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Health inequities, within and across countries, stand as a critical global challenge of our time. Over 1 billion people face preventable diseases and premature deaths due to limited access to [...]

Sexual health is fundamental to overall health and well-being, to the dignity of the individual and to the social and economic development of communities and countries. (1) Three decades ago, [...]

Normative leadership is a core function of the World Health Organization's (WHO) mandate, as outlined in its founding principles. (1) This leadership role is realized by developing evidence-based and ethically [...]

Health system strengthening is key to achieving universal health coverage, a target of the sustainable development goals. For policy-makers to effectively focus health system strengthening efforts and translate them into [...]

The financial and economic choices societies make determine whether all individuals can enjoy the right to health. Crises quickly expose the values and interests that drive decisions towards health, as [...]

Rehabilitation is included in the universal health coverage (UHC) target of the sustainable development goals as an essential health service; access to rehabilitation is a human right. (1) Rehabilitation services [...]

As of 19 March 2021, 121 million cases and over 2.6 million deaths due to coronavirus disease 2019 (COVID-19) had been reported to the World Health Organization. While heads of [...]

Despite the severe impacts of climate change on human health, socioeconomic development and the natural environment, the United Nations (UN) Framework Convention on Climate Change has failed to reach its [...]

Health systems face increasingly complex challenges, such as the growing burden of chronic noncommunicable diseases, multisource pollution, new epidemics and antimicrobial resistance. These challenges have prompted an important shift in [...]

In 2015, all United Nations (UN) Member States committed to achieving universal health coverage (UHC) through the health-related sustainable development goal (SDG 3). Achieving UHC would enable all people to [...]

Abstract The most important public health priority in agricultural policy-making is currently food safety, despite the relatively higher importance of food security, nutrition, and other agricultural-related health issues in terms [...]

Abstract The evolving domain of international health law encompasses increasingly diverse and complex concerns. Commentators agree that health development in the twenty-first century is likely to expand the use of [...]

Abstract Global challenges raised by biomedical advances require global responses. Some international organizations have made significant efforts over the last few years to establish common standards that can be regarded [...]

Abstract The environment continues to be a source of ill-health for many people, particularly in developing countries. International environmental law offers a viable strategy for enhancing public health through the [...]

Abstract This article explores the relevance of international human rights law in the response to the HIV/AIDS epidemic at national and international levels. Public health advocates can use arguments based [...]

Abstract Historically, international law has played a key role in global communicable disease surveillance. Throughout the nineteenth century, international law played a dominant role in harmonizing the inconsistent national quarantine [...]

Abstract It is estimated that by 2020 two-thirds of the global burden of disease will be attributable to chronic noncommunicable diseases, most of them strongly associated with diet. The nutrition [...]

Since late 1998 the coverage of the DOTS strategy in India has been expanded rapidly. In both 2000 and 2001 the country probably accounted for more than half the global increase in the number of patients treated under DOTS and by early 2002 more than a million patients were being treated in this way in India. As a result, nearly 200 000 lives were saved. The lessons learnt relate to the importance of the following elements of the programme: (1) getting the science right and ensuring technical excellence; (2) building commitment and ensuring the provision of funds and flexibility in their utilization; (3) maintaining focus and priorities; (4) systematically appraising each area before starting service delivery; (5) ensuring an uninterrupted drug supply; (6) strengthening the established infrastructure and providing support for staff; (7) supporting the infrastructure required in urban areas; (8) ensuring full-time independent technical support and supervision, particularly during the initial phases of implementation; (9) monitoring intensively and giving timely feedback; and (10) continuous supervision. Tuberculosis (TB) control still faces major challenges in India. To reach its potential, the control programme needs to: continue to expand so as to cover the remaining half of the country, much of which has a weaker health infrastructure than the areas already covered; increase its reach in the areas already covered so that a greater proportion of patients is treated; ensure sustainability; improve the patient-friendliness of services; confront TB associated with human immunodeficiency virus (HIV) infection. It is expected that HIV will increase the number of TB cases by at least 10% and by a considerably higher percentage if HIV becomes much more widespread. India's experience shows that DOTS can achieve high case-detection and cure rates even with imperfect technology and oftenwith an inadequate public health infrastructure. However, this can only happen if the delivery programme is appropriately designed and effectively managed. Keywords BCG vaccine; Mycobacterium bovis/immunology/genetics; Mycobacterium tuberculosis/immunology/genetics; Drug evaluation, Preclinical; Models, Animal; Clinical trials, Phase I; Research (source: MeSH, NLM). Mots cles Vaccin BCG; Mycobacterium bovis/immunologie/genetique; Mycobacterium tuberculosis/immunologie/genetique; Evaluation preclinique medicament; Modele animal; Essai clinique phase I; Recherche (source: MeSH, INSERM). Palabras clave Vacuna BCG; Mycobacterium bovis/inmunologia/genetica; Mycobacterium tuberculosis/inmunologia/genetica; Evaluacion preclinica de medicamentos; Modelos animales; Ensayos clinicos fase I; Investigacion (fuente: DeCS, BIREME). Bulletin of the World Health Organization 2002;80:457-463., Voir page 463 le resume en francais. En la pagina 463 figura un resumen en espanol. Background Between October 1998 and October 2001 the DOTS strategy in India increased its [...]

Objective To analyse the five-point tuberculosis (TB) strategy, DOTS, 10 years after its implementation in one-half of China's population, and to suggest lessons for future implementation of the DOTS strategy. Methods We analysed trends in case-finding and treatment outcome over time following implementation of the DOTS strategy in each county, using routine reporting data from the Infectious and Endemic Disease Control (IEDC) project (1991-2000). We also determined the proportion of counties with different levels of case-finding for the fifth and sixth years of DOTS implementation. Findings From 1991 to 1995, DOTS expanded rapidly to cover more than 90% of target population and counties. By 2000, 8 million TB suspects had received free diagnostic evaluation: 1.8 million TB cases were diagnosed, free treatment was provided to 1.3 million smear-positive cases, and more than 90% were cured. During DOTS implementation, the percentage of previously treated cases decreased among all smear-positive cases and treatment outcomes improved. Despite these achievements, the detection rate for new smear-positive cases in the project was estimated to be only 54% in 1998, and 41.2% of the counties had a below average or low level of case-finding (with substantial variation between provinces). Conclusions The IEDC project demonstrated that it is feasible to rapidly expand DOTS on a large scale, The global target of an 85% cure rate was quickly achieved, and the level of drug-resistance was probably reduced by this project. However, case-detection did not reach the 70% global target, and more research is needed on how to enhance this. Keywords Tuberculosis, Pulmonary/drug therapy; National health programs/organization and administration; Disease notification; Treatment outcome; Program evaluation; China (source: MESH, NZM). Mots cles Tuberculose pulmonaire/chimiotherapie; Programme national sante/organisation et administration; Notification maladie; Evaluation resultats traitement; Evaluation programme; Chine (source: MeSH, INSERM). Palabras clave Tuberculosis pulmonar/quimioterapia; Programas nacionales de salud/organizacion y administracion; Notificacion de enfermedad; Resultado del tratamiento; Evaluacion de programas; China (fuente: DeCS, BIREME). Bulletin of the World Health Organization 2002;80:430-436. Voir page 435 le resume en francais. En la pagina 436 figura un resumen en espanol., Introduction In 1991, the Government of China introduced a TB control project using the WHO-recommended, rive-point strategy called DOTS. The project, entitled the Infectious and Endemic Disease Control (IEDC) project, [...]

Poverty and ill-health are intertwined. Poor countries tend to have worse health outcomes than better-off countries. Within countries, poor people have worse health outcomes than better-off people. This association reflects causality running in both directions: poverty breeds ill-health, and ill-health keeps poor people poor. The evidence on inequalities in health between the poor and non-poor and on the consequences for impoverishment and income inequality associated with health care expenses is discussed in this article. An outline is given of what is known about the causes of inequalities and about the effectiveness of policies intended to combat them. It is argued that too little is known about the impacts of such policies, notwithstanding a wealth of measurement techniques and considerable evidence on the extent and causes of inequalities. Keywords Poverty; Health status; Income; Health services accessibility; Financing, organized; Social justice (source: MeSH, NLM). Mots cles Pauvrete; Etat sanitaire; Revenu; Accessibilite services sante; Organisation financement; Justice sociale (source: MeSH, INSERM). Palabras clave Pobreza; Estado de salud; Renta; Accessibilidad a los servicios de salud; Organizacion del financiamiento; Justicia social (fuente: DeCS, BIREME). Bulletin of the World Health Organization 2002;80:97-105., Resume Pauvrete et inegalites dans le secteur de la sante Pauvrete et mauvaise sante vont de pair. Les pays pauvres tendent a avoir de plus mauvais resultats dans le domaine [...]

Objective To describe a dynamic compartmental simulation model for Botswana and India, developed to identify the best strategies for preventing spread of HIV/AIDS. Methods The following interventions were considered: a [...]

More assertive political leadership in the global response to AIDS in both poor and rich countries culminated in June 2001 at the UN General Assembly Special Session on AIDS. Delegates made important commitments there, and endorsed a global strategy framework for shifting the dynamics of the epidemic by simultaneously reducing risk, vulnerability and impact. This points the way to achievable progress in the fight against HIV/AIDS. Evidence of success in tackling the spread of AIDS comes from diverse programme areas, including work with sex workers and clients, injecting drug users, and young people. It also comes from diverse countries, including India, the Russian Federation, Senegal, Thailand, the United Republic of Tanzania, and Zambia. Their common feature is the combination of focused approaches with attention to the society wide context within which risk occurs. Similarly, building synergies between prevention and care has underpinned success in Brazil and holds great potential for sub-Saharan Africa, where 90% reductions have been achieved in the prices at which antiretroviral drugs are available. Success also involves overcoming stigma, which undermines community action and blocks access to services. Work against stigma and discrimination has been effectively carried out in both health sector and occupational settings. Accompanying attention to the conditions for success against HIV/AIDS is global consensus on the need for additional resources. The detailed estimate of required AIDS spending in low- and middle-income countries is US$ 9.2 billion annually, compared to the $ 2 billion currently spent. Additional spending should be mobilized by the new global fund to fight AIDS, tuberculosis and malaria, but needs to be joined by additional government and private efforts within countries, including from debt relief. Commitment and capacity to scale up HIV prevention and care have never been stronger. The moment must be seized to prevent a global catastrophe. Keywords Acquired immunodeficiency syndrome/prevention and control; HIV infections/prevention and control; International cooperation; United Nations; Intersectoral cooperation; Socioeconomic factors; Social support; Politics; Anti-HIV agents/supply and distribution/economics; Prejudice (source: MESH). Mots cles SIDA/prevention et controle; HIV, Infection/prevention et controle; Facteur socioeconomique; Cooperation internationale; Nations Unies; Cooperation intersectorielle; Soutien social; Politique; Agents anti-HIV/ ressources et distribution/economie; Prejuge (source: INSERM). Palabras clave Sindrome de inmunodeficiencia adquirida/prevencion y control; Infecciones por VIH/prevencion y control; Cooperacion internacional; Naciones Unidas; Cooperacion intersectorial; Factores socioeconomicos; Apoyo social; Politica; Agentes anti VIH/provision y distribucion/economia; Prejuicio (fuente: BIREME). Bulletin of the World Health Organization, 2001, 79:1106-1112. Voir page 1111 le resume en francais. En la pagina 1111 figura un resumen en espanol., Renewed international resolve The year 2001 has seen a remarkable convergence of political, scientific and economic forces, creating major new opportunities for a more intensive global response to the AIDS [...]

In developing countries, chronic respiratory diseases represent a challenge to public health because of their frequency, severity, projected trends, and economic impact. Health care planners, for example, are faced with a dramatic increase in tobacco use and must establish priorities for the allocation of limited resources. Nevertheless, smoking prevention and standardized management programmes for asthma and chronic obstructive pulmonary disease should be implemented in developing countries whenever possible. International measures will be required to reverse tobacco smoking trends, and international agencies could define essential drugs and equipment and encourage the use of generic drugs, particularly for corticosteroids inhaled at high dosages. For such programmes to be effective, producers of high-quality generics will need to be identified, and the medications added to national lists of essential drugs and included in procurement procedures. Other recommendations for alleviating the burden of chronic respiratory diseases in developing countries are: adapting guidelines to local contexts and ensuring their distribution; upgrading equipment at district level; purchasing high-quality drugs at low prices; routine training and supervision of health services personnel; and regular monitoring of performance. Social mobilization by professional societies, nongovernmental organizations, and the mass media will also increase government commitment to tobacco control and standardized case management. Keywords Lung diseases, Obstructive/economics/prevention and control/epidemiology; Asthma/economics/ prevention and control/epidemiology; Cost of illness; Smoking cessation; Essential drugs; Developing countries (source: MeSH). Mots cles Bronchopneumopathies obstructives/economie/prevention et controle/epidemiologie; Asthme/ economie/prevention et controle/epidemiologie; Cout maladie; Sevrage tabagique; Medicaments essentiels; Pays en developpement (source: INSERM). Palabras clave Neumopatias obstructivas/economia/prevencion y control/epidemiologia; Asma/economia/ prevencion y control/epidemiologia; Costo de la enfermedad; Cese del tabaquismo; Medicamentos esenciales; Paises en desarrollo (fuente: BIREME). Bulletin of the World Health Organization, 2001, 79:971-979., Voir page 977 le resume en francais. En la pagina 977 figura un resumen en espanol. Introduction Chronic respiratory diseases represent a public health challenge in both industrialized and developing [...]

There is no doubt that communicable diseases will remain the predominant health problem for the populations in sub-Saharan Africa, including adults, for the next 10-20 years. Concern has been expressed that the available resources to deal with this problem would be reduced by increasing the emphasis on noncommunicable diseases. The latter, however, already present a substantial burden because their overall age-specific rates are currently higher in adults in sub-Saharan Africa than in populations in Established Market Economies. There is also evidence that the prevalence of certain noncommunicable diseases, such as diabetes and hypertension, is increasing rapidly, particularly in the urban areas, and that significant demands are being made on the health services by patients with these diseases. To ignore the noncommunicable diseases would inevitably lead to an increase in their burden; the provision of health services for them would be largely undirected by issues of clinical and cost effectiveness, and their treatment and prevention would be left to the mercy of local and global commercial interests. Improved surveillance of all diseases within sub-Saharan Africa is needed in order to place noncommunicable diseases properly within the context of the overall burden of disease. Research is needed to guide improvements in the clinical and cost effectiveness of resources currently committed to the care of patients with noncommunicable diseases, and to direct and evaluate preventive measures. Keywords Chronic disease/economics/epidemiology/therapy; Cost of illness; Primary prevention; Health services research; Health priorities; Africa South of the Sahara (source: MeSH). Mots cles Maladie chronique/economie/epidemiologie/therapeutique; Cout maladie; Prevention; Recherche en sante publique; Priorites en sante; Afrique subsaharienne (source: INSERM). Palabras clave Enfermedad cronica/economia/epidemiologia/terapia; Costo de la enfermedad; Prevencion primaria; Investigacion sobre servicios de salud; Prioridades en salud; Africa del Sur del Sahara (fuente: BIREME). Bulletin of the World Health Organization, 2001, 79: 947-953., Voir page 952 le resume en francais. En la pagina 952 figura un resumen en espanol. Noncommunicable diseases in sub-Saharan Africa: not a priority? At present, conventional wisdom states that [...]

Cervical cancer is an important public health problem among adult women in developing countries in South and Central America, sub-Saharan Africa, and south and south-east Asia. Frequently repeated cytology screening programmes -- either organized or opportunistic -- have led to a large decline in cervical cancer incidence and mortality in developed countries. In contrast, cervical cancer remains largely uncontrolled in high-risk developing countries because of ineffective or no screening. This article briefly reviews the experience from existing screening and research initiatives in developing countries. Substantial costs are involved in providing the infrastructure, manpower, consumables, follow-up and surveillance for both organized and opportunistic screening programmes for cervical cancer. Owing to their limited health care resources, developing countries cannot afford the models of frequently repeated screening of women over a wide age range that are used in developed countries. Many low-income developing countries, including most in sub-Saharan Africa, have neither the resources nor the capacity for their health services to organize and sustain any kind of screening programme. Middle-income developing countries, which currently provide inefficient screening, should reorganize their programmes in the light of experiences from other countries and lessons from their past failures. Middle-income countries intending to organize a new screening programme should start first in a limited geographical area, before considering any expansion. It is also more realistic and effective to target the screening on high-risk women once or twice in their lifetime using a highly sensitive test, with an emphasis on high coverage (>80%) of the targeted population. Efforts to organize an effective screening programme in these developing countries will have to find adequate financial resources, develop the infrastructure, train the needed manpower, and elaborate surveillance mechanisms for screening, investigating, treating, and following up the targeted women. The findings from the large body of research on various screening approaches carried out in developing countries and from the available managerial guidelines should be taken into account when reorganizing existing programmes and when considering new screening initiatives. Keywords Cervix neoplasms/diagnosis/prevention and control; Cervix uteri/cytology; Vaginal smears/utilization; Mass screening/organization and administration; Developing countries; Central America; South America; Africa South of the Sahara; South Africa; India; South-East Asia (source: MESH). Mots cles Tumeur col uterus/diagnostic/prevention et controle; Col uterin/cytologie; Frottis vaginal/utilisation; Depistage systematique/organisation et administration; Pays en developpement; Amerique centrale; Amerique du Sud; Afrique subsaharienne; Afrique du Sud; Inde; Asie Sud-Est (source: INSERM). Palabras clave Neoplasmas del cuello uterino/diagnostico/prevencion y control; Cuello uterino/citologia; Frotis vaginal/utilizacion; Tamizaje masivo/organizacion y administracion; Paises en desarrollo; America Central; America del Sur; Africa del Sur del Sahara; Sudafrica; India; Asia Sudoriental (fuente: BIREME). Bulletin of the World Health Organization, 2001, 79: 954-962., Voir page 960 le resume en francais. En la pagina 961 figura un resumen en espanol. Introduction Cervical cancer is an important public health problem for adult women in developing [...]

Community-based programmes for prevention and control of cardiovascular diseases (CVD) started in Europe and the USA in the early 1970s. High mortality from CVD in Finland led to the start of the North Karelia Project. Since then, a vast amount of scientific literature has accumulated to present results and discuss experience. The results indicate that heart health programmes have a high degree of generalizability, are cost-effective and can influence health policy. In the 1980s the focus of programmes expanded from CVD to noncommunicable diseases (NCD), mainly because of the common risk factors. Attention has now turned to promoting this approach in developing countries, where the prevalence of NCD is growing. Theory and experience show that community-based NCD programmes should be planned, run and evaluated according to clear principles and rules, collaborate with all sectors of the community, and maintain close contact with the national authorities. In view of the burden of disease they represent and of globalization, there is a great need for international collaboration. Practical networks with common guidelines but adaptable to local cultures in a flexible way have proved to be very useful. Keywords Cardiovascular diseases/prevention and control; Chronic disease; Risk factors; Community health services/organization and administration; Intersectoral cooperation; Health promotion; Health behavior; Cost of illness; Developed countries; Developing countries (source: MeSH). Mots cles Cardiovasculaires, Maladies/prevention et controle; Maladie chronique; Facteur risque; Service public sante/organisation et administration; Cooperation intersectorielle; Promotion sante; Hygiene de vie; Cout maladie; Pays developpe; Pays en developpement (source: INSERM). Palabras clave Enfermedades cardiovasculares/prevencion y control; Enfermedad cronica; Factores de riesgo; Servicios de salud comunitaria/organizacion y administracion; Cooperacion intersectorial; Promocion de la salud; Conducta de salud; Costo de la enfermedad; Paises desarrollados; Paises en desarrollo (fuente: BIREME). Bulletin of the World Health Organization, 2001, 79: 963-970., Voir page 968 le resume en francais. En la pagina 968 figura un resumen en espanol. Introduction Noncommunicable diseases (NCD) are the major health burden in the industrialized countries, and [...]

Objective To evaluate the impact of the National Healthy Lifestyle Programme, a noncommunicable disease intervention programme for major cardiovascular disease risk factors in Singapore, implemented in 1992. Methods The evaluation was carried out in 1998 by the Singapore National Health Survey (NHS). The reference population was 2.2 million multiracial Singapore residents, 18-69 years of age. A population-based survey sample (n = 4723) was selected by disproportionate stratified and systematic sampling. Anthropometric and blood pressure measurements were carried out on all subjects and blood samples were taken for biochemical analysis. Findings The 1998 results suggest that the National Healthy Lifestyle Programme significantly decreased regular smoking and increased regular exercise over 1992 levels and stabilized the prevalence of obesity and diabetes mellitus. However, the prevalence of high total blood cholesterol and hypertension increased. Ethnic differences in the prevalence of diabetes mellitus, hypertension, and smoking; and in lipid profile and exercise levels were also observed. Conclusion The intervention had mixed results after six years. Successful strategies have been continued and strengthened. Keywords Cardiovascular diseases/etiology/; Risk factors; Diabetes mellitus/epidemiology/ethnology; Hypertension/epidemiology/ethnology; Obesity/epidemiology/ethnology; Smoking/epidemiology/ethnology; Exercise; Ethnic groups; Life style; National health programs; Cross-sectional studies; Singapore (source: MeSh). Mots cles Cardiovasculaires, Maladies/etiologie; Facteur risque; Diabete/epidemiologie/ethnologie; Hypertension arterielle/epidemiologie/ethnologie; Obesite/epidemiologie/ethnologie; Tabagisme/epidemiologie/ethnologie; Exercice physique; Groupes ethniques; Style vie; Programme national sante; Etude section efficace; Singapour (source: INSERM). Palabras clave Enfermedades cardiovasculares/etiologia; Factores de riesgo; Diabetes mellitus/epidemiologia/ etnologia; Hipertension/epidemiologia/etnologia; Obesidad/epidemiologia/etnologia; Tabaquismo/epidemiologia/ etnologia; Ejercicio; Grupos etnicos; Estilo de vida; Programas nacionales de salud; Estudios transversales; Singapur (fuente: BIREME). Bulletin of the World Health Organization, 2001, 79: 908-915., Voir page 914 le resume en francais. En la pagina 914 figura un resumen en espanol. Introduction The island of Singapore has undergone rapid socioeconomic development since independence in 1965. [...]

Described are the results of an international collaborative study to evaluate th e use of the whole blood samples spotted on filter-paper (BSP) for the detection of antibodies to human [...]

The disposal of wastes from paper and pulp mills-a problem of particular importance in the northern European countries of Norway, Sweden and Denmark, where wood-processing is one of the main industries-is discussed. The various types of waste produced are described, and their pollution potential is assessed, in terms of population equivalents, with special reference to the present position in Finland. The methods available for the treatment of these wastes are briefly outlined.