Equity and the goal of health for all

There is a basic difference between the causes of diseases in population. We know that cigarette smoking causes cancer of the lung. If everyone in a population smoked, some would develop cancer, but we would never be able to identify tobacco as an etiologic factor. However, if one is seeking to enhance the health of populations, which is the main focus of public health, one has to be concerned with the distribution of the problems and the factors that influence such distribution in those populations. In the late 1970s the countries of the Caribbean, where I come from, were very advanced in their thinking about the steps to be taken to deal with population health issues, and they actually elaborated concepts that were very similar to those that subsequently were included under the heading of "primary health care." I found later that the Caribbean countries were not alone and that there was considerable ferment in public health circles in Latin America about the social causes of disease and the link between health and the various measures to achieve social progress. Health figured in the Pan American efforts to build a better future for the Americas. It could not have come as much of a surprise to the health authorities of this part of the world when the 30th World Health Assembly of the World Health Organization (WHO), in 1977, called for social justice and set Health for All as a goal. It is no accident that the main proponent and advocate of Health for All, Halfdan Mahler, of Denmark, was a man with a strong social conscience and was a firm believer in the possibility of galvanizing the world's nations to see the indecency of the differences in health that existed within and between nations (AU)

Obstetric complications and autism in Jamaican children [abstract]

OBJECTIVE: There has been an increased prevalence of autism worldwide. Research in developed countries has identified a number of associations, though no direct agent has been identified. Mothers of autistic children have been shown to have more obstetric complications than others. There is little information available about autistic disorder in developing countries. This study sought to determine the relationship between obstetric and perinatal history and the diagnosis of autistic disorder in Jamaican children. METHODS: Children with autistic disorder were identified from public hospital records, private paediatricians' records and from registers of special schools. Parents of 55 Jamaican children were interviewed about the pre-natal and peri-natal periods. Their experiences were compared with those of a national sample of young children for whom pre-natal and peri-natal information was already available. The same questionnare was administered to both groups of parents. RESULTS: The mean ñ Standard Deviation age of autistic children was 6.3 ñ 4.3 years. There was a male preponderance in the autistic group (79 percent), compared with the control group (forty eight percent). Families with autistic children had significantly fewer children (mean/SD 2.54 ñ 1.5) than the non-autistic control group (mean/SD4.02 ñ 2.5) (p<0.05). Mothers of autistic children had higher rates of complications during labour (30.2 percent compared with 12.8 percent) and pregnancy (30.2 percent compared with 13.4 percent), but these did not achieve statistical significance. A greater proportion of autistic children was either born prematurely or late and was admitted to the hospital but these differences were not statistically significant. Breast feeding rates were similar. CONCLUSION: This study showed that mothers of autistic children in Jamaica have a higher rate of obstetric complications, as has been found in other countries. Mothers have a significantly higher mean age at the birth of an autistic child and have significantly fewer children. Parents may opt not to have any more children once a child with a disability has been born. (AU)

The application of biotechnology to health in developed and developing countries

The potential of biotechnology to ameliorate the health problems in developing countries is closely related to the population growth rate verus the growth rate in medical assistance. World population continues to grow at 1.5 percent per annum and is projected to reach 8 billion by 2020 and 11 billion by 2050. Almost all this growth will occur in the already over-populated, poorer region of Asia, Africa, Latin America and the Caribbean, which are home to nearly 90 percent of the world population. Demands for food will double by the year 2025. A high proportion of the population of developing countries is facing malnutrition, infectious diseases, AIDS and other (re) emerging disease, and lacks resources for prevention, diagnosis, and treatment. Each country should finds its own way of overcoming these difficulties, emphasizing indigenous scientific development. Biotechnology lags behind in developing countries. There are few examples of local developments in medical biotechnology which have had great impact on the health of their population; the case of Cuba is a good example in this regard. In developed countries, there are hundreds of researhers working in molecular biology and biotechnology. Recombinant proteins, produced in bacteria, yeast and mammalian cells, are increasingly being used to produce new vaccines, drugs and diagnostic tests. Transgenic animals for pharmaceutical production and organ transplantation are in the pipeline. The Human Genome Project for diagnosing and predicting disease and disease susceptibility, with its possibilites for new ways to treat, cure, or even prevent thousands of disease, is close to completion. These are some examples of the enormous scientific achievements, fed by the revolution in communications and computer sciences, taking place in developed countries with strong economies and growing expenditure on health research. POSSIBLE SOLUTIONS: 1) The work of academic and non-academic organisations in developing countries must heighten the awareness of governments to biotechnology's application to health. 2) Greater commintment and contribution from international organisations. 3) Greater commitment and contribution from developed countries. 4) Strenghten south-south cooperation. 5) Increased commitment of the private sector in developing countries to the development of science and technology. 6) Greater attention from local governments to information technology.(Au)

International trends in mortality from stroke, 1968 to 1994

BACKGROUND AND PURPOSE: The World Health Organization data bank is an invaluable source of information for international comparison of mortality trends. We present rates and trends in mortality from stroke up to 1994, with a particular emphasis on the last 10-year period. Data are presented for men and women in 51 industrialized and developing countries from different parts of the world. METHODS: We included all deaths from cerebrovascular disease for the population aged 35 to 84 years from all the countries in which death certificates were estimated to be available for at least 80% for the period from 1968 to 1994. Age-standardized mortality rates from stroke were calculated for each country for the last available 5 years. Time trends were calculated by using ordinary linear regression and are presented for the entire study period and for 3 separate time periods: 1968 to 1974, 1975 to 1984, and 1985 to 1994. The last 10-year period was further subdivided into 2 parts of 5 years each. We analyzed data separately for men and women and for groups aged 35 to 74 years and 75 to 84 years. RESULTS: The highest rates at the end of the study period for the population aged 35 to 74 years were observed in eastern Europe and previous Soviet Union countries (309 to 156/100 000 per year among men and 222 to 101/100 000 per year among women), Mauritius (268/100 000 per year among men and 138/100 000 per year among women), and Trinidad and Tobago (185/100 000 per year among men and 134/100 000 per year among women). Relatively low to average rates (<100/100 000 per year among men and <70/100 000 per year among women) were reported for Western Europe, with an exception of Portugal (162/100 000 per year among men and 95/100 000 per year among women). The countries with lowest stroke mortality rates at the end of the study period, such as the United States, Canada, Switzerland, France, and Australia, experienced steep declining trends. However, the slope of the decline was substantially reduced during the last 5 years in these countries. Mortality from stroke increased most in the eastern European countries, especially during the last 5 years. Among other high-risk populations, no change in stroke mortality trends was observed in Mauritius, whereas somewhat declining trends were seen in Trinidad and Tobago. CONCLUSIONS: We observed large differences in mortality rates from stroke around the world together with a wide variation in mortality trends. A widening gap was observed between 2 groups of nations, those with low and declining stroke mortality rates and those with high and increasing mortality, in particular, between western and eastern Europe. Eastern European countries should initiate actions aiming at the reduction of stroke risk, perhaps by looking at the examples of Japan and Finland and the other countries that have been the most successful in reducing previously very high mortality from stroke.

The grass is not always greener on the other side [abstract]

Too often one hears the comment that `you in the first world live a better life and make a lot more than us who live in the third world'. This statement is unfortunate, as I believe it is not true. I will try to discuss the pros and the cons of living in the `first world' and at the end suggest to you that you could be better off in most respects by staying where you are. Do not be in too much of a hurry to trade places with me because `the grass is not always greener on the other side'. (AU)

Environmental health: catching up with the developed world

Environmental health is the ecological balance that must exist between man and his environment in order to ensure his well being. This paper describes the range of environmental hazards (physical, biological, chemical and social) and discusses the differences in level and quality of environmental health programmes between developed and developing countries. The hazards are the same in both realms; the difference is in the level of advocacy and, thus, the demand for implementation of sound environmental health policies and practices. Issues which developing countries need to address to improve environmental health management are outlined.(AU)

AIDS: profile of an epidemic

This publication reflects the interest and concern of the community of workers and scientists in the health field in the face of the problem caused by acquired immunodeficiency syndrome (AIDS) in the Region of the Americas. It constitutes what could be considered an epidemiologic mosiac of the similiarities and differences of AIDS and human immunodeficiency virus (HIV) infection in various countries and subregions of the Hemisphere. The North American experience, in which transmission among homosexuals and by contaminated needles and syringes predominates, contrasts with the rapid changes observed in the distribution of cases in the English-speaking Caribbean and Haiti, where an increasing number of women are affected by AIDS, and with the persistence of blood transmission in countries of Latin America. The first part of this publication provides a descriptive and analytic sample of the epidemiology of AIDS that-ranging from the northern to the southern end of the Hemisphere-comprises Canada, the United States of America, Mexico, Columbia, and Brazil, as well as Cuba and the English-speaking Caribbean. Interestingly, some of the articles not only document what has happened with the disease, but venture projections, derived from various premises and forecasting techniques, about the future of the epidemic. Withal, the consensus is that the problem will get considerably worse in the near future (Regional Adviser-PAHO)

A disease of disadvantage: AIDS hits US Blacks and Hispanics

AIDS is still widely regarded as a disease which primarily affects homosexual white men in the United States. This picture is no longer true internationally-nor is it true in the United States itself. of all reported US AIDS cases, almost 40 percent occur in people of black or Hispanic origin, although these groups comprise only 19 percent of the US population (AU)