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The author presents some of the historical determinations of the policies of human reproduction in Brazil, placing them among other social policies. She argues that reproductive profile of the social classes depends upon not only the biological reproduction, but also upon the work power.
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As a result of the restrictive reproductive health policies enforced under the 25-year Ceausescu dictatorship, Romania ended the 1980s with the highest recorded maternal mortality of any country in Europe--159 deaths per 100,000 live births in 1989. An estimated 87 percent of these maternal deaths were caused by illegal and unsafe abortion. Under the Ceausescu regime, all contraceptive methods were forbidden and induced abortion was available only for women who met extremely narrow criteria. Immediately after the December 1989 revolution that overthrew Ceausescu, the new government removed restrictions on contraceptive use and legalized abortion. This legislative change has had beneficial effects on women's health, seen in the drop in maternal mortality in 1990 to 83 deaths per 100,000 live births--almost half the ratio in 1989. In addition, changes instituted since the revolution have led to the improved availability of reproductive health services and to the creation of new educational and training opportunities related to reproductive health services and to the creation of new educational and training opportunities related to reproductive health. The newly created contraceptive and abortion services have presented health system managers and policymakers with many challenges as they work to expand the availability of high-quality, comprehensive reproductive health care in a setting of economic hardship, political unrest, insufficient infrastructure, and outdated medical knowledge and practice.
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Hawaii has a long tradition of commitment to care of the seriously disabled mentally ill. Over the years, some of the more innovative programs and policies were initiated first by the Territory and then by the State to provide humane treatment of this special population in need.
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The East African Medical Journal which started in 1923 has now reached its 70th year. To what extent has the journal focused the attention of policy and decision makers on the most relevant problems of and solutions for Community Health in Eastern Africa? To answer this question this paper surveys the Journal's publications on Community Health in four eras into which the 70 years can be subdivided. It then tries to match these publications with what has been happening in the political field and in the development of health services related to community health. The conclusion is that the journal has, in this geographical region, been keeping pace with important trends and has been a stimulus to the development of improved and more relevant services for communities. Although the predominant focus has often been on publications based on clinical research in hospital settings, it is hoped that the journal will step up even further its publication of papers related to community health and Primary Health Care. By doing so it can make an even greater contribution to the health and well being of the populations of Eastern Africa and not just to the care of individuals who gain access to medical institutions.
The basic goal of nutrition strategy in the United States has been to ensure an adequate intake of all essential nutrients for the population. To achieve this goal, emphasis has been placed on human nutrition research, studies of the dietary and nutritional status of the population and its subgroups, and the expansion of federal programs to directly and indirectly enhance food consumption patterns, nutrient intake, and the health of the nation's citizens.
The purpose of the paper is to highlight issues related to deinstitutionalization and community care of the mentally ill by using a comparative approach. Through a comparison of the trends in the U.S.A. and Israel, an attempt is made to account for factors which promoted deinstitutionalization. The paper focuses on specific policies and programs which were crucial in reducing the rate of resident population in mental institutions and facilitating the development of community care for the mentally ill in the U.S. It points out the environmental conditions, social, political, legal and organizational, which may be conducive to legislative and administrative actions in order to facilitate deinstitutionalization.
In the decades immediately following World War II a strong coalition of professionals and reformers emerged to shape agendas, debates, and national policy on caring for the mentally ill. The heterogeneity of mental health problems, the demographic shifts in populations at risk, and the realities of designing and implementing effective programs, were often overlooked; yet profound elements of change have taken place. Components essential for maintenance of function and rehabilitation have yet to be linked into a responsible alternative to long-term or episodic hospital care.
Statements regarding the absence of suicidal and other self-harmful behaviour among Australian Aborigines are now untenable. The preceding paper presented the wider context of suicides in custody by examining suicide and other self-harmful behaviour in the Aboriginal population of the Kimbereley region of Western Australia. The emergence of suicide in that population was further located within an increase in deaths from non-natural causes over the last two decades. Following a brief history of the region, this paper develops an even wider context--suicidal behaviour among indigenous groups elsewhere. The relevance of these findings to the trends among Kimberely Aborigines is explored, leading to the central theme of the paper, the importance of an understanding of the socio-historical context in evaluating emerging patterns of harmful behaviour, and their relationship to alcohol use. Results obtained during a survey of the patterns and consequences of alcohol use from a stratified random sample of 516 Kimbereley Aborigines are presented. The author concludes by using the behaviours described in this and the preceding paper to examine the way in which Aboriginal 'problems' are constructed by the wider society, and 'solutions' defined.
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This article is an examination of the nature and extent of the problem presented by medically uninsured children in the United States. First, the characteristics of the uninsured population are explored with a description of how age, family income, and employment status disproportionately affect families with children. Second, the Medicaid program and its historically inadequate response to this growing problem of uninsured children is examined. Third, the relationship between insurance status and the health and development of children is discussed. Finally, recent public policy initiatives that have been enacted or proposed to address this inequity in the present health care system are reviewed with a recommendation to establish a "Universal Maternal and Child Health Program."
This paper traces the development of the US federal government's program to provide personal and public health services to American Indians and Alaska Natives since the 1940s. Minimal services had been provided since the mid 19th century through the Bureau of Indian Affairs of the Department of the Interior. As a result of attempts by western congressmen to weaken and destroy the bureau during the 1940s, responsibility for health services was placed with the US Public Health Service. The transfer thus created the only US national health program for civilians, providing virtually the full range of personal and public health services to a defined population at relatively low cost. Policy changes since the 1970s have led to an emphasis on self-determination that did not exist during the 1950s and 1960s. Programs administered by tribal governments tend to be more expensive than those provided by the Indian Health Service, but appropriations have not risen to meet the rising costs, nor are the appropriated funds distributed equitably among Indian Health Service regions. The result is likely to be an unequal deterioration in accessibility and quality of care.
The development of psychiatry in Carinthia is described in its sociological context. There appears to be a correlation between the self-esteem of the population and its attitude to fellow human beings with psychomedical problems. Responsible social policy is important in constellations in which anxiety, power and cynicism are latent owing to major emotional conflicts.