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PubMed2002

Global and regional estimates of cancer mortality and incidence by site: I. Application of regional cancer survival model to estimate cancer mortality distribution by site.

BACKGROUND: The Global Burden of Disease 2000 (GBD 2000) study starts from an analysis of the overall mortality envelope in order to ensure that the cause-specific estimates add to the total all cause mortality by age and sex. For regions where information on the distribution of cancer deaths is not available, a site-specific survival model was developed to estimate the distribution of cancer deaths by site. METHODS: An age-period-cohort model of cancer survival was developed based on data from the Surveillance, Epidemiology, and End Results (SEER). The model was further adjusted for the level of economic development in each region. Combined with the available incidence data, cancer death distributions were estimated and the model estimates were validated against vital registration data from regions other than the United States. RESULTS: Comparison with cancer mortality distribution from vital registration confirmed the validity of this approach. The model also yielded the cancer mortality distribution which is consistent with the estimates based on regional cancer registries. There was a significant variation in relative interval survival across regions, in particular for cancers of bladder, breast, melanoma of the skin, prostate and haematological malignancies. Moderate variations were observed among cancers of colon, rectum, and uterus. Cancers with very poor prognosis such as liver, lung, and pancreas cancers showed very small variations across the regions. CONCLUSIONS: The survival model presented here offers a new approach to the calculation of the distribution of deaths for areas where mortality data are either scarce or unavailable.

Age Distribution↗
PubMed1989

LTC in the Third World.

1. More than half the world's elderly, 370 million people, live in Third World Nations. As this population increases, the growth rate is fastest for the oldest of the old, those most likely in need of health services. Provision of long-term care is a vital issue in future development planning. 2. A major threat to the elderly's health was communicable disease, a societal dilemma that will require further economic development and advances in the country's community health system. 3. The aged in this setting in India experienced multiple chronic diseases and degenerative conditions, potential problems with polypharmacy, and major functional losses. Some also expressed feelings of uselessness and dependency. These issues can be compared to those of institutionalized elderly in the West.

Aged↗
PubMed1998

Reflections on health in development and human rights.

As the end of the 20th century draws near, the goal of health for all by the year 2000 will not have been achieved. Social and economic development, sporadic and biased in terms of regions, countries and social groups, has been inhibiting the achievement of health for all, just as gender, age and ethnic discrimination has been preventing access to health care and other essential goods and services. On the other hand, the intrinsic value of health and its contribution to the realization of human rights have been increasingly recognized. The need to promote the full enjoyment of all human rights as being essential to the achievement of health for all has also been increasingly acknowledged. WHO's renewed health-for-all policy seeks to realize the right to health as the most basic tenet of the WHO Constitution by creating the conditions whereby people everywhere, throughout their lives, have the opportunity to reach and maintain their own health potential. This article traces the evolution of the concept of health in development in WHO and highlights the importance of putting health at the centre of development efforts if we are to achieve health for all in the next century. It also calls attention to the need for using a health-in-development approach to work towards the progressive realization of the right to health as enshrined in the WHO Constitution and in numerous international and regional instruments. Major lines of action that WHO will be pursuing in its commitment to health in development and human rights are also outlined.

Global Health↗
PubMed1984

The economics of parasitic diseases: research priorities.

Parasitic diseases are primarily diseases of poverty. At serious risk are individuals, communities and countries least able to afford the costs of treatment or prevention. In turn, economic development projects which aim to increase income levels may lead to negative results because of increased transmission of parasitic diseases often results. In attempting to analyse the economic consequences of parasitic diseases and the economics of their control, economists have usually relied on the tools of cost-benefit analysis, cost-effectiveness analysis and financial analysis. These efforts are briefly reviewed in the paper. The results have been subject to considerable criticism because of conceptual and methodological problems. For example, most studies have not taken into account the epidemiology and natural history of the disease in estimating the associated economic losses, thereby leading to inappropriate conclusions. The UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases through its Social and Economic Research Scientific Working Group (SER-SWG) is promoting research on the economics of parasitic diseases. In an attempt to improve the usefulness and reliability of such studies, conceptual and methodological approaches have been suggested which are reported on here. To improve the research design of these projects, a conceptual framework is proposed which consists of four components: (1) baseline social, cultural and economic conditions influencing disease transmission; (2) resources already invested in the health system and investments in other related sectors such as agriculture, housing, water supply and sanitation; (3) health consequences resulting from (1) and (2); and (4) social and economic consequences resulting from (3). A key concern in relation to the framework is to determine the most useful basis for linking results from studies of one component to another so as to analyse more systematically the impacts of disease on individuals and society. Such studies are inherently interdisciplinary and close collaboration of economists with medical scientists and disease control programme staff is needed to ensure completeness and reliability of input data and results. Results from these studies could be used to inform national decision-makers about the social and economic consequences of the parasitic diseases and their control and, thus, should strengthen support for increased investment to reduce the parasitic disease burden in developing countries.

Communicable Disease Control↗
PubMed2001

Drugs for neglected diseases: a failure of the market and a public health failure?

Infectious diseases cause the suffering of hundreds of millions of people, especially in tropical and subtropical areas. Effective, affordable and easy-to-use medicines to fight these diseases are nearly absent. Although science and technology are sufficiently advanced to provide the necessary medicines, very few new drugs are being developed. However, drug discovery is not the major bottleneck. Today's R&D-based pharmaceutical industry is reluctant to invest in the development of drugs to treat the major diseases of the poor, because return on investment cannot be guaranteed. With national and international politics supporting a free market-based world order, financial opportunities rather than global health needs guide the direction of new drug development. Can we accept that the dearth of effective drugs for diseases that mainly affect the poor is simply the sad but inevitable consequence of a global market economy? Or is it a massive public health failure, and a failure to direct economic development for the benefit of society? An urgent reorientation of priorities in drug development and health policy is needed. The pharmaceutical industry must contribute to this effort, but national and international policies need to direct the global economy to address the true health needs of society. This requires political will, a strong commitment to prioritize health considerations over economic interests, and the enforcement of regulations and other mechanisms to stimulate essential drug development. New and creative strategies involving both the public and the private sector are needed to ensure that affordable medicines for today's neglected diseases are developed. Priority action areas include advocating an essential medicines R&D agenda, capacity-building in and technology transfer to developing countries, elaborating an adapted legal and regulatory framework, prioritizing funding for essential drug development and securing availability, accessibility, distribution and rational use of these drugs.

Communicable Diseases, Emerging↗
PubMed2002

Sustainable watershed management: an international multi-watershed case study.

Global freshwater resources are being increasingly polluted and depleted, threatening sustainable development and human and ecosystem health. Utilizing case studies from 4 different watersheds in the United States, Japan, Switzerland, and Brazil, this paper identifies the most relevant sustainability deficits and derives general vectors for more sustainable water management. As a consequence of the demographic and economic developments experienced in the last few decades, each watershed has suffered declines in water quality, streamflow and biotic resources. However, the extent and the cultural perception of these water-related problems vary substantially in the different watersheds, leading to specific water-management strategies. In industrialized countries, exemplified by the US, Switzerland, and Japan, these strategies have primarily consisted of finance- and energy-intensive technologies, allowing these countries to meet water requirements while minimizing human health risks. But, from a sustainability point of view, such strategies, relying on limited natural resources, are not long-term solutions. For newly industrialized countries such as Brazil, expensive technologies for water management are often not economically feasible, thus limiting the extent to which newly industrialized and developing countries can utilize the expertise offered by the industrialized world. Sustainable water management has to be achieved by a common learning process involving industrialized, newly industrialized, and developing countries, following general sustainability guidelines as exemplified in this paper.

Conservation of Natural Resources↗
PubMed1990

Forecasting chronic disease risks in developing countries.

Declining fertility and infant mortality has caused the population in many developing countries to age. Population ageing can produce a rapid shift in the predominant public health problems from infant mortality and infectious diseases to chronic disease mortality at later ages. Designing public health strategies to deal with the health consequences of population ageing in developing countries is difficult both because of a remaining burden of infectious diseases and because of changes in life style associated with economic development that may raise chronic disease risks. Because there are few longitudinal studies of chronic disease risks in developing countries, we investigate the use of a planning and forecasting model, which combines data from multiple sources, in six developing countries.

Adolescent↗
PubMedDate not supplied

Turkey: distribution of cities and change over time.

Patterns of urbanization in Turkey from 1945 to 1975 are examined, with emphasis on the analysis of rank-size patterns. Attention is given to changes over time in the national rank-size distribution of cities, the growth rates of new cities, and the rank-size distribution of cities in various regions. "In general, the patterns of distribution of cities in Turkey are quite regular when compared with other developing countries. Since 1945 the city system has moved to a state more adjusted to the rank-size rule, paralleling the economic development of the country."

Asia↗
PubMed2003

GHG emission reductions and costs to achieve Kyoto target.

Emission projection and marginal abatement cost curves (MACs) are the central components of any assessment of future carbon market, such as CDM (clean development mechanism) potentials, carbon quota price etc. However, they are products of very complex, dynamic systems driven by forces like population growth, economic development, resource endowments, technology progress and so on. The modeling approaches for emission projection and MACs evaluation were summarized, and some major models and their results were compared. Accordingly, reduction and cost requirements to achieve the Kyoto target were estimated. It is concluded that Annex I Parties' total reduction requirements range from 503-1304 MtC with USA participation and decrease significantly to 140-612 MtC after USA's withdrawal. Total costs vary from 21-77 BUSD with USA and from 5-36 BUSD without USA if only domestic reduction actions are taken. The costs would sharply reduce while considering the three flexible mechanisms defined in the Kyoto Protocol with domestic actions' share in the all mitigation strategies drops to only 0-16% .

Air Pollution↗
PubMed2002

Determinants of child immunization in four less-developed states of north India.

Four northern states of India - Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh - lag far behind the other states of the country regarding demographic transition and socio-economic development. The study described in this article shows the utilization of child immunization services in these states, utilizing data from the National Family Health Survey, India, 1992-3 (IIPS, 1995a, 1995b, 1995c) The study used multivariate logistic regression to correlate the utilization of child immunization. The results showed that children are more likely to receive immunization if their parents are a couple, with the father literate and the mother with at least a middle-school-education level who received antenatal care or delivered in an institutional environment.

Child, Preschool↗
PubMed2003

[Health and innovation: a systemic approach in health industries].

Recognizing the importance of generating and disseminating innovation for the social and economic development of capitalist countries and the systemic, institutional, and historical nature of this process, this paper emphasizes the need to deal with innovation in the health sector within a framework linking economic, institutional, and policy dynamics. Analysis of the main health goods industries (manufacturers of pharmaceuticals, vaccines, and diagnostics) shows that in the developed countries there is a certain compatibility between the health system and the innovation systems in terms of requirements, and that the state is an essential player in this articulation. In Brazil, however, there is a marked disconnection between the health and innovation systems. The few initiatives aimed at this link have enhanced the competitiveness of national agents and have been essential elements in national health policy. Based on this analysis, it is argued that beyond its social dimension, health policy is a strategic means to consolidate a dynamic innovation system, with direct effects on national development.

Biomedical Technology↗
PubMed2004

Pharmaceuticals in Australia: developments in regulation and governance.

The pharmaceutical domain represents a type of internationalised policy network theorised in recent writings on neo-liberalism, neo-corporatism and governance. This article presents an analysis of developments in prescription drug regulation in Australia. A relatively stable, state-managed pattern of interaction has been superseded by less closed exchange, and the government itself has fragmented into agencies pursuing different objectives. Developments in the three core regulatory areas are described: safety and efficacy controls, social policy (access and equity), and state support for industry (economic) development. Consensus-building occurs within the context of the National Medicines Policy. The pharmaceutical industry, represented by Medicines Australia, has a stake in all aspects of pharmaceutical policy and regulation, and draws upon unique resources (expertise and lobbying capacity). The context for the developments described is Australia's abandonment of a protectionist version of the Keynesian welfare national state in favour of the model of the competition state, which is oriented towards support for the growth of high technology industries such as pharmaceuticals, premised on partnerships with business.

Australia↗
PubMed2006

The emergence of obesity among indigenous Siberians.

Once considered a disease of affluence and confined to industrialized nations, obesity is currently emerging as a major health concern in nearly every country in the world. Available data suggest that the prevalence rate of obesity has reached unprecedented levels in most developing countries, and is increasing at a rate that far outpaces that of developed nations. This increase in obesity has also been documented among North American circumpolar populations and is associated with lifestyle changes related to economic development. While obesity has not been well studied among indigenous Siberians, recent anthropological studies indicate that obesity and its associated comorbidities are important health problems.The present study examines recent adult body composition data from four indigenous Siberian populations (Evenki, Ket, Buriat, and Yakut) with two main objectives: 1) to determine the prevalence of overweight and obesity among these groups, and 2) to assess the influence of lifestyle and socioeconomic factors on the development of excess body fat. The results of this study indicate that obesity has emerged as an important health issue among indigenous Siberians, and especially for women, whose obesity rates are considerably higher than those of men (12% vs. 7%). The present study investigated the association between lifestyle and body composition among the Yakut, and documented substantial sex differences in lifestyle correlates of obesity. Yakut men with higher incomes and who owned more luxury consumer goods were more likely to have excess body fat while, among Yakut women, affluence was not strongly associated with overweight and obesity.

Adolescent↗
PubMedDate not supplied

Nurturing grassroots initiatives for health and housing.

This article has discussed the need to support grassroots community development. Grassroots community development requires the development and maintenance of voluntary community organizations (e.g., block, neighborhood, and tenant associations). These organizations have proved effective in the social, physical, and economic development of a community. The challenge facing policy makers and strategists is to develop a system that supports a multitude of community initiatives. This article has discussed such an "enabling system" and structure, functions, and services required as part of this system. The challenge we face is to increase the problem-solving capacity of disenfranchised communities. One of the biggest barriers we face in this mission is the competition and lack of coordination among professional service organizations.

Community Participation↗
PubMed2001

[Contribution of Communal Hygiene Department to creation and development of norm-setting basis of water sanitary legislation].

Legal regulation of problems related to drinking water supply to the population is a pressing social problem, particularly during the transitional period of Russian economic development. Communal Hygiene Department participated in the formation and development of norm-setting base of drinking water supply to the population since the thirties. During recent 5 years the Department contributed to development of the "Law on Drinking Water and Drinking Water Supply" (the first in Russia), basic normative legislative acts regulating hygienic requirements to drinking water quality, choice and exploitation of sources of drinking water supply, zones of their sanitary protection, and many methodological documents. The paper sums up the principal basis of new generation documents of sanitary legislation concerning water.

Guidelines as Topic↗
PubMed1994

Dimensions of health system reform.

During recent years there has been a growth of worldwide interest in health system reform. Countries at all levels of economic development are engaged in a creative search for better ways of organizing and financing health care, while promoting the goals of equity, effectiveness, and efficiency. Together with economic, political, and ideological reasons, this search has been fueled by the need to find answers to the complexities posed by the epidemiologic transition, whereby many nations are facing the simultaneous burdens of old, unresolved problems and new, emerging challenges. In order to better understand reform attempts, it is necessary to develop a clear conception of the object of reform: the health system. This paper presents the health system as a set of relationships among five major groups of actors: the health care providers, the population, the state as a collective mediator, the organizations that generate resources, and the other sectors that produce services with health effects. The relationships among providers, population, and the state form the basis for a typology of health care modalities. The type and number of modalities present in a country make it possible to characterize its health system. In the last part, the paper proposes that health system reform operates at four policy levels: systemic, which deals with the institutional arrangements for regulation, financing, and delivery of services; programmatic, which specifies the priorities of the system, by defining a universal package of health care interventions; organizational, which is concerned with the actual production of services by focusing on issues of quality assurance and technical efficiency; and instrumental, which generates the institutional intelligence for improving system performance through information, research, technological innovation, and human resource development. The dimensions of reform offer a repertoire of policy options, which need to be enriched by cross-national comparison of experiences and rigorous social experimentation. Maybe then reform will be a more systematic effort, and nations will be better able to learn from each other.

Delivery of Health Care↗
PubMed1989

Burn injuries during the puerperium in Zaria, Nigeria.

Of the 35 women who sustained burn injuries during the puerperium in Zaria, 31 had practised ritual hot baths or "Wankan-jego" which caused severe scalds. Five of the women also developed peripartum cardiac failure. Two died. Three of the newborns also died partly as a result of the mothers' illness. Formal education and general economic development would help in eliminating this preventable source of maternal and infant morbidity and mortality.

Adolescent↗
PubMed2004

Strategies for increasing fruit and vegetable intake in grocery stores and communities: policy, pricing, and environmental change.

BACKGROUND: Grocery stores and community settings are important and promising venues for environmental, policy, and pricing initiatives to increase fruit and vegetable intake. This article examines supermarket-based and community environmental, policy, and pricing strategies for increasing intake of fruits and vegetables and identifies promising strategies, research needs, and innovative opportunities for the future. METHODS: The strategies, examples, and research reported here were identified through an extensive search of published journal articles, reports, and inquiries to leaders in the field. Recommendations were expanded with input from participants in the CDC/ACS-sponsored Fruit and Vegetable, Environment Policy and Pricing Workshop held in September of 2002. RESULTS: Four key types of grocery-store-based interventions include point-of-purchase (POP) information; reduced prices and coupons; increased availability, variety, and convenience; and promotion and advertising. There is strong support for the feasibility of these approaches and modest evidence of their efficacy in influencing eating behavior. Church-based programs, child care center policies, and multisectoral community approaches show promise. CONCLUSIONS: Both descriptive and intervention research are needed to develop and evaluate more effective environmental strategies to increase F&V intake in grocery stores and communities. Innovative strategies, partnerships, grass roots action involving economic development for low-income communities, and sustainability are important considerations.

Commerce↗