Charting a future for health in the Americas: quadrennial report of the Director

Charting a Future for Health in the Americas describes the work of the Pan American Health Organization in recent years. The report opens with a disquisition on the significance of its title-how PAHO has had, and will continue to need, to chart and steer a steady course, dealing with and even capitalizing on changes along the way, in order to reach its goal: health in the Americas. With pointillistic highlights of the organization's century-long work in its major fields of responsibility, the report brings the accounting of its actions to the present. It describes the resources PAHO has employed and the impact its cooperation with member countries has had on assessing the regional health situation, enhancing health and human development, preventing and controlling diseases, promoting health, protecting the environment, and strengthening health systems and services. Morever, because of the stature it has attained, the organization has been able to strike alliances with other international agencies, nongovernmental organizations, and the private sector-and the story of their shared agenda is recounted here. This, then, is the latest in a series of reports of progress in public health throughout the Americas and, at the same time, of the work of an organization built to last (Back cover)

Caribbean cooperation in health: a new vision for Caribbean health

The initiative promotes health as that state of well being which goes beyond the absence of disease and includes mental, spiritual and emotional health. In addition, it recognizes that the factors affecting health go far beyond the ambit of the health sector and encompass the physical and social environment, and the individual's genetic makeup and lifestyle. Thus interventions for improved health must include education for healthy life choices and skills, food security, satisfactory housing, access to potable water supplies and proper disposal of waste. In the Caribbean the debate on health will be expanded from health sector reform in which greater focus is placed on the intrinsic value of health as a resource for sustainable human development. It is one of the four (4) pillars of the people-centered development implicit in the CARICOM Charter for Civil Society, along with education, wealth and freedoms associated with democracy. Further as the Caribbean seeks to maximize tourism as a, if not the, key engine for economic development, the health sector will strengthen the partnership with the tourism and hospitality sectors and play a significant role in making the Caribbean a safe destination

Health promotions: issues and answers

In recent years, increased attention has been given to the development of health promotion programmes in a number of countries worldwide. Although health promotion itself is not new, a number of issues have been emerged as the underlying concepts are articulated and put into practice. These relate to its relevance and ownership and to practical issues such as measurement of outcomes. This article provides a brief discussion on some of these issues and makes reference to Caribbean framework for implementing health promotion (AU)

Health and related needs of women in mid-life and their implication for programme planning

The study investigates, analyses and comments on the health of 103 Jamaican women 45-49 years. These women are referred to as women at mid-life. This is the period when women experiences a lot of psychologocial and physiological changes. These women were chosen using a haphazard sampling method. Women were identified at the Norman Manley International Airport, Barbican Community, Maxfield, Old Harbour, Santa Cruz, Papine Market, University Hospital and Soverign Plaza. The methods of investigation weer focus group discussions and a questionnaire. The study revealed that academic status had no bearing on the perception of health or the concept. Only 18.7 percent of those who responded to the concept of "good health" gave an appropriate response and 15.5 percent gave an appropriate response to the concept of "bad health". This is probably one of the reasons why most of the respondents focused only on the physical aspects of health when asked about how they rated their health and reasons for their responses. There was no significant difference between age, income, educational status and health seeking behaviours. However, there was a significant difference between age group and illness (p<0.01) and perception of one's health and present illness (p<0.001). Respondents who said their health was bad were thirteen times more likely to indicate that they were presently suffering from an illness, 85 percent, (11/13). Major illnesses were identified as hypertension and diabetes. A few women reported having some cardiac conditions. Employment status was high, and income ranged from less than J$5,000 to over J$10,000. For those women who got check-ups, 51 percent did so at a private facility, whilst 33.8 percent did so at a public facility. Main reasons for choosing the particular facility were stated as convenience (59.9 percent), and quality of services (39.4 percent). Income was not a considering factor. The women in this study identified some of their needs as education and counseling, affordable health care, a home, respect and money. They also felt that with an increase in salary and a decrease in the cost of living they will be able to obtain and maintain an acceptable standard of health and well-being. Of the 103 women interviewed only 14 persons has no form of savings. Nineteen per cent of them indicated that the future was good for them while the remaining 81 percent gave negative responses.(Au)

Cancer in minority ethnic populations: priorities from epidemiology data

The aim of this paper is to review the literature on the frequency of cancers to develop priorities for cancer policy, prevention, services and research for black and minority ethnic populations in Britain. Data on populations originating in the Indian sub-continent, and Caribbean and African Commonwealth were extracted from published works. Cancers were ranked (top seven) on the basis of the number of cases, actual frequency, and also on relative frequency (SMR, SRR, PMR). Cancer was found to be a common cause of death. For example, during 1979-83 the proportion of death resulting from neoplasms in immigrants living in England and Wales was 11 percent for Indian and African men aged 20-49, and 19 percent for Caribbeans. The corresponding proportions were higher among women. The pattern of cancer depended on the method used to assess rankings. On the basis of the number of cases the top 3 ranking cancers for adults were breast, lung and neoplasms of the lymphatic system. Based on SMR's cancer of the gall bladder, liver and oral cavity ranked amongst the top 3 for adults. For children the top ranking cancers were acute lymphoblastic leukaemia, central nervous system tumours and neuroblastoma. Variations by ethnic groups were more evident in the rankings of relative frequency than in rankings based on numbers of cases. In conclusion, the most common and preventable cancers among minority ethnic populations were the same as those for the general population. The different cancer pattern based on SMRs highlight additional needs and provide potential models for research into understanding the causes of these cancers. Health services policy and practice should ensure that the common and preventable cancers take priority over rare cancers and those for which there is no effective treatment or prevention. Priorities for policy, prevention, clinical care and research should be set separately, for they differ. (AU)

The integration of health and environment in national planning for sustainable development in Saint Lucia

States that the methodology adopted for undertaking this analysis is to consider the status of environmental health problems by analysing the performance of the various institutions responsible for administering environmental health problems (AU)

Health care in Jamaica: quality, outcomes, and labor supply

This paper investigates the relationship among labor force participation, health outcomes, and the availability and quality of health care in a developing country. We develop an econometric model that addresses the demand for health care in a choice model and then link it to health status outcomes and labor force participation decisions. The econometric model has two parts to it. First, we estimate a discrete choice model to determine how ill people choose among the various providers of health care. Using the parameter estimates from this model, we calculate the expected value of the best available to each individual. In the second stage, health is allowed to affect labor force participation in a simultaneous equations probit model where the potential endogeneity of reported health is controlled for with a set of instruments that includes the constructed health care quality. We report the results of simulating the impact on health outcomes and labor force participation of policy changes such as improving access to and quality of health care as well as reducing the price of health services. We use data from the 1989 Jamaican Survey of Living Conditions, the 1989 Jamaican Labour Force Survey, and a sample (also from 1989) of Jamaican health care facilities. We find that the quality of health facilities has a small improving effect on health but no significant effect on labor force participation (AU)

Analysis of investment process in health and the environment in Netherland Antilles

Analyses the investment process in the environment and health in the Netherlands Antilles. Provides a macroeconomic and sectoral overview then proceeds to consider investment policies; public investments in health and environment; the principal constituents in the investment process and their interrelationships and investment allocation and project preparation. Suggests that intiatives be undertaken to get more involvement in the process of environment and health investments and that multi-year planning be instituted. (AU)

Analysis of investment process in health and the environment in Suriname

Documents a proposal for activities aimed at enhancing the capability of identifying and appraising investment initiatives in the health and environment sectors of Suriname. Presents a macro-economic review which covers the Structural Adjustment Programme and the Multi-annual Development Plan, highlighting the health and environment sectors including legal regulations. Identifies and characterizes the key institutions in both sectors, determining their interrelationships and relating them to the stage in the flow of investments. Analyzes, trends in investments in both sectors; consistency between policies and investments; the degree of cooperation; and the existence of clear procedures for investment programming, budgeting and project preparation. (AU)

Cost-effectiveness and health sector reform

Considers measures to improve health care based on a review of a World Bank Study, "World Development Report: investing in health "(1993). Considers the proposal for health reform by discussing issues such as, disease burden and cost-effectiveness; cost-effectiveness as an objective measure; the compatibility of cost-effectiveness with equity and with ethic; and implementing reform incorporating cost-effectivness. (AU)

Towards a healthy nation: proposals for the future health-related services of Trinidad & Tobago

Proposes change for health services in Trinidad and Tobago, the key elements of which are: decentralization, target-led financing, the Ministry of Health as a policy-making body, provision of better health care, fewer but better hospitals and a national ambulance service, involvement of the private sector, more information for decision-making and proper audits and reviews. Explains the rationale for the reform indicating agencies that will bring about this reform. Outlines the components of the health service to be effected such as primary health care, primary clinical care, hospitals, support services and manpower. Indicates aspects of implementation activities put in place from the end of 1993 to early 1994 such as Regional Health Authorities Act, the involvement of the staff of the Ministry of Health in planning for health reform, training sessions in order to inform the ministry's staff about proposed changes and garnering of technical assistance to prepare for the reform (AU)

Human resources in nursing: determining requirements and skills

Beset with feeble economies and debt servicing obligations, many countries have no recourse but to impose stringent structural adjustment policies, particular in the nonproductive social sectors such as health and education. Below, a look at the effects of these restraints on the health services and on nursing and some recommendations on how nurses respond, particularly in planning human resources. (AU)