The challenge of world health

2 development specialists have expounded on the demands world health has placed on public health. Striking declines in infant and child mortality occurred with the advent of biomedical and technical interventions in developing countries after World War II. At the same time, these interventions promoted longer lives by curing and/or treating chronic diseases in developed countries. In the 1970s, however, it was apparent that the hospital based, curative approach could not meet health needs and was very costly. In developed countries, biomedical and social sciences showed that chronic diseases did not occur due to modernization but from unhealthy behaviors, diet, and lifestyle. In fact, in 1975, the US Centers for Disease Control announced that unhealthy lifestyles contributed to 50% of all deaths while the medical system was responsible for only 11%. The US and other developed countries then began to promote healthy lifestyles, and in the 1980s, considerable improvements in health occurred, especially among adults. Developing countries which depended on the Western medical model did not experience health gains in the 1970s. Yet developing countries where health systems concentrated on carrying essential services to all people and promoted basic hygiene and sound dietary practices continued to achieve considerable health gains. In 1978, WHO an UNICEF hosted the International Conference on Primary Health Care in Alma Ata, the Soviet Union to hold these developing countries with community based health systems as models of primary health care (PHC). The 1980s witnessed the spread of PHC especially in the form of child survival which focused on oral rehydration therapy and breast feeding. The biomedical and social sciences are needed to move this health policy and program strategy forward. Governments must see to policies that promote healthy people. Political will is needed to make human welfare a high priority.     

How organizational characteristics affect the adaptive tactics used by human service nonprofit managers confronting financial uncertainty

The way that nonprofits respond to funding uncertainty is crucial to their ability to meet goals and position themselves for future success. This article investigates how structural, managerial, and financial characteristics affect the adaptive tactics used by human service nonprofits during times of financial stress. These tactics include adding new programs, reducing programs or staff, expanding or starting joint programs, pursuing earned income, and expanding advocacy involvement. Using longitudinal data on human service nonprofits collected on either side of the 2002–2003 economic downtown, we find that larger size provides organizations with a unique ability to choose among different adaptive tactics, as larger size was significantly predictive of adding new programs, reducing programs, expanding advocacy, and pursuing earned income. Strategic planning was positively associated with innovative tactics such as starting joint programs or pursuing earned income. Financial stress or declines in an organization's major funding source led to cutbacks, as expected, but managers who foresaw these challenges were able to respond proactively by adding programs or starting joint programs. However, managers with more training did not respond much differently than did other managers, and organizational age and use of performance management tools had no effect in guiding organizational responses to financial uncertainty.     

Prospective study of birth interval dynamics in rural Bangladesh

A group of 209 married, fecund women in rural Bangladesh were studied prospectively for 24 months from 1969 to 1971 to define some of the biological and sociological factors relating to fertility performance. These women were selected from a larger study population of 112,000 that had been followed with a daily house-to-house vital registration programme since 1966. The selected women were interviewed bi-weekly and were asked questions about menstruation, pregnancy, lactation, husband's occupational absences, and monthly urine tests for pregnancy were taken. The results for 193 non-contracepting women revealed that the seasonal pattern of births previously observed in this population could be associated with a corresponding seasonal pattern of conceptions and that this was due to a seasonal trend in fecundability. The highest conception rates were in the coolest months of the year. Post-partum lactational amenorrhoea was very prolonged, averaging 17 months for women with a surviving child. The appearance of the first post-partum menstrual flow (onset of ovulation) also had a seasonal trend which could not be adequately explained. The median waiting time to conception, once menstruation had resumed was eight months. This interval was influenced by seasonal fluctuations, as well as by the age of women and by husbands' absences. The foetal wastage rate was 15·0 per 100 conceptions, with 62 per cent of the foetal losses occurring during the second month of gestation. Overall, the average birth interval was 33 months, with the prolonged lactational amenorrhoea accounting for almost 45 per cent of this interval.      

Simultaneity in the use of maternal-child health care and contraceptives: evidence from developing countries

This study examined the relationship between the use of maternal-child health (MCH) care and the use of contraceptives. The high correlation between the two may be due to the independent effect of one on the other or to an association of both with the same or similar background factors. We used structural equation models to examine the relationship between these two interventions. The data were derived from six Demographic and Health Surveys: Zimbabwe from Sub-Saharan Africa, Thailand from Asia, Egypt and Tunisia from North Africa, and Guatemala and Colombia from Latin America. The results show that in all six countries, the use of contraceptives and MCH care are significantly associated, independent of intervening factors; this finding suggests that families develop a joint demand for better-quality health and limited family size and translate these demands into action by using health services for mothers and for children and by voluntarily regulating fertility.     

Prospective study of birth interval dynamics in rural Bangladesh

Abstract A group of 209 married, fecund women in rural Bangladesh were studied prospectively for 24 months from 1969 to 1971 to define some of the biological and sociological factors relating to fertility performance. These women were selected from a larger study population of 112,000 that had been followed with a daily house-to-house vital registration programme since 1966. The selected women were interviewed bi-weekly and were asked questions about menstruation, pregnancy, lactation, husband's occupational absences, and monthly urine tests for pregnancy were taken. The results for 193 non-contracepting women revealed that the seasonal pattern of births previously observed in this population could be associated with a corresponding seasonal pattern of conceptions and that this was due to a seasonal trend in fecundability. The highest conception rates were in the coolest months of the year. Post-partum lactational amenorrhoea was very prolonged, averaging 17 months for women with a surviving child. The appearance of the first post-partum menstrual flow (onset of ovulation) also had a seasonal trend which could not be adequately explained. The median waiting time to conception, once menstruation had resumed was eight months. This interval was influenced by seasonal fluctuations, as well as by the age of women and by husbands' absences. The foetal wastage rate was 15·0 per 100 conceptions, with 62 per cent of the foetal losses occurring during the second month of gestation. Overall, the average birth interval was 33 months, with the prolonged lactational amenorrhoea accounting for almost 45 per cent of this interval. From the Department of Population Dynamics, Johns Hopkins University, School of Hygiene and Public Health, Baltimore, Maryland 21205.     

Incentivising trust

We argue that trust can be incentivised by measures which increase the ability of trusters to protect themselves against risk. We work within the framework originally established by Berg, Dickhaut, and McCabe (1995) in which trust is measured experimentally as the ability to generate reciprocity in response to an initial offer of money within a two-person game. An incentive is conveyed both by means of variations in the multiplier applied to the first player’s initial offer and by giving the first player the opportunity to insure themselves against the possibility that the second player will fail to reciprocate their initial offer. Measured trust is strongly responsive to both these incentives. Thus third parties have the ability to influence the outcome of the game, not only, as in the analysis of Charness, Cobo-Reyes, and Jimenez (2008), by punishing failure to reciprocate and rewarding ‘good’ initial offers, but also by offering protection which strengthens the first player’s risk efficacy, or ratio of assets to risk.     

The International Debt Crisis

Book reviewed in this article: Common Crisis (‘Second Brandt Report’). Brandt Commission. London: Pan, 1983. 174pp. £1.95. Adjustment and Financing in the Developing World: The Role of the International Monetary Fund. Edited by Tony Killick. Washington, DC: IMF in association with the Overseas Development Institute, 1982. 232pp. £4.50 pb. The Quest for Economic Stabilisation: The IMF and the Third World. Edited by Tony Killick. 320pp. £16.50 hb, £7.50 pb; and The IMF and Stabilisation: Developing Country Experiences. Edited by Tony Killick. 272pp. £15.00 hb, £6.95 pb. London: Heinemann Educational, 1984. Development Financing: A Framework for International Financial Cooperation. Edited by S. El-Shaikhly. London: Frances Pinter, 1982. £16.50. International Reserves, Exchange Rates and Developing Country Finance. Edited by Norman C. Miller. Lexington, Mass.: Lexington Books, 1982. 161pp. £15.50.     

Remarriage,Cohabitation, and Changes in Mothering Behavior

We used data from two waves of the National Survey of Families and Household to investigate changes in mothering behavior associated with remarriage or cohabitation by single mothers. We considered three dimensions of mothering: (a) time and supervision, (b) harsh discipline, and (c) relationship quality. Mothers and children agreed that mothers who remained in new partnerships used harsh discipline less frequently than mothers who remained single or whose new partnership had ended by the second interview. Mothers reported less supervision if they had experienced a disrupted partnership, whereas children reported less supervision if their mothers remained in a new partnership at the second interview. Children but not mothers reported better relationships with mothers in partnerships at the second interview, compared with children whose mothers remained single or whose new partnership had ended. Only a small part of the differences in harsh discipline, and none of the other observed differences, could be explained by maternal or family characteristics or by mothering behavior and relationships in the first interview. Although cohabiting partnerships were more likely to end than were marriages, we found no differences in effects of cohabiting or marital partnerships, net of their status at the second interview.