Patterns of fertility decline in developing countries, 1950-75

Since 1965 there have been substantial declines in the crude birth rates of many countries in the developing world, particularly the largest countries. This auspicious trend is shown clearly in an analysis of population figures for the last 25 years, despite the fact that there are deficiencies in the data. In 1950 the average crude birth rate for developing countries was 42 per thousand per year. Over the next 15 years, declines in the crude birth rate were limited to a relatively few, and for the most part small, countries. After 1965, however, for the 13 developing countries with a population numbering 35 million and over, there have been declines in the crude birth rate averaging 13 percent, with declines of over 12 percent in 9 of them. The effects of a number of sociodemographic factors on crude birth rates are examined, and the analysis shows that increases in the age at marriage and decreases in marital fertility were the principal factors affecting declines since 1965.     

Palliative care: a public health priority in developing countries

Palliative care is an emerging specialist discipline worldwide with the majority of services located in developed countries. Developing countries, however, have higher incidences of cancer and AIDS and most of these patients would benefit from palliative care. While there is prominent coverage of this issue in the palliative care literature, there is limited coverage in the specialist public health literature, which suggests that the challenges of palliative care may not yet have been generally recognized as a public health priority, particularly in developing countries. The aim of this article is to introduce the topic of "Palliative care in developing countries" into the specialist public health literature to raise awareness and stimulate debate on this issue among public health professionals and health policy makers, thereby potentially facilitating establishment of palliative care services in developing countries.     

Drug Launch Timing and International Reference Pricing

This paper analyzes the timing decisions of pharmaceutical firms to launch a new drug in countries involved in international reference pricing. We show three important features of launch timing when all countries refer to the prices in all other countries and in all previous periods of time. First, there is no withdrawal of drugs in any country and in any period. Second, whenever the drug is sold in a country, it is also sold in all countries with larger willingness to pay. Third, there is no strict incentive to delay the launch of a drug in any country. We then show that the first and third results continue to hold when the countries only refer to the prices of a subset of all countries in a transitive way and in any period. We also show that the second result continues to hold when the reference is on the last period prices only. Last, we show that the seller's profits increase as the sets of reference countries decrease with respect to inclusion. Copyright © 2014 John Wiley & Sons, Ltd.     

Targeted interventions required against genital ulcers in African countries worst affected by HIV infection.

It remains unclear why there is such marked variation in the severity of the human immunodeficiency virus (HIV) epidemic between African countries. The prevalence of HIV infection has reached high levels in many parts of southern Africa but in most countries of West Africa the levels are much lower. Although there is good evidence that sexually transmitted infections (STIs) and genital ulcers in particular facilitate heterosexual transmission of HIV, there is little comparative STI data from the African countries worst affected by HIV infection. A MEDLINE search covering the period 1966 to August 2000 using the keywords "sexually transmitted diseases", "genital ulcers" and "Africa" was performed to identify factors that might be relevant to the spread of HIV infection in countries with the highest prevalences of the virus. In the countries worst affected by HIV infection, the proportions of men and women with STI who had genital ulcers lay in the ranges 45-68% and 13-68%, respectively. The proportions were much lower in countries of West Africa than in those of southern Africa. The African countries worst affected by HIV infection should adopt a more specialized approach to STI control than hitherto and specifically target the high incidence of genital ulceration. Locally, technical STI committees should draw up country-specific guidelines taking into account the prevalence of the various causes of genital ulceration. In these countries, national AIDS control programmes and donor agencies should develop a specific focus for decreasing the incidence of genital ulcer disease.     

An empirical analysis of the demand for physician services across the European Union

This paper presents parameter estimates for physician service equations using the "European Community Household Panel" for 12 countries covering the period 1994-1996. The focus is on two specific points: (1) the identification of behavioural similarities and differences in the demand for health services across the 12 countries; (2) the variability in demand for health services represented through a joint model for all countries. We found that there are significant differences among countries, although there are also similarities in the effect of variables such as health stock, labour situation or family structure. An important fraction of the variability in the demand for health services across countries could be explained by differences in age, income and the role of general practitioners as gatekeepers in the public health system. We found some evidence of induced demand in the decision to visit a specialist and in the number of such visits.     

Income inequality and health: Importance of a cross-country perspective

This paper uses a unique dataset-containing information collected in 2006 on individuals aged 40–79 in 21 countries throughout the world to examine whether individual income, relative income in a reference group, and income inequality are related to health status across middle/low and high-income countries. The dependent variable is self-assessed health (SAH), and as a robustness check, activities of daily living (ADL) are considered. The focus is particularly on assumptions regarding an individual's reference group and on how the estimated relationships depend on the level of economic development. Correcting for national differences in health reporting behavior, individual absolute income is found to be positively related to individual health. Furthermore, in the high-income sample, there is strong evidence that average income within a peer-age group is negatively related to health, thus supporting the relative income hypothesis. In middle/low-income countries, it is instead average regional income that is negatively associated with health. Finally, there is evidence of a negative relationship between income inequality and individual health in high-income countries. Overall, the results suggest that there might be important differences in these relationships between high-income and middle/low-income countries.     

Work related injuries in Qatar: a framework for prevention and control

Work related injuries (WRIs) are a growing public health concern that remains under-recognized, inadequately addressed and largely unmeasured in low and middle-income countries (LMIC’s). However, even in high-income countries, such as those in Gulf Cooperating Council (GCC) like Qatar, there are challenges in assuring the health and safety of its labor population. Countries in the GCC have been rapidly developing as a result of the economic boom from the petrochemical industry during the early seventies. Economic prosperity has propelled the migration of workers from less developed countries to make up for the human resource deficiency to develop its infrastructure, service and hospitality industries. Although these countries have gradually made huge gains in health, economy and human development index, including improvements in life expectancy, education, and standard of living, there remains a high incidence of work-related injuries especially in jobs in the construction and petrochemical sector. Currently, there is scarcity of literature on work-related injuries, especially empirical studies documenting the burden, characteristics and risk factors of work injuries and the work injured population, which includes large numbers of migrant workers in many GCC countries. This paper will focus on the current understanding of WRIs in those countries and identify the gaps in current approaches to workplace injury prevention, outlining current status of WRI prevention efforts in Qatar, and propose a framework of concerted action by multi-sectoral engagement.     

The socioeconomic determinants of cancer

This paper provides a synthesis on socioeconomic inequalities in cancer incidence, mortality and survival across countries and within countries, with particular focus on the Italian context; the paper also describes the underlying mechanisms documented for cancer incidence, and reports some remarks on policies to tackle inequalities.From a worldwide perspective, the burden of cancer appears to be particularly increasing in developing countries, where many cancers with a poor prognosis (liver, stomach and oesophagus) are much more common than in richer countries. As in the case of incidence and mortality, also in cancer survival we observe a great variability across countries. Different studies have suggested a possible impact of health care on the social gradients in cancer survival, even in countries with a National Health System providing equitable access to care.In developed countries, there is increasing awareness of social inequalities as an important public health issue; as a consequence, there is a variety of strategies and policies being implemented throughout Europe. However, recent reviews emphasize that present knowledge on effectiveness of policies and interventions on health inequalities is not sufficient to offer a robust and evidence-based guide to the choice and design of interventions, and that more evaluation studies are needed.The large disparities in health that we can measure within and between countries represent a challenge to the world; social health inequalities are avoidable, and their reduction therefore represents an achievable goal and an ethical imperative.     

National legislation on school smoking restrictions in eight European countries

OBJECTIVE: To review and compare national legislation addressing smoking at school in eight European countries during the late 1990s. DESIGN: The data are from the EC-funded Control of Adolescent Smoking (CAS) study in eight European countries. The information on national legislation was gathered during the period 1998-1999, through a review of scientific and official documents and interviews with key informants in each country. RESULTS: Four of the participating countries (Austria, French-speaking Belgium, Finland and Norway) had legislation specifically restricting smoking at school, while the remaining countries (Denmark, North Rhein Westphalia region of Germany, Scotland and Wales in the UK) did not have such legislation in place. In those countries with legislation in place, smoking among students aged 15 years and younger was not permitted. The position with regard to teacher smoking varied considerably among countries, but with the exception of Finland, there was no legislation regulating outdoor smoking by teachers during school hours. CONCLUSIONS: The findings suggest that there were inconsistencies within countries in terms of legislation that had been developed and the enforcement, compliance and monitoring practices that were in place. Further work is required to develop and resource such mechanisms, although it may be possible to build on existing practice, such as increasing the involvement of school health services, school inspectorate services or working through health promoting school networks already established in many countries.     

Traditional birth care

The automatic transfer of the techniques of Western medicine to the care of pregnant women and management of delivery in developing countries is currently undergoing critical reassessment. Ironically, this move toward unquestioned use of Western medical procedures in the Third World is occurring at the same time as women in developed countries are rejecting such orthodoxy. For example, there had been a movement by physicians and patients in both France and England against the traditional view that women should lie on their back during delivery. Studies have shown that the duration of labor is reduced by 36% by women who deliver in an upright position and there is less risk of reduced fetal blood flow from pressure of the pregnant uterus on the mother's aorta and major blood vessels. However, in Africa, where upright deliveries had been traditional, Western aid agencies are vigorously promoting horizontal labor, allegedly because it is earlier to monitor. Similarly, while there is a trend in developed countries back to breastfeeding, feeding with commercial baby foods is considered a sign of modernization in many Third World countries. Finally, at the same time as women in Africa are being urged to deliver in hospitals, women in developed countries with no risk factors are questioning the advantage of hospital deliveries over home birth. Given the limited resources available for health care in developing countries, the emphasis on medical high technology may be unwise.     

First do no harm: the impact of recent armed conflict on maternal and child health in Sub-Saharan Africa

OBJECTIVES: To compare the rates of under-5 mortality, malnutrition, maternal mortality and other factors which influence health in countries with and without recent conflict. To compare central government expenditure on defence, education and health in countries with and without recent conflict. To summarize the amount spent on SALW and the main legal suppliers to countries in Sub-Saharan African countries (SSA), and to summarize licensed production of Small Arms and Light Weapons (SALW) in these countries. DESIGN: We compared the under-5 mortality rate in 2004 and the adjusted maternal mortality ratio in SSA which have and have not experienced recent armed conflict (post-1990). We also compared the percentage of children who are underweight in both sets of countries, and expenditure on defence, health and education. SETTING: Demographic data and central government expenditure details (1994-2004) were taken from UNICEF's The State of the World's Children 2006 report. MAIN OUTCOME MEASURES: Under-5 mortality, adjusted maternal mortality, and government expenditure. RESULTS: 21 countries have and 21 countries have not experienced recent conflict in this dataset of 42 countries in SSA. Median under-5 mortality in countries with recent conflict is 197/1000 live births, versus 137/1000 live births in countries without recent conflict. In countries which have experienced recent conflict, a median of 27% of under-5s were moderately underweight, versus 22% in countries without recent conflict. The median adjusted maternal mortality in countries with recent conflict was 1000/100,000 births versus 690/100,000 births in countries without recent conflict. Median reported maternal mortality ratio is also significantly higher in countries with recent conflict. Expenditure on health and education is significantly lower and expenditure on defence significantly higher if there has been recent conflict. CONCLUSIONS: There appears to be an association between recent conflict and higher rates of under-5 mortality, malnutrition and maternal mortality. Governments spend more on defence and less on health and education if there has been a recent conflict. SALW are the main weapon used and France and the UK appear to be the two main suppliers of SALW to SSA.     

The contribution of health to the economy in the European Union

Despite increasing recognition of the link between health and economic development in low-income countries, the relationship has to date received scant attention in rich countries. We argue that this lack of attention is not justifiable. While the economic argument for investing in health in rich countries may differ in detail from that in low-income countries, there is considerable and convincing evidence that significant economic benefits can be achieved by improving health not only in poor, but also in rich countries. Better health increases labour supply and productivity and historically, health has been a major contributor to economic growth. In spite of remaining evidence gaps economic policy-makers also in developed countries should consider investing in health as one (of few) ways by which to achieve their economic objectives.     

Remuneration of medical specialists. Drivers of the differences between six European countries

Between countries there are large differences in the remuneration of medical specialists. We compared the remuneration levels in 2010 in six countries: Belgium, Denmark, England, France, Germany and the Netherlands. We used OECD figures for the remuneration levels, but corrected them extensively for differences in measurement between countries. English doctors earned most in 2010, French doctors earned least. For the six countries under study the number of doctors per capita is most consistent with the differences in income. Surprisingly, the payment scheme (salaried or fee-for-service) does not seem to account for differences between countries, although within countries fee-for-service specialists earn more than their salaried counterparts. Differences in the role of the GP, differences in workload, composition of the workforce and education could not account for differences in remuneration between these six countries. As our conclusions are based on only six countries more research involving a larger number of countries is needed to confirm these findings.     

Biomedical research in developing countries: the case of Morocco in the 1990s

Moroccan biomedical research occupies the third place among African or Arab countries, and its outputs considerably increased during the last decade. The quality of publications from developing countries should be improved as suggested by the comparison with developed countries. The gap between developed and developing countries is very large considering the number of publications and their quality, the number of edited journals, and the number of patented inventions, thus making developing countries more as consumers then producers. Accordingly, there is a large gap between developing and developed countries when considering the human and financial resources devoted to scientific research.     

Sucres et poids corporel : analyse des données épidémiologiques

It is often suggested that the dietary intake of sugars is related to the increasing incidence of obesity in western countries. However, epidemiological evidence is conflicting. There is confusion over terminology, with a large number of terms used to describe sugars in the diet and inadequate data on the sugars content of food in many countries, making examinations of trends in intake over time and comparisons between countries difficult. Food balance information is also frequently used incorrectly to describe intake. For those countries with good data on intake of sugars from individual surveys, there is little evidence for either adults or children, of an increase in intake of sugars over the time period over which obesity incidence has increased. In cross sectional surveys, sugars intake is not related to BMI and most often the inverse is found. No longitudinal studies of sugars intake and body weight changes are available. For those longitudinal studies examining intake of sugar sweetened beverages or fruit juice and relationships to body weight, there are conflicting results and conclusions. Hence it cannot currently be concluded that there is a relationship between intake of sugars in the diet and weight gain. Better sugars intake data and longitudinal studies using such data to examine changes over time are needed.     

Scientific production and international collaboration in occupational health, 1992-2001

OBJECTIVES: The objectives of the present study were twofold, to describe international scientific production in occupational health and to examine international collaboration in this discipline. METHODS: A bibliometric study was carried out, using Science Citation Index, in order to evaluate the articles published during the period 1992-2001 in eight representative occupational health journals. Scientific production, collaborative profiles for each country, and the significant relationships established between countries are reported. RESULTS: One or more institutions in the United States had contributed to over 40% of the articles examined. The United States was followed by the United Kingdom (9.15%) and then Sweden (8.65%). When population size effects were eliminated, the Scandinavian countries proved to be the leading producers. After correction for gross domestic product, there was an increase in the ranking of apparently scientifically modest countries. The Scandinavian countries remained high. In terms of international collaboration in general, there was an inverse relationship between the production of a country and the proportion of articles co-authored with institutions in other countries. Finally, the significant relationships between countries permitted the identification of up to six large collaboration nuclei. CONCLUSIONS: The high absolute and relative Scandinavian production is suggestive of the great importance of occupational health in these countries. Access to publication by more modest countries, scientifically speaking, is observed to occur through collaboration with the high-production countries. In this sense, it would seem necessary to study the basis underlying these relationships. Finally, the characterization of the collaborative nuclei does not differ greatly from what was expected.     

Is globalization good for your health?

Four points are made about globalization and health. First, economic integration is a powerful force for raising the incomes of poor countries. In the past 20 years several large developing countries have opened up to trade and investment, and they are growing well--faster than the rich countries. Second, there is no tendency for income inequality to increase in countries that open up. The higher growth that accompanies globalization in developing countries generally benefits poor people. Since there is a large literature linking income of the poor to health status, we can be reasonably confident that globalization has indirect positive effects on nutrition, infant mortality and other health issues related to income. Third, economic integration can obviously have adverse health effects as well: the transmission of AIDS through migration and travel is a dramatic recent example. However, both relatively closed and relatively open developing countries have severe AIDS problems. The practical solution lies in health policies, not in policies on economic integration. Likewise, free trade in tobacco will lead to increased smoking unless health-motivated disincentives are put in place. Global integration requires supporting institutions and policies. Fourth, the international architecture can be improved so that it is more beneficial to poor countries. For example, with regard to intellectual property rights, it may be practical for pharmaceutical innovators to choose to have intellectual property rights in either rich country markets or poor country ones, but not both. In this way incentives could be strong for research on diseases in both rich and poor countries.     

An international call to arms to improve allied health workforce planning

Although the funding and organization of the health care systems in the United States and England are quite different, there are striking similarities in the allied health workforce planning challenges facing the two countries. This paper identifies some common issues facing workforce policy-makers in both countries and suggests key next steps to enhance workforce research and planning in both countries, including the creation of a national minimum data set for allied health professions.     

Governance within the World Health Assembly: A 13-year analysis of WHO Member States’ contribution to global health governance

There is a widespread perception that developed countries in the Western world dictate the shaping and governance of global health. While there are many bodies that engage in global health governance, the World Health Organisation (WHO) is the only entity whereby 194 countries are invited to congregate together and engage in global health governance on an equal playing field. This paper examines the diversity of governance within the World Health Assembly (WHA), the supreme decision-making body of the WHO. It explores the degree and balance of policy influence between high, middle and low-income countries and the relevance of the WHO as a platform to exercise global governance. It finds that governance within the WHA is indeed diverse: relative to the number of Member States within the regions, all regions are well represented. While developed countries still dominate WHA governance, Western world countries do not overshadow decision-making, but rather there is evidence of strong engagement from the emerging economies. It is apparent that the WHO is still a relevant platform whereby all Member States can and do participate in the shaping of global health governance.     

Delivery of health informatics education and training

An overview is provided of education and training in health information management in the context of national information strategies. Although the article focuses upon British programmes, there are examples from North America, Australasia and other countries. Reference is made to international activities in the development of generic courses for education and training, the need for education and training, the content of courses, and methods of delivery, including Internet-based training and education. Governments and health authorities in many countries have recognized the urgent need for a highly educated and trained workforce in information management, but universities have been slow to respond, until the last few years. However, there is now a plethora of education and training programmes in North America, most European countries, and Australasia.