Population causes and consequences of leading chronic diseases: a comparative analysis of prevailing explanations

CONTEXT: The mortality numbers and rates of chronic disease are rising faster in developing than in developed countries. This article compares prevailing explanations of population chronic disease trends with theoretical and empirical models of population chronic disease epidemiology and assesses some economic consequences of the growth of chronic diseases in developing countries based on the experiences of developed countries. METHODS: Four decades of male mortality rates of cardiovascular and chronic noncommunicable diseases were regressed on changes in and levels of country income per capita, market integration, foreign direct investment, urbanization rates, and population aging in fifty-six countries for which comparative data were available. Neoclassical economic growth models were used to estimate the effect of the mortality rates of chronic noncommunicable diseases on economic growth in high-income OECD countries. FINDINGS: Processes of economic growth, market integration, foreign direct investment, and urbanization were significant determinants of long-term changes in mortality rates of heart disease and chronic noncommunicable disease, and the observed relationships with these social and economic factors were roughly three times stronger than the relationships with the population's aging. In low-income countries, higher levels of country income per capita, population urbanization, foreign direct investment, and market integration were associated with greater mortality rates of heart disease and chronic noncommunicable disease, less increased or sometimes reduced rates in middle-income countries, and decreased rates in high-income countries. Each 10 percent increase in the working-age mortality rates of chronic noncommunicable disease decreased economic growth rates by close to a half percent. CONCLUSIONS: Macrosocial and macroeconomic forces are major determinants of population rises in chronic disease mortality, and some prevailing demographic explanations, such as population aging, are incomplete on methodological, empirical, and policy grounds. Rising chronic disease mortality rates will significantly reduce economic growth in developing countries and further widen the health and economic gap between the developed and developing world.     

International Monetary Fund and World Bank policies can hurt poor, study says.

According to a study by a World Bank economist, developing countries that do not follow International Monetary Fund and World Bank economic programs have seen more of their people lifted out of poverty in times of economic growth than have countries that do take the advice of these lenders.     

The World Bank and pharmaceuticals

Within less than a decade the World Bank has become the largest single source of finance (loans) for health in low and middle income countries as well as a major player in the field of pharmaceuticals. Often 20-50% of the recurrent government health budget in developing countries is used to procure drugs. Drugs are among the most salient and cost-effective elements of health care and often a key factor for the success of a health sector reform. However, pharmaceuticals are frequently being used irrationally, mainly due to market imperfections in health care, such as information asymmetries, leading to serious health problems and a heavy financial burden on the health system. Lending priorities set by the World Bank could be used to promote public health sector reform, leading to the rational use of affordable and available drugs of good quality in developing countries. This report provides the first analysis of World Bank activity in the pharmaceutical sector worldwide. The analysis of 77 staff appraisal reports, describing the planning phase of World Bank country projects, shows that 16% of the total World Bank health, nutrition and population budget, or approximately US$1.3 billion, has been committed to loans or credits supporting pharmaceutical activities in the programme countries between 1989-95. Roughly US$1.05 billion has been committed to procurement of drugs and medical equipment. Only 5% of the total pharmaceutical sector lending is committed to software components such as drug policy work and rational use of drugs. No more than 45% of the projects were developed in collaboration with pharmaceutical expertise. The World Bank is recommended to improve its pharmaceutical sector involvement by promoting drug policy research and development including national and international dialogue on pharmaceutical issues to ensure rational use of both drugs and loans. In this, the World Bank has an advantage given its experience from working with both the private and the public sector, its in-house expertise in health economics, and lastly its ability to be listened to by governments through its power.     

The demographic impact of family planning programs

In response to concerns about the adverse consequences of rapid population growth, family planning programs have been implemented in many developing countries. The aim of the present study is to assess the impact of this programmatic approach on long-range population growth. The result of a new and hypothetical population projection indicates that in the absence of family planning programs the population of the developing world could be expected to reach 14.6 billion in the year 2100 instead of the 10 billion that is currently projected by the World Bank. Despite the apparent success of existing interventions, fertility control is far from complete, as many women continue to bear unwanted births. To assess the impact of this unintended childbearing a second hypothetical projection is made. With perfect implementation of reproductive preferences, the population size of the developing world in 2100 would be reduced by an estimated 2.2 billion below the current projection. Further strengthening of family planning programs and improvements in birth control technology are therefore likely to provide important demographic benefits.     

Non-Medical prescribing policies: A global scoping review

BackgroundAuthorizing health care providers other than physicians to prescribe medicines (i.e., non-medical prescribing, NMP) has been used to improve access to healthcare in many countries. This paper aimed to identify the scope of policies facilitating NMP worldwide and investigate the relationship of such policies with a country’s physician to population ratio and economic status.MethodsA hierarchical search strategy was used. First, we compiled a list of countries and territories (n = 216) based upon World Bank record. Then, we collected relevant information for each country by using country name combined with key terms in PubMed, Google, and World Health Organization (WHO) country pharmaceutical profiles. Countries’ socio-economic status and physician to population ratio were determined using data from the World Bank.ResultsLegislation allowing NMP was found for 117 of 216 (54%) countries and territories. The most prevalent policy identified was that of autonomous prescribing authority (59%). Countries with low or high incomes and those with low or high physician to population ratios (<1/1000 or >3/1000) had the highest concentration of policies for NMP rights.ConclusionDespite the varied scope of relevant policies, NMP has been implemented in countries of varied income levels and physician to population ratios. Future research is warranted to empirically examine its impact on access to care.     

Health care spending growth: how different is the United States from the rest of the OECD?

This paper compares the long-term (1970-2002) rates of real growth in health spending per capita in the United States and a group of high-income countries in the Organization for Economic Cooperation and Development (OECD). Real health spending growth is decomposed into population aging, overall economic growth, and excess growth. Although rates of aging and overall economic growth were similar, annual excess growth was much higher in the United States (2.0 percent) versus the OECD countries studied (1.1 percent). That difference, which is of an economically important magnitude, suggests that country-specific institutional factors might contribute to long-term health spending trends.     

The World Bank's perspective on global health

Over the next 25 years, as populations age and tobacco consumption increases, most developing regions will likely see noncommunicable diseases become the leading causes of disability and premature mortality. The already existing problems of malnutrition and infectious diseases will remain. In this context, the World Bank is examining its role and contribution to global health. From a small start approximately 25 years ago, the Bank has greatly expanded its role in international health, population, and nutrition to become the largest single external financier of health activities in low- and middle-income countries. Many other Bank-supported activities affect health, including poverty reduction, housing, water and sanitation, and the education of girls. The Bank is also increasingly active in health policy debates, publishing numerous studies annually. Most of these studies focus upon specific countries, but some address key issues of concern to many developing countries. This article explains why the Bank continues to expand its resources devoted to health and the rationale for the changing emphasis of its activities in the field.     

Mediational pathways connecting secondary education and age at marriage to maternal mortality: A comparison between developing and developed countries

While studies have shown that maternal mortality rates have been improving worldwide, rates are still high across developing nations. In general, poor health of women is associated with higher maternal mortality rates in developing countries. Understanding country-level risk factors can inform intervention and prevention efforts that could bring high maternal mortality rates down. Specifically, the authors were interested in investigating whether: (1) secondary education participation (SEP) or age at marriage (AM) of women were related to maternal mortality rates, and (2) adolescent birth rate and contraceptive use (CU) acted as mediators of this association. The authors add to the literature with this current article by showing the relation of SEP and AM to maternal mortality rates globally (both directly and indirectly through mediators) and then by comparing differences between developed and developing/least developed countries. Path analysis was used to test the hypothesized model using country level longitudinal data from 2000 to 2010 obtained from United Nations publications, World Health Organization materials, and World Bank development reports. Findings include a significant correlation between SEP and AM for developing countries; for developed countries the relation was not significant. As well, SEP in developing countries was associated with increased CU. Women in developing countries who finish school before marriage may have important social capital gains.     

Factor analysis of attributive determinants for life expectancy and infant mortality rate with recipient country data in consideration of socioeconomic environment

OBJECTIVE: From a financial viewpoint, it is important that international medical care and cooperation in recipient countries by NGOs or governments of donor countries, and health promotion carried out by recipient countries' governments, are carried out efficiently. In this paper, we performed analysis of factors that determine life expectancy and infant mortality rates in recipient countries, in consideration of the socioeconomic environment. METHODS: We used data from World Development Indicators 2002 and 2003, published by the World Bank, and Human Development Indicators 2002, published by the United Nations Development Programme. We analyzed 68 countries classified as middle and low income countries by the World Bank, because complete data for these countries were available. We used life expectancy and infant mortality rates as health indicators and did multiple regression analysis; with these indicators as dependent variables, and with socioeconomic environmental data as independent variables. Furthermore, we undertook multiple regression analysis after carrying out group divisions of the countries according to the numbers of refugees, birthrates, and expenditures on armaments. RESULTS: We ascertained the following points. 1) For improving health of people in recipient countries, it is important to secure safe drinking water, improve literacy, and increase income and the possibility of access to basic medicines. 2) For countries where there are a lot of refugees, it is important to increase the measles vaccine inoculation rate. 3) In countries where there are few refugees, life expectancy will be prolonged by as much as three years if the measles vaccine inoculation rate increases by just 10%. 4) In countries with a high armaments expenditure rate in proportion to GNI, it is important to secure access to sanitary toilet facilities. 5) Life expectancy in countries tends to shorten if life expectancy in their neighboring countries is short. 6) The rate of public health expenditures in proportion to GDP has no affect on health. 7) If the literacy rate rises 10%, life expectancy will be prolonged by about 1.2 years and the infant mortality rate will decrease about 6%. CONCLUSION: Though improvement of the socioeconomic environment is more effective for improving life expectancy and infant mortality rates in recipient countries than medical conditions, the effectiveness differs according to the number of refugees, the birthrate and expenditures on armaments.     

Demographic aspects of population aging in developed countries

There has been a dramatic growth of the elderly (aged 60+) population in the developed countries since 1950. By the year 2000, roughly 20% of the population in these countries will belong to the aged. Women far outnumber men among the elderly due to differential mortality trends between the sexes. Male life expectancy at age 60 varies from 19.1 years in Japan to 14.6 years in Hungary. Among females, the range is from 23.2 years (Canada) to 18.4 years (Romania). Mortality rates have declined dramatically in several countries since 1970 due primarily to declines in death rates from ischaemic heart disease and stroke.     

Availability, safety, and quality of blood for transfusion in the Americas.

OBJECTIVES: This article has two objectives: (1) to present for countries and territories of the Region of the Americas data on the number of blood donations, proportion of voluntary blood donors versus remunerated blood donors, coverage of screening for infectious agents, and separation of donated blood into its components and (2) to explore the relationships of those characteristics with economic and organizational factors in the countries and territories. METHODS: We carried out comparative analyses using population and health information gathered annually by the Pan American Health Organization (PAHO) from national health officials from the countries in the Americas, as well as economic information (gross national product (GNP) per capita) obtained from publications of the World Bank. RESULTS: There is a direct correlation between the availability of blood for transfusion and GNP per capita. Seven countries with a GNP per capita above US$ 10 000 per year account for 38% of the Regional population but 68% of the Regional blood donations. Voluntary blood donation is more common in the countries with better blood availability. There is no association between GNP per capita and coverage of screening for infectious agents. Nevertheless, of the six countries with a GNP per capita below US$ 1 000, only one of the six screens all units for human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B surface antigen (HBsAg). Countries with a higher proportion of voluntary blood donors tend to have lower prevalence rates of infectious markers. Separation of blood into its components is also more common in countries with higher blood donation rates. CONCLUSIONS: The availability, safety, and quality of blood for transfusion in the Americas needs to be improved. As part of that effort, national policies and strategies must be put into place so that the resources already allocated for blood services are better utilized.     

Income inequality and population health in Islamic countries

Objectives

To undertake a fresh examination of the relationship between income inequality and population health for a group of Islamic countries using recent information derived from data resource sites from the World Bank and Islamic countries.

Study design

: Cross-sectional data on different measures of income distribution (prosperity, health care, women’s role and environment) and indicators of population health were used to illuminate this issue.

Methods

The relationship between income inequality and population health for a group of Islamic countries was tested using recent information derived from data resource sites from the World Bank and Islamic countries. After consideration of previous studies, seven dependent variables were determined and tested in six equation formats.

Results

According to the equations, the urban population percentage and gross domestic product are the most important significant variables that affect life expectancy and the infant mortality rate in Islamic countries. The income distribution coefficient, regardless of the type of measure, was almost insignificant in all equations.

Conclusions

In selected Islamic countries, income level has a positive effect on population health, but the level of income distribution is not significant. Among the other dependent variables (e.g. different measures of income distribution, health care, role of women and environment), only environment and education had significant effects. Most of the Islamic countries studied are considered to be poorly developed.     

Determinants of health status and the influence of primary health care services in Latin America, 1990-98

Primary health care (PHC) services have been advocated as a means by which less developed countries may improve the health of their populations even in the face of poverty, low levels of literacy, poor nutrition and other factors that negatively influence health status. Using aggregated data from the World Bank and UNICEF this study examined which factors, both within the health care system and outside of it, are associated with under-5 mortality rates in 22 countries of Latin America and the Caribbean during the 1990s. In a multivariate analysis using generalized estimating equations for repeated measures, five factors were found to be independent predictors of lower under-5 mortality rates (U5MRs). These were vaccination levels, female literacy, the use of oral rehydration therapy, access to safe water and GNP per capita. When the magnitude of these associations were assessed, higher levels of GNP per capita was found to be very weakly associated with lower U5MRs, compared with female literacy and vaccination rates. These findings suggest that government policies which focus only on promoting economic growth, while not making important investments in PHC services, female education and access to safe water are unlikely to see large improvements in health status.     

People versus development: An overview of the economics of population growth

Population growth and economic change are tightly bound together. The very high rates of population growth in the poor countries of Africa, Asia, and Latin America complicate the resolution of basic economic problems and make it more difficult to assure an adequate rate of growth of income per capita. Simultaneously, the relative stagnation of per capita incomes, especially in the rural areas of the very poor countries, helps to maintain high levels of fertility, thus completing a circle of rapid population growth and poverty. There is no one solution to the dilemma. Neither dramatic improvements in the standard of living nor the rapid adoption of fertility control are likely in the poorest countries. Moreover, population control by itself will certainly not solve the problem of poverty, both because population limitation without economic growth would merely share the poverty and because the masses of the population are unlikely to reduce their fertility without the prospect of some improvement in the standard of living. On the other hand, it seems to be equally clear that, with the exception of those few countries that are possessed of enormous wealth in the form of natural resources, poverty will not be eliminated without a major reduction in the rate of population growth. Thus, the best hope lies in some judicious combination of social and economic reform and population control. This solution probably implies an increased commitment of finance and other resources to population programs.     

Family planning program: world review 1974. Introduction.

The 1974 Population Conference at Bucharest was marked with controversy between developed and developing countries, with the latter strongly critical of aid for population control but less for social and economic development. The Plan of Action which was finally approved emphasized the importance of social and economic factors in relation to population growth while recommending that couples in all nations should have access to family planning information. Different regions of the world, however, have widely divergent population policies and goals. The Asia-Pacific region of the developing world, which has 3/4 of the population of the developing world, has articulated a strong stance in favor of reducing birth rates at Post-Bucharest Consultation. Government-supported family planning programs are seen as a high priority item to reduce rapid population growth. Rapid population growth is not seen as a high-priority problem in most African, Arab, and Latin American countries. Population problems will be solved with economic and social advancement. There is more concern in Latin America for family planning as a "human right" issue than to promote demographic goals. Latin America was also concerned with migration/urbanization issues. All of the Regional Consultations after Bucharest favored a greater emphasis on population in development planning, concern for the problems caused by migration and urbanization, improvement in the status of women, and support for the reduction of mortality levels. Some 74 countries containing 93% of the population of the developing world, supported family planning, with only 4 populous countries -- Burma, Ethiopia, Peru, and North Korea not in support. More than 98% of the population of Asia lives in countries which support family planning; the figures are 94% for Latin America, 90% for the Middle East and North Africa and 64% for Sub-Saharan Africa. The governments of 39 countries with a combined population of 2.3 billion have stated that rapid population growth is detrimental to the rapid attainment of social and economic development; 35 additional developing countries favor family planning as a basic human right, to improve the status of women, and for health reasons. There is a wide range of acceptance rates for contraceptives among the developing countries with gains shown for most countries between 1972 and 1974. There is a strong pattern of fertility decline in 11 East Asian and Latin American countries plus Mauritius. Induced abortion countries to be a major means of birth control even in countries where it is illegal. Legal access to abortion on broad grounds is available in China, North Vietnam, Tunisia, Singapore, India, Zambia, and Hong Kong. It seems likely that liberalization of abortion laws will occur in more developing countries in the near future for health reasons as well as for demographic reasons.     

The role of the World Bank in international health: renewed commitment and partnership

During the course of the past ten years, the World Bank has become the single largest external financier of health activities in low and middle income countries and an important voice in national and international debates on health policy. This article highlights the Bank's new strategic direction in the health sector aimed at: improving health, nutrition, and population outcomes of the poor; enhancing the performance of health care systems; and securing sustainable health care financing. Millions of preventable deaths and treatable illnesses, together with health systems that are inefficient, inequitable and ineffective, have motivated expanded Bank support for the health sector in many of its client countries. The new policy directions and system-wide reforms observed in these countries are the result of both demand and supply factors. It is part of a general shift in the Bank's approach to development assistance, which sees systemic reform as a way to improve the impact and sustainability of investments in health. On the demand side, the Bank is trying to adapt to ongoing political, technological, economic, demographic, epidemiological and social pressures. On the supply side, the Bank's growing international experience and substantial financial resources are used to complement the development assistance provided by other organizations and the global effort to improve health and health systems in low and middle income countries.     

The policy of the Save the Children Fund UK

The choices available to people deciding on family size are determined by cultural, economic and social considerations. Before any realistic and acceptable action can be advised, which might influence family size and population growth, it is necessary to understand the balance between resource availability and consumption, access to contraceptive technology, and the social and cultural influences under which people live. Any intervention should seek to increase the range of choices available to people and to create the conditions which enable them to afford those choices. It is in the poorer parts of the world that population growth is greatest and choices are most limited. Inequitable resource distribution globally is at the root of high population growth rates in poorer areas. Excessive consumption patterns in the industrialized countries pose as great a threat to the development of a sustainable global environment as do the high growth rates in the developing countries. There is no technological short cut to limiting population growth. For any service, including family spacing, to have a significant impact over a long period of time, it must be delivered through a secure, reliable and effective system to families who fully understand the benefits and the implications, and whose choice is informed and made freely.     

Challenges and options for animal and public health services in the next two decades

Trade in livestock and livestock products makes up approximately one sixth of global agriculture trade. This trade is demand driven, primarily by growing human populations, changing economies, and consumer preferences in developing countries. Different rates of population growth, economic growth, urbanisation, environmental sustainability, and technology transfer will determine which countries will reap the greatest benefits. Global trends in demand and supply for food, not terrorism, will drive the future of animal and public health service delivery. To benefit the greatest number of people and countries, animal and public health services should support policies that temper growing disparities among rich and poor countries, city and rural populations, and the sexes. Economic growth is critical to overcoming disparities between countries and best supported by integrated animal health, public health, labour, and foreign policies. Opportunities for job growth will be the greatest along the value added chain of food production and will require significant investments in science- (risk-) based education.     

Economic development, political-economic system, and the physical quality of life.

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 for 123 countries (97 per cent of the world's population). PQL variables included: indicators of health, health services, and nutrition (infant mortality rate, child death rate, life expectancy, 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. Capitalist countries fell across the entire range of economic development (measured by gross national product per capita), while the socialist countries appeared at the low-income, lower-middle-income, and upper-middle-income levels. All PQL measures improved as economic development increased. In 28 of 30 comparisons between countries at similar levels of economic development, socialist countries showed more favorable PQL outcomes.     

Economic development and population growth

High rates of population growth cause the population to be younger reducing the relative number of persons of productive age. The younger cohorts are not easily absorbed into the labor market or adequately educated because of lack of funds. The rate of population growth also affects the distribution of the population as illustrated in the high degree of migration to cities from rural areas. The size of the population affects the amount of population pressure experienced by the economy and the degree of division of labor. Aside from growth factors, population size itself affects the economy. Although a large population can be healthy for the economy, this seldom seems to be the case in developing countries because of the restricted availability of resources.