[Modern trends in mortality from cardiovascular diseases in the economically developed capitalistic countries].
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Shigellosis due to Shigella sonnei is rare among people growing up and living in developing countries; however, infections due to S sonnei becomes more common than those due to S flexneri as societies develop economically. The relation between risk of S sonnei infection and economic development may be explained by the exposure of developing-country populations to Plesiomonas shigelloides. P shigelloides is often found in surface water, and one serotype (serotype 17) possesses a cell-wall lipopolysaccharide identical to that of S sonnei. Thus, exposure to P shigelloides by drinking contaminated water may immunise populations to S sonnei. As economic development occurs, water quality improves and populations become susceptible to S sonnei. Although drinking water has many advantages, immunisation against S sonnei may be one benefit of traditional water sources.
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Economic growth has brought with it substantial environmental damage. Nature has been abused and little consideration has been given to the consequences, among them the adverse effects on health. Healthy people are vital for local development that is both economically and ecologically sound. The health sector should be actively involved in the movement for sustainable development. What this would require in practice is considered below, with particular reference to the quality of life in regions of tropical forest.
Four countries, Botswana, Cote d'Ivoire, Ghana and Zimbabwe, were chosen as cases to study the impact of national health policies on national health status in sub-Saharan Africa. Through a conceptual framework that covers health problem identification, policy formulation and implementation procedures, the study examined national translations of Primary Health Care (PHC) and Health for All by the Year 2000 (HFA/2000) strategies. A series of government measures, taken between 1980-1986 for health policy development and implementation in these countries, were treated as policy determinants of national health outcomes for the period ending 1990. The impact of these determinants on national health status was then analyzed through a comparative description and documentation of observable patterns and trends in infant mortality rates (IMR), under-5 mortality rates (U5MR) and life expectancy. Policy guidelines from PHC and HFA/2000 were used in conjunction with the respective per capita Gross National Products to categorize the four cases. Based on these guidelines, Botswana was ranked high, both in terms of policy development and the level of economic development, while Zimbabwe ranked high in terms of policy development but relatively low in economic terms. Cote d'Ivoire ranked high on economic development but low with regard to its policy framework. Ghana was at the other end of the spectrum, ranking low both in terms of its policy development and its economic performance. The comparative analysis revealed that Botswana and Zimbabwe performed better than Cote d'Ivoire and Ghana on the three outcome indicators. Despite Cote d'Ivoire's superior level of economic development, its health status fell behind that of Zimbabwe and even Ghana. The study concluded that policies formulated and implemented in accordance with key PHC principles could account for improvements in national health status. Since the end of the study period (1990), there have been significant political changes in the sub-Saharan African region as a whole and in some of the case countries in particular. Political leadership has changed in Ghana and Cote d'Ivoire with some course corrections in Ghana's health plans. Health sector financing in the region has become more dependent on external donors. The World Bank leads the external donor community in promoting policy-based lending. The complexity of a number of health problems has changed while the problems themselves remain the same as before. Essentially, building viable public health infrastructures to address basic public health needs must still be high on the agenda of action for most governments in the region. Thus, notwithstanding some course corrections and reasonable shifts in priorities, all the PHC principles are still applicable, indeed, much needed in the sub-Saharan African region. This study's findings, underscoring the fact that significant improvements in health are possible even where financial resources are limited, still hold true.
The effect of economic development on motor vehicle-related mortality was assessed using per capital GNP from 46 countries, Gini coefficients from 34 countries and mortality statistics reported to WHO. The data suggest that these commonly used indicators of economic development do not reliably predict a given country's current experience with motor vehicle-related mortality. Implications for health planners and traffic safety workers are discussed.
The interpretation of health economics chosen for this paper is broad. It includes the relation between economic and other factors in health development. This interpretation has been chosen lest the acceptance of a disciplinary approach in the commissioning of papers should have the unintended effect of excluding some key areas of research which require the consideration of crucial interrelationships between disciplines. The only justification for covering this area in a paper on economics rather than, for example, epidemiology is that increasingly there is and indeed has to be a heavy focus on costs in considering alternative paths to health development. The word 'research' is loosely interpreted and not restricted to the type of activity which could lead to the award of a PhD. The compilation of experience in many areas is, in the view of the author, a priority need, to plan where further research and experiment is needed.
In its recent reengineering efforts, the Mount Sinai Hospital developed economic tools to assure that this major restructuring project would reach its predetermined financial objectives. We discuss how these tools were designed and implemented and what impact they had.
All demographic theories make statements on the relationship between population developments and economic developments. The demographic teachings of Adam Smith, Thomas Robert Malthus, and Karl Marx are embedded in their specific economic theories and contain ideologic statements which are not detrimental to demographic and economic sciences but a stimulus for research. The demographic theories which developed with the onset of the industrial revolution of the 19th century are all sceptical of too high populations independent of their analysis of the market mechanisms or of capitalistic production relationships. This has remained unchanged to date. The statistical evaluation of the 1980's underlines this problem. The reproductive behaviour and demographic theory of a highly industrialized economy can not be based on experience alone but must also be based on rational findings. The rejection of the prestige value of children on the reproductive behaviour which is independent of circumstances must be recognized.
Although the infant mortality rate (IMR) has reduced by 50% during the past century, it compares poorly with the advanced countries and some developing countries. The observed fall in IMR has been mostly in post-neonatal mortality, with the result that neonatal deaths now account for over 60% of all infant deaths. The overall perinatal mortality rate (PMR) in India is still over 50 per 1000 and has shown virtually no decline during the past decade, However, PMR differs widely in different states, urban/rural areas, different hospitals and so on. PMR is seen to correlate better with social development than economic development of the representative community. The causes of perinatal deaths suggest poor health of mother and poor health facilities and are hence potentially preventable. Various studies have shown that PMR can be significantly reduced within a short span of time. The registration of vital statistics continue to be highly unsatisfactory especially in rural areas.
Originally, many of the initiators of the World Population Conference, which took place in Bucharest in 1974, had hoped that the Conference would imply a final breakthrough for the view that family planning measures should be given top priority in all less-developed countries. In fact, however, the Plan of Action passed by the Conference contains very little relating to population and family planning. Instead, the document is dominated by wordy phrases about the necessity of attaining social and economic development in those countries. Will the insight that family planning programs work efficiently only if they are an integral part of programs for the social and economic development of a country lead to such programs being realized? There is every reason to doubt that the plan of Action will have any such effect. The reasons for the underdevelopment of Third World countries cannot be removed through such United Nations resolutions. In the People's Republic of China, family planning is widely accepted, especially in the towns, and now also among the rural population. Limiting the number of children is considered part of China's development effort. China is a less-developed country that is in the process of rapid social and economic development. The issue at stake in other Third World countries is how to achieve a similar development. As soon as this goal is achieved, family planning efforts are meaningful and have a chance of success. The experience of China demonstrates that even there it took time before the efforts succeeded. There are many Third World countries that could, without much difficulty, support a population considerably larger than the present one. But there are no doubt also a number of countries where the population is already so large that a continued population increase would be harmful. The need to achieve rapid development becomes increasingly urgent, not in the least to make it possible to attain a reduced population growth. The sad truth is that so little development takes place in those countries. Without social and economic development, the present rapid population increase will continue in those countries where there is already an overly dense population.
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This study compared capitalist and socialist countries in measures of the physical quality of life (PQL), taking into account the level of economic development. The World Bank was the principal source of statistical data, which pertained to 123 countries and approximately 97 percent of the world's population. PQL variables included indicators of health, health services, demographic conditions, and nutrition (infant mortality rate, child death rate, life expectancy, crude death rate, crude birth rate, population per physician, population per nursing person, and daily per capita calorie supply); measures of education (adult literacy rate, enrollment in secondary education, and enrollment in higher education); and a composite PQL index. All PQL measures improved as economic development increased. In 30 of 36 comparisons between countries at similar levels of economic development, socialist countries showed more favorable PQL outcomes (p less than .05 by two-tailed t-test). This work with the World Bank's raw data included cross-tabulations, analysis of variance, and regression techniques, which all confirmed the same conclusions. The data indicated that the socialist countries generally have achieved better PQL outcomes than the capitalist countries at equivalent levels of economic development.
BACKGROUND: Mortality from childhood cancer in general and childhood leukemia in particular has sharply declined in economically developed countries over the last 30 years, whereas the incidence of these diseases has remained essentially unaltered. Therefore, childhood malignancies can be used as tracers of accessibility to and effectiveness of medical care. The objective of this study was to compare the reduction of mortality from childhood cancer in general, and childhood leukemia in particular, in four economically developed areas of the world, to assess accessibility to and effectiveness of technologically advanced medical care. METHODS: The authors used data from the World Health Organization to compare the evolution over time of gender specific, age-adjusted mortality from childhood cancer in general and childhood leukemia in particular in the childhood (birth to age 14 years) populations of North America, western Europe, Japan, and Australia and New Zealand during the period 1960-1993. They assessed the evolution over time and the cumulative percentage representing the decline in mortality from childhood cancer and childhood leukemia in the four aforementioned areas of the world. RESULTS: The decline in mortality from both the disease entities considered and for both genders has been more pronounced in North America than in other economically developed areas of the world. CONCLUSIONS: When disease control depends on technologically advanced medical care, as in the case of cancer, the North American population is benefited by earlier and effective introduction of new therapeutic approaches. This conclusion does not apply to other childhood diseases, the incidence of which is higher among low-income groups and control of which depends on prevention rather than treatment.
In the course of economic development from the pre-industrial to the post-industrial stages, human communities go through major social and economic transitions. The demographic transition, a long established concept, refers to the change from a stage of high birth rates and mortality rates to one of low birth rates and mortality rates. The mortality rates have always decreased before the birth rates, giving rise to a period of rapid population growth in each society. The recently-coined term "health transition" provides a more detailed view of the different aspects of the mortality decline and of the changes in morbidity and causes of morbidity which also accompany economic development. The health transition is associated with major changes in exposure to environmental and occupational health hazards. The traditional hazards of the pre-industrial stage include unsafe drinking-water, poor sanitation, infected food, tropical disease vectors, indoor air pollution from biomass smoke, and accidents in agriculture and fishing. Gradually these are replaced by or overlap with the modern hazards, such as urban air pollution, tobacco smoking, pesticides, occupational hazards in new industries and traffic accidents. The health impact of these hazards depends very much on the preventive measures taken. For some hazards there is an increasing health risk, in parallel with the increasing occurrence of the hazard, which is followed by a decreasing health risk as preventive actions become effective. This intervention transition does not occur automatically with economic development, but requires specific policies and plans, as well as community involvement. The adult age group (15-59 years) is likely to be at particular risk for environmental and occupational hazards which emerge during the health transition.(ABSTRACT TRUNCATED AT 250 WORDS)