Equity in health and economic globalisation.

PIP: This article proposes that equity in health is inseparable from social equity in its broadest sense. An equitable system allows the lowest income sectors to have access to an acceptable level of basic goods and services. Equity in health thus entails decreasing the differences in access to, and use of all health services. Globalization, on the other hand, means the process by which economic power is expanding and increasingly concentrated in the hands of corporations that are progressively entering national economies worldwide through the international free-market ideology. Explored in this article were some ways in which globalization leads to inequities.^ieng

The decade of the African child.

PIP: The Organization of African States and UNICEF in 1992 jointly proposed that 1994-2003 be designated the Decade of the African Child. Although Africa would like to solve its children's problems on its own, especially in health and nutrition, it cannot do so alone. This paper identifies nine challenges and windows of opportunity on which consensus exists in Africa, and where donors can collaborate with moral, technical, and financial support to improve every African child's quality of life. Sections discuss the empowerment factor; health and nutrition policies; breaking out of poverty; women and child care; the right to know; linking people, primary health care, and nutrition; the need for early warning systems; restructuring the economy; and the changing face of the 1990s. The author stresses that neither governments, nongovernmental organizations, nor donors can afford to be passive observers of the pressing problems of the 1990s. Concerted efforts are needed now more than ever to fight important problems head-on.^ieng

Income generation activities for woman: the ninth element of PHC?

PIP: The concept of primary health care (PHC) generally refers to eight technical components related to health and health care. The author proposes making income generating activities (IGA) for women the ninth element of PHC. Although it would be a major move to add the non-health component to PHC, requiring different new technical and organizational inputs, income derived from women's IGAs could have a significant effect upon individual health and nutritional status in low-income households. Disposable household income is known to correlate positively with health and nutrition indicators. Women's IGAs affect that income which then tends to be added to cover routine household expenditures. The author stresses that IGAs for women can be promoted as a technical PHC element to address the key determinants of morbidity and malnutrition, and ultimately organize and empower women in a way which prepares them to take more active roles in health care and other important community decision-making and action.^ieng

Comparison of two hypocaloric diets in obese children.

OBJECTIVE: To examine whether a protein-sparing modified fast diet and a hypocaloric balanced diet are safe and effective for children in an outpatient weight reduction program. DESIGN: Randomization of two groups to either diet, with follow-up at 14.5 months. SETTING: Physician or parent referral to outpatient program at Children's Hospital of New Orleans, La. PARTICIPANTS: Nineteen children, ranging in age from 7.5 to 16.9 years, weighing 45% to 131% more than the mean weight for age, sex, and height. INTERVENTION: During the first 10 weeks, 10 children were placed on a protein-sparing modified fast diet (2520 to 3360 J), and nine children and adolescents were placed on a hypocaloric balanced diet (3360 to 4200 J). Subsequently, all participants were placed on a hypocaloric diet; calories were increased from 4200 to 5040 J in a 3-month period and maintained for 1 year. SELECTION PROCEDURES: Children were assigned to one of two diets for the first 10 weeks according to their time of enrollment. MEASUREMENTS/MAIN RESULTS: Both diets produced significant weight loss during the first 6 months. However, the protein-sparing modified fast diet produced significantly greater changes in the percentage of overweight at 10 weeks (-30% vs -14%) and at 6 months (-32% vs -18%). At 10 weeks, a significant loss of adipose tissue with preservation of lean body mass occurred in the protein-sparing modified fast group. A transient slowing of growth velocity was noted at 6 months in both dietary groups compared with values at 14.5 months. Growth velocity approached normal levels at 14.5 months compared with standards for North American children. When dietary groups were combined, the initial mean blood pressure decreased significantly at all points in the study. The initial mean serum cholesterol value also decreased significantly at 10 weeks. No biochemical or clinical complications were observed. CONCLUSIONS: These hypocaloric diets appear to be safe and effective in the short-term management of pediatric obesity. However, these diets should not be used without close medical supervision.

The Child Survival Revolution: a critique.

The purpose of this paper is to critically examine what has come to be known as the Child Survival Revolution, a programme launched by UNICEF to promote growth monitoring, oral rehydration therapy (ORT), breast-feeding and immunizations in the Third World. These four health interventions have collectively come to be known as GOBI or GOBI-FF if one adds the provision of food and family planning services. Two (not necessary original) hypotheses will be explored here: firstly, the child survival revolution cannot work in isolation. It must be tied to other, more fundamental changes in political and economic power structures; secondly, the success of these interventions is inextricably tied to their acceptance and implementation at the grassroots level (a bottom-up versus a top-down approach).

Preparing food and nutrition / primary health care programs: experiences from Cameroon and Liberia.

PIP: This article describes a process for identifying major food and nutrition problems and their determinants in Liberia and the Cameroon. The article describes the process of applying the information to an operational strategy and developing a plan of operations. The appendices provide a detailed checklist for assessing nutritional problems and their causes, a sample card for prioritizing interventions, and a food and nutrition primary health care program plan of action. The assessment required visits to various ministries and local international agencies offices. These visits yielded 20-35 documents pertaining to an analysis of malnutrition. The documents were read and relevant passages were underscored. The objective was to establish a list of macro- and more immediate microdeterminants of the existing poor health and nutrition situation. The underscored passages, which were referenced by document and page number, were clipped and pasted into a shorter document that was organized by topic. Liberia's final abstract was 30 pages long and included 13 topical headings. The Cameroon document was not organized by topic and resulted in a 96-page final document. The author made attempts to fill in missing data and to resolve contradictory information. The final documents were used to prepare the checklist in appendix A. The checklist and Basic Background Documents were prepared by the author and representatives from each of the agencies providing data. This core group of planners worked over a 7-10 week period. An extended group of policy reviewers met to discuss the first draft and revisions. The review raised the level of awareness of technical personnel. Cards were developed to describe each proposed plan of action. These cards were organized into a coherent order and sequence by the core group. Continual review resulted in the establishment of priorities. The operational strategies were developed and incorporated in national 5-year plans.^ieng

Survey on attitudes to nutrition planning.

PIP: The results of a worldwide survey of nutrition planning professionals' attitudes towards nutrition policy are presented. The objective of the survey was to determine what those involved in nutrition planning perceive to be the causes of hunger and malnutrition, and their views on the effectiveness of the programs implemented to overcome these problems. In mid-1979, a questionnaire was compiled comprising 48 questions related to attitudes towards nutrition policy, voluntary questions about social class, political classification and professional behavior and a question on perceived major impediments to solving malnutrition in the world. The questionnaire was sent to 728 professionals 87 countries; 250 replies from 55 countries; 250 replies from 55 countries were received. 44% of respondents resided in the US, 16% in Latin America and the Caribbean, 14% in the Far East, 12% in Africa and the Middle East and 13% in Europe, Canada and Australasia. Self-classification of political beliefs is the most clear cut correlate in predicting attitudes towards food and nutrition policy. There appear to be 2 clear schools of scientific/political behavior in the sample: one holds a more moderate, but generally liberal, set of views regarding the failure of modern technology in resolving world hunger and nutrition problems; a 2nd more liberal group believes political causes to be at the root of hunger. There is no single profession that can be typified as a breeding ground for nutrition planners. While the European trained and/or native group tends to be more to the left in their attitudes than their counterparts in the US, both groups are decidedly liberal and believe that social structural changes are needed to solve the problems of hunger and malnutrition in the world.^ieng

Foreign aid and its role in maintaining the exploitation of the agricultural sector: evidence from a case study in Africa.

Today most foreign aid donors are genuinely committed to the idea that development in Third World countries should start with rural development. Therefore, a sizable proportion of their development funds are invested in rural projects. However, donors channel these funds through local governments (most often representing local bourgeois interests) that are not as committed to the principle of rural development. These governments are often also embarked in policies that are actually--directly or indirectly--expropriating the surpluses generated by agriculture and investing them in the other sectors of the economy. The peasants are therefore footing most of the bill of overall national development. This paper contends that, because of this state of affairs, foreign aid directed toward rural development is actually filling the investment gap left by an internal system of unequal returns to production in agriculture. In so doing, foreign aid is indirectly financing the development of the other sectors of the economy, even if this result is unintended. This perpetrates maldevelopment without redressing the basic exploitation process of peasants which lies at the core of underdevelopment. Evidence to support this hypothesis is presented using data from a primarily agricultural exporting country: the United Republic of Cameroon.