Nursing Experts, Hygienic Modernity, and Nation Building: The Case of Nursing in Ethiopia in the Post-Colonial Era.

This is a tale in three parts. It begins with an exploration of the story of Princess Tsahai, daughter of Haile Selassie, and the highly successful British campaign led by suffragette E. Sylvia Pankhurst to bring British-style nursing and medicine to Ethiopia in the 1940s and 1950s. Second, it examines the role of foreign women, most notably Swedish missionary nurses, in building health services and nursing capacity in the country. Finally, it examines the way in which nursing brought together gendered notions of expertise and geopolitical pressures to redefine expectations for Ethiopian women as citizens of the new nation-state.

Demanding a bigger role: Palestinian women in politics and decision making.

The political participation1 of Palestinian women in its many forms has been significantly influenced by Palestinian history. The male-dominated society and political system have hindered women's prominence in society and in politics. Although slowly on the rise, lack of women's representation and their voices is reflected in the low number of women in higher political echelons and in policy and decision making in general. After the signing of the Oslo Accords in 1993 and 19952 in 1993, women were integrated in state building processes, yet formal female participation was weak and marginalized and their representation, despite women's political activism, remained low and not to the extent hoped for. This paper sheds light on the Palestinian women's involvement in politics and decision making firstly in the pre-Oslo era under non-indigenous Palestinian government and then in the post-Oslo era after the establishment of the Palestinian National Authority, with focus on involvement in negotiations with Israel and internal Palestinian reconciliation efforts. It also focuses on UNSCR 1325, the degree of influence it has had on women's engagement and the mechanisms established to enhance a bigger role for women in politics and decision making, leading towards a larger role in nation-state building and reconciliation and peace negotiations. Recommendations are offered for measures to increase future participation.

Legal and policy requirements of basic health insurance package to achieve universal health coverage in a developing country.

OBJECTIVES: This study has analyzed the policy-making requirements related to basic health insurance package at the national level with a systematic view. RESULTS: All the documents presented since the enactment of universal health insurance in Iran from 1994 to 2017 were included applying Scott method for assuring meaningfulness, authenticity, credibility and representativeness. Then, content analysis was conducted applying MAXQDA10. The legal and policy requirements related to basic health insurance package were summarized into three main themes and 11 subthemes. The main themes include three kinds of requirements at three level of third party insurer, health care provider and citizen/population that contains 5 (financing insurance package, organizational structure, tariffing and purchasing the benefit packages and integration of policies and precedents), 4 (determining the necessities, provision of services, rules relating to implementation and covered services) and 2 (expanded coverage of population and insurance premiums) sub themes respectively. According to the results, Iranian policy makers should notice three axes of third party insurers, health providers and population of the country to prepare an appropriate basic benefit package based on local needs for all the people that can access with no financial barriers in order to be sure of achieving UHC.

Height development of men and women from China, South Korea, and Taiwan during the rapid economic transformation period of the 1960s-1980s.

We study height trends among Chinese, South Korean, and Taiwanese groups during the rapid economic growth period of the 1960s to the 1980s. Heights rose strongly as income grew. Did rapid income growth also cause a decline in gender inequality? Or did it rise because the gains were unevenly distributed? Gender inequality is particularly interesting given the traditionally strong son preference in the region. For mainland China, we find that gender inequality was relatively modest in the pre-reform period (before the 1980s). Especially in comparison to the early 20th century, female heights grew faster than male heights. In contrast, the 1980s transition period to an economic system with market elements was characterized by increasing gender inequality in China. This was the case to an even greater extent in South Korea, where gender dimorphism noticeably increased during the 1980s, paralleling a similar increase in sex-selective abortions. Moreover, we also study other inequality patterns in the three countries, focusing on socioeconomic, regional, and educational differences between groups.

The history of occupational health in South Korea.

South Korea has experienced rapid economic development over a 60-year period, since the 1960s, rising up from the ruins of the 1950-1953 Korean War. During this short period, South Korea experienced a wide range of occupational safety and health (OSH) problems, similar to that experienced in most developed countries about 100-200 years previously. In response, the South Korean government established a national OSH services system that is on par with most developed countries. In recent years, South Korea now faces a new collection of OSH challenges, such as mental health issues, microenterprise issues, precarious workers, and the promotion of work ability in a rapidly changing socioeconomic structure. This study evaluates the establishment of South Korea's OSH services system, including the socio-politico-economic contexts that have had a profound influence on the system during each historical period.

Health and economic development since 1900.

The 20th century has brought unprecedented gains in health. While these have improved citizens' lives worldwide, progress has been uneven and have in turn led to substantial cross-country health inequalities. This article looks at the effects of these inequalities on between-country economic inequality since 1900 using a level accounting framework that includes life expectancy as an important part of human capital besides education. The main results show that health has been a historically important source of cross-country income variation. In 1900 and 1955, differences in life expectancy accounted for almost 20 percent and a quarter of between-country income inequality. In addition, I find that the reduction of cross-country health differentials between mid-20th century and 1990 was an important source of income convergence. In a counterfactual exercise, I show that between-country income inequality would have been almost 20 percent higher nowadays, had the process of health convergence after 1955 not taken place. Finally, I find that the relative importance of health for income levels has stayed constant in the last three decades due to a deceleration in the rate of health convergence.

Neurosurgery in East Africa: Foundations.

This article is the first in a series of 3 articles that seek to provide readers with an understanding of the development of neurosurgery in East Africa (Foundations), the challenges that arise in providing neurosurgical care in developing countries (Challenges), and an overview of traditional and novel approaches to overcoming these challenges to improve healthcare in the region (Innovations). We review the history and evolution of neurosurgery as a clinical specialty in East Africa. We also review Kenya, Uganda, and Tanzania in some detail and highlight contributions of individuals and local and regional organizations that helped to develop and shape neurosurgical care in East Africa. Neurosurgery has developed steadily as advanced techniques have been adopted by local surgeons who trained abroad, and foreign surgeons who have dedicated part of their careers in local hospitals. New medical schools and surgical training programs have been established through regional and international partnerships, and the era of regional specialty surgical training has just begun. As more surgical specialists complete training, a comprehensive estimation of disease burden facing the neurosurgical field is important. We present an overview with specific reference to neurotrauma and neural tube defects, both of which are of epidemiologic importance as they gain not only greater recognition, but increased diagnoses and demands for treatment. Neurosurgery in East Africa is poised to blossom as it seeks to address the growing needs of a growing subspecialty.

Temporal Dynamics of the Driving Factors of Urban Landscape Change of Addis Ababa During the Past Three Decades.

Mapping and quantifying urban landscape dynamics and the underlying driving factors are crucial for devising appropriate policies, especially in cities of developing countries where the change is rapid. This study analyzed three decades (1984-2014) of land use land cover change of Addis Ababa using Landsat imagery and examined the underlying factors and their temporal dynamics through expert interview using Analytic Hierarchy Process (AHP). Classification results revealed that urban area increased by 50%, while agricultural land and forest decreased by 34 and 16%, respectively. The driving factors operated differently during the pre and post-1991 period. The year 1991 was chosen because it marked government change in the country resulting in policy change. Policy had the highest influence during the pre-1991 period. Land use change in this period was associated with the housing sector as policies and institutional setups were permissive to this sector. Population growth and in-migration were also important factors. Economic factors played significant role in the post-1991 period. The fact that urban land has a market value, the growth of private investment, and the speculated property market were among the economic factors. Policy reforms since 2003 were also influential to the change. Others such as accessibility, demography, and neighborhood factors were a response to economic factors. All the above-mentioned factors had vital role in shaping the urban pattern of the city. These findings can help planners and policymakers to better understand the dynamic relationship of urban land use and the driving factors to better manage the city.

Trends of improved water and sanitation coverage around the globe between 1990 and 2010: inequality among countries and performance of official development assistance.

BACKGROUND: As the Millennium Development Goals ended, and were replaced by the Sustainable Development Goals, efforts have been made to evaluate the achievements and performance of official development assistance (ODA) in the health sector. In this study, we explore trends in the expansion of water and sanitation coverage in developing countries and the performance of ODA. DESIGN: We explored inequality across developing countries by income level, and investigated how ODA for water and sanitation was committed by country, region, and income level. Changes in inequality were tested via slope changes by investigating the interaction of year and income level with a likelihood ratio test. A random effects model was applied according to the results of the Hausman test. RESULTS: The slope of the linear trend between economic level and sanitation coverage has declined over time. However, a random effects model suggested that the change in slope across years was not significant (e.g. for the slope change between 2000 and 2010: likelihood ratio χ2 = 2.49, probability > χ2 = 0.1146). A similar pro-rich pattern across developing countries and a non-significant change in the slope associated with different economic levels were demonstrated for water coverage. Our analysis shows that the inequality of water and sanitation coverage among countries across the world has not been addressed effectively during the past decade. Our findings demonstrate that the countries with the least coverage persistently received far less ODA per capita than did countries with much more extensive water and sanitation coverage, suggesting that ODA for water and sanitation is poorly targeted. CONCLUSION: The most deprived countries should receive more attention for water and sanitation improvements from the world health community. A strong political commitment to ODA targeting the countries with the least coverage is needed at the global level.

As through a glass, darkly: the future of sexually transmissible infections among gay, bisexual and other men who have sex with men.

The trajectory of sexually transmissible infection (STI) incidence among gay and other men who have sex with men (MSM) suggests that incidence will likely remain high in the near future. STIs were hyperendemic globally among MSM in the decades preceding the HIV epidemic. Significant changes among MSM as a response to the HIV epidemic, caused STI incidence to decline, reaching historical nadirs in the mid-1990s. With the advent of antiretroviral treatment (ART), HIV-related mortality and morbidity declined significantly in that decade. Concurrently, STI incidence resurged among MSM and increased in scope and geographic magnitude. By 2000, bacterial STIs were universally resurgent among MSM, reaching or exceeding pre-HIV levels. While the evidence base necessary for assessing the burden STIs among MSM, both across time and across regions, continues to be lacking, recent progress has been made in this respect. Current epidemiology indicates a continuing and increasing trajectory of STI incidence among MSM. Yet increased reported case incidence of gonorrhoea is likely confounded by additional screening and identification of an existing burden of infection. Conversely, more MSM may be diagnosed and treated in the context of HIV care or as part of routine management of pre-exposure prophylaxis (PrEP), potentially reducing transmission. Optimistically, uptake of human papillomavirus (HPV) vaccination may lead to a near-elimination of genital warts and reductions in HPV-related cancers. Moreover, structural changes are occurring with respect to sexual minorities in social and civic life that may offer new opportunities, as well as exacerbate existing challenges, for STI prevention among MSM.

Towards an anthropometric history of latin America in the second half of the twentieth century.

We examine the evolution of adult female heights in twelve Latin American countries during the second half of the twentieth century based on demographic health surveys and related surveys compiled from national and international organizations. Only countries with more than one survey were included, allowing us to cross-examine surveys and correct for biases. We first show that average height varies significantly according to location, from 148.3cm in Guatemala to 158.8cm in Haiti. The evolution of heights over these decades behaves like indicators of human development, showing a steady increase of 2.6cm from the 1950s to the 1990s. Such gains compare favorably to other developing regions of the world, but not so much with recently developed countries. Height gains were not evenly distributed in the region, however. Countries that achieved higher levels of income, such as Brazil, Chile, Colombia and Mexico, gained on average 0.9cm per decade, while countries with shrinking economies, such as Haiti and Guatemala, only gained 0.25cm per decade.

At the Roots of The World Health Organization's Challenges: Politics and Regionalization.

The World Health Organization's (WHO's) leadership challenges can be traced to its first decades of existence. Central to its governance and practice is regionalization: the division of its member countries into regions, each representing 1 geographical or cultural area. The particular composition of each region has varied over time-reflecting political divisions and especially decolonization. Currently, the 194 member countries belong to 6 regions: the Americas (35 countries), Europe (53 countries), the Eastern Mediterranean (21 countries), South-East Asia (11 countries), the Western Pacific (27 countries), and Africa (47 countries). The regions have considerable autonomy with their own leadership, budget, and priorities. This regional organization has been controversial since its beginnings in the first days of WHO, when representatives of the European countries believed that each country should have a direct relationship with the headquarters in Geneva, Switzerland, whereas others (especially the United States) argued in favor of the regionalization plan. Over time, regional directors have inevitably challenged the WHO directors-general over their degree of autonomy, responsibilities and duties, budgets, and national composition; similar tensions have occurred within regions. This article traces the historical roots of these challenges.

Trends in Between-Country Health Equity in Sub-Saharan Africa from 1990 to 2011: Improvement, Convergence and Reversal.

It is not clear whether between-country health inequity in Sub-Saharan Africa has been reduced over time due to economic development and increased foreign investments. We used the World Health Organization's data about 46 nations in Sub-Saharan Africa to test if under-5 mortality rate (U5MR) and life expectancy (LE) converged or diverged from 1990 to 2011. We explored whether the standard deviation of selected health indicators decreased over time (i.e., sigma convergence), and whether the less developed countries moved toward the average level in the group (i.e., beta convergence). The variation of U5MR between countries became smaller from 1990 to 2001. Yet this sigma convergence trend did not continue after 2002. Life expectancy in Africa from 1990-2011 demonstrated a consistent convergence trend, even after controlling for initial differences of country-level factors. The lack of consistent convergence in U5MR partially resulted from the fact that countries with higher U5MR in 1990 eventually performed better than those countries with lower U5MRs in 1990, constituting a reversal in between-country health inequity. Thus, international aid agencies might consider to reassess the funding priority about which countries to invest in, especially in the field of early childhood health.

50th anniversary of the Declaration of Helsinki: the double standard was introduced.

The Declaration of Helsinki (DoH), adopted by the World Medical Association (WMA), is one of the most influential international documents in research ethics, is turning 50 in 2014. Its regular updates, seven versions (1975, 1983, 1989, 1996, 2000, 2008, 2013) and two notes of clarification (2002, 2004), characterize it as a 'live' document. The seventh version of the DoH was amended by the 64th WMA General Assembly, Fortaleza, Brazil, October 2013. The new version was reorganized and restructured, with paragraphs subdivided and regrouped. However, the DoH remains controversial and some ethical issues are still uncovered. The major problem was the insertion of the phrase 'less effective than the best proven' on placebo paragraph in order to allow double standard in medical research in low-resource countries. The DoH is a 'live' document, which will continually have to deal with new topics and challenges. Health equity needs to be a priority, and with that, a single ethical standard for medical research.

Punitive limb amputation.

BACKGROUND: Limb amputation has been carried out through the ages as a punitive method in various parts of the world. This article highlights the historical and societal background associated with the use of punitive limb amputation. METHODS: We performed an extensive electronic search of the pertinent literature augmented with a hand-search of additional sources. RESULTS: Evidence for punitive amputation is available as early as the court of the Babylonian Code of King Hammurabi (circa 1750 Before the Common Era [BCE]), which imposed punitive limb amputations on slaves who used force against free citizens. Other reports provided evidence that punitive amputation was used as early as the 4th century BCE in ancient Peru. Limb amputation restored law and order during the Roman and Byzantine periods. Amputation as a punitive instrument prevailed in Europe throughout the 17th century. During the Enlightenment, the intellectual movement in Europe approached criminal law from a humanistic perspective, incorporated it into societal practice, and promoted its preventive dimensions. Punitive limb amputation still exists in several Arab and African countries. CONCLUSION: Amputation as a punitive or correctional method has its roots in old civilizations. It has been used through the ages in various parts of the world. While it has been abandoned in modern western societies, punitive amputation is still used in several third-world countries.

Transplantation in Turkey.

The cornerstone events of transplantation history in Turkey are summarized herein. In 1975, we performed the first living-related renal transplant in Turkey. We followed this in 1978 with the first deceased donor kidney transplantation, using an organ supplied by Eurotransplant. In 1979, the law on harvesting, storage, grafting, and transplantation of organs and tissues was enacted; later that year, the first local deceased donor kidney transplantation was performed by our team. In 1988, another groundbreaking event in Turkey was successfully achieved: the first cadaveric liver transplantation. In 1990, the first pediatric living-related segmental liver transplantation in Turkey, the region, and Europe was performed by our team. One month later, an adult-to-adult living-related liver transplantation was successfully performed. In May 1992, we performed the first combined liver-kidney transplantation from a living-related donor, which was the first operation of its kind. To date, we have performed 2,084 kidney and, since 1988, 439 liver transplantations. During 29 years of solid organ transplantation history in Turkey, 20,794 kidney transplants have been performed nationwide in 62 different centers, as well as 6,565 liver, 621 heart, and 168 pancreas transplants. In 2001, the Ministry of Health established the National Coordination Center as an umbrella organization to promote transplantation activities, especially for deceased donor organ procurement. Transplantation activities are accelerating daily throughout the country, but deceased donors are still far below the desired rates.