologies seek to measure the level and distribution of the burden of health care finance on households, and the financial protection offered to them by the health care system. Four indicators are presented: 1) the Index of Fairness in Financial Contributions, 2) the proportion of households with catastrophic health expenditure, 3) the proportion of households with impoverishment due to health spending and 4) the sum of the proportion of households with catastrophic or impoverishing health spending, which is referred to as excessive health spending. The analysis presented in this document is descriptive, leaving for later studies a deeper analysis of causal aspects. RESULTS: The number of families that suffer impoverishment due to health spending increased from 5.2% in 1992, reached a high of 9.9% in 1996, and then gradually declined to 1.8% by 2004. The proportion of households with catastrophic expenses began at 2.8% in 1992, increased to 4.2% in 1998 and then fell to a level of 2.6% in 2004. The improvements from 2000 on are concentrated among the uninsured population, families affiliated to Popular Health Insurance, and households in the poorest two quintiles of the income distribution. CONCLUSIONS: The patterns over time in excessive health spending reflect a worsening during periods of economic crisis, post-crisis recovery, and a sustained improvement beginning in the year 2000. The data suggest that part of the reduction in the number of households with excessive health spending is due to the extension of financial protection for Mexican families through the Popular Health Insurance, while another part is associated with a decline in poverty. In addition,this paper documents an important relationship between economic trends and catastrophic and impoverishing health spending, suggesting the importance of financially protecting families through health insurance. Financial protection assists in guaranteeing that when economic crisis--of a country or of a family--coincides with illness, health care payments do not become the cause of a long or permanent period of impoverishment for households.

Humans↗

Insurance, income, and access to ambulatory care in King County, Washington.

OBJECTIVES: We studied simultaneous effects of income and insurance on access measures in an indigent population, focusing on Medicaid and the marginal effects of increasing income. METHODS: Surveys were distributed in waiting rooms of county clinics and welfare offices. Models examined insurance (private, Medicaid, or none), income (to twice the poverty level), single-parent status, age, gender, and presence of a regular source of care; first-order interactions were evaluated. RESULTS: In terms of ease of access, postponing care, and having a regular source of care, uninsured respondents fared worst and Medicaid recipients were at an intermediate level. However, relative to those with private insurance, Medicaid recipients had four times the odds, and uninsured respondents twice the odds of being denied care. Income had no consistent effect; however, older, poorer people may have greater problems. For preventive services, income was significant, while differences between Medicaid and private insurance were generally not significant. CONCLUSIONS: Except for denial of care, access for indigent people is improved by Medicaid but remains worse than the access of those with private insurance. Income had variable effects, but support for income criteria used for public insurance eligibility was not found.

Adolescent↗

Contraceptive prevalence in the slums of Rio de Janeiro.

A community-based family planning operations research project was undertaken in selected low income communities of Rio de Janeiro; project field work began in February 1982. Prevalence data were collected and service delivery strategies were tested, including home visits promoting family planning, home distribution of condoms, and the introduction of community family planning depots. A high baseline contraceptive prevalence rate (CPR) of 70.1 percent was found for nonpregnant women currently in union, as well as substantial use of the private sector for contraceptive supply, despite the presence of free or subsidized sources within the communities. However, the most economically disadvantaged subgroups made the greatest use of the subsidized sources. The provision of additional service delivery sites may have contributed to a small increase in contraceptive prevalence noted over the life of the project; however, the high baseline CPR precluded a large increase in contraceptive use as a result of the program.

Adolescent↗

The influence of socio-economic variables on the prevalence of periodontal disease in South Africa.

The purpose of this study was to assess the influence of race, level of education and income on the frequency distribution of periodontal disease in an adult South African population. A retrospective data analysis of the National Oral Health Survey (NOHS, 1988/89) was done on 3,763 adults with an age range of 20-64 years. From the results obtained it would appear that socio-economic variables have an influence on the prevalence of periodontal disease in South Africa.

Adult↗

Income inequality and health. Coastal communities in British Columbia, Canada.

OBJECTIVE: An imbalance in the distribution of economic resources, i.e., income inequality, is a characteristic of a community that may influence the aggregate health of the population. In North America, income inequality seems to be strongly related to mortality rates among American communities such as states and metropolitan areas but largely irrelevant for health at similar levels of geopolitical aggregation in Canada. This article summarizes relevant international and North American evidence and then explores relationships between income inequality and mortality rates among coastal communities in the province of British Columbia, Canada. METHODS: Cross-sectional analysis was conducted among twenty-four coastal communities in British Columbia, utilizing four measures based on the 1996 Census to measure income inequality and crude, age-standardized and age- and gender-specific mortality rates averaged over the five-year period 1994-98 to measure health. RESULTS: The three valid measures of income inequality were positively and significantly related to the crude mortality rate but were not significantly related to the age-standardized mortality rate. Two of the inequality measures were related to mortality rates for males aged 0-44 and for males aged 45-64 before but not after controlling for mean household income. DISCUSSION: Health researchers have yet to report a meaningful relationship between income inequality and population health within Canada. At the risk of committing the ecological fallacy, these findings provisionally support a psycho-social interpretation of the individual-level relationship between income and health wherein members of these communities compare themselves to an encompassing community, e.g., all Canadians.

Adolescent↗

Evaluation of some vitamin B-complex nutriture in Ile-Ife and environs (Nigeria).

A nutritional survey was conducted in two rural areas and in the urban city of Ile-Ife (Nigeria) to determine the nutritional status of the population with respect to thiamin, riboflavin and niacin intake. On basis of socio-economic groupings, most subjects in the rural areas were found to fall under relatively low to middle income, whereas in the urban areas the subjects were more evenly distributed between low and high income. Both the rural and urban communities were found to be deficient in thiamin intake but the intakes of riboflavin and niacin were adequate and they met the daily vitamin recommended intake. A small but insignificant difference was found between male and female vitamin intake in both the urban and the rural areas. In the overall, vitamin nutriture was found to be superior in the urban areas compared with the rural areas. Lack of education and proper environmental sanitation are contributing factors in this apparent deficiency.

Adult↗

More or less equal? Comparing Australian income-related inequality in self-reported health with other industrialised countries.

OBJECTIVE: To measure the distribution of self-reported health by income in order to compare the level of health inequality in Australia with other industrialized countries. METHOD: Using data from the two National Health Surveys undertaken in 1989-90 and 1995, concentration indexes were calculated to quantify the distribution of self-reported health by equivalent income. The concentration index for Australia was compared with those reported for nine industrialized countries in Europe and North America. RESULTS: The estimated income-related concentration indexes were -0.1172 in 1989-90 and -0.1094 in 1995. CONCLUSION: The level of health inequality is not significantly different from the US or the UK, but significantly greater than seven other European nations. IMPLICATIONS: Australia has significant income related health inequalities and the distribution of health appears to be more unequal than in many other industrialized nations. There is a need to further investigate and quantify those features of the anglophone societies that set them apart from some other industrialized nations.

Adolescent↗

How older people in the United States and Germany fared in the growth years of the 1980s: a cross-sectional versus a longitudinal view.

OBJECTIVES: The goal of the study was to show that cross-sectional and longitudinal data yield dramatically different answers to a basic question: "How did older persons fare in the recovery years of the 1980s?" METHODS: The United States Panel Study of Income Dynamics and the German Socio-Economic Panel are used cross-sectionally to capture changes in the economic well-being of older persons in the trough and peak years of the 1980s business cycle, and longitudinally to trace how the economic well-being of a given cohort of older persons changed over those years. Kernel density estimation is then used to show how the distribution of economic well-being of these populations changed over these years. RESULTS: Cross-sectional comparisons confirm that persons aged 65 and over in the peak year were better off than persons aged 65 and over in the trough year in both countries. Longitudinal comparisons, however, show that persons aged 65 and over in the trough year who survived to the peak year received a substantially smaller share of the rewards of economic recovery than cross-sectional comparisons imply. Moreover, the entire income distribution of older persons in the United States shifted downwards. DISCUSSION: Compositional changes in the cross-sectional data, caused by the entry of high-income persons who are young in the peak year but old in the trough year, obscure the decline in the economic well-being of the cohort of older persons who survived the trough year, in cross-sectional comparisons of older populations in the United States in the 1980s.

Age Factors↗

Differences in neonatal mortality by race, income, and prenatal care.

To determine the extent to which the social and physical environment affects the association between prenatal care and black pregnancy outcome in Chicago, we performed a stratified analysis of 1982-1983 Illinois vital records and 1980 United States census income data. Median family income of the mother's census tract was used as the ecologic variable. In very-low-income census tracts (less than $10,000 per year), 40% of blacks and 47% of whites received adequate prenatal care. There was no racial disparity in the percentage of low-birth-weight infants attributed to inadequate prenatal care among poor mothers. For mothers who resided in moderate-income areas ($20,001 to $30,000 per year), 50% of blacks and 67% of whites received adequate prenatal care. Although adequate (compared to inadequate) prenatal care was associated with improved birthweight distribution independent of community income, only in moderate-income areas was it related to black neonatal survival. For term black infants who received adequate prenatal care, residence in impoverished areas was associated with a nearly fourfold greater neonatal mortality rate (deaths per 1000 live births): 5/1000 vs 1/1000; RR = 3.8 (1.3-11.0). We conclude that place of residence is an important risk factor for black neonatal mortality.

Black or African American↗

RadSim: a program to simulate individual particle interactions for educational purposes.

A program was developed, RadSim, which can be used to simulate certain individual interactions of photons, electrons, positrons and alpha particles with a single atom for educational purposes. The program can be run in two modes: manual and simulated. In the manual mode, an individual particle undergoing a specified interaction with a target atom can be simulated, which essentially comes down to a graphical evaluation of kinematic equations. In the simulated mode, a preset number of identical particles are allowed to undergo a specified interaction type with a target atom. The exit channel of the interaction is sampled from probability distributions using Monte Carlo methods. The incoming and outgoing particles are visualized and the frequency distribution of the kinematic variables of the exit channel is displayed graphically. It has to be emphasized that RadSim was mainly developed for educational purposes.

Computer Simulation↗

Height distributions of U.S. children: associations with race, poverty status and parental size.

The stature of children, relative to that of a reference population, is often used as a measure of the nutritional status of a population. But while undernourished children are often small in stature, all small-statured children cannot be assumed to be undernourished as a wide range of hereditary, socioeconomic and health factors also influence growth processes. The distribution of heights of 3850 "healthy" U.S. children 1-11 years of age who participated in the first National Health and Nutrition Examination Survey, a probability sample of the U.S. population, have been examined in relation to age- and sex-specific reference medians, and in relation to race, family income, and height of their parents. The distribution of heights of black children was shifted to the right (i.e., taller) of that of white children (Index of Dissimilarity = 7.9%). The distribution of heights of children of above poverty level income families was shifted to the right of that of children of below poverty level income families (Index of Dissimilarity = 8.4%). In both races, and with family incomes both above and below the poverty income level, the distribution of heights of children of tall parents was shifted to the right of that of children of short parents (Index of Dissimilarity = 20.25%). We concluded that parental stature, economic conditions and race must be considered in interpreting the growth of children in all societies, and before concluding that nutritional factors are the major determinants of short stature.

Black People↗

Relation between income inequality and mortality: empirical demonstration.

OBJECTIVE: To assess the extent to which observed associations at population level between income inequality and mortality are statistical artefacts. DESIGN: Indirect "what if" simulation by using observed risks of mortality at individual level as a function of income to construct hypothetical state level mortality specific for age and sex as if the statistical artefact argument were 100% correct. SETTING: Data from the 1990 census for the 50 US states plus Washington, DC, were used for population distributions by age, sex, state, and income range; data disaggregated by age, sex, and state from the Centers for Disease Control and Prevention were used for mortality; and regressions from the national longitudinal mortality study were used for the individual level relation between income and risk of mortality. RESULTS: Hypothetical mortality, while correlated with inequality (as implied by the logic of the statistical artefact argument), showed a weaker association with states' levels of income inequality than the observed mortality. CONCLUSIONS: The observed associations in the United States at the state level between income inequality and mortality cannot be entirely or substantially explained as statistical artefacts of an underlying individual level relation between income and mortality. There remains an important association between income inequality and mortality at state level over and above anything that could be accounted for by any statistical artefact. This result reinforces the need to consider a broad range of factors, including the social milieu, as fundamental determinants of health.

Adult↗