International occupational health

Working conditions for the majority of the world's workers do not meet the minimum standards and guidelines set by international agencies. Occupational health and safety laws cover only about 10 percent of the population in developing countries, omitting many major hazardous industries and occupations. With rare exception, most countries defer to the United Nations the responsibility for international occupational health. The UN's international agencies have had limited success in bringing occupational health to the industrializing countries. The International Labor Organization (ILO) conventions are intended to guide all countries in the promotion of workplace safety and in managing occupational health and safety programs. ILO conventions and recommendations on occupational safety and health are international agreements that have legal force only if they are ratified by ILO member states. The most important ILO Convention on Occupational Safety and Health has been ratified by only 37 of the 175 ILO member states. Only 23 countries have ratified the ILO Employment Injury Benefits Convention that lists occupational diseases for which compensation should be paid. The World Health Organization (WHO) is responsible for the technical aspects of occupational health and safety, the promotion of medical services and hygienic standards. Limited WHO and ILO funding severely impedes the development of international occupational health. The U.S. reliance on international agencies to promote health and safety in the industrializing countries is not nearly adequate. This is particularly true if occupational health continues to be regarded primarily as an academic exercise by the developed countries, and a budgetary triviality by the international agencies. Occupational health is not a goal achievable in isolation. It should be part of a major institutional development that touches and reforms every level of government in an industrializing country. Occupational health and safety should be brought to industrializing countries by a comprehensive consultative program sponsored by the United States and other countries that are willing to share the burden. Occupational health and safety program development is tied to the economic success of the industrializing country and its industries. Only after the development of a successful legal and economic system in an industrializing country is it possible to incorporate a successful program of occupational health and safety.     

Nematodes: worms of the world

Intestinal nematodes remain a world health issue. Their ubiquitous nature makes them difficult to control, and treatment is ineffective when the source of the infection can not be eradicated. International travel and immigration from developing countries have effectively increased the numbers of people infected in the US, especially in the northeast and southern coastal areas. It is important to provide sensitive and accurate methods to diagnose these parasites. Additionally, the WHO and other agencies must remain vigilant and continue their efforts to improve the health of vulnerable populations throughout the world.     

Controversies at international organizations over asbestos industry influence.

International scientific organizations have been subject to repeated efforts by Canadian government officials and representatives of the asbestos industry to issue reports that would be favorable to the industry on questions of asbestos use and public health implications. In recent years these efforts have been met with international opposition from scientists, governments, unions, and environmental groups, and a pattern of improprieties, often involving the same individuals and tactics, has emerged. This has been a serious threat to scientific objectivity at the most respected international scientific bodies in the world. The manipulation of these international organizations takes on unprecedented significance in this age of the World Trade Organization.     

International politics and primary health care in Costa Rica

Costa Rica's internationally-renowned rural health program exemplifies the principles put forth by the 1978 Alma Ata Declaration on Primary Health Care with one exception: the government has not succeeded in achieving active community participation in health. This paper uses a historical and political-economic perspective to explain why the Costa Rican government failed in its efforts to enhance community participation after Alma Ata. International agencies have been closely involved in the design and implementation of rural health services in Costa Rica since the early 1900s, yet community participation did not figure in these programs until the mid-1970s. The demise of community participation in the early 1980s is attributed to a combination of factors including partisan conflicts, social class conflicts, interest group politics and, particularly, to the shifting priorities of international health and development agencies.     

Globalization and international trade in the twenty-first century: opportunities for and threats to the health sector in the south.

Globalization and international trade are important forces at the turn of the century. This article explores how freer international trade will affect developing countries that are net importers of health care goods and services. Four commodities are used as special cases for discussion: pharmaceuticals, health care technologies, pesticides, and tobacco and its related products. The authors discuss the role of international specialized agencies, such as the World Trade Organization, World Health Organization, and World Bank, that are concerned with international trade and its health and health care consequences, and argue that closer collaboration is required among these agencies if the negative effects of trade liberalization on developing countries are to be mitigated. The authors pose a number of research questions that could help in developing proactive policies for the South on the trade of goods and services with harmful effects on health as well as those with potential health and economic benefits.     

Ideological dimensions of community participation in Latin American health programs

A comparative analysis of community participation in urban and agricultural programs, and health programs in Latin America suggests that the promotion of community participation was based in all cases on two false assumptions: the belief that the traditional values of the poor were the main obstacle for development and for health improvement; and the idea that the poor were incapable of organizing themselves. A country by country examination indicates that health participation programs in Latin America, in spite of promotional efforts by international agencies, have not succeeded. Then, the article discusses the political objectives behind international support for these programs. It is argued that, through symbolic participation, international agencies had two purposes in mind: the legitimization of low quality care for the poor, also known as primary health; and the generation of much needed support from the masses for the liberal democracies and authoritarian regimes of the region.     

To achieve "health for all" we must shift the world's paradigm to "primary care access for all".

Since the early 1950s, the World Health Organization has proposed programs to promote primary health care around the world. From the 1978 Alma-Ata Declaration to the current promulgation of the Millennium Development Goals, the World Health Organization has tried to improve health in developing countries through a focus on disease-oriented (vertical) programs. The World Health Organization and other organizations have not focused on the horizontal role of primary care. The expectations created by these programs have not been met. Evidence demonstrates that the advent of health care through a base of primary care improves health better than through the traditional vertical disease-oriented health programs used around the globe. The global "family" of family medicine must advocate for a shift from the current solutions to one in which the family doctor is part of a well-trained health care team that can function in networks that incorporate the vertical programs into a broad horizontal approach for better access to primary care. Perhaps in this way "health for all" can be achieved.     

Rural health around the world: challenges and solutions

Despite the huge differences between developing and developed countries, access is the major issue in rural health around the world. Even in the countries where the majority of the population lives in rural areas, the resources are concentrated in the cities. All countries have difficulties with transport and communication, and they all face the challenge of shortages of doctors and other health professionals in rural and remote areas. Many rural people are caught in the poverty- ill health-low productivity downward spiral, particularly in developing countries. Since 1992, WONCA, the World Organization of Family Doctors, has developed a specific focus on rural health through the WONCA Working Party on Rural Practice. This Working Party has drawn national and international attention to major rural health issues through World Rural Health Conferences and WONCA Rural Policies. The World Health Organization (WHO) has broadened its focus beyond public health to partnership with family practice, initially through a landmark WHO-WONCA Invitational Conference in Canada. From this has developed the Memorandum of Agreement between WONCA and WHO which emphasizes the important role of family practitioners in primary health care and also includes the Rural Health Initiative. In April 2002, WHO and WONCA held a major WHO-WONCA Invitational Conference on Rural Health. This conference addressed the immense challenges for improving the health of people of rural and remote areas of the world and initiated a specific action plan: The Global Initiative on Rural Health. The "Health for All" vision for rural people is more likely to be achieved through joint concerted efforts of international and national bodies working together with doctors, nurses and other health workers in rural areas around the world.     

Skirting the issue: women and international health in historical perspective

Over the last decades women have become central to international health efforts, but most international health agencies continue to focus narrowly on the maternal and reproductive aspects of women's health. This article explores the origins of this paradigm as demonstrated in the emergence of women's health in the Rockefeller Foundation's public health programs in Mexico in the 1920s and 1930s. These efforts bore a significant reproductive imprint; women dispensed and received services oriented to maternal and childbearing roles. Women's health and social advocacy movements in Mexico and the United States partially shaped this interest. Even more important, the emphasis on women in the Rockefeller programs proved an expedient approach to the Foundation's underlying goals: promoting bacteriologically based public health to the government, medical personnel, business interests, and peasants; helping legitimize the Mexican state; and transforming Mexico into a good political and commercial neighbor. The article concludes by showing the limits to the maternal and reproductive health model currently advocated by most donor agencies, which continue to skirt--or sidestep--major concerns that are integral to the health of women.     

The straw men of primary health care

The following paper discusses the progress made in providing primary health care (PHC) to the developing world in the 10 years following the joint WHO/UNICEF International Conference on Primary Health Care held at Alma Ata, U.S.S.R., in 1978. UNICEF is now 12 years from the goal to provide Health for All by the Year 2000. In this context, the authors describe UNICEF's 'country programming approach' to PHC as part of the child survival and development revolution (CSDR), articulated by the agency in 1982. A polarization between the two concepts of 'selective' and 'comprehensive' PHC is examined in the light of quotations from the original conference document which set forth strategies and priorities. The authors, a consultant and a staff member of UNICEF, respond to criticism of the agency in this regard by drawing directly on UNICEF's own work in the field and its record of success, even at a time when developing countries are battling severe economic constraints and health budgets are being slashed--a contingency not foreseen at Alma Ata. WHO evaluations of both the Expanded Program on Immunization (EPI) and oral rehydration therapy (ORT) show that accelerated programs develop best when underpinned by a good health infrastructure. The challenge is to develop priority programs in such a way as to build on or strengthen this infrastructure. Flexibility is the key in adapting national priorities to local programs. The point is made that international agencies should be careful to limit themselves to advocacy and support.(ABSTRACT TRUNCATED AT 250 WORDS)     

A stocktake of physical activity programs in the Pacific Islands

Population non-communicable disease (NCD) risk is among the highest in the world in the Pacific region. Increasing physical activity (PA) levels may be effective in reducing NCD risk in the developing and culturally diverse Pacific region. To describe the current practice in promoting PA in the Pacific, program information was sourced from NCD representatives from 19 countries during the Pacific NCD Forum (2009). Additional online searches were undertaken; health officials from 22 countries and NCD key informants from the Secretariat of the Pacific Community and from the World Health Organization were contacted. Eighty-four PA initiatives were identified in 20 Pacific Island countries: 26 took place in the workplace setting, 17 occurred in the school setting, 37 in the community setting and 4 in a clinical or health sector setting. Seventeen programs reached 100-500 individuals, 9 programs reached 500-1000 participants, 13 programs reached over 1000 participants and 3 programs targeted the whole population. The majority (51 of 84) of the programs commenced since 2006. There is a notable increase in the development of PA programs in multiple settings across the Pacific. Lead agencies are often the Ministry of Health offices with leadership support from high-level government positions.     

Cooperation between developing countries and the pharmaceutical industry in the control of parasitic diseases: A proposal for a practical approach

In this paper a pragmatic approach to the cooperation between developing countries and the pharmaceutical industry is proposed. This approach is based upon a division of tasks between the partners involved, thus maximizing the output through optimal use of each partner's capabilities. In the model proposed here, the pharmaceutical industry remains responsible for continued therapeutic research and development. These efforts are rewarded by the industry's transfers of active ingredients to pharmaceutical production plants. Pharmaceutical production and packaging plants can be decentralized and located in developing countries. Local organized integrated health care programs are the clients of the regional pharmaceutical plants. These programs can be coordinated and sponsored by national and international agencies and organizations. It is suggested that the transactions, possibly with the exception of the delivery of the products to the patients, be concluded along principles of the market economy. Dirigism and bureaucracy must be avoided.     

International cooperation and preparedness in responding to accidental or deliberate biological disasters: lessons and future directions

Preparations for international cooperation in response to disease disasters at the regional or continental levels are poorly coordinated and cooperation is limited, although intergovernmental and international organisations have been advocating for years that emergency responses to infectious disease outbreaks should be planned for and prepared at the national level. National governments are responsible for contingency planning to protect the public; however, this responsibility needs to be broadened to encompass regional and international approaches. Little public domain information is available on international coordinated responses to the deliberate introduction of biological pathogens. Terrorist events in the early 21st Century have increased awareness of the risks, but solid commitment and internationally resourced initiatives are still lacking. The current avian influenza disaster has largely been addressed by the three global agencies: Food and Agriculture Organization (FAO), World Organisation for Animal Health (OIE) and World Health Organization (WHO), using the underlying precepts that shape the Global Framework for the Progressive Control of Transboundary Animal Diseases (GF-TADs). The GF-TADs offers a substantial base to improve regional epidemiological and environmental information, diagnostic networking, trend analysis and intervention against the important epidemic animal diseases. International prevention, preparedness and response require multidisciplinary teams working in an environment of intergovernmental cooperation that encompasses numerous ministries and agencies. This paper focuses on known international aspects of collaboration on emergency preparedness and addresses the FAO/OIE initiative to strengthen veterinary and public health systems involved in controlling and preventing serious health threats.     

ASM LabCap’s contributions to disease surveillance and the International Health Regulations (2005)

The revised International Health Regulations [IHR(2005)], which requires the Member States of the World Health Organization (WHO) to develop core capacities to detect, assess, report, and respond to public health threats, is bringing new challenges for national and international surveillance systems. As more countries move toward implementation and/or strengthening of their infectious disease surveillance programs, the strengthening of clinical microbiology laboratories becomes increasingly important because they serve as the first line responders to detect new and emerging microbial threats, re-emerging infectious diseases, the spread of antibiotic resistance, and the possibility of bioterrorism. In fact, IHR(2005) Core Capacity #8, "Laboratory", requires that laboratory services be a part of every phase of alert and response.Public health laboratories in many resource-constrained countries require financial and technical assistance to build their capacity. In recognition of this, in 2006, the American Society for Microbiology (ASM) established an International Laboratory Capacity Building Program, LabCap, housed under the ASM International Board. ASM LabCap utilizes ASM's vast resources and its membership's expertise-40,000 microbiologists worldwide-to strengthen clinical and public health laboratory systems in low and low-middle income countries. ASM LabCap's program activities align with HR(2005) by building the capability of resource-constrained countries to develop quality-assured, laboratory-based information which is critical to disease surveillance and the rapid detection of disease outbreaks, whether they stem from natural, deliberate or accidental causes.ASM LabCap helps build laboratory capacity under a cooperative agreement with the U.S. Centers for Disease Control and Prevention (CDC) and under a sub-contract with the Program for Appropriate Technology in Health (PATH) funded by the United States Agency for International Development (USAID). Successful activities of ASM LabCap have occurred throughout Africa, Asia, Central America and the Caribbean. In addition, ASM LabCap coordinates efforts with international agencies such as the WHO in order to maximize resources and ensure a unified response, with the intended goal to help build integrated disease surveillance and response capabilities worldwide in compliance with HR(2005)'s requirements.     

Managing the ecosystem to improve human health: integrated approaches to safe drinking water

The ecosystem approach to human health is a holistic concept of health for both humans and the environment in which they live. This approach requires a holistic management of all facets of the ecosystem, be they physical, biologic, or indeed human-such as culture, economy, and developmental needs. This paradigm may at first glance seem theoretical and difficult to put into practice in everyday field research. However, using basic human needs, such as water and sanitation, as entry points illustrates how ecosystem health can indeed prove a powerful tool for sustainable development, promoting both human well-being and sustainable ecosystems. The authors describe the efforts of international agencies, particularly the International Development Research Centre (IDRC), to promote household safe drinking water security in developing countries. Essential to the success of these endeavors are strong partnerships with communities, research institutions, and donor agencies. The roles of these players are delineated. An important feature of IDRC projects, which is critical to their success, is the establishment of a simple, community-based water-quality monitoring program that the people can maintain with the limited resources available to them. The process and outcomes of past IDRC projects are presented and ongoing efforts are described.     

Effective global health promotion achievements, tools, and strategies used in the Americas over the past decade

There have been numerous international commitments made by governments from around the world to promote health and prevent illness and disease. As globalization increases our interdependence with both positive and negative effects, the World Health Organization and the Pan American Health Organization (its Regional Office for the Americas), have responded to ever increasing mandates from their member countries by developing responses to support governments in promoting health and incorporating upstream approaches into their policies, programs and activities. This article highlights some of the most important of these political declarations that have direct impact on health education and promotion ranging from the Alma Ata Declaration on Primary Health Care in 1978 to the Rio Declaration on the Social Determinants of Health in 2011. Additionally, emphasis is placed on identifying and providing examples of the application of specific tools, strategies and approaches to facilitate fulfillment of these mandates; ones that should be useful for health education and promotion practitioners everywhere. It closes by raising some of the challenges that health education and promotion will face in the future given the current trends in the world today.     

Die Toronto-Charta für Bewegung

The World Health Organization and other international health promotion organisations and agencies have recognised physical inactivity as a major health risk factor. However, physical inactivity still receives less attention than other risk factors for non-communicable diseases (e.g. tobacco use, unhealthy diets and overweight). Therefore, in 2009 the Council for Global Advocacy for Physical Activity (GAPA) of the International Society for Physical Activity and Health (ISPAH) initiated the development of the first Charter for Physical Activity as a global call for action. The Charter was presented at the International Congress on Physical Activity and Public Health in Toronto, Canada, in May 2010. A strategic implementation of the Charter fosters intersectoral collaboration and can significantly contribute to increasing the prevalence of a population-wide active lifestyle.     

Impediments to global surveillance of infectious diseases: consequences of open reporting in a global economy

Globalization has led to an increase in the spread of emerging and re-emerging infectious diseases. International efforts are being launched to control their dissemination through global surveillance, a major hindrance to which is the failure of some countries to report outbreaks. Current guidelines and regulations on emerging and re-emerging infectious diseases do not sufficiently take into account the fact that when developing countries report outbreaks they often derive few benefits and suffer disproportionately heavy social and economic consequences. In order to facilitate full participation in global surveillance by developing countries there should be: better and more affordable diagnostic capabilities to allow for timely and accurate information to be delivered in an open and transparent fashion; accurate, less sensationalist news reporting of outbreaks of diseases; adherence by countries to international regulations, including those of the World Trade Organization and the International Health Regulations; financial support for countries that are economically damaged by the diseases in question. The article presents two cases--plague in India and cholera in Peru--that illuminate some of the limitations of current practices. Recommendations are made on measures that could be taken by WHO and the world community to make global surveillance acceptable.     

Multilateral agencies and world population growth. Introductory statement: the need for United Nations leadership

There is a widespread interest by United Nations agencies in family planning programs; this is evidenced by large scale financial aid that is offered. The UN has some advantages in providing support in national efforts to include population planning in their development plans: a) since the issue is highly political, the existence of an institution such as the UN where the whole world is represented helps operate the family planning field; b)as this is an international operation, it is possible to make use of international talent and experience; and c) because practically the whole world has shown some interest in the issue and is undertaking official programs, it is good that a highly select staff is acting as a guiding hand. The author urges that the forthcoming World Population Conference establish a new UN unit situated above the existing organization, for this purpose.     

Declaration of Monastir

The recommendations of the 2nd International Congress for Maternal and Neonatal Health, which meet in Monastir, Tunisia, in November, 1984, are presented. Participants represented many governments, numerous international health organizations, including the International Association for Maternal and Neonatal Health, several UN agncies, and a variety of professional health organizations. The representatives focused their attention on high risk pregnancies and on the unacceptably high rates of perinatal, infant, and maternal morbidity and mortality in developing countries. They noted that in many of the least developed countries there has been no imprrovement or a deterioration in infant and maternal health in recent years. They called on governments and organizations to renew their commitment to ameliorate this situation. They suggested that 1) organizations should distribute more aid to the least developed countries, 2) coordination between various UN agencies should be improved, 3) existing international and national health organizations should be strengthened and appropriate new organizations should be created, and 4) communication between the developed and less developed countries should be improved. Specific recommendations for preventing and caring for high risk pregnancy were 1) to increase prenatal visits to all maternal and child health facilities; 2) to improve the diagnosis and treatment of high risk pregnancies; 3) to promote the expansion and decentralization of health care systems, including family planning services; 4) to reduce the pregnancy rate among those under 19 years of age and among those over 35 years of age; 5) to increase birth intervals; 6) to vaccinate all pregnant women with tetanus toxoid; 7) to improve hygiene standards in the delivery of obstetrical care; 8) to promote breastfeeding; 9) to improve the nutritional status of pregnant and lactating women; and 10) to reduce smoking among pregnant women. The participants suggested that the UN agencies and other health organizations should develop and promote the use of simple and effective preventive and curative techniques, such as oral rehydration therapy. Greater efforts should be made to coordinate the health care systems in developing countries. Specifically, a liason should be created between facilities offering prenatal care and those providing delivery services, the transportion of women in labor should be improved, more information should be exchanged when patients are referred, and the collection of epidemiological data should be increased and coordinated. In Addition, educational opportunities for women should be increased, and training programs for medical personnel should be expanded. Community participation in the health care system should be encouraged, and the services of traditional birth attendants should be utilized to expand the health care delivery system in developing countries.