"Put your money where your mouth is!": the need for public investment in women's organisations.
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Economics↗
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[Some theoretical issues of population policy].
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Demography↗
Ferdinando Galiani on population and economic growth.
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Communication↗
Resurgent and emergent disease in a changing world.
Emerging infectious diseases pose important public health problems for both the developed and developing world. Many new or previously unrecognized bacterial, fungal, viral, and parasitic diseases have emerged within the past two decades. At the same time, many once-controlled infections have re-emerged or become resistant to antimicrobial therapy. This emergence is the result of changes in society, technology, the environment, and the microbes themselves, and these changes have had often unpredictable consequences. Important factors influencing emergence include changes in human demographics and behaviour, changes in technology and industry, changes in economic development and land use, increasing and rapid international travel and commerce, microbial adaptation and change, and the breakdown of public health measures. Addressing emerging infectious diseases will require international and interdisciplinary partnerships to build an appropriate infrastructure to detect and respond to these often unanticipated threats to health.
Communicable Diseases↗
Seasonality of births: stability and change in a developing country.
A marked seasonality of births for the two main ethnic groups of peninsular Malaysia, far exceeding the cyclic fluctuations in births in the United States and Canada, was reported for the 1960s. A 36% excess of births over the average monthly number was observed among Malays each January. Among the ethnic Chinese in Malaysia a regular periodicity in the numbers of births was also found, but it was far less marked and the peak occurred in October or November. The peaks in both groups were due in large measure to conceptions that correlate with religious observances or holidays. Here I report on cyclic birth patterns in peninsular Malaysia for the period 1970-1985. Rapid economic development has occurred during this time and has brought with it demographic changes, such as a massive rise in contraceptive use and a decline in birth rates. These demographic changes have been accompanied by the loss of the pronounced seasonal pattern of births among the Malays. The seasonality of Malay births is now of roughly the same magnitude as the seasonality in the United States and Canada, whereas seasonality of births among the Chinese in Malaysia remains essentially unchanged.
Birth Rate↗
Schistosomiasis and the social patterning of infection.
Social, cultural, behavioural and economic factors interact with local environmental and ecological factors to produce extraordinary variation in the epidemiology of schistosomiasis, including with respect to prevalence and intensity of infection and the potential for control. This article reviews the literature on schistosomiasis infection, primarily derived from African studies, to identify its major social themes. Research has demonstrated a strong link between economic development strategies, where irrigation has been introduced to boost agricultural production, and the increased transmission of infection. Water-contact studies have provided the fullest and most detailed descriptions of social risk factors, and have isolated age, sex, religion and occupation as primary risk factors. However, fuller explorations of the social and cultural context of infection have yet to be undertaken. The social context of water-related behaviour and patterns of water use within communities and households, the intersection of social and economic activities, and the significance that people give to these activities, remains poorly explored, and although research papers concerned with community-based interventions refer to poor community understanding of the cause, prevention and treatment of the disease, this domain has also received little scholarly attention. Finally, economic studies have focused primarily on working capacity, and extrapolated these findings to generalize about the impact that this might have on productivity, but have yet to address either household or community costs of schistosomiasis infection.
Africa↗
Towards a sustainable livestock production in developing countries and the importance of animal health strategy therein.
Livestock and animal health development projects have not always led to substantial increases in animal productivity or in farmers' welfare. Some have even resulted in unsustainable systems, when they were not based on an understanding of (livestock) production systems. The multipurpose functions of livestock and complex relationships between the biological, technical and social components require a systems approach, whereby nutrition, animal health, breeding, biotechnology knowhow, inputs and technologies are used to optimise resource use. The challenge for developed and developing countries is to reverse the current degradation of the environment, and arrive at sustainable increases in crop and livestock production to secure present and future food supplies. For rural development, governments should show long term commitment and political will to support the rural population in development programmes, because smallholders (including women and landless livestock keepers) represent a large labour force in developing countries. Different systems need different approaches. Pastoral systems must focus on effective management of grazing pressure of the rangelands. Communal rangelands management involves not only the development and application of technologies (e.g. feedlots, vaccination campaigns), but also land tenure policies, institutional development, economic return and a reduction in the number of people depending upon livestock. Smallholder mixed farms must aim at intensification of the total production system, in which external inputs are indispensable, but with the emphasis on optimum input-output relationships by reducing resource losses due to poor management. Resource-poor farming systems must aim at the improved management of the various livestock species in backyards and very small farms, and proper packages for cattle, buffaloes, sheep, goats, rabbits and poultry should be developed. Specialised commercial livestock farming systems (poultry, pigs, dairy or meat) can only be sustainable with adequate marketing, supply of quality feed, veterinary services, labour, management and control of pollution. Animal health programmes play a keyrole in the proposed system approach.
Agriculture↗
Population and family planning: an international perspective.
Since the 1960s, the U.S. government has supported population and family planning programs in Third World countries, on the grounds that rapid population growth impairs the ability of those countries to develop economically; family planning programs contribute to fertility decline; and such programs help improve the health of mothers and children. Although the United States remains the largest single donor of funding for international population programs, its support has weakened during the eight years of the Reagan administration and patterns of funding for those programs have changed substantially. Since the 1960s, however, contraceptive use has increased in the Third World and fertility has fallen substantially. The decline has been uneven, though--considerable in some countries, moderate in others but very small in many. The performance of family planning programs around the world has varied widely, and questions remain as to what, if anything, can be done to increase success. For the future, three aspects of population and fertility control in developing countries merit special attention: the supply of contraceptive commodities going to family planning programs; the maintenance and strengthening of the family planning infrastructure; and the need to examine the policy implications of differing patterns of fertility and population growth for national development and individual well-being.
Developing Countries↗
The injustice of unsafe motherhood.
This paper presents an overview of the dimensions of unsafe motherhood, contrasting data from economically developed countries with some from developing countries. It addresses many common factors that shape unsafe motherhood, identifying medical, health system and societal causes, including women's powerlessness over their reproductive lives in particular as a feature of their dependent status in general. Drawing on perceptions of Jonathan Mann, it focuses on public health dimensions of maternity risks, and equates the role of bioethics in conscientious medical care to that of human rights in public health care. The microethics of medical care translate into the macroethics of public health, but the transition compels some compromise of personal autonomy, a key feature of Western bioethics, in favour of societal analysis. Religiously-based morality is seen to have shaped laws that contribute to unsafe motherhood. Now reformed in former colonizing countries of Europe, many such laws remain in effect in countries that emerged from colonial domination. UN conferences have defined the concept of 'reproductive health' as one that supports women's reproductive self-determination, but restrictive abortion laws and practices epitomize the unjust constraints to which many women remain subject, resulting in their unsafe motherhood. Pregnant women can be legally compelled to give the resources of their bodies to the support of others, while fathers are not legally compellable to provide, for instance, bone-marrow or blood donations for their children's survival. Women's unjust legal, political, economic and social powerlessness explains much unsafe motherhood and maternal mortality and morbidity.
Abortion, Legal↗
Designing membrane electrochemical reactors for oxidoreductase-catalysed synthesis.
The purpose of this work was to design an electrochemical reactor to enhance the high selectivity of enzyme-catalysed processes. In order to develop economically efficient syntheses, the enzymes must be confined in the strict vicinity of the electrode surface. Here the confinement was achieved with a dialysis membrane in a so-called Dialysis-Membrane Electrochemical Reactor (D-MER). Oxidation of glucose into gluconic acid catalysed by glucose oxidase was a first example. The ADH-catalysed reduction of cyclohexanone into cyclohexanol was also tested in a new type of MER. NADH was electrochemically regenerated thanks to mediator (methyl viologen or rhodium complex). The key point in developing electro-enzymatic process is to ensure the perfect fitting of the reactor design to the reactions that are to be processed.
Alcohol Dehydrogenase↗
Health care expenditure in Sweden--an international comparison.
This paper analyses health care expenditure in Sweden and compares this with the corresponding expenditure in OECD countries. The definition and measurement problems of health care expenditure are discussed, new figures for the development of health care expenditure are presented and different measures of health care expenditure are provided. We found that health care expenditure has increased by about 20% in constant prices for Sweden between 1980 and 1988, but that health care expenditure as a share of the GDP has dropped during the same period in current prices. Health care expenditure disaggregated on different age groups show for Sweden that in the age group 15-64 years, health care expenditure has not increased in constant prices between 1976 and 1985, but in the oldest age group, health care expenditure has increased considerable during this period. Health care expenditure in Sweden is as high as would be expected, taking into account the degree of economic development and the growth of expenditure during the 80s, and has followed that in comparable OECD countries. However, the relative price is lower, which means that the input of real resources are greater than in other countries.
Australia↗
Agricultural sustainability in a sensitive environment--a case analysis of Loess Plateau in China.
Loess Plateau, an arid and semi-arid region in Northwest China, is well-known for its most serious soil erosion in terms of sediment yield each year. Soil erosion, which is intensified by agricultural activities, is the major factor influencing sustainable agriculture development in this region. It reduces productivity by removing nutrients and especially reducing water availability that is essential for crop production in the area. It also brings about off-site costs by demanding more efforts for maintenance of banks and dams along Yellow River through raising the riverbed with sediment. Climate is capricious and extreme weather conditions occur frequently, which impairs normal agricultural production with erosion and also decrease of water availability. Extensive way of farming still dominates on the Loess Plateau, which cannot produce satisfying economic results and needs to be improved or altered. Conventional agricultural production pattern needs to be reconsidered for husbandry has not been granted its due position. Agriculture is the backbone of economy. Poor agricultural production impedes economic development and vice versa, backward economy also influences the advancement of agriculture. Besides a large population, education status of farmers is another threshold that requires being resolved for a sustainable agriculture. Although conventional agriculture has been practiced there for more than 5000 years, now it cannot meet the demand for food and fiber by the increasing population and some of its farming practices are contributing to environmental degradation directly or indirectly and can sustain no longer. Agriculture on Loess Plateau needs to find its own way of sustainability. To work toward a sustainable agriculture, chances and challenges both indwell on Loess Plateau.
Agriculture↗
From basic needs to basic rights.
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Economics↗
A veteran recalls a decade of progress in family planning programmes of the region.
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Economics↗
[Parasitoses and development: malaria and echinococcosis].
After having placed emphasis on the cyclic oscillations characterizing the interest of the scientific and political world for parasitology, the author analyzes the various standpoints from which parasitic diseases, and above all malaria, have been dealt with ever since the beginning of this century. Specific criticism is addressed to the military model, which has provided the basis for many eradication campaigns. The author also analyzes the "vicious circle theory", which labelled the activity of the WHO in its first decade of life, and which assumed that breaking the disease and underdevelopment circle was possible by acting mainly or even exclusively on endemic and debilitating diseases. Both these models were tested with success in Sardinia with the 1947-49 antimalaria campaign. However, socio-economic development of the island did not occur as expected, and attempts to export the same approaches to other parts of the world soon disclosed their limitations, leading to major failures. The experience on the fight against echinococcosis is subsequently examined. The conclusions drawn are that many successes may be obtained through a systemic rather than a sectorial approach; and that a "conflicting cohabitation" with diseases is foreseen as a long-lasting reality, and must thus be controlled with the appropriate means.
Developing Countries↗
Narrowing sex differentials in life expectancy in the industrialized world: early 1970's to early 1990's.
Between the early 1970's and 1990's, twelve industrialized nations experienced for the first time a narrowing of their sex differences in life expectancy at age zero. In another set of countries, the differential has not yet reached a stage of convergence, although in some of these nations the female advantage appears to be increasing at a slower pace than ever before. We discuss the demographic and epidemiologic conditions for this new and largely unanticipated trend, as well as its applied and theoretical implications in the context of the following questions: (1) Is the observed change a function of males' faster pace of gains in life expectancy since the early 1970s? (2) What is the relationship between country differences in socioeconomic development (as measured by GNP) and the degree of convergence in the sex gap in average length of life? (3) What is the degree of association between temporal change in age-sex specific death rates and change in the sex gap in life expectancy over the twenty-year interval between the early 1970s and early 1990s? Our results indicate that where some convergence has taken place, in relation to women, men have experienced more rapid gains in survival; the higher a nation's level of social and economic development, the greater the amount of convergence in male and female life expectancies. The most pronounced age-specific association with the changing sex gap in longevity is that of ages 25-59, where the greater reductions in male mortality, as compared to that for females, contributed to a significant portion of the observed convergence in life expectancy across industrialized nations.
Adolescent↗
Rubella and congenital rubella syndrome: global update.
Worldwide, it is estimated that there are more than 100.000 infants born with congenital rubella syndrome (CRS) each year. In 1998, standard case definitions for surveillance of CRS and rubella were developed by the World Health Organization (WHO). In 2001, 123 countries/territories reported a total of 836.356 rubella cases. In the future more countries are expected to report on rubella as a global measles/rubella laboratory network is further developed under the coordination of WHO. Operational research is being conducted to improve rubella surveillance. This includes projects on initiating CRS surveillance, comparative studies on diagnostic laboratory methods, and molecular epidemiology research to expand the global understanding of patterns of rubella virus circulation. In 1996 a WHO survey found that 78 od 214 reporting countries/territories (36%) were using rubella vaccine in their routine immunization services. By the en of 2002 a total of 124 of the 214 counties/territories (58%) were using rubella vaccine. Rubella vaccine use varies by stage of economic development: 100% for industrialized countries, 71% for countries with economies in transition, and 48% for developing countries. A safe effective rubella vaccine is available, and there are proven vaccination strategies for preventing rubella and CRS. A WHO position paper provides guidance on programmatic aspects of rubella vaccine introduction. The introduction of rubella vaccine is cost-effective and cost-beneficial but requires ongoing strengthening of routine immunization services and surveillance systems.
Developing Countries↗
The epidemiological features of heart failure in developing countries: a review of the literature.
Cardiovascular diseases are increasingly recognised as an important cause of morbidity and mortality in developing countries. This is due to the ageing of the population and better control of communicable disease and malnutrition. We review the published data on the epidemiology of heart failure in such countries. Rheumatic heart disease remains a major cause of heart failure in Africa and Asia, especially in the young. Hypertension is an important cause of heart failure especially in the African and African-American population. Chagas' disease is still a cause of heart failure in South America. However, as countries go through epidemiological transition and undergo socio-economic development, the epidemiology of heart failure becomes increasingly similar to that of Western Europe and North America with coronary artery disease being the single most common cause of heart failure. Preventive and public health strategies need to be specific to the local epidemiological characteristics.
Africa↗