Global human progress occurs in a complex web of interactions between society, technology and the environment as driven by governance and infrastructure management capacity among nations. In our globalizing world, this complex web of interactions over the last 200 years has resulted in the chronic widening of economic and political gaps between the haves and the have-nots with consequential global cultural and ecosystem challenges. At the bottom of these challenges is the issue of resource limitations on our finite planet with increasing population. The problem is further compounded by pleasure-driven and poverty-driven ecological depletion and pollution by the haves and the have-nots respectively. These challenges are explored in this paper as global sustainable development (SD) quantitatively; in order to assess the gaps that need to be bridged. Although there has been significant rhetoric on SD with very many qualitative definitions offered, very few quantitative definitions of SD exist. The few that do exist tend to measure SD in terms of social, energy, economic and environmental dimensions. In our research, we used several human survival, development, and progress variables to create an aggregate SD parameter that describes the capacity of nations in three dimensions: social sustainability, environmental sustainability and technological sustainability. Using our proposed quantitative definition of SD and data from relatively reputable secondary sources, 132 nations were ranked and compared. Our comparisons indicate a global hierarchy of needs among nations similar to Maslow's at the individual level. As in Maslow's hierarchy of needs, nations that are struggling to survive are less concerned with environmental sustainability than advanced and stable nations. Nations such as the United States, Canada, Finland, Norway and others have higher SD capacity, and thus, are higher on their hierarchy of needs than nations such as Nigeria, Vietnam, Mexico and other developing nations. To bridge such gaps, we suggest that global public policy for local to global governance and infrastructure management may be necessary. Such global public policy requires holistic development strategies in contrast to the very simplistic north-south, developed-developing nations dichotomies.
Non-CF bronchiectasis remains a major cause of morbidity not only in developing countries but in some indigenous groups of affluent countries. Although there is a decline in the prevalence and incidence in developed countries, recent studies in indigenous populations report higher prevalence. Due to the lack of such data, epidemiological studies are required to find the incidence and prevalence in developing countries. Although the main characteristics of bronchiectasis are similar in developing and affluent countries, underlying aetiology, nutritional status, frequency of exacerbations and severity of the disease are different. Delay of diagnosis is surprisingly similar in the affluent and developing countries possibly due to different reasons. Long-term studies are needed for evidence based management of the disease. Successful management and prevention of bronchiectasis require a multidisciplinary approach, while the lack of resources is still a major problem in the developing countries.
By restructuring the World Health Organization (WHO) and instituting some basic changes in policy priorities, the effectiveness of the organization would be increased. Instead of assigning resources to combating the health-related issues of individual choice which exist in rich nations, such as wearing seat belts, smoking, or consuming alcohol, WHO should concentrate its funding on developing countries which continue to suffer from preventable diseases like cholera, typhoid, and malaria. Providing public health assistance to third-world countries was the original mission of WHO, but the organization was given great flexibility when it was set-up. Therefore, while WHO dollars address such issues as the medical effects of nuclear war or developing essential drug lists for circumpolar regions, people in developing nations die from preventable communicable diseases. Like other large bureaucracies, WHO is mired in a cycle of "talk, talk, talk," instead of simply tackling the problems which are pressing and evident. The resources devoted to endless meetings, conventions, and coordinating sessions prove that talk is no longer cheap, and WHO must respond positively to the demands of its poorer member states that it reorient its efforts to help those who really need help. WHO's scarce resources can no longer be stretched to fund "fashionable" issues in countries which have already achieved a longer life span and better health than is possible for citizens of African nations. By abolishing its European office and programs, WHO could increase the country budget for Africa by two-thirds. Proper use of its 1994-95 budget of approximately US $1.8 billion would go a long way towards fulfilling the goal of vaccinating every child in the world against the major childhood diseases. Instead of continuing to help those who can help themselves, WHO should direct its efforts to saving lives in the Third World.
This article is one of a series commissioned to mark the tenth anniversary of the Canadian HIV/AIDS Legal Network, discussing past developments and future directions in areas of policy and law related to HIV/AIDS. It looks at HIV-related stigma and discrimination. The article summarizes the present situation as described in reports from numerous countries throughout the world. It reviews the institutional, non-institutional, and structural dimensions of HIV-related discrimination. It also identifies some essential components of anti-discrimination efforts: legal protection; public, workplace, and health-care programs; community mobilization; and strategizing on the determinants of health.
Based on articles found on the PubMed and Popline databases on the provision of first-trimester abortion by mid-level providers, this article describes policies on type of abortion provider, comparative studies of different types of abortion provider, provider perspectives, and programmatic experience in Bangladesh, Cambodia, France, Mozambique, South Africa, Sweden, the United States of America and Viet Nam. It shows that it is safe and beneficial for suitably trained mid-level health-care providers, including nurses, midwives and other non-physician clinicians, to provide first-trimester vacuum aspiration and medical abortions. Moreover, it finds that projects in Kenya, Myanmar and Uganda have successfully trained nurse-midwives to provide post-abortion care for incomplete abortion with manual vacuum aspiration, and that studies in Ethiopia and India have recommended that providers such as auxiliary nurse-midwives should be trained in abortion service delivery to ensure that they provide safe abortions for low-income women. The paper recommends the authorization of all qualified mid-level health-care providers to carry out first-trimester abortions, and it also recommends the integration of training in providing first-trimester abortion care into basic education and clinical training for all mid-level providers and medical students interested in obstetrics and gynaecology. Finally, it calls for documentation of the role of mid-level providers in managing second-trimester medical abortions to further inform policy and practice.
Global health should encompass circumpolar health if it is to transcend the traditional approach of the "rich North" assisting the "poor South." Although the eight Arctic states are among the world's most highly developed countries, considerable health disparities exist among regions across the Arctic, as well as between northern and southern regions and between indigenous and nonindigenous populations within some of these states. While sharing commonalities such as a sparse population, geographical remoteness, harsh physical environment, and underdeveloped human resources, circumpolar regions in the northern hemisphere have developed different health systems, strategies, and practices, some of which are relevant to middle and lower income countries. As the Arctic gains prominence as a sentinel of global issues such as climate change, the health of circumpolar populations should be part of the global health discourse and policy development.
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Cervical cancer incidence and mortality has been reduced by effective screening programmes particularly in British Columbia and the Nordic countries. There remains two outstanding problems. The first is overtreatment of dysplasia in the developed world. However, in the developing world cervical cancer is the most important female cancer. In these countries the Western model of cytology based screening is impractical and inappropriate. New strategies of better health education and novel methods of screening such as visual inspection are the most cost-effective means of reducing mortality from this cancer.