Third World experiences in health planning.

In response to an invitation by the American Public Health Association, the author discusses his experiences in health work with particular reference to the Third World. These cover a period of four decades of activities in many countries, the discussion being primarily directed toward the North American audience attending the panel organized by the International Health Committee at the 104th Annual Meeting of the Association in Miami Beach in October 1976. First the paper deals with the legacy of broad social teaching resulting from the years of international collaboration from the time of Franklin D. Roosevelt to that of Richard Nixon. Public health problems, whether new or old, are essentially social in character and can only be solved in terms of social policy. Attention is directed to the current mistake of placing the emphasis on individual behavior, divorced from its social base, in the work of health professionals servings in Third World countries. The weakness of national average values and the consequent need of measuring the differentials between social groups and classes are widely illustrated. Finally, positive and negative lessons learned by experimenting with health technology consistent with the expected development of countries are examined as a basis for a genuinely emancipatory approach to the health problems in the Third World.     

HIV Infection and AIDS in Africa and the Third World

Acquired immunodeficiency syndrome (AIDS) threatens to undermine the health status and economic development of Third World populations unless there is global cooperation to prevent the further spread of infection. Poor people in developing countries are considered to be at greatest risk of developing AIDS because their immune systems have been compromised by prior infections. The poor are further placed at risk by their lack of accessibility to health care services and information about AIDS. Despite a host of competing health problems (e.g., childhood diarrhea and malnutrition) and scarce funds for mass educational campaigns, some Third World countries have launched government-sponsored prevention programs. Leaders in this area include Zambia, Rwanda, Uganda, and Brazil. The fact the 90% of those with AIDS are in the economically productive age group (10-49 years) has serious implications for the future of Third World countries. In Zaire, for example, it has been projected that premature deaths from AIDS will reduce the gross national product by 8% in 1995. The World Health Organization (WHO) is in the best position to spearhead the global campaign against AIDS and has called for the integration of AIDS prevention activities into family planning programs. The US's withdrawal of financial support from family planning programs that provide abortion and its reduction in recent years in its contributions to the WHO general budget are unfortunate, given the need for massive international assistance to stop the transmission of AIDS in developing countries.     

Militarism and world health.

Militarism is a rapidly growing factor in that complex network of social, political and economic causes of ill health among the world's poor. This complex of causes is driving a spiral of class inequality, political instability, and military repression in many less developed nations. These nations share a uniform security doctrine, which has major health impacts. Here five impacts are noted: diversion of resources, suppression of dissent, military classism, environment damage, and crime and terrorism. The demand stimulated by the recent Persian Gulf War for expensive, high-technology weapons may deepen Third World debt and fuel the cycle of poverty, ill health, social unrest, and military oppression. International health workers need to take account of the causes and effects of militarism in their studies of health problems. Their work could be aided by organizations that promote disarmament and environment preservation.     

Strategies to influence nutrition behaviour

An attempt is made in this paper to consider first the current nutritional scene with its problems, and then to suggest strategies for improvement. Since the quality of people's diets everywhere is influenced by many different factors, not least by availability of food, ability to pay for it, and some (however basic) understanding of its effects upon health, a strong plea is made for consideration to be given to those most in need of nutritional help--the least advantaged and least motivated groups in the developed countries, as well as the poor in the Third World. Some strategies aimed at improving nutrition behaviour are outlined.     

A review of UK housing policy: ideology and public health

OBJECTIVES: The aim of this paper is to review UK public health policy, with a specific reference to housing as a key health determinant, since its inception in the Victorian era to contemporary times. REVIEW: This paper reviews the role of social and private housing policy in the development of the UK public health movement, tracing its initial medical routes through to the current socio-economic model of public health. The paper establishes five distinct ideologically and philosophically driven eras, placing public health and housing within liberal (Victorian era), state interventionist (post World War 1; post World War 2), neoliberal (post 1979) and "Third Way" (post 1997) models, showing the political perspective of policy interventions and overviewing their impact on public health. The paper particularly focuses on the contemporary model of public health since the Acheson Report, and how its recommendations have found their way into policy, also the impact on housing practice. CONCLUSIONS: Public health is closely related to political ideology, whether driven by the State, individual or partnership arrangements. The current political system, the Third Way, seeks to promote a sustainable "social contract" between citizens and the State, public, private and voluntary organizations in delivering community-based change in areas where health inequalities can be most progressively and successfully addressed.     

Transnational tobacco companies and health in underdeveloped countries: recommendations for avoiding a smoking epidemic

This paper examines the impact of transnational tobacco companies on health in underdeveloped countries and makes recommendations for avoiding a coming smoking epidemic. Although tobacco is generally seen as primarily a health problem, tobacco's future in the Third World depends upon a number of nonhealth related considerations, especially political and economic factors. Unfortunately, there is very little relationship between what the World Health Organization and others have recommended, and what most Third World countries are doing today. Although the controversy concerning cigarette smoking and health has only become a 'burning issue' in recent decades, tobacco products have been used around the world for hundreds of years. The public outcry against cigarette smoking has become increasingly widespread since the 1964 U.S. Surgeon General's report on smoking and health. The ill effects of cigarette smoking are now widely considered collectively as the number one preventable health problem in the world, responsible for an estimated 2.5 million deaths per year. In response to declining sales in developed countries, the tobacco transnational corporations have begun focusing their attention on Third World markets, where tobacco consumption has increased dramatically in recent years. Cigarettes not only take precious limited resources away from desperately needed basic human needs, but they also inflict future health problems on vast numbers of Third World people who have only a vague understanding of the risks involved in cigarette smoking. Until Third World governments address the long-term consequences of their short-term lust for cash, the probabilities of a smoking epidemic in the Third World grow increasingly likely.(ABSTRACT TRUNCATED AT 250 WORDS)     

An integrated sociocultural curriculum for community medicine in Bali, Indonesia

Since 1983, social scientists have collaborated with teaching staff at the Faculty of Medicine, Udayana University, Bali, Indonesia, to develop an integrated sociocultural curriculum for undergraduate students in community health. The Udayana curriculum is discussed in the context of an international commitment over the last two decades to appropriate education for primary health care and community health in developing countries. The authors describe their work as consultants with Udayana staff. Participants formulated a five-stage project of curriculum development and community health research that could be continued as part of an ongoing community medicine teaching program. Recommendations for integrating social science perspectives within medical domains are outlined, based on the project experience. The paper also discusses the undertaking as a 'development project' suggesting that many of the issues and problems that arose are common to bureaucratic institutions in Third World countries when development projects are initiated.     

Globalization and local response to epidemiological overlap in 21st century Ecuador

Background  

Third World countries are confronted by a complex overlay of two sets of health problems. Traditional maladies, including communicable diseases, malnutrition, and environmental health hazards coexist with emerging health challenges, including cardiovascular disease, cancer, and increasing levels of obesity. Using Ecuador as an example, this paper proposes a conceptual framework for linking epidemiologic overlap to emerging social structures and processes at the national and global levels.     

Reaching the unreached: a miracle in the making.

The survival and well-being of children is identified as the primary frontier of international health. In this regard, 1990 is identified as the most historic year ever in world history for children, and the achievements of the Universal Child Immunization program in immunizing 80% of children of the Third World under one year of age by December 1990 and the Convention on the Rights of the Child and the World Summit for Children are cited. The importance of the world community exercising its capacity to act on a common problem together, of the health services taking on a much stronger social purpose, and of the tireless and dedicated spirits in these efforts is stressed as essential for making a much better world for children in the centuries to come.     

Comparative study about the conceptions of health and disease between social science and dentistry students from a public university of Rio de Janeiro State

The purpose of this article was to compare the social representation between dentistry and social sciences students, concerning the process of health and disease, and the conception of health professional position in our society, aiming a contribution to improve dentistry students' social formation. It is a qualitative research and its methodology was based in interviews performed by two researchers with one free association question and five open questions directed to ten first and ten last year students from both graduation courses of a public university. The first year students from both courses said that health and disease was based in the World Health Organization (WHO) concept. The social sciences students showed more engagement about social questions while dentistry's cared more about the individual than the community. Considering that, we can conclude that dentistry students from the last year did not show social sensitivity either worried about Brazilian's population problems, while social sciences students do.     

Global perspective on health service financing

Are there new sources of finance which Third World countries can tap to pay for Health for All? Is there anything valuable to be learnt in this respect from the experience of countries which are now developed?Countries have drifted into different ways of paying for health services, often without foreseeing the long run consequences. In many Third World countries the financing of services has been strongly influenced by their colonial past. This explains why many of them attempt to provide wholly free services and provide privileged services not only to the armed forces but to public servants as well. Introducing charges is one way of securing more revenue. It is noticeable that in some countries which were never colonized, there is a greater willingness to use charging and that this stimulates the growth of informal systems of voluntary health insurance.While many developed countries have made a transition from health insurance to universal services while retaining a considerable element of contributions from employers and employees, it is more difficult in political terms to introduce contributions unless those who contribute get something specific for them. The problem for developing countries contemplating the introduction of compulsory health insurance is to design systems which avoid all the problems which have manifested themselves in Europe, North America and on a wider scale in Latin America. These problems include the escalation of costs, failure to collect contributions due, the provision of ‘paper’ rights, bureaucratic obstacles to receiving care, different funds with varying rights, wholly separated services for insured persons, the bias to urban curative services and the separation of curative from preventive services. World experience suggests that services provided under compulsory health insurance need to be closely coordinated with governmental services and the policy governing them should be kept under the close supervision of Ministers of Health.     

Developing applied medical anthropology in Third World countries: problems and actions.

Recognition of the usefulness of ethnographic research in Third World community health projects and programs developed rapidly during the 1980s. As a result, the various agencies and organizations promoting community health programs (UNICEF, WHO, NGOs) have greatly increased their recruiting of social scientists, particularly medical anthropologists, for research and other programmatic activities in primary health care, child survival (especially diarrhea, acute respiratory infections, maternal and child nutrition, infectious disease, and AIDS). However, it has proved very difficult to identify well-trained anthropologists and/or other social scientists for these roles, particularly in Third World countries. This paper examines some of the background of this problem, and presents examples of methodological training (in both qualitative and quantitative research techniques) that seek to increase the skills of social scientists and other researchers in the arena of international community health.     

Rethinking literacy and women's health: a Bangladesh case study

Health and literacy are two major areas of women's development in the Third World. Although health and literacy have been recognized as essential elements for improving the quality of women's lives, questions emerge from Eurocentric and colonial assumptions about development, including the following: Does literacy have an impact on women's health? If it does, what are the mechanisms whereby literacy could have an impact on women's health? Using Bangladesh as a case study, I question the Eurocentric and colonial nature of dominant discourses in the answers to questions about literacy and women's health. I argue that literacy and women's health need to be reconsidered from the local women's standpoint since dominant discourses fail to take into consideration local women's worldviews, indigenous knowledge, and oral traditions. Finally, I make some recommendations for future research and programming in literacy and women's health in Bangladesh and in health care in Third World contexts.     

What have we learnt about the cultural, social and behavioural determinants of health? From selected readings to the first Health Transition Workshop

The article explores the issue of whether the holding of an international workshop in Canberra in 1989, and the preparation of papers for it, increased our knowledge of the cultural, social and behavioural determinants of health and whether the publication of the proceedings placed new knowledge in the public domain. The approach adopted is to compare those proceedings with a collection of selected readings on the subject made shortly before as part of the same program and also with certain other publications. The conclusions reached are that, in addition to having stimulated interest in the field, the workshop and its proceedings furthered knowledge in at least five important areas: (1) the existence of mortality-prone households; (2) the impact of differing cultural situations of women in terms of individualism on their children's survival; (3) the mechanisms whereby maternal education is translated into child survival; (4) the impact of culture and ethnicity on mortality; and (5) indirect indices of the impact of care. The workshop failed to contribute to substantial advances (or draw attention to the lack of advance) in the following areas: (1) the measurement of Third World morbidity or health; (2) adult health transition; (3) the impact of radicalism or egalitarianism in communities other than Kerala and Sri Lanka on mortality; (4) the impact of lifestyle diseases on Third World mortality; (5) the identification of economically optimum mixes of social change and the provision of health services in reducing mortality and improving health; and (6) the employment of health transition knowledge in the reduction of mortality and the improvement of health.     

Strategies to influence nutrition behaviour

An attempt is made in this paper to consider first the current nutritional scene with its problems, and then to suggest strategies for improvement. As the quality of people's diets everywhere is influenced by many different factors, not least by availability of food, ability to pay for it, and some (however basic) understanding of its effects upon health, a strong plea is made for consideration to be given to those most in need of nutritional help–the least advantaged and least motivated groups in the developed countries, as well as the poor in the Third World. Some strategies aimed at improving nutrition behaviour are outlined.
Having given some considerable thought to the exact meaning of the title, I decided it is best understood as 'ways and means of bringing about beneficial changes in food habits from the health point of view'. The more I considered what such changes might entail, the less appropriate it seemed to think merely in terms of one's own immediate area, or even of the developed parts of the world. Thus, although many of the examples offered are taken either from my native Scotland or from the UK as a whole, I have attempted to aim for a wider view.     

Human rights, health, and capital accumulation in the Third World.

This article examines the relationship between human rights and the pattern of capital accumulation in the Third World. The repressive authoritarian State increasingly constitutes the means for enforcing the intensive exploitation of labor in Third World industrial enclaves and commercial agriculture. While the development of center capitalism has evolved toward "the Welfare State" and a framework of liberal sociodemocracy, the "peripheral State" is generally characterized by nondemocratic forms of government. This bipolarity in the state structure between center and periphery is functionally related to the international division of labor and the unity of production and circulation on a world level. The programs and policies of the center Welfare State (health, education, social security, etc.) constitute an input of "human capital" into the high-technology center labor process. Moreover, welfare programs in center countries activate the process of circulation by sustaining high levels of consumer demand. In underdeveloped countries, the underlying vacuum in the social sectors and the important allocations to military expenditure support the requirements of the peripheral labor process. Programs in health in the center and periphery are related to the bipolarity (qualification/dequalification) in the international division of labor. The social and economic functions of health programs are intimately related to the organic structure of the State and the mechanics whereby the State allocates its financial surplus in support of both capitalist production and circulation.     

Health systems as defences against the consequences of poverty: equity in health as social justice

The main development problems in the Third World are known to be gross socioeconomic inequality, widespread poor health status accompanied by high fertility and infant mortality rates, low life expectancy, mass illiteracy and mass poverty. In most of these countries governments invest a great deal of scarce resources toward the consequences of poverty rather than its causes. The paucity of resources for such social services is exacerbated by continuously increasing demands and needs which have to be satisfied. Unmet needs tend to cause apathy in the population. For purposes of controlling poverty and its consequences, these must be clearly formulated and relevant policies, a commitment to implement such policies, adequate administrative capacity and reasonably adequate resources. In the case of the health services system, the same requirements apply. Above all, the health system has to be directed toward the greatest needs of the population. This must involve policy makers, implementors and the consumer community. This paper argues that health systems cannot be an effective weapon against the consequences of poverty unless the above kinds of policy exist and are implemented.     

Health information imperatives for Third World countries

The role of health information in the health delivery services of a nation is stressed with examples from the advanced nations. Factors responsible for the poor state of health information systems in the Third World and the effects on health delivery services are identified. probable factors that may Lead to the development of health information systems in the Third World in the future are posited. Recommendations for the establishment of health information systems based on funding, staffing, functions and networking are made.     

Economic adjustment and the future of health services in the Third World

Hard economic times in the Third World in the 1980s found many countries unable to maintain previous levels of health and social services in the face of the mounting service cost of their external debt and declining export earnings. The economic adjustment policies promoted by the World Bank and International Monetary Fund on the basis of market ideology were not able alone to improve the economic status of the debtor countries and did have deleterious effects on their health services and the health status of their population. Less pressure to privatize health services, more aid from abroad for the public sector, and a reallocation of scarce government resources from military to social purposes would help to rectify the situation, although sustained long-run improvement would still depend on the external factors that determine economic prosperity, and the prognosis in this respect is uncertain.     

Latin American social medicine: contributions and challenges]

This piece presents and analyzes a number of issues related to social medicine: the context of the emergence of social medicine; the differences between social medicine and public health; the theories, methods, and debates in social medicine; the main subjects or problems considered in social medicine; and the difficulties of disseminating the concepts of social medicine among English-speaking persons and among medical and public health professionals in general. Latin American social medicine has challenged other views by contributing to an understanding of the determinants of the health-disease-health care process and by using theories, methods, and techniques that are little known in the field of public health. Introducing Latin American social medicine, especially among English speakers, will be difficult due to the conceptual complexity of this field for persons who are accustomed to the theoretical framework of public health and medicine and also due to skepticism concerning research coming from the Third World. A multidisciplinary team is facing this challenge through two primary initiatives: 1) the creation of an Internet portal and database where there are structured abstracts in English, Portuguese, and Spanish of books, book chapters, and articles on social medicine and 2) the electronic publication of two journals on Latin American social medicine.