Health manpower requirements for the achievement of health for all by the year 2000 through primary health care. Report of a WHO Expert Committee.
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Community Health Centers↗
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Planning for change in a department of radiodiagnosis.
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Health Facility Closure↗
Amendment procedures can work.
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Health Plan Implementation↗
[Progress in occupational medicine and occupational pathology in Kazakhstan].
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Health Plan Implementation↗
Health promotion: Smoking control.
Cigarette smoking is the largest single preventable cause of illness and premature death in the United States. It is the major single cause of cancer mortality in the United States and is a causal factor for coronary heart disease and arteriosclerotic peripheral vascular disease; is associated with increased risk of coronary atherosclerosis; and is the most important cause of chronic obstructive lung disease. Cigarette smoking increases the risk of bladder, pancreatic, and renal cancer, and peptic ulcer disease. Maternal cigarette smoking during pregnancy causes: retarded fetal growth; an increased risk for spontaneous abortion, fetal death, and neonatal death; and, possibly, slight impairment of growth and development during early childhood. Cigarette smoking acts synergistically with oral contraceptives to increases the risk for coronary heart disease and some forms of cerebrovascular disease; with alcohol to increase the risk of cancer of the larynx, oral cavity, and esophagus; with asbestos and some other occupationally encountered substances to increase the likelihood of cancer of the lung and larynx; and with other coronary risk factors such as hypercholesteremia to enhance cardiovascular risk. Smoking is the major identifiable cause of residential fire deaths and injuries as well as a contributor to accidental injuries. Cigarette smokers have a 70 percent higher overall death rate than nonsmokers, and tobacco is associated with an estimate in excess of 300,000 premature deaths a year. It is estimated that smoking contributes to as many as 225,000 deaths from coronary heart disease, the major cause of death among men and women in the United States; more than 100,000 deaths from cancers; and more than 20,000 deaths from chronic obstructive lung disease. Another 10 million Americans currently suffer from debilitating chronic disease caused by smoking. But substantial progress has been made since the release of the first Surgeon General's Report in 1964. More than 30 million smokers have quit since 1964 and the proportion of adult smokers has declined from about 42 percent in 1965 to approximately one-third today. Adult per capita consumption of cigarettes declined temporarily in 1953, 1954, 1964 and 1968-70, and the rate of decline has accelerated since 1977. Teenage smoking, particularly among adolescent girls, appears to be declining.
Adolescent↗
Health promotion: Alcohol and drug misuse prevention.
Currently, average apparent consumption of alcohol for all persons older than 14 is 10 percent higher than 10 years ago, and is equivalent to about 2.75 gallons of ethanol per person per year. Approximately 10 million adult Americans (i.e., 7 percent of those 18 or older) can be considered problem drinkers. Youthful problem drinkers, aged 14 to 17, are estimated to number more than 3 million and comprise 19 percent of this age group. In addition to the social costs, the economic costs to society as a result of alcohol misuse are substantial--an estimated +49.4 billion in 1977. Ten percent of all deaths in the United States are alcohol-related. Cirrhosis, which is largely attributable to alcohol consumption, ranks among the 10 leading causes of death. Alcohol use also is associated with cancer of the liver, pancreas, esophagus, and mouth. Alcohol consumption during pregnancy is associated with a wide range of possible harmful effects to the fetus--among them decreased birth weight, spontaneous abortion, and physical and mental birth defects. Drug misuse is also an expanding problem. There are some 16 million current marijuana users. The popularity of cocaine continues to increase--over 10 million Americans have tried cocaine at least once and there are an estimated 1 to 2 million current users. Misuse of barbiturates remains a significant problem with at least 1 million persons believed to misuse these drugs and the 30,000 estimated to be addicted to them. In addition, heroin addiction is still considered by many to be the most serious drug problem in the United States. Drug misuse leads to a number of social and health problems. Excessive doses of depressants can result in both physical and psychological dependence. The toll from heroin includes premature death and severe disability, family disruption, and crime committed to maintain the habit. Misuse of hallucinogens often results in emergency room visits. A special problem is the relationship of marijuana to automobile accidents, especially when used in combination with alcohol. While these events are disconcerting, progress has been made. National surveys indicate no changes in peak quantity consumed by teenagers 12 to 17 or in regularity of their drinking, between 1974 and 1978. Alcoholism mortality rates and alcoholic psychosis rates have shown little overall increase between 1950 and 1975. And similar encouraging trends have occurred in drug misuse. Several drug abuse data sources simultaneously have begun to reflect a down turn in use rates. These early indicators must be monitored overtime before conclusions as to their true significance can be evaluated.Nonetheless, the daily use of marijuana by high school seniors dropped from a peak of 10. 7 percent in 1978 to 7.0 percent in 1981. Daily regular cigarette smoking among seniors also declined dramatically-from 28 percent to 10 percent in the same period. The use of the hallucinogenic drug PCP also dropped markedly. Cocaine,heroin and sedative use among high school seniors remained relatively stable in terms of annual and lifetime prevalence, although the use of stimulants rose markedly. Of the 16 categories of drug use analyzed in the recent High School Senior Drug Use Survey, drug use in 15 categories was either stable or was decreasing(the second year of decline since the survey began in 1975).
Adolescent↗
Health promotion: Improved nutrition.
Appropriate nutrition is necessary for optimal growth and development, physical activity, reproduction, lactation, recovery from illness and injury, and maintenance of health throughout the life cycle. A variety of health problems can occur when persons have deficits of essential nutrients or have excessive or inappropriate consumption of some nutrients. While the role of nutrition in health problems is not fully understood, epidemiologic and laboratory studies offer important insights which may help people in making food choices to enhance their prospects of attaining or maintaining health. Current data indicate an inappropriate nutritional status for a substantial proportion of the American public. For example, for people aged 20 to 74 about 14 percent of men and 24 percent of women are classified as obese. The rates are significantly higher for women regardless of their economic status. Iron and folic acid deficiencies are common among pregnant or lactating women. It has been estimated that between 10 to 15 percent of infants and children among migratory workers and certain rural poor populations suffer growth retardation due to dietary inadequacies. And the average daily sodium ingestion is substantially higher for the U.S. population generally than the recommended intake levels. But some progress has been made over the last decade. Studies indicate that people have begun to consume less total fat, saturated fat, and cholesterol. Prevalence of breast feeding has increased to a point where it is the mode of feeding for 45 percent of newborns in the country. And a number of recent surveys indicate that more people are interested in nutrition, are more aware of the actions they can take to maintain health through their daily eating patterns, and have initiated changes in their nutritional practices.
Adolescent↗
Health promotion: Physical fitness and exercise.
The American lifestyle is still relatively sedentary. The proportion of adults aged 18 to 65 regularly exercising has been estimated at just over 35 percent, with children participating in daily physical education programs at 33 percent, and 36 percent of adults over 65 taking regular walks. Though the past decade has exhibited a resurgence of interest in physical fitness and exercise, there is much need for improvement. Awareness of the benefits of regular exercise and what is considered to be appropriate physical activity (e.g., aerobic for cardiovascular conditioning) is limited. Most people do not exercise in the manner necessary to achieve maximum benefits. Further, exercise as a therapeutic regimen has also been largely ignored by health professionals. Although the health benefits accrued from exercise have not been fully assessed, continuing research has suggested that appropriate physical activity can enhance approaches to the treatment and prevention of heart disease, obesity, hypertension, diabetes, musculoskeletal problems, stress, anxiety, and depression. Health and economic benefits are achievable, but there is need for cooperative efforts in the public and private sectors to support research and increase the public's awareness of and participation in regular physical fitness and exercise activities.
Adolescent↗
Preventive health services: Family planning.
Family planning in the United States has been a noteworthy success. More than 80 percent of the married women aged 15 to 44 are regular users of contraceptives. Further, virtually all primary care physicians provide contraceptives or family planning services, and there are now an estimated 4,000 family planning clinics in the country receiving support under the Title X Family Planning Authority. Despite this record of success, serious family planning problems remain. Of the slightly more than three and one half million births, an estimated one million are unplanned. More than one million pregnancies are terminated by legal abortion. Certain subgroups of the population have disproportionately high risks of unintended pregnancy. For example, unplanned births are almost twice as frequent among poor as among nonpoor women; one of every four births to black women is unintended versus one in ten to white women; and teenagers, women with language barriers, and women living in rural areas and on Indian reservations experience high rates of unintended pregnancy.
Adolescent↗
Health promotion: Control of stress and violent behavior.
Stress is an inevitable part of life in today's society. Some stress may be beneficial and can lead to improved productivity. Unless suitably managed, however, stress may contribute to physiological and psychological dysfunctions such as depression, fatigue, obesity, coronary heart disease, suicide, or violence. The impact of stress on the Nation's physical and mental health may be considerable. Tens of thousands of premature deaths annually are consequences of suicide and homicide. It is estimated that 2,000 deaths to children and up to four million injuries inflicted by abusing parents occur each year partially as a result of stress. Recent years have focused a considerable amount of public and professional interest upon the relationship between stress and physical and mental health. Scientific inquiry has demonstrated various associations between stress and health and disease and has provided evidence that stressful factors can be assessed. Much remains, however, to be elucidated about vulnerability to stress and its control. Some groups such as teenagers, the elderly, and the economically disadvantaged appear to be more vulnerable to stress, and the public in general has limited information about what can be done to reduce stress. There is a clear need to investigate the psychological, environmental, and biological interactions which link stress to health disorders.
Adolescent↗
Preventive health services: Pregnancy and infant health.
From 1950 to 1977, infant mortality dropped from 30 to 14 deaths per 1,000 live births. The annual decline in infant mortality between 1965 and 1973 was 3.5 percent. The proportion of women receiving prenatal care during the first 3 months of pregnancy also increased-from 68 to 74 percent during the years 1969 to 1977. The factors underlying improvements in infant mortality are complex, but include increased access to prenatal services, increased availability of regionalized intensive care units, and improvements in maternal nutritional status. The principal threats to infant health are birth defects that can lead to lifelong handicapping conditions, and problems associated with low birth weight. Today, approximately seven percent of all babies are of low birth weight (2,500 grams or less). Unfortunately, many children are born to women with an increased risk of having a low birth weight infant, i.e., women making no prenatal visit during the first trimester, and teenagers. Further, in 1978 1 in 4 women giving birth made no prenatal visit during the first trimester and 1 in 20 made no prenatal visit during the first two trimesters.
Adolescent↗
Preventive health services: Immunization.
The seven major childhood infectious diseases-measles, mumps, rubella, polio, diphtheria, pertussis, and tetanus-can cause permanent disability and, in some cases, death. They all can be prevented by immunization, but prior to the National Childhood Immunization Initiative of 1977 more than a third of all children under age 15 were not properly protected. And even though vaccines are now available to reduce the risk of influenza, hepatitis B, and pneumococcal pneumonia, many high risk patients are not protected. Outbreaks of measles and pertussis, and occasionally of diphtheria and polio, during the mid-1970s indicate that immunization must be emphasized continually. With the combination of safe, effective vaccines, public and private programs, and a reliable disease surveillance and outbreak containment system, infectious diseases can be controlled. The Department of Health and Human Services has proposed a major initiative designed to eliminate the indigenous occurrence of measles.
Adolescent↗
Preventive health services: Sexually transmitted disease control.
Over 10 million cases of sexually transmitted diseases (STD) occur annually, 86 percent of them in 15- to 29-year-olds. The most common STDs are trichomoniasis, gonorrhea, non-gonococcal urethritis, genital herpes, and syphilis. In 1950 the reported syphilis rate was 146 per 100,000. The rate decreased to 30 per 100,000 by 1978, resulting in approximately 80,000 new cases of syphilis a year. During the same time span the gonorrhea rate increased from 192 cases per 100,000 to 468 cases per 100,000. In each year between 1967 and 1976, reported cases of gonorrhea increased between 10 and 15 percent. Between 1976 and 1978 the annual increase was less than 1 percent, but the total number of case of gonorrhea still exceeded 2.5 million. In addition to the large number of syphilis and gonorrhea cases, 3 million cases of trichomoniasis, 2.5 million cases of non-gonococcal urethritis, and 500,000 cases of genital herpes occur annually. The most serious complications caused by sexually transmitted agents are pelvic inflammatory disease, sterility, infant pneumonia, infant death, birth defects, and mental retardation. There is clear evidence that both the quality of the services and the attitudes with which they are delivered are important in attracting those who need STD services. While existing programs are interrupting the transmission of syphilis and gonorrhea, many vulnerable groups are not yet being served. To approach them effectively will require not only the efforts of STD clinics and investigators but also those of family planning clinics, private physicians, diagnostic and public health laboratories, and schools and other educational institutions.
Adolescent↗
Health protection: Toxic agent and radiation control.
It is estimated that of the four million chemical compounds which have been synthesized or isolated from natural materials, more than 55,000 are produced commercially. Approximately 1,000 new compounds are introduced annually; pesticide formulations alone contain about 1,500 active chemical ingredients. Diagnostic x-rays are used extensively in medicine and dentistry. Over 2,000 chemicals are suspected carcinogens in laboratory animals--epidemiologic evidence suggests that 26 of these chemicals and/or industrial processes are carcinogenic in humans. More than 20 agents are known to be associated with birth defects in humans; 47 atmospheric contaminants have been identified in animal studies as recognized carcinogens and 128 as mutagens; and, of the 765 contaminants identified in drinking water, 12 were recognized carcinogens, 31 suspected carcinogens, and 59 mutagens. Radiation has known carcinogenic and genetic effects at significant levels of exposure. Problems with toxic agents and radiation sources occur not only in industry, but also in medical and dental care (x-rays and drugs), agriculture (pesticides and herbicides), Government activities (biological and chemical agents), consumer products (incorrect use of consumer products which contain toxic substances), and natural sources (fungal products).
Adolescent↗
Preventive health services: High blood pressure control.
An estimated 60 million Americans have high blood pressure that increases their risk of illness and premature death. Of these persons approximately 35 million need some form of continuing treatment, while the remaining 25 million have borderline high blood pressure that requires medical surveillance. Untreated hypertension is the largest single contributor to stroke and a major contributor to heart disease and kidney failure. The National High Blood Pressure Education Program, started in 1972, has helped to improve hypertension control in the Nation. With providers and the public better informed about hypertension, patient visits and medication prescriptions for hypertension have increased, as has the number of persons whose hypertension is well controlled. Associated deaths, especially from stroke, have declined rapidly and dramatically. There is much room for improvement. Provider interest in and attention to long-term regimen adherence needs more emphasis. Large segments of the population, especially ethnic and racial minority groups, continue to face access problems. Awareness and attempted application of patient management technologies have improved, but stronger efforts are needed to address care delivery system management issues.
Adult↗
Health protection: Occupational safety and health.
Many of the Nation's approximately 100 million workers are exposed to some kind of occupational health hazard: carcinogenic agents, pulmonary or other physical disease incitant, physical agents or job-related pressures of noise, crowding, or stress. Exposure to toxic chemicals or physical hazards can produce chronic lung disease, cancer, degenerative disease in a number of vital organ systems, birth defects, and genetic changes. These exposures are estimated to result in 100,000 Americans dying each year from occupationally related illnesses, with an additional 400,000 cases of occupationally related disease. Yet many workers are inadequately protected from common hazards. Recent experience has demonstrated that occupational hazards can be controlled by modifying the work environment, patterns of job performance, or both. Among the health protection measures available are those which: alter the work environment to prevent exposures and injuries; provide workers with special protective equipment; specify design and maintenance of equipment; and provide employees with proper training. Some companies have ventured into the health promotion arena and offered their employees worksite programs for promoting health through health education, physical fitness activities, stress reduction activities, and preventive medicine including screening for high blood pressure, high cholesterol, and other factors related to heart disease.
Accidents, Occupational↗
Health protection: Fluoridation and dental health.
Tooth decay, which affects 95 percent of Americans, is our most common health problem, costing an estimated +2 billion yearly for treatment. By the time children reach 17 years of age, 94 percent have experienced caries and 36 percent have lost one or more permanent teeth due to caries. Dental disease prevention embodies the spectrum of many activities from the fluoridation of community and school water supplies to the dental health education of the child and adult. At this stage of our knowledge, the most effective and cost-beneficial intervention is fluoridation. Fluoridation can reduce the incidence of dental caries by about 65 percent, reduce the need for multiple surface fillings, crowns and extractions, and significantly increase the number of children who are completely free of cavities. No other public health measure is as effective in building a decay-resistant tooth while being available to all without regard to education or socio-economic background. The number of people served by fluoridated water systems has increased steadily since its introduction. Currently, however, less than half of all Americans have access to fluoridated water. In areas where community water supplies are not fluoridated, school drinking water is seldom fluoridated despite evidence supporting the efficacy of this procedure.
Child↗
Health protection: Surveillance and control of infectious diseases.
Although pneumonia and influenza are the only infectious diseases remaining among the 10 leading causes of death in this country, more than 290 million infectious illnesses occur annually--more than one for every person. These diseases have a significant impact on the population when measured in terms of increased social costs, including quality of life, decreased work productivity, and increased health care costs. During the next decade, no dramatic changes are anticipated in infectious disease trends; however, diseases may be newly recognized, epidemiologic patterns will be defined, antibiotic resistant patterns will change, and changing immigration patterns and refugee migrations may affect disease trends in the United States (e.g., tuberculosis). These factors will require the development and application of effective prevention methods, including disease surveillance, sanitation, casefinding and control, and development and use of vaccines and drugs. In addition, efforts to improve the rapidity and accuracy of diagnosis as well as the appropriateness of therapy are also important activities.
Communicable Disease Control↗