Continuing improvement in health quality of China's population.

PIP: This article describes the health of the Chinese population, based on a report presented by the Minister of Public Health at a National Conference on Health Work. China is considered to have a healthier population than the world average. Infant mortality declined from 200/1000 to 31.4/1000 during 1949-95. Maternal mortality declined from 1500/100,000 women to 61.9/100,000 women during the past 45 years. Life expectancy doubled to 70 years. China has 5.37 million medical professionals, 1.22 million country doctors working in 190,000 medical institutions, and 56,000 graduates of 126 medical schools. 92,000 graduated from 551 secondary medical and pharmacy schools. Many infectious and parasitic diseases were eliminated during the 1950s and 1960s. Small pox was eliminated in 1963. Snail fever was reduced considerably and eliminated in 278 out of 391 counties with a high prevalence of this disease. 85% of township children were immunized. Filariasis was eliminated in 1994, and polio was eliminated in 1995. Leprosy is very close to extinction. Infectious diseases declined from 7061/100,000 to 176/100,000 between the 1970s and 1995. Notifiable diseases declined to 176.2/100,000 in 1995. Endemic diseases, such as Kaschin-Beck disease, Keshan disease, goiter, and diseases due to highly fluorinated water, declined. 80% of population had access to iodized salt. Improvements were evident in maternal and child health care and treatment of common gynecological infections. China has 2957 infant-related hospitals out of 7779 worldwide and is making progress in the treatment of gerontological diseases. China's health care delivery focuses on prevention and treatment of cerebrovascular and cardiovascular diseases and cancer. Each year more attention is paid to environmental protection.^ieng

Japanese government takes steps toward approving birth control pill.

PIP: On September 12, 1995, the Central Pharmaceutical Affairs Council of Japan recommended approval of low-dose oral contraceptives as a method of family planning. Doctors should be able to prescribe the pills after the standing members of the Council, part of the Ministry of Health and Family Welfare, meet next March. High-dose oral contraceptives can be obtained currently to treat menstrual irregularities, although many of the 200,000 prescriptions written annually are used for family planning. Approval for the low-dose contraceptives has been slow because of concerns regarding a possible relaxation of sexual mores (1965); adverse side effects (until 1987 when the Japanese Ministry of Health initiated clinical trials that established the safety and efficacy of the contraceptives); increased rates of human immunodeficiency virus (HIV) infection (1992); a higher number of drug reimbursement claims under the national health insurance system; and a decline in Japan's birthrate. Japan's birthrate fell from 4.5 children per woman in 1947 to 1.5 in 1993. 80% of contraceptive users rely on condom; 22% use the rhythm method, usually in conjunction with the condom; 7% use the IUD; and less than 2% use sterilization. Sterilization is only permitted for married couples and only when the woman's life or health is in danger, or either spouse has a mental illness, leprosy, or a hereditary disorder.^ieng

Health resources and management in Korea: development in the past, current issues and perspectives.

PIP: Korea's health system has undergone major changes since the late 1970's due to massive economic growth developments. Compulsory health insurance was initiated for all wage earners in 1977 and was expanded to all rural and urban residents in 1980 and 1989. Health resources in the form of human and physical resources and health expenditures are very important to the success of any health insurance system. Korean economic growth in the past 40 years is staggering. It has gone from a per capita income of US $70 in the 50's to over US $2000 in the 80's. Korea is now an upper middle-income country. Population has more than doubled since 1949. Urbanization has increased from 28% in 1960 to 65% in 1985. Reduction of fertility through family planning practices is currently being promoted. Korea has developed 5 health care plans over a 25 year period -- from the 1954-60 allocation of funds for leprosy and tuberculosis control to the 1982-86 'health for all by 2000" policy. The National Health Insurance Program will be initiated in 1989. Communicable diseases were the major cause of death in the 60's, cardiovascular disease in the 70's, and chronic degenerative diseases in the 80's. Incidences of communicable diseases, tuberculosis and parasite infection have all decreased dramatically in the past few decades. Perceived unhealthiness has increased from 1981-87. The 1980's has ushered in a higher utilization of curative care, safe deliveries and immunizations. Inequalities in health care still exist and result from socioeconomic inequalities. Medical resources must be distributed adequately to alleviate inequality. Middle-level health personnel is lacking in Korea at this time, while upper-level personnel has increased. Physical resources tend to be wasted -- there is a high nonoccupancy rate of hospital beds. Other physical resource problems can be partially eliminated by a more equal distribution of health facilities relative to demand. Health insurance utilization has grown annually, however low income populations usually show a low usage rate. Payment-reimbursement methods include fee-for-service (FFS), capitation, salary, case payment, or a combination. In the future this payment system must be improved in order to achieve comprehensive care. Important policy issues are consensus on rising health expenditure; equity and efficiency of health services; role of the hospital and clinic; priority of primary care; rural health care delivery; rural hospitals; health care delivery system; payment-reimbursement scheme; governmental financial input; primary care reinforcement; and measures for the changes in disease patterns.^ieng

[The new marriage law and planned birth].

PIP: The New Marriage Law was passed during the Fifth National People's Congress. It raised the minimum marriage age from 20 years for men and 18 years for women stipulated by the Old Marriage Law to 22 years for men and 20 years for women. It also differs from the Old Marriage Law in that it strengthens its encouragement of late marriage, late births and birth control, emphasizes that birth planning is the duty of both husband and wife, and prohibits marriage of collateral blood relations within 3 generations (the Old Marriage Law's standard was "to follow custom"). A third of the provisions of the New Marriage Law concern family planning, of which the first 3 clauses are the most important: 1) To set guidelines for the relationship between marriage and family: the New Marriage Law is concerned with not just the family, but also marriage and birth and expects all citizens to comply with and protect these standards. 2) To implement freedom in marriage--equality for men and women; to protect the rights of women, children, and the aged; to implement planned birth. 3) To prohibit any action that prevents freedom of marriage, such as marriage on a mercenary basis and to prohibit financial profit from marriages. Other clauses include: 1) direct blood relations and victims of leprosy or other diseases determined unmarriageable by the medical profession are prohibited from marriage; 2) after marriage registration and with the mutual agreement of both parties, either partner can become a member of the other's family; children can take either parent's surname; both partners have mutual rights of inheritance, as do parents and children. In Heilungjiang Province, data from September 1980 show that 87.5% of its fertile women used contraceptives. From January to September 1980 85.6% married late; the rate of applications for One Child Certificates was 80%. By 1979 the rate of natural population increase was 10.14/1000.^ieng

[Essay on the history of population policy in Japan--around the concept of population quality].

PIP: The development of the concept of population quality is found in the history of population policy in prewar Japan. Between 1916 and 1926 the Japanese government was concerned with high death rate and low birth rate. The condition was attributed to the poor health condition of the population, and a committee was organized to investigate public health problems. The committee studied the following: 1) infants and children, 2) tuberculosis, 3) venereal disease, 4) leprosy, 5) psychoses, 6) food, clothing, and housing conditions, 7) rural area hygiene, and 8) vital statistics. The resulting population policy was illustrated by infant/toddler welfare and social welfare works. Between 1927 and 1930 the possibility of overpopulation was discussed in the background of depression. The government organized a committee of investigation pertaining to population and food problems in 1927. The interrelation of high birth rate and high death rate was noted in the report, and it was proposed that the country should maintain natural population increase by adopting a policy of low birth/death rates. The proposal favored the reasonable practice of birth control from the standpoints of public health and eugenics. Thus, the population quality concept was originated in the eugenic aspects of population policy when the nation was faced with the problem of population control in a quantitative sense.^ieng