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PubMed1986

Mortality transition in Korea: its implications for health policy and education.

This paper discusses the progress and prospects for mortality reduction in Korea, drawing upon the scanty data available in the literature. Data suggest that recent mortality improvement in Korea is slowing; that male mortality patterns at older ages are deviating from model life tables: that infant and child mortality is relatively high; and that transitional changes in the cause-of-death structure of infants and children are lagging behind their elders. Implications of these trends form a principal basis for concern about health policy issues in Korea. Any continuing progress in mortality would require major effort in several areas: accurate and adequate assessment of disease patterns and health behavior; reexamination of current health care strategies and public health measures; and analyses of social and economic development policies relevant to health conditions.

Adolescent↗

PubMed1991

Health care expenditure and mortality from amenable conditions in the European Community.

This paper addresses the question whether within the European Community a higher national level of health care expenditure is associated with a larger degree of success in eliminating mortality from preventable and curable conditions. An aggregate measure of mortality from 12 amenable conditions was derived, incorporating an adjustment for the level of socio-economic development. In 1980-84, between country variation in this measure was almost 2-fold and showed surprising patterns. Rates are relatively low in Greece, The Netherlands and Denmark, and relatively high in Portugal, Italy and Germany. There was no association at all between this measure and the level of health care expenditure. These disturbing findings, which suggest substantial variation in the cost-effectiveness of different health service systems, warrant further investigation.

Cause of Death↗

PubMed1991

Long term care: the case of the elderly.

Health care for the elderly in industrialized countries has been characterized by a variety of persistent myths, nurtured by an amazing blindness for facts, and pertaining to their number, the related morbidity, the models of care, the unbearable costs and the financial situation of the elderly. Today a more optimistic perspective about the elderly is emerging emphasizing an older person with a remarkable physical and mental fitness and living in satisfying housing and income conditions. There is a less alarming prognosis about the increase of the elderly population and the share of elderly in the increase of health care budgets seems to be incremental. A wide spectrum of models of care has unfolded over Europe and the plausible explanations for the differences relate to the North-South gradient, the cultural patterns, the history of the health care system and the level of economic development. Europe is focusing on community care: in northern Europe to substitute for institutional care and in southern Europe as a response to changing family patterns. There is a danger of overshooting with policies for the aged, but more than special attention is to be given to the vulnerable risk groups which are the octogenarians, suffering from dementia and poor in housing assets.

Aged↗

PubMed1986

Current approaches to malaria chemotherapy and prophylaxis.

Malaria continues to be one of the most serious and widespread parasitic diseases, still occurring in over 100 countries despite concentrated efforts to eradicate it from many regions. Sixty-one countries now report their malaria cases to the WHO, and the latest analysis of these figures' shows little improvement in the overall problem during the last 15 years. Some countries, notably India and China, continue to report downward trends, but the problem continues to deteriorate in rural areas where intense economic development is taking place, particularly in Asia and the Americas. In 1984, 5.3 million cases of malaria were reported to the WHO. This is believed to represent but a small fraction of the total number because, for example, 38 of the tropical African countries do not report their malaria cases. Estimates based on the degree of malaria endemicity suggest a total incidence o f around 100 million cases annually. Chloroquine-resistant falciporum malaria has been confirmed in more than 40 countries, often showing cross-resistance to other drugs, and attempts to combat resistance using combination drugs have led to disturbing reports of side-effects as well as multidrug resistance. Vector control is also impaired in many areas due to insecticide resistance. Faced with these problems, we asked Dr Walther Wernsdorfer, head of the WHO Malaria Action Programme, what is the current WHO philosophy of malaria chemotherapy and prophylaxis?

Journal Article↗

PubMed1987

The impact of small dams on parasitic diseases in Cameroon.

Economic development in Africa implies the provision of vast, sparsely populated regions with improved road networks and agricultural techniques. Climatic constraints mean that control of water resources is essential in arid areas. But hydrogrophic modifications also have the potential for adverse impact on the health of local populations. The extension of water sources and their all year round supply of water mean that people are attracted towards them, and to the same places where conditions favour the spread of intermediate hosts and vectors of parasitic diseases such as schistosomiasis, onchocerciasis, drocunculiasis and malaria. Doctor, epidemiologists, and the engineers involved in rural earth-works must therefore work together to establish systems that impede the transmission of such diseases. Examples from the Cameroon typify the need for such an approach.

Journal Article↗

PubMed1991

Control of tsetse flies and trypanosomiasis: Myth or reality?

The African trypanosomiasis are among Africa's most devastating diseases. The human disease, sleeping sickness, and the animal disease, nagana, are caused by trypanosomes, protozoan parasites transmitted by tsetse flies, Glossina spp. Attempts have been made to control tsetse and trypanosomiasis for over 70 years, supported by ever-increasing amounts of foreign aid. Although progress has been made in the control of sleeping sickness, this disease still persists in many countries. Nogono excludes cattle from many of the potentially most productive areas of Africa and is a major constraint on economic development. In this paper, Robert Dransfield, Brian Williams and Robert Brightwell review the control of tsetse and trypanosomiasis in the light of recent progress in our understanding of tsetse population dynamics, with special reference to the experience gained in tsetse control on a Maasai ranch at Ngurumon in the Rift Valley of Kenya, and make suggestions for the management and funding of future control programmes in relation to rural development.

Journal Article↗

PubMed1982

Comparative studies of health care systems.

This paper reveals the dynamics of hierarchical medical pluralism through a comparative analysis of the health care systems in three Chinese societies (the China mainland, Taiwan and Hong Kong). It is argued that the hierarchical relationships among medical traditions within a national society should be studied in terms of structural superiority (power, prestige and wealth) and functional strength (distribution and utilization) and should be understood in the context of modernization. The world-wide movement of modernization through science has made scientific biomedicine become structurally superior to other medical traditions in virtually every contemporary society but its functional strength varies with the society's political-organizational and economic development. The national will to modernize through science has also resulted in many alternative traditions being increasingly absorbed into the scientific biomedical sector. The various efforts to revive alternative remedies may turn out to facilitate the process of both technical and organizational absorption by scientific biomedicine.

China↗

PubMed1983

Planning priorities and health care delivery in Nigeria.

Economic development had grave as well as beneficial effects on the health of a nation. While it might enhance health standards through better prevention, diagnosis and treatment of diseases, it could endanger health via new eating habits and a tempo of life not conductive to healthy living. These effects of development necessitate rational health planning, the main ingredients of which are manpower planning, physical planning to ensure an even and equitable distribution of medical facilities between urban and rural localities, measures to integrate traditional and orthodox medical practices and financial planning to ensure an adequate allocation of funds to the health sector. In spite of official declarations of intentions to effect a comprehensive health coverage for Nigeria, financial allocation and planning priorities have failed to reflect this. Planned capital expenditure for the health sector has consistently hovered around the 2% mark, only attaining 4.6% in the second development plan, 1970-1974. This low priority accorded the health sector manifests itself in inadequate medical manpower, facilities and coverage of the population by modern medical services. Meeting the health needs of the Nigerian population requires a substantial financial allocation, the integration of modern and traditional medical practices and the reorganisation and improved management of medical facilities.

Delivery of Health Care↗

PubMed1983

Malnutrition and pregnancy wastage in Zambia.

An analysis of recent nutritional status and dietary surveys in Zambia reveal a widespread prevalence of malnutrition. Pregnant women suffer from serious protein inadequacy. Variations in the nutritional status of the population is shown to vary with respect to different ecological conditions and to the level of socio-economic development within each province. Because of the interdependence between the nutritional health of the mother and the outcome of pregnancy, there is reason to believe that the prevailing malnutrition among pregnant women may be responsible, not only for lower birth weight and congenital malformations, but also, for increased maternal and perinatal mortality and morbidity in Zambia. Long-term solutions lie in the integration of nutrition concerns into sectoral development strategies; a commitment to reduce existing income disparities between the rural and urban areas; and innovative attempts to improve the efficiency of rural health institutions in the country.

Female↗

PubMed1987

Health sector structures: the case of Poland.

A 'portrait' of the health system in Poland is presented in the context of Polish historical, political, cultural and socio-economical developments. As a sensitive indicator of overall societal functioning, the health system suffers from the grave systemic pathologies which are reflected in petrified, rigid structures, a continuous underfinancing and underinvestment, and a lack of adequate information. It is argued that: several problems of the Polish health system are characteristic of industrialized countries; the National Health Care in Poland bears more responsibilities than the National Health Care in Britain; the Polish health system deserves special appreciation for its desperate coping in the most difficult situation.

Female↗

PubMed1988

Obstetric care in The Netherlands: regional differentiation in home delivery.

In this paper attention is focused on home delivery in the Netherlands, which still accounts for 36% of the total number of births delivered. Compared to countries with a similar level of socio-economic development, home delivery plays an important role within Dutch obstetric care. To understand this unique situation, one needs to have insight into the organization and structure of Dutch obstetric care which is described in the first part of this paper. In the second part of this paper regional differentiation in the relative importance of home delivery is described. Finally regression analysis is used in order to explain the observed regional pattern. A brief abstract from the vast amount of Dutch literature on the discussion between advocates and adversaries of home delivery is included in an appendix.

Delivery, Obstetric↗

PubMed1989

Women, household and health in Latin America.

Although recent studies have identified some of the links in Latin America between uneven capitalist economic development and health, the impact of development on either the health of women or on household health is still largely unknown. This account identifies several areas of needed research. It focuses on how changing women's roles and patterns of domestic production affect women's reproductive behavior, and the consequences of these changes for the health of women and other members of their households.

Family↗

PubMed1989

Infant mortality and health care in Mexican communities.

Data from the 1976-77 Mexican Fertility Survey show a high degree of correlation among community background characteristics, access to medical services and utilization of health care in a sample of 125 localities. All of these factors are related to infant mortality at the bivariate level. Use of prenatal and infant health care, but not proximity to medical personnel and facilities, is found to affect infant survival independently of the community's degree of socio-economic development. The findings point to the need to employ separate measures of medical access and health utilization.

Adolescent↗

PubMed1990

How significant are the spatial configurations of health care systems?

After briefly reviewing some of the problems of examining 'the spatial', this paper sets out to demonstrate the importance of examining spatial configurations of health care systems. It isolates major ordering principles for understanding such systems, namely the level of economic development, political structure and ideology, and allocational mechanism. It then assesses the role of 'the spatial' in terms of system differentiation (e.g. availability, accessibility, types of care) and as confounding or modifying the impact of the major ordering principles or ideal-typifications. It concludes by suggesting that while the role of the spatial may vary from high or low (or no) significance, it should not be ignored. The combination of spatial and societal configurations in specific or comparative analyses must be undertaken cautiously.

Allied Health Personnel↗

PubMed1993

Demographic variables in fetal and child mortality: Hmong in Thailand.

Conventional theories would not predict the 60% decline of infant mortality which has occurred among the Hmong population of Thailand, from 123/1000 in the mid-1960s to 48 in the mid-1980s. The Hmong population in northern Thailand has sustained high fertility and low use of modern health services. Most Hmong live in relatively remote rural villages and earn their living by self-employed farming. They have low levels of education, especially for women. They live in multi-generational patrilineal-patrilocal extended family households. Women's status is low. These characteristics contrast strongly with the majority ethnic Thai population, among whom a comparable mortality decline has been accompanied by widespread use of family planning, rapidly declining fertility, widespread use of modern health facilities, rapidly increasing levels of education for both sexes, rapid economic development, and a predominance of nuclear-based family households. Distributions of Hmong pregnancies by birth order and maternal age have remained relatively constant while fetal and young child death rates have declined for each level of parity and all maternal ages in recent cohorts. As predicted by conventional theories, infant mortality rates are highest among higher order births and for births to mothers of the highest ages, however there is relatively little effect on risk of infant mortality of first order pregnancies, or births to very young (10-14 year old) women. Fetal and infant mortality have declined steadily in recent cohorts at each parity level and all maternal ages. Modern medical care and decline in a surplus of female deaths associated with low status of women might explain the declines in fetal and child deaths regardless of parity or maternal age. Use of modern medical care for delivery is recent and accounts for less than 10% of all recent Hmong births, but survival rates are not consistently or significantly higher for children born with a modern birth attendant. Sex-specific mortality rates calculated from reproductive histories show no surplus of female deaths in the past, but females have benefitted more from recent mortality declines than males. Ethnographic evidence suggests that Hmong have customs which act to protect the health of mother and child ('chicken soup theory'), and that they are predisposed to accept innovations (including use of modern medicine) which they see as beneficial. This may allow them to respond especially quickly to small opportunities for improving their children's survival, as compared with other ethnic groups.

Birth Order↗

PubMed1995

Flows of social support and health status among older persons in China.

As a consequence of the political, social, and economic developments in contemporary China, there have been considerable changes in the patterns of flows of social support between Chinese older people and their significant others. There is evidence that Chinese elders are now under strong pressure to provide more social support, instrumental support in particular, to their children and other relatives while they receive less. Such a change in the direction of flows of social support has been reported to worsen the elders' health. This paper describes the general pattern of social support both to and from the Chinese elders, using data of a probability sample survey conducted in Wuhan, China in 1991. The association between social support, both receiving and providing, and old-age health status is also analysed within a multivariate framework. The results of two probit models suggest that emotional support received plays a crucial role in affecting an elder's health status, while instrumental support received does not have explicit impacts. In addition, there is no empirical evidence that increased instrumental support from elders has worsened their health status as reported.

Adaptation, Psychological↗

PubMed1994

The prevalence of informal caregiving to persons with AIDS in the United States: caregiver characteristics and their implications.

Based on U.S. national (N = 2673) and central cities (N = 8263) probability samples, this paper: (1) presents estimates of the proportion of the United States population that has provided informal care to persons with AIDS; (2) identifies socio-demographic characteristics of 'typical' AIDS caregivers in the U.S.; and (3) discusses social, economic and health-related implications of informal caregiving to persons with AIDS. Results indicate that 5.0% of all adults age 18-75 living within central cities and 3.2% of the entire adult U.S. population have provided care to a friend, relative or lover with AIDS. Although caregivers are distributed throughout different age and ethnic groups, the majority of caregivers are younger (< 40 years) and white. Males, gay and bisexual men in particular are over-represented among central cities caregivers. Data on the types of caregiving tasks performed show that 64.4% of all caregivers within central cities perform domestic types of caregiving tasks, while 27.7% are involved in personal care of AIDS patients. Caregivers are more likely than non-caregivers to have been tested for HIV, and among the tested, caregivers are more likely to have tested positive. While informal caregiving reduces costs to the formal medical sector, costs to the caregivers themselves should be considered. Physical and emotional stress, as well as reduced opportunity for social and economic development, represent potential outcomes of caregiving. Socio-demographic characteristics of AIDS caregivers, such as their typically young age, suggest that these caregivers may be at particular risk for detrimental consequences.

AIDS Serodiagnosis↗

PubMed1994

Elderly support in rural and suburban villages: implications for future support system in China.

This study compares current elderly support between rural and suburban elderly, drawn from a 1987 and 1989 cluster sample involving 6 Chinese villages purposely selected to reflect geographic variations and different standards of living. The results of the study indicate that social support for the elderly through pension and subsidy is improving, particularly in suburban villages where there is greater level of economic development and there are increasingly more industrial enterprises. The current pension or subsidy status is mainly a function of the presence of well-developed economy (as represented by our proxy variables RURALITY, and PRIORJOB). In terms of family support, our study shows it serves largely as a substitute for social support. Elderly not receiving pension support are more likely to receive monetary support from their children. The implications of these findings are analyzed in the context of the socioeconomic and demographic transitions in China and alternative solutions to elderly support are discussed.

Aged↗