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National Occupational Health Service policies and programs for workers in small-scale industries in China.

Over the 14 years since economic reform began, and the restructuring of the economy to encourage international trade, a large number of township enterprises have been developed and put into operation in the Peoples Republic of China. From 1978 to 1991, the number of enterprises has increased 11.5 times; the number of employees has increased 2.4 times; the fixed assets have increased 13.7 times; and the value of the total output has increased 22.5 times. In this article, a report is given on a sample survey in 30 counties in 1990, which showed that 82.69% of rural industrial enterprises had at least one type of occupational hazard in their work environments. Workers engaged in at least one type of hazardous working environment accounted for 33.91% of the blue-collar workers. Physical examinations were performed for seven types of occupational diseases: silicosis, coal worker's pneumoconiosis, asbestosis, chronic lead poisoning, benzene analogs poisoning, chronic chromium poisoning, and noise-induced hearing loss. The total detectable rate of the seven types of occupational diseases was 4.4% among those workers. In addition, 11% had illnesses suspected of being (though not proven to be) caused by occupational exposures. Most township enterprises do not provide basic occupational health services. The coverage of five routine occupational health service activities provided for township enterprises were very limited, from 1.4 to 36%.

China↗

The Spanish health care system: lessons for newly industrialized countries.

This article summarizes the organization, financing, and delivery of health care services in Spain, and discusses the elements that made it possible to maintain high levels of health among the population, while spending comparatively fewer resources on the health care system than most industrialized countries. The case of Spain is of particular interest for newly industrialized countries, because of the fast evolution that it has undergone in recent years. Considered, by United Nations' economic standards, a developing country until 1964, Spain became in a few years the fastest growing economy in the world after Japan. By the early 1970s the infant mortality rate was already lower than in Britain or the United States.

Delivery of Health Care↗

An effect of organization of medical care upon health: manpower distribution.

Data are presented from the Medical Care Group of Washington University and from several other organized medical care settings responsible for prepaid enrollees. As few as 8 per cent of visit may be made to specialists under systems which are organized to emphazide primary care. Further, the proportions of primary care and specialty visits vary inversely weith the "strictness" of this organization. Those groups which employ family physicians have a higher proportion of primary care physicians than do those which employ general intermists and pediatricans, or than exist in the medical care system at large. The data suggest strongly that the organization of medical care, as well as the training of personnel employed has a major influence upon the types of health manpower needed. Future research in this area is urgent, but even the currently available data have important implications for health manpower policy.

Health Maintenance Organizations↗

A comprehensive scheme of health manpower development for Nepal.

How does a land-locked, mountainous, newly emergent country produce the manpower to serve the essential health care needs of its population? The absence of a tradition of medical education, a paucity of medical personnel and the major problems of deployment and communication pose immense challenges to health manpower producers. The policies, plans and programmes of the Government of Nepal to develop appropriate levels of manpower and the discernible problems and prospects faced by the Institute of Medicine are examined. The institutional framework that has been established for an ongoing monitoring and evaluation of the processes and some of the successes achieved have been described.

Allied Health Personnel↗