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PubMed2001

Welfare state and infant mortality.

This article seeks to understand the effects of welfare-state spending on infant mortality rates. Infant mortality was chosen for its importance as a social indicator and its putative sensitivity to state action over a short time span. Country fixed-effects models are used to determine that public health spending does have a significant impact in lowering infant mortality rates, net of other factors, such as economic development, and that this effect is cumulative over a five-year time span. A net effect of health spending is also found, even when controlling for the level of spending in the year after which the outcome is measured (to account for spurious effects or reverse causation). State spending effects infant mortality both through social mechanisms and through medical ones. This article also shows that the impact of state spending may vary by the institutional structure of the welfare state. Finally, this study tests for structural breaks in the relationship between health spending and infant mortality and finds none over this time period.

Economics, Medical↗
PubMed1995

Social inequality in mortality in São Paulo State, Brazil.

BACKGROUND: Epidemiological studies have consistently demonstrated social inequality to be an important factor in the distribution of illness and death in society. However, little work has been published on social differentials in mortality in the world's developing countries, where socioeconomic contrasts are often considerably greater. METHODS: In order to evaluate the extent of social differentials in mortality in a setting of major social inequality -- the State of São Paulo, Brazil, deaths in men aged 15-64 years residing in São Paulo from 1980 to 1982 were linked in broad, occupationally-determined categories to estimates of population size based on the 1980 Brazilian national census. The occupational categorizations utilized a Brazilian classification scheme and additionally that of the British Registrar General. RESULTS: Mortality was 3.8 and 2.9 times greater comparing least to most socially favoured occupational category in each of the two classification systems, respectively. Independent of system, mortality decreased approximately 1.1% for each 1% increase along the occupationally-defined social gradient. This decrease was 48% greater than the equivalent calculated decrease for men of England and Wales. CONCLUSIONS: These data support the contention that mortality for Brazilian adults, even more so than for adults of the world's more economically developed nations, is inextricably bound to the issue of social equity.

Adolescent↗
PubMed2005

Factors influencing development of management strategies for the Abou Ali River in Lebanon II: seasonal and annual variation.

The water quality of a river at any point reflects several major influences including but are not limited to climatic conditions and anthropogenic inputs. Assessing these influences is essential for managing land and water resources within a particular river catchment. The objectives of this study were to identify the causes of increasing or decreasing trends in the concentrations of various water quality parameters in the Abou Ali River in North Lebanon and to account for the consequential variations both annual and seasonal (low/high flow). The assessment was conducted at the end of the dry season in October 2002 and 2003 and the end of the wet season in March 2003 and 2004. Results established that dissolved oxygen levels were consistently higher at the end of the wet season. The concentrations of biochemical oxygen demand, ammonia nitrogen and ortho-phosphates did not exhibit a clear seasonal or annual variation. While the levels of total dissolved solids and nitrate nitrogen exhibited a decreasing trend in urban catchments, an increasing trend was observed in rural, agricultural and forested areas. The findings of this study reinforce the notion that management of point and non-point sources should be integrated as the combination of both sources connected with land use results in deleterious effects on water quality. The lack of good quality water hinders economic development and the potential for long term sustainability.

Ammonia↗
PubMed1995

[Geographical distribution of physicians in Chile].

In 1994, Chile had 15,451 active physicians (less than 70 years old) for a population of 14,027,344 with a ratio of 1 physician per 908 inhabitants, a satisfactory figure compared to other countries of similar socio-economical development. Ratios of 1:880 and 1:843 are projected for 1999 and 2004 respectively. The annual rate of physician's population growth (2.2%), that is superior to the general population's growth rate (1.6%), will increase to about 2.5% per annum in 2001 as a consequence of the creation of three new medical schools. However, the distribution of physicians along the country is unsatisfactory. While the capital (Metropolitan Region) has a ratio of 1 physician per 629 inhabitants, the figure for the Region of Maule is 1:2,113. Only two of ten regions, excepting the capital, have a ratio lower than 1:1,000. Sixty percent of physicians live in Santiago while only 40% of the general population does so, illustrating their high concentration. Median ratio in Chile, that better reflects the reality than the mean, is 1:1,280. The heterogeneous distribution of physicians in Chile is a sign of social inequity that must be corrected. In a free society a better physician distribution is achieved with economical and professional incentives given by health institutions.

Chile↗
PubMed1987

The control of malaria vectors in the context of the Health for All by the Year 2000 Global Strategy.

The changing picture of malaria worldwide needs to be viewed in the context of other developments before we can determine the directions to take to be able to provide the thrusts required in malaria vector control. As a result of population growth, increasing urbanization and continuing pressure on scarce natural resources, the epidemiology of malaria and its manifestation as a public health problem are undergoing profound modifications, indeed in several parts of the world. This picture is further complicated by the spread of resistance to pesticides in the vector and to drugs in Plasmodium falciparum. In the immediate future, these trends will continue. In addition, the appearance of suitable vaccines is a highly probable event to be taken into consideration. The WHO Global Strategy of Health For All by the Year 2000 aims at the improvement of levels of health through primary health care. Among other things, this implies a greater reliance on community involvement and on intersectoral collaboration for health. In this light, the major malaria problems in the year 2000 will be: (1) "hard core" endemic areas with inadequate infrastructure and poor socio-economic development; (2) resource development areas, in particular those under illegal or poor controlled exploitation; (3) expanding urban areas and (4) increased mobility of non-immunes, particularly if uncontrolled. In order to cope with these problems, thrusts are required towards the development of vector control strategies, covering the following fields: (1) tools for vector control integrated in primary health care, (2) new chemicals, (3) improved and new biologicals, (4) environmental management and the adoption of health safeguards in resource development projects and (5) manpower development.

Animals↗
PubMed1993

The health status of women in the world-system.

The health status of women is examined within the context of a global political economy. The authors present a beginning attempt to model some key macrolevel processes linked to the health of women. In particular, a structural modeling technique known as LVPLS (or "soft modeling") is used to empirically test one recent formulation of world-system theory. The findings give added emphasis to the importance of the larger economic forces that affect women's health.

Economics↗
PubMedDate not supplied

Epidemiology of childhood burn injuries in Fars province, Iran.

Childhood burn injuries are a major environmental agent responsible for significant morbidity and mortality in Iran. Thus, the objective of this study was to analyze the epidemiology and current causative factors of hospitalized burn injuries among the approximately 1.6 million children between the ages of birth through 15 years residing in the Fars province of Iran. These data will be used as a basis for developing a targeted preventive program to protect children from burns. Epidemiologic data for 760 children, aged 0 to 15 years, admitted to the two burn centers of Shiraz University of Medical Sciences, over a 4-year period, 1994 to 1998, were collected and analyzed. The overall hospitalization rate was 11.8 per 100,000 person-years (PY). The sex ratio (boys/girls) was 1.38. About 60% were children aged 7 years or younger. Children aged 2 years had the highest burn incidence rate (36.9/100,000 PY). A total of 77.4% of the children had body surface area burns less than 40%. Scalds accounted for 46.2% of the burns, whereas 42.9% were caused by flame. Most of the burn injuries occurred at home (93%). There were 31 burns from suicide attempts among children aged 11 to 15 years (1.4/100,000 PY), showing a major public health problem for these children in our society. During the period of the study, 131 children died of the consequences of burns (2/100,000 PY). The epidemiology of childhood burn injuries in the Fars province is similar to that reported in other economically developing countries. It is suggested that a public health education campaign on this issue would help to reduce the incidence of childhood burn injuries in this region.

Adolescent↗
PubMed2003

Population ageing in the Balkan countries.

INTRODUCTION: As we enter the third millennium, we are witnessing an unprecedented rapid expansion of the population of older persons in both the developed and developing world. The total worldwide aged population (aged 60 and older) is projected to rise from 605 million in 2000 to 1.2 billion in 2025 and to nearly 2 billion in 2050. AIM: To study the process of population ageing in Bulgaria and Balkan countries and to reveal its main characteristics, similarities and differences as compared to other European countries. MATERIAL AND METHODS: Primary information was obtained from the European Database "Health for all", the European Public Health Information Network for Eastern Europe and the US Census Bureau International Database. Total, male and female old and youth dependency ratios and ratio of people over 65 to 0-14 years were calculated and trends were followed for 30 years. Countries were ranked and compared with Europe and East European countries. RESULTS: From 1970 to 1999 the old dependency ratio increased dramatically in Bulgaria (14.2-23.6%), Greece (17.2-24.7%), Romania and Slovenia. The ratio of old to young people surpassed 100% in Greece (107.3%, for female 122.6%) and in Bulgaria (99.7% and 116.8%, respectively). Albanian and Turkish populations differ substantially from the other Balkan countries. DISCUSSION: Population ageing creates great socio-economic and health problems--slower economic growth, lack of young labour force, higher tax charges on working-age population, etc. The process in Balkan countries is aggravated by the rise of inflation, unemployment and other socio-economic factors. CONCLUSION: All Balkan countries face multiple challenges posed by population ageing. Most of them experience the same demographic tendencies as for market economy countries even though their economic development is far worse. This is especially true for Bulgaria.

Adolescent↗
PubMed2003

Environmental health in Egypt.

Egypt shares most of the environmental problems of developing countries. One of the most important health and environmental problems is air pollution resulting from using fuel, burning operations, and the increase of automobile exhaust in cities. Moreover, the deficiency of efficient sanitation services and water pollution caused by the breaking down of old and consumed water networks, as well as the various problems in construction, designing and maintenance of sewage system resulted in the appearance and prevalence of communicable and non-communicable diseases. There are several examples of exposure to chemical genotoxicants, and lifestyle exposures in the population, which create unique combinations of environmental risk factors for diseases such as cancer. Environmental factors may interact with infection and lead to enhancement of carcinogenicity processes. Currently, there is a growing interest in environmental mutagenicity and carcinogenicity research. The use of different biomarkers and genetic susceptibility testing can contribute effectively to risk assessment. The Government of Egypt recognizes and deals seriously with these problems. The State Ministry of Environment has initiated new policies that include risk minimization, law enforcement, treatment of pollution at source, mitigation procedures and inter-sectorial collaboration. The Ministry of Health and Population recognized the link between economic development, environment and health. It elaborated a national environment health strategy in accordance with the format of the regional and global environmental health policy. This strategy identified priority areas, which requires further action to be taken and to be implemented. Environmental health was included as one of the four main objectives of the strategic Healthy Egyptians 2010 Initiative. Specific objectives and plans for the initiative are presented.

Air Pollution↗
PubMed2002

The practice and challenges of solid waste management in Singapore.

This paper presents an overview of the current solid waste management situation in Singapore and provides a brief discussion of the future challenges. Singapore is a small island city-state with a large population, warm climate and high humidity. Over the past two to three decades, rapid industrialization and economic development have caused a tremendous increase in solid waste generation. The yearly disposed solid waste increased from 0.74 million tonnes in 1972 to 2.80 million tonnes in 2000. Solid waste management in Singapore has traditionally been undertaken by the Ministry of Environment (ENV), with the participation of some private sectors in recent years. The hierarchy of solid waste management in Singapore is waste minimization (reduce, reuse and recycle or so-called 3 Rs), followed by incineration and landfill. As land is extremely scarce and only one newly constructed offshore landfill site is available, solid waste incineration has been identified as the most preferred disposal method. Waste minimization, the utilization of incineration ashes, industrial waste management are regarded to be the major challenges in the future.

Economics↗
PubMedDate not supplied

Socio-demographic variables and family health: A prospective study of a Katcha in north-central Nigeria.

BACKGROUND: Healthy families are vital prerequisites for a stable society and economic development of the community. The health status of families and communities is influenced by several socio-demographic variables such as educational status, marital pattern and gender relationships. The objective of this study is to examine the effect of certain socio-demographic variables on the health status of a rural community in Northern Nigeria. METHOD: A prospective survey over a six month period, which commenced in May 2005, was done in rural primary health care centre in Katcha local Government area of Niger state. All consecutive parents either male or female of children seeking care in the health center who gave consent to participate in the survey were recruited. A structured researcher administered questionnaire was used in sourcing data. Data was analyzed using Microsoft Excel version 2003. RESULTS: A total of 608 parents comprising 302 (49.67%) male and 306 (50.33%) females (M: F = 1:1.01) were surveyed. Of these 78.48% females were uneducated compared to only 41.83% males. While most males were gainfully employed, 20.86% of females were full time housewives. Polygamy was the predominant marital pattern. The findings indicate that women in the community were socially disadvantaged compared to males. CONCLUSION: There is a significant socio-economic gap which puts females at a disadvantage in the rural community surveyed. Bridging this Socio-economic gap between men and women in rural communities will help improve the health status in our rural communities.

Adult↗
PubMed2005

Changes in access to health care in China, 1989-1997.

The post-1979 period in China has seen the implementation of reforms that dismantled much of the Maoist era social welfare system and permitted a significant reallocation of society's resources. The result has been rapid but uneven economic development that has profoundly altered the environment within which consumers make health investment decisions. Many studies report significant and apparently non-random reductions in health care utilization during this period. Scholars have tended to focus on the loss of insurance coverage and the growth of fees for services in explaining such reductions. An alternative explanation is growing inequality in access to care. This possibility has not received much research attention. As a result, our understanding of the patterns of changes in health care access, and of the types of populations that have been most adversely affected, has been rather limited. This research examines the distribution of the changes in several indicators of access to health care across communities during the period 1989 to 1997. We find evidence of relatively uneven changes to these indicators. Money charges for routine services increased consistently, though this trend was less pronounced in lower-income communities. Most communities experienced reductions in travel distance to clinics but increases in distance to hospitals. There were major improvements to the quality of care in wealthier rural areas, but not in poorer villages. Wealthier villages experienced less improvement in waiting time and drug availability. These trends appear to be closely associated with changing economic circumstances during the reform era.

China↗
PubMed1999

Infant and child growth and fatness and fat distribution in Guatemalan adults.

To examine whether poor growth in utero or young childhood is associated with adult abdominal fatness in a developing country context, the authors analyzed prospectively collected data on 372 female and 161 male Guatemalans measured as children between 1969 and 1977 and remeasured as adults in 1988-1989 (men and women) and 1991-1994 (women only). Childhood stunting (height-for-age z score) was associated with a lower body mass index and percent body fat in men, while no associations were found in women. In both sexes, however, severely stunted children had significantly greater adult abdominal fatness (waist:hip ratio), once overall fatness and confounders were controlled. The adult waist:hip ratio (x100) was increased by 0.65 (95% confidence interval 0.10 to 1.20) in men and 0.29 (95% confidence interval -0.03 to 0.61) in women for each height-for-age z score less at age three. Migration to urban centers was significantly associated with an even greater waist:hip ratio in severely stunted females (p = 0.03). In a subsample of 137 women, short and thin newborns had significantly greater adult abdominal fatness compared with long and thin or short and fat newborns or children who became stunted postnatally. The adult waist:hip ratio (x100) was increased by 1.58 (95% confidence interval 0.35 to 2.81) for each kilogram less birth weight. The authors conclude that, in countries where maternal and child malnutrition exists alongside rapid economic development and urban migration, abdominal obesity and related chronic diseases are likely to increase.

Adult↗