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The establishment of environmental health indicators for assessing the adverse effects of environmental changes on the population's health and quality of life is, as yet, a goal that has not been fully reached in Latin America and the Caribbean. As such, the United Nations Environment Program and the Pan American Health Organization (PAHO) have convened Region's institutions and experts to develop a comprehensive method for assessing environmental health. This paper evaluates several methodologies, comprehensive or otherwise, for assessing health and the environment, and describes the frameworks that have historically undergirded the key methods that have either structured or generated the environmental health indicators being used in Latin America and the Caribbean. The recurring, methodological limitations were identified: (a) relying heavily on secondary data, which points out the need for technological infrastructure that is rarely available in Latin America and the Caribbean today; and (b) a lack of clear criteria for developing inclusive tools that would facilitate the discussion of environmental health issues at the grass-roots level. Despite the progress made by the field of environmental health with regard to understanding its interdisciplinary complexities, intersectoral operations must be improved to favor open communication and implementation of integrated policies on environmental and health.

Objective: This paper characterizes the current stage of traditional medicine in nine countries of Latin America and the Caribbean., Material and Methods: This qualitative study was conducted between March and December 1998. Data were collected on the components of traditional health systems in countries of Latin America and the Caribbean, by means of a network of individuals and institutions from different countries that acted as expert informants from different specialty areas., Results: Findings from the analysis of traditional medicine regulation are presented in three groups: a) Countries with some developments in the area of legislation; b) Countries where legislation is underway; and, c) Countries with no legislation or incipient regulation., Conclusions: Several stages of traditional medical practice legislation are found in the region. This heterogeneity shows the complexity involved in regulating the practice of providers with low levels of formal training, with different therapeutic practices, and with customs that are frequently difficult to include within the standards of the official health system. These findings are important for designing and implementing healthcare policies to adequate traditional medical practices to the needs of populations that commonly use them.

In the early 1990s, most Latin American and Caribbean countries were beginning, or planning to begin, health sector reform processes. This paper presents the status and trends of health sector reform at the end of the 1990s. The authors relied on information in 20 health system and services profiles completed by the Pan American Health Organization between August 1998 and October 1999. The analysis, which follows a methodology that had been applied earlier, was organized on two different levels: (1) monitoring the reform processes (dynamics and content) and (2) evaluating their outcomes. In looking at the dynamics of the reform processes, the article examines the context in which they take place and the actors involved in their different phases: inception, design and negotiation, implementation, and evaluation. The description and analysis of the contents of health sector reform initiatives are organized into 12 broad thematic areas. Outcomes evaluation was only possible in the eight countries that provided enough pertinent information, and should be viewed as preliminary. Nevertheless, the article does present detailed information on the outcomes of health sector reform in terms of equity, effectiveness and quality, efficiency, sustainability, and societal participation and control. The article also discusses the potential causes and determining factors for the observed outcomes.

"The objective of this paper is to discuss the role that three of the proximate determinants of fertility (marriage, contraception and post-partum insusceptibility) have played in fertility change in Latin America and the Caribbean. First we look at issues of data availability and comparability on measures of the proximate determinants from retrospective surveys. Most of the data utilized come from the World Fertility Survey (WFS) and the Demographic and Health Surveys (DHS) projects. Second, we present results from the most widely applied model for assessing the impact that these proximate determinants have on fertility, that of Bongaarts....Finally, we compare the results from the application of the Bongaarts model with those from an alternative method proposed by Moreno. Both models show that increased use of contraception is by far the most important reason for fertility decline, with marriage and post-partum insusceptibility making much smaller contributions. However, the second model suggests that the role of the marriage and post-partum insusceptibility factors is much smaller than is shown by the Bongaarts model." (SUMMARY IN ENG), (excerpt)

"This paper reviews survey-based data regarding contraceptive prevalence and methods employed in Latin America and the Caribbean, with an emphasis on changes in the mix of methods over time. The most striking recent trend is the rise in use of female sterilization.... By contrast, use of male sterilization remains negligible in most countries. The oral contraceptive pill is by far the most popular of the temporary methods, though its prevalence has more often declined than increased in recent years. Together female sterilization and the pill make up around [two-thirds] of contraceptive practice in Latin America and the Caribbean." (SUMMARY IN ENG), (excerpt)

A methodological experiment was conducted as part of the Demographic and Health Surveys (DHS) project to determine whether different approaches to measuring the same variables would yield similar results. The experiment consisted of the use of a new questionnaire, incorporating variants of many of the traditional approaches to the collection of demographic and health data. The experimental questionnaire was applied in 2 countries, Peru and the Dominican Republic at the same time as the standard survey. The most salient feature of this new questionnaire pregnancies, contraceptive practice, and postpartum, marriage, employment, and migration information. In this paper, the authors evaluate whether the use of the calendar in the experimental questionnaire improved the quality of the resulting information on contraception in the DHS surveys from the abovementioned countries. Specifically, the author determine whether the monthly calendar led to better estimates of contraceptive prevalence, failure, and discontinuation, and discuss the advantages and drawbacks of the calendar over the more standard approach. Results from this evaluation suggest that the major advantages of the calendar over the more standard questionnaire are 3-fold: it allows for more complete reports of use for periods prior to the survey; it allows for a detailed study of contraceptive use patterns; and it obtains information which is more internally consistent with other types of information. On the bases of these findings, the DHS project will include a calendar in the new standard questionnaire to be used in the 2nd round of surveys (DHS II).