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PubMed2000

The health effects of economic sanctions and embargoes: the role of health professionals. Ethics and Human Rights Committee.

As a widely used tool of foreign policy, economic sanctions take many forms. They include mandating trade restrictions (for example, limiting imports from or exports to a sanctioned nation), freezing bank accounts, limiting international travel to and from an area, imposing additional tariffs, and exerting other pressures that are intended to slow key economic activities. Since the end of the Cold War, as the global market has expanded, many countries and the United Nations have increasingly used economic sanctions instead of military intervention to compel nations to end civil or extraterritorial war or to reduce abuse of human rights. Similarly, the United States has attempted to influence international governments' domestic policies by using other economic means, such as relating "most favored nation" trading status to a country's human rights record or prohibiting the import of goods from countries in which illegal child labor is widespread. Repercussions from these measures influence a country's economic development and, therefore, can also affect the overall welfare of a nation's population. In contrast to war's easily observable casualties, the apparently nonviolent consequences of economic intervention seem like an acceptable alternative. However, recent reports suggest that economic sanctions can seriously harm the health of persons who live in targeted nations. For this reason, the American College of Physicians-American Society of Internal Medicine has undertaken this examination of physicians' roles in addressing the health effects of economic sanctions.

Economics↗
PubMed2006

[A future image of clinical inspection from health economics].

Do you let medical costs increase in proportion to the growth rate of GDP? A way of thinking of the Council on Economic and Fiscal Policy. Should we exclude public medical insurance? It is not a problem, it is an absolute sum if you are effective. If there is no insurance, and individuals pay the total amount, there is no problem, but it is impossible. Economic development will cease if there is no insurance. As medical personnel, to offer good medical care with an appropriate cost. An appeal to the nation is necessary. Economic technical evaluation to identify a cheap method for each clinical inspection. Does medical insurance have a deficit? I. Japanese Health insurance system. (1) Health insurance union. When you look at the contribution money, it is originally 2,479,800,000,000 yen, with premium income and a profit of 45%. (2) Government management health insurance. When you look at the contribution money, it is originally 2,163,300,000,000 yen, with premium income and a profit of 36%. (1) + (2) Employed insurance meter. (3) Mutual aid. (4) National Health Insurance. II. A clinical economic method. III. Expense of medical care and its effect. A. Expense. B. A medical economic technical evaluation method. 1. Cost-effectiveness analysis CEA. 2. Cost utility analysis CUA. 3. Cost-benefit analysis CBA. 4. Expense minimization analysis.

Clinical Laboratory Techniques↗
PubMed1998

The epidemiology of diabetes mellitus and diabetic retinopathy.

An apparent epidemic of diabetes is occurring in adults worldwide. This trend seems to be associated with socioeconomic and lifestyle changes. The population of developing countries and some communities within developing countries are at higher risk. Diabetic eye disease and its complications, especially diabetic retinopathy, are a leading cause of blindness and visual dysfunction in adults in economically developed societies. Epidemiological studies of the impact of diabetic eye disease in developing countries are scarce. Risk factors for the development and progression of diabetic retinopathy include, among others, hyperglycemia, genetic factors, race, duration of the disease, arterial hypertension, and proteinuria.

Blindness↗
PubMed2001

Sustainability of coastal resource use in San Quintin, Mexico.

San Quintin, Mexico, provides a useful site for integrated analyses of material fluxes and socioeconomic constraints in a geographically isolated system. Natural resource utilization on the land is dominated by groundwater exploitation for cultivation of horticulture crops (primarily tomatoes). Irrigation exceeds water recharge minus export by a factor of 6. Resource utilization in the bay is dominated by oyster culture; food for the oysters is provided by tidal exchange of bay and ocean water. Consideration of oyster respiration and system respiration suggests that the present level of aquaculture is about 40% of the sustainable level. A "physical unsustainability index" (PhUI) was developed to measure the proportional departure of utilization of the most limiting resource for sustainability: 6 on land; 0.4 in the bay. Based on PhUI and measures of economic development, we conclude that aquaculture is more viable than agriculture.

Animals↗
PubMed2006

Economic transition and household food consumption: a study of Bulgaria from 1985 to 2002.

Major economic transitions typically entail changes in the availability of and purchasing power for different types of foods leading to long-term changes in the composition of the diet. Bulgaria, a former Eastern Bloc country, underwent a difficult and protracted transition from a centralized to market economy with acute economic crises and a much slower recovery of income levels than in Poland, the Czech Republic, and Hungary. Using annual data from the Bulgarian National Household Survey, we study changes in the reported consumption of major foods (excluding alcoholic drinks) and their constituent macronutrients from 1985 to 2002, examining also the differences in dietary patterns between the period prior to and following the transition. The consumption of most major food items decreased, resulting in a fall in per capita energy consumption of 429 kcal/day (1.80 MJ/d), following the economic transition of 1991. As expected, the consumption of foods that were more expensive per unit of energy decreased greater than cheaper foods, -34% for animal products and -19% for visible fats, but only -10% for carbohydrates. These changes are related to the changes in income and market prices as well as the general negative trend in economic growth and hyperinflation in the mid-1990s. Thus, Bulgaria experienced a decrease in food consumption without significant changes in the dietary pattern following the economic transition of 1991. The fact that part of this decline may be attributed to continued economic challenges suggests that future transitions in the diet may be expected as economic development proceeds.

Agriculture↗
PubMed2006

Social health insurance in a developing country: the case of the Philippines.

Very little is known about the Philippine health care system, and in particular its experience with social health insurance (SHI). Having initiated an SHI programme 35 years ago, the Philippines hold many lessons for the development of such schemes in other low and middle-income countries. We analyse the challenges currently facing PhilHealth, the national health insurer. PhilHealth was formed in 1995 as a successor to the Medicare programme and was given a mandate to achieve universal coverage by 2010. To date, PhilHealth has been quite successful in some areas (e.g. enrollment), but lags behind in others (e.g. quality and price control). We conclude that SHI in the Philippines has been a success story so far and provides lessons for countries in a similar situation. For example: (i) SHI is based on value decisions and the clear statement of societal goals can give guidance in the technical execution, (ii) SHI is a financing institution and needs to be treated accordingly, (iii) SHI can be implemented independently of the current economic situation and might actually contribute to economic development, (iv) community-based health care financing schemes should be merged with the national SHI in the long run, and (v) there is a strong need to push for high quality care and improved physical access. No clear suggestions can be given with respect to the benefit catalogue and the balance between economies of scale and decentralisation. Although riddled with many inadequacies, PhilHealth was set up as a strong and largely politically independent institution for the development of SHI. SHI can act as a stabilizing institution in a politically and economically volatile environment.

Developing Countries↗
PubMed2006

Changes in the biological status of Polish girls from a rural region associated with economic and political processes in the period 1967-2001.

The age at menarche, body height and weight of the daughters of farmers, farmer-workers and landless villagers in a rural region of Poland were studied. In the period 1967-1977, a time of economic development, a decrease in age at menarche (by 0.74 years) and a secular trend in body height (by 2.4 cm/decade) was observed. In 1977-1987, a period of acute economic crisis, age at menarche increased by 0.16 years and the secular trend in body height was only 1.1 cm/decade. In 1987-2001, age at menarche decreased and body height increased by 0.28 years and 2.9 cm respectively. The percentage of families owning a car, freezer and video increased during this period. These last results are indicative of an improvement in living conditions, but the villagers regard themselves as losers as a result of the political transformation (1989) in Poland.

Adolescent↗
PubMed1999

Public health developments in colonial Malaya: colonialism and the politics of prevention.

In both African and Asian colonies until the late 19th century, colonial medicine operated pragmatically to meet the medical needs first of colonial officers and troops, immigrant settlers, and laborers responsible for economic development, then of indigenous populations when their ill health threatened the well-being of the expatriate population. Since the turn of the century, however, the consequences of colonial expansion and development for indigenous people's health had become increasingly apparent, and disease control and public health programs were expanded in this light. These programs increased government surveillance of populations at both community and household levels. As a consequence, colonial states extended institutional oversight and induced dependency through public health measures. Drawing on my own work on colonial Malaya, I illustrate developments in public health and their links to the moral logic of colonialism and its complementarity to the political economy.

Africa↗
PubMed1993

[Economic expansion and the health crisis in Paraguay].

In spite of the rapid economic development experienced by Paraguay during recent years, the country's health conditions remain among the poorest in Latin America. This article strives to explain, by presenting a model of Paraguay's economic and health care systems, why health care and economic growth have not advanced at the same rate. By examining various economic and health care indicators, hospital registries, family planning activities, and statistics on drinking-water and health care services distribution among central departments with established populations, as well as recently populated peripheral areas, the conclusion is reached that the country's poor health conditions might be the direct result of accelerated expansion of the agricultural frontier. In closing, recommendations are made for updating health statistics via new health survey, improved training for rural health care personnel, and closer coordination among the four public hospital systems in the cities.

Adolescent↗
PubMed1982

Citizen participation in neighborhood health centers for the poor: the politics of reform organizational change, 1965-77.

Through a longitudinal study of neighborhood health centers for the poor in the United States, this paper presents an analysis of the political economy of change within reform organizations. In the final accounting, we seek to explain the shift in the role of poor people participating in health care decision making from that of program developer and change agent to the role of program restrictor. We conceptualize the neighborhood health center (NHC) as a reform organization whose initial objective was to use health care as a tool for achieving political and economic development within low-income rural and urban communities. The analysis, based on a prospective study of NHCs between 1965 and 1977, using interviews with citizen board members, NHC project administrators, NHC physicians, HEW decision elites, and oral history interviews with former Office of Economic Opportunity (OEO) administrators and directors, exemplifies the generic social organizational problem of how social, political, economic, and ideological forces shape the emergence and performance of a new reform organization.

Community Health Centers↗
PubMed2006

Countdown to 2015: tracking donor assistance to maternal, newborn, and child health.

BACKGROUND: Timely reliable data on aid flows to maternal, newborn, and child health are essential for assessing the adequacy of current levels of funding, and to promote accountability among donors for attainment of the Millennium Development Goals (MDGs) for child and maternal health. We provide global estimates of official development assistance (ODA) to maternal, newborn, and child health in 2003 and 2004, drawing on data reported by high-income donor countries and aid agencies to the Organisation for Economic Development and Cooperation. METHODS: ODA was tracked on a project-by-project basis to 150 developing countries. We applied a standard definition of maternal, newborn, and child health across donors, and included not only funds specific to these areas, but also integrated health funds and disease-specific funds allocated on a proportional distribution basis, using appropriate factors. FINDINGS: Donor spending on activities related to maternal, newborn, and child health was estimated to be US1990 million dollars in 2004, representing just 2% of gross aid disbursements to developing countries. The 60 priority low-income countries that account for most child and newborn deaths received 1363 million dollars, or 3.1 dollars per child. Across recipient countries, there is a positive association between mortality and ODA per head, although at any given rate of mortality for children aged younger than 5 years or maternal mortality, there is significant variation in the amount of ODA per person received by developing countries. INTERPRETATION: The current level of ODA to maternal, newborn, and child health is inadequate to provide more than a small portion of the total resources needed to reach the MDGs for child and maternal health. If commitments are to be honoured, global aid flows will need to increase sharply during the next 5 years. The challenge will be to ensure a sufficient share of these new funds is channelled effectively towards the scaling up of key maternal, newborn, and child health interventions in high priority countries.

Child↗
PubMed1998

Protecting paradise: tourism and AIDS in the Dominican Republic.

This study summarizes results from six data collection instruments administered to tourists, hotel workers, and commercial sex workers (CSWs) in the Dominican Republic (D.R.). The objective of this study was to assess: 1. how HIV/AIDS may affect tourism; 2. how tourists are likely to react to prevention campaigns; and 3. how tourism may affect the spread of HIV/AIDS. It was found that an overwhelming proportion of tourists did not consider the prevalence of HIV to be a factor when making their travel plans, and that most did not consider themselves at greater risk of becoming infected while on holiday than when they were at home. This study determined that the spread of HIV/AIDS was unlikely to affect the demand for tourism services in the D.R. The study also found that most tourists would respond positively to an HIV/AIDS prevention campaign and would not be discouraged from visiting the D.R. because of such campaigns. Those most receptive to prevention efforts were also those who felt they were at highest risk, according to study data. Finally, it was determined that while most tourists probably do not engage in high risk activities, there were some male and female tourists who do engage in sexual encounters with multiple Dominican CSWs and hotel employees. These encounters represent a risk to the health and economic development of the D.R., as well as to tourists and their other sexual partners. Based on these findings, it is recommended that in order to minimize the potential social and economic impact of HIV/AIDS in the D.R., prevention messages need to reach a number of groups which have not yet been adequately targeted. These groups include tourists, with a special emphasis on 'sex tourists', and hotel employees, with a special emphasis on entertainment staff.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Policy implications of new scientific knowledge.

Recent research findings have augmented the nutrition variable to a higher category of importance than previously appreciated. Inadequate nutrition can impair cognitive development and is associated with educational failure among impoverished children. This suggests that poor nutrition interferes with the formation of human capital, the cornerstone of a nation's social and economic development. Even temporary food shortages can produce adverse outcomes in developed as well as developing countries. The long-held concept of a critical period of brain development has been modified in light of the new understanding that developmental and morphological plasticity are far greater than previously recognized. This knowledge does not mean that there are no lasting adverse outcomes, but that from a policy perspective, intervention and rehabilitation can play crucial roles. This article highlights the relevance of this evidence to social and health programs and policies.

Child↗
PubMed2001

Independent effects of income and education on the risk of obesity in the Brazilian adult population.

With a view to assess the independent effects of income and education on the risk of obesity we studied cross-sectional randomly selected samples of the adult population (20 y and over) living in 1996/97 in the less (northeastern) and the more (southeastern) developed region of Brazil (1971 and 2588 northeastern and 2289 and 2549 southeastern men and women, respectively). Independent effects of income and education on obesity (BMI > or = 30 kg/m(2)) were assessed through logistic regression analyses that controlled for age, ethnicity, household setting (urban or rural) and either education or income. The risk of obesity in men strongly increased with income in the two regions. The level of education did not influence the risk of male obesity in the less developed region but, in the more developed one, better-educated men had slightly less chance to be obese. In the less developed region obesity in women was strongly associated with both income (direct association) and education (inverse association). In the more developed region only the women's education influenced the risk of obesity, and the association between the two variables was inverse and strong as in the less developed region. Findings from this study reveal a scenario that is far from what has been generally admitted for the social distribution of obesity in the developing countries. They indicate that in transition societies income tends to be a risk factor for obesity, whereas education tends to be protective and that both gender and level of economic development are relevant modifiers of the influence exerted by these variables.

Adult↗
PubMed2006

Solutions to nutrition-related health problems of preschool children: education and nutritional policies for children.

OBJECTIVE: By reviewing the literature, lessons learned and experience regarding the nutrition-related health problems of preschool children, draw conclusions and make recommendations on education and nutrition policies for young children. RESULTS: The most common causes of under-5 mortality in low-income countries have been identified as neonatal disorders, diarrhoea, respiratory infections, malaria, measles, and in some developing countries, AIDS. More than half (56%) of all child deaths have underlying malnutrition and undernutrition as a contributing factor. Children must have optimal growth and physical and intellectual development to learn and achieve their potential in society. Solutions include both preventive and curative interventions at all levels and include both improved health and education systems. Recent focus has been on health systems interventions that address averting deaths by cause for the 42 countries that account for 90% of worldwide under-5 deaths (the majority in sub-Saharan Africa). However, parallel or multisectoral interventions must be addressed to all children at risk for death, poor health and compromised growth and development. Adequate health care and nutrition is a human right, legally established in the Convention on the Rights of the Child. CONCLUSIONS: Improved health and nutrition will lead to enhanced economic development, but having a poverty focus appears to be essential, if poor people are not to be marginalized further. The HIV/AIDS pandemic illustrates this challenge clearly. The role of education, especially girls' education, in improved health and nutrition status of children and birth-spacing is now clear, as is improving women's status. Increases in female status and education have been estimated to account for half of the reduction in child malnutrition rates during the past 25 years.

Adult↗
PubMed2003

Intelligent infrastructure for sustainable potable water: a roundtable for emerging transnational research and technology development needs.

PROBLEM STATEMENT: Recent commercial and residential development have substantially impacted the fluxes and quality of water that recharge the aquifers and discharges to streams, lakes and wetlands and, ultimately, is recycled for potable use. Whereas the contaminant sources may be varied in scope and composition, these issues of urban water sustainability are of public health concern at all levels of economic development worldwide, and require cheap and innovative environmental sensing capabilities and interactive monitoring networks, as well as tailored distributed water treatment technologies. To address this need, a roundtable was organized to explore the potential role of advances in biotechnology and bioengineering to aid in developing causative relationships between spatial and temporal changes in urbanization patterns and groundwater and surface water quality parameters, and to address aspects of socioeconomic constraints in implementing sustainable exploitation of water resources. WORKSHOP OUTCOMES: An interactive framework for quantitative analysis of the coupling between human and natural systems requires integrating information derived from online and offline point measurements with Geographic Information Systems (GIS)-based remote sensing imagery analysis, groundwater-surface water hydrologic fluxes and water quality data to assess the vulnerability of potable water supplies. Spatially referenced data to inform uncertainty-based dynamic models can be used to rank watershed-specific stressors and receptors to guide researchers and policymakers in the development of targeted sensing and monitoring technologies, as well as tailored control measures for risk mitigation of potable water from microbial and chemical environmental contamination. The enabling technologies encompass: (i) distributed sensing approaches for microbial and chemical contamination (e.g. pathogens, endocrine disruptors); (ii) distributed application-specific, and infrastructure-adaptive water treatment systems; (iii) geostatistical integration of monitoring data and GIS layers; and (iv) systems analysis of microbial and chemical proliferation in distribution systems. IMPACT: This operational framework is aimed at technology implementation while maximizing economic and public health benefits. The outcomes of the roundtable will further research agendas in information technology-based monitoring infrastructure development, integration of processes and spatial analysis, as well as in new educational and training platforms for students, practitioners and regulators. The potential for technology diffusion to emerging economies with limited financial resources is substantial.

Conservation of Natural Resources↗