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PubMed1999

Reversal in mortality trends: evidence from the Agincourt field site, South Africa, 1992-1995.

OBJECTIVE: To examine changes in mortality in rural South Africa over the period 1992-1995 by age, sex and cause of death. DESIGN: As with much of sub-Saharan Africa, South Africa lacks effective vital registration and information on mortality is lacking. The Agincourt demographic and health surveillance system was established to inform health policy and practice with regard to rural subdistrict populations. METHODS: Prospective community-based study involving annual update of a household census with enquiry into all birth, death and migration events. All reported deaths (n = 1001) are the subject of a verbal autopsy. RESULTS: An increasing trend in overall mortality relative to general population growth in the study area is apparent. There is evidence for a reversal in the previously declining trend in mortality among women 20-44 years. A comparison of 1992-1993 with 1994-1995 shows that most of the increase in mortality is concentrated in the younger adult (20-49 year) age group. AIDS and related diseases, particularly tuberculosis, appear primarily responsible. Injuries and violence (especially homicide) and circulatory disease are important, under-recognized causes of death, although their levels have remained constant over the period. CONCLUSIONS: Mortality from AIDS and related diseases appears responsible for the probable reversal in mortality emerging in South Africa's rural northeast. Findings carry implications for the emerging system of decentralized health care.

Acquired Immunodeficiency Syndrome↗
PubMed2006

From slavery to incarceration: social forces affecting the epidemiology of sexually transmitted diseases in the rural South.

The high rates of sexually transmitted diseases (STDs) in the southeastern United States have been shaped by historic and contemporary social forces. More than other regions of the country, the South was defined by slavery, an extremely hierarchical relationship between whites and blacks. Emancipation left much of the racial hierarchy intact with whites as farm owners and blacks as hired workers or sharecroppers. Agricultural policies that favored mechanization caused blacks to leave farm work and move into segregated towns, leading to the advent of the rural ghetto. Post-World War II mass migration, mostly by young men, to the industrial north altered the sex ratio and social capital of the southern towns left behind. The cocaine epidemic of the 1990s, followed by the high incarceration rates of the "War on Drugs," disproportionately affected low-income blacks. Each of these forces led to sexual and care-seeking behaviors that favor transmission of STDs.

Ethnicity↗
PubMed2006

Access to health care for migrants returning to Mexico.

Continued migration from Mexico over the past several decades has created a large population of elderly Mexicans in the U.S. There is no system in Mexico for those Mexicans who would like to retire there to obtain health insurance during their retirement years. Using a nationally representative dataset of Mexican elders, we explore the current state of health insurance status for Mexican elders with a history of migration to the U.S. We find a robust negative association between years spent in the U.S. and the probability of being insured. Coordination between the U.S. and Mexico on policy options to insure Mexicans migrants may prove beneficial to the social security systems in both countries as well as to migrants themselves.

Aged↗
PubMed1977

The impact of colonialism on health and health services in Tanzania.

This article is about the problems of malnutrition and disease in a rural area of an underdeveloped country, Tanzania. The particular way in which health problems were conceptualized during the colonial era, the structure of the medical services established, and the effects of health care on the health status and size of the rural population of Songea District in Tanzania are shown in the article to have been determined by the economic, social, and political requirements of German and British colonial rulers rather than by the health needs of the African population. Colonial economic policy emphasized the production of cash crops for export, whether by African peasant farmers or by European plantation owners. To provide workers for the plantations, a system of labor migration was instituted. Songea District became an area that supplied male workers to other parts of the country, with grave consequences to the health and nutrition of the women and children left behind. Domestic food production was neglected by Africans forced to migrate in search of cash to pay taxes and by those enganged in the cultivation of cash crops. Extensive malnutrition and persistent ill health related to poor diet are thus traced directly to capitalist underdevelopment of th Tanzanian economy and the structural distortions of a dependent relationship between Tanzania and the metropolitan power.

Adolescent↗
PubMedDate not supplied

[The World Health Organization and the development of human resources of the health system].

Health workforce is among the main components of the health care system. The performance of the latter depends on the knowledge, competence and motivations of the various categories of health workers. The task of the World Health Organization is to analyze the main problems related to health workforce and to help member-states overcome these problems. An other task is to facilitate intercountry comparisons. To attain these objectives, WHO has developed a conceptual framework, taking into account elements such as the labour market, the health care system, the policies and macro-factors (economic, socio-demographic). Among the main issues related today to health workforce, one can quote: the numbers and distribution of health workers, their migration, their involvement into the field of public health, the contents of their training, and, finally, the increased risk factors they are challenging.

Career Mobility↗
PubMed1988

Establishment of National Manpower Commission, August 1987.

In August 1987, the Prime Minister of Pakistan established a National Manpower Commission to undertake analysis and the determination of the dimension of unemployment in Pakistan and make recommendations on both short- and longterm policies for dealing with this issue. The Commission was established because of special problems arising from the emigration of Pakistani workers to foreign countries and the new phenomenon of reverse migration as a result of the changing pattern of labor demand in the Middle East and other countries.

Asia↗
PubMed2004

Unhealthy landscapes: Policy recommendations on land use change and infectious disease emergence.

Anthropogenic land use changes drive a range of infectious disease outbreaks and emergence events and modify the transmission of endemic infections. These drivers include agricultural encroachment, deforestation, road construction, dam building, irrigation, wetland modification, mining, the concentration or expansion of urban environments, coastal zone degradation, and other activities. These changes in turn cause a cascade of factors that exacerbate infectious disease emergence, such as forest fragmentation, disease introduction, pollution, poverty, and human migration. The Working Group on Land Use Change and Disease Emergence grew out of a special colloquium that convened international experts in infectious diseases, ecology, and environmental health to assess the current state of knowledge and to develop recommendations for addressing these environmental health challenges. The group established a systems model approach and priority lists of infectious diseases affected by ecologic degradation. Policy-relevant levels of the model include specific health risk factors, landscape or habitat change, and institutional (economic and behavioral) levels. The group recommended creating Centers of Excellence in Ecology and Health Research and Training, based at regional universities and/or research institutes with close links to the surrounding communities. The centers' objectives would be 3-fold: a) to provide information to local communities about the links between environmental change and public health; b) to facilitate fully interdisciplinary research from a variety of natural, social, and health sciences and train professionals who can conduct interdisciplinary research; and c) to engage in science-based communication and assessment for policy making toward sustainable health and ecosystems.

Agriculture↗
PubMed2004

Estimating the stability of census-based racial/ethnic classifications: the case of Brazil.

This study presents a method of estimating the degree to which people change their racial/ethnic identity from one census enumeration to another. The technique is applied to the classification of skin colour in Brazil (white, black, brown, yellow). For the period 1950-80, the findings show a deficit of 38 per cent in the black category and a gain of 34 per cent in the brown category, suggesting that a large proportion of individuals who declared themselves black in 1950 reclassified themselves as brown in 1980. Estimates for 1980-90, adjusted for the effects of international migration, reveal a similar pattern, although the magnitude of colour reclassification may have declined somewhat during the 1980s. Procedures to determine the stability of racial/ethnic identity produce data useful to recent policy initiatives that rely on demographic censuses to measure changes in the status of minority groups in less developed countries.

Brazil↗
PubMed1998

An evaluation of partner notification for HIV infection in genitourinary medicine clinics in England.

OBJECTIVE: To evaluate the feasibility and effectiveness of a standardized HIV partner notification programme within genitourinary medicine clinics in England. DESIGN: A prospective survey of HIV partner notification activity over a 12-month period. SETTING: Nineteen genitourinary medicine clinics in England. PATIENTS AND PARTICIPANTS: A total of 501 eligible HIV-positive patients (either newly diagnosed or with whom partner notification had not been undertaken previously) seen during the study period. MAIN OUTCOME MEASURES: The numbers of partners named by patients, and the number of contacts notified, counselled and HIV-tested. RESULTS: Information on overall partner notification activity was obtained by reviewing available medical records of 471 patients; 353 (75%) had discussed partner notification with a health-care worker during the study period and 197 (42%) had undertaken partner notification. Detailed information on outcomes was obtained for only 70 patients who named 158 contacts as being at risk of acquiring HIV. Although 71 (45%) contacts were eventually notified, only 28 were subsequently seen in participating clinics. Almost all contacts (n = 27) requested HIV counselling and testing, and five were diagnosed HIV-positive. Patient referral was the most popular notification method chosen. CONCLUSIONS: This study illustrates some of the practical difficulties that limit HIV partner notification within genitourinary medicine clinics. These include health-care workers' misgivings about undertaking partner notification, insufficient locating information to identify contacts, and migration of newly diagnosed patients, which prevents continuity and completion of notification. Nevertheless, HIV partner notification uncovered previously undiagnosed HIV infections. Further work needs to be undertaken in staff training and policy implementation if higher rates of partner notification and outcome measurements are to be achieved.

Adolescent↗
PubMed2004

Plumbing the brain drain.

Opportunity is the driving force of migration. Unsatisfied demands for higher education and skills, which have been created by the knowledge-based global economy, have generated unprecedented opportunities in knowledge-intensive service industries. These multi-trillion dollar industries include information, communication, finance, business, education and health. The leading industrialized nations are also the focal points of knowledge-intensive service industries and as such constitute centres of research and development activity that proactively draw in talented individuals worldwide through selective immigration policies, employment opportunities and targeted recruitment. Higher education is another major conduit of talent from less-developed countries to the centres of the knowledge-based global economy. Together career and educational opportunities drive "brain drain and recirculation". The departure of a large proportion of the most competent and innovative individuals from developing nations slows the achievement of the critical mass needed to generate the enabling context in which knowledge creation occurs. To favourably modify the asymmetric movement and distribution of global talent, developing countries must implement bold and creative strategies that are backed by national policies to: provide world-class educational opportunities, construct knowledge-based research and development industries, and sustainably finance the required investment for these strategies. Brazil, China and India have moved in this direction, offering world-class education in areas crucial to national development, such as biotechnology and information technology, paralleled by investments in research and development. As a result, only a small proportion of the most highly educated individuals migrate from these countries, and research and development opportunities employ national talent and even attract immigrants.

Developed Countries↗
PubMed2004

Biodiversity conservation: climate change and extinction risk.

Thomas et al. have carried out a useful analysis of the extinction risk from climate warming. Their overall conclusion, that a large fraction of extant species could be driven to extinction by expected climate trends over the next 50 years, is compelling: it adds to the many other reasons why new energy policies are needed to reduce the pace of warming.

Adaptation, Physiological↗
PubMed1996

Anthill and other injuries: a case for mobile allied health teams to remote Australia.

Remote rural districts of Australia can continue to expect a loss of public services due to the low population density and migration loss. However allied health services such as physiotherapy, are cost-effective services that are in demand in remote Australia. This paper was derived from a report to the Rural Health Policy Unit of Queensland Health that granted funds for a mobile allied health team to visit the remote western shires of the Peninsula and Torres Strait health region. By presenting an outline of an unusual group of parochial occupational injuries it can be shown that there is indeed both a considerable demand for allied health services and these services can be provided to remote communities by a mobile remote outreach service for a reasonable cost.

Adult↗
PubMedDate not supplied

Taming the brain drain: a challenge for public health systems in Southern Africa.

In southern Africa, rapid out-migration of health professionals is compounding the problems of health systems already faced with budget constraints and the impacts of HIV/AIDS. These negative effects are unlikely to be offset by remittances from abroad. The same dynamics that affect the international migration of health professionals operate within nations, for instance as they move from public to private systems. "Push," "pull," and "stick" factors contribute to the migration. Some Canadian provinces have emerged as key destinations. The authors outline a program of research on how Canada and the international community might address the negative impacts of the brain drain. Policy options have been identified, but implementation may be complicated by provisions of GATS, fundamental economic disparities, and domestic political priorities.

Africa↗
PubMed2002

Acid deposition and integrated zoning control in China.

China's rapidly growing economy is coupled with the consumption of large amounts of coal. An energy mix dominated by coal and inefficient energy utilization processes have led to increasingly serious problems of acid rain and sulfur dioxide pollution. Moreover, trends in the emissions of acidifying air pollutants lead to predictions of a very serious acid deposition problem in the future. In the absence of mitigating actions, these trends foretell a future of increasingly detrimental impacts to ecosystems in China and, potentially, to ecosystems in neighboring countries. China has implemented a two control zone (TCZ) policy, resulting in the establishment of acid rain and sulfur dioxide control zones, in an attempt to implement a cost-effective approach to mitigating acid deposition problems. While some short-term successes have resulted from management actions associated with the TCZ policy, it is clear additional measures and new policy directions are needed to reverse worsening acid deposition problems in the long term. To this end the following recommendations are presented: adjusting the primary energy mix, placing a greater emphasis on abating the effects of acid deposition, concentrating pollution control on large point sources, implementing an emission permit system for coal-fired power plants, utilizing an integrated approach in designing and evaluating control measures, and developing a greater research capacity. Research strategies must be developed that will lead to: (1) an improved scientific understanding of the sources of acidifying pollutants, their associated migration patterns, and their impacts; and (2) an identification of cost-effective mitigating strategies for the entire country.

Acid Rain↗
PubMed1999

Lessons in environmental health in the twentieth century.

Environmental health has evolved rapidly in recent decades, drawing largely on new analytic technologies, advanced data acquisition and modeling, mechanistic studies in toxicology, and the conceptual framework of risk assessment. The latter combines toxicologic and epidemiologic data with improved techniques for quantifying exposure, producing estimates of risks from environmental hazards or conditions to selected target populations. The public and governments have become increasingly concerned with environmental health and quality. The major lessons have been (a) environmental-health scientists must participate in policy debates; (b) environmental health problems are exceedingly complex and require interdisciplinary research; and (c) environmental health is a global issue. The globalization of commerce, the untested impact of international trade agreements, increased migration, and especially increased population, have profound impact on the quality as well as availability of air, water, land, and food. Global atmospheric transport of pollutants and the effect on atmosphere and climate are two examples of globalization of environmental health.

Environmental Health↗