The imperative for health promotion in universal health coverage.

Health promotion and disease prevention have huge impact on health, yet given low priority, risk being overlooked in universal health coverage efforts. To effectively prioritize promotion and prevention, strong cadres of personnel are needed with expertise in legislation and health policy, social and behavior change communication, prevention and community health, health journalism, environmental health, and multisectoral health promotion.

International health financing and the response to AIDS.

Efforts to finance HIV responses have generated large increases in funding, catalyzed activism and institutional innovation, and brought renewed attention to health issues and systems. The benefits go well beyond HIV programs. The substantial increases in HIV funding are a tiny percentage of overall increases in health financing, with other areas also seeing large absolute increases. Data on health funding suggest an improved "pro-poor" distribution, with Africa benefiting relatively more from increased external flows. A literature review found few evidence-based analyses of the impact of AIDS programs and funding on broader health financing. Conceptual frameworks that would facilitate such analysis are summarized.

[The economic impact of tobacco consumption in Africa]. / L'impact économique de la consommation de tabac en Afrique.

The economic contributions from tobacco cultivation and sales of products are often noted - jobs and incomes for farmers and employees, tax revenues for governments and enormous profits for cigarette companies, and for some countries, foreign exchange from net exports and foreign investment These are of course important. But set against these economic gains, there are also large economic losses that are less visible and less talked about, but also need to be counted. Many of these economic losses arise from the adverse health effects of tobacco use, but there are others too that affect a much wider group of citizens, and in particular, may exacerbate poverty among smokers and their families. This paper looks at the economic impact of tobacco use from the perspective of families, and at national level, for developing countries, providing a framework for considering the specific situations in Francophone African countries. Set against the economic benefits from tobacco, there are substantial economic costs. Annual health care costs are higher for smokers, and the burden of these costs falls on families, the public purse and employers/insurers. Earnings and productivity losses because of tobacco-related illness and premature death can be huge, and are borne by employers and employees. Illness is a major precipitating cause of poverty. Lit cigarettes cause thousands of fires and lost lives. Environmental damage to the soil from tobacco growing, pesticides and fertilizer, and deforestation resulting from firewood use to cure tobacco, can impose high economic losses. And there is the insidious, often overlooked cost of harm to the well-being of poor families whose scarce resources are used for cigarettes and other tobacco products instead of food and other necessities. We conclude that reducing tobacco use is good for health, good economics, and good for development

Tobacco industry price-subsidizing promotions may overcome the downward pressure of higher prices on initiation of regular smoking.

Real cigarette prices in the US increased from the early 1980s to early 1990s. Holding all else equal, adolescent initiation of regular smoking should have declined during this period. Using national population-based surveys (n = 336 343) conducted in the 1990s, we present trends (early 1960s to mid-1990s) in the initiation of regular smoking among 14-17-year-old adolescents and 18-21-year-old young adults. We also present trends in consumer-price-index-adjusted cigarette price and tobacco-industry expenditures for price-subsidizing promotions. We relate price and price-subsidizing tobacco industry expenditures to trends in initiation in the two age groups, using autoregressive integrated moving average models (ARIMA). From the model results, we conclude that price-subsidizing promotions may provide the tobacco industry with an effective way to segment the market. That is, they effectively offer lower prices to population subgroups that are more price-sensitive (e.g. young smokers not yet addicted), countering the depressing effect of general price increases on smoking. Thus, we find that the relationship of cigarette price to smoking behavior is more complex than previously described.