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Global Health in Transition: A Synthesis: Perspectives from International Organizations
Global Health in Transition: A Synthesis
Perspectives from International Organizations
John H. Bryant and
Polly F. Harrison
for the Board on International Health
INSTITUTE OF MEDICINE
NATIONAL ACADEMY PRESS
Washington, D.C.
1996
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Global Health in Transition: A Synthesis: Perspectives from International Organizations
National Academy Press
2101 Constitution Avenue, N.W. Washington, D.C. 20418
NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.
This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.
This document is a synthesis of the content of selected reports published in the international health literature during the last 5 years. It consists of summaries of those reports, accompanied by a synthesis of the major themes they express, and contains only the conclusions and recommendations that are presented in those reports. It was developed by its authors, Institute of Medicine Staff Officer Polly F. Harrison, and John H. Bryant, Board on International Health member, as a foundation document for the work of that Board. Though approved for distribution by the previous and incumbent Boards on International Health, it should not be construed as reflecting the views of the National Academy of Sciences or the Institute of Medicine.
The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine.
Support for this project was provided by The Rockefeller Foundation.
Additional copies of this report are available in limited quantities from:
Institute of Medicine
Board on International Health
2101 Constitution Avenue, NW
Washington, DC 20418
Copyright 1996 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America.
Cover: Woodcuts from the Book of Trades (Ständebuch) by Jost Amman and Hans Sachs (New York: Dover Publications, 1973, with an Introduction by Benjamin A. Rifkin) are reprinted in this report with the permission of the publisher. The woodcuts were originally published in Frankfurt am Main in 1568.
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Global Health in Transition: A Synthesis: Perspectives from International Organizations
BOARD ON INTERNATIONAL HEALTH
1992–1994
William H. Foege, M.D., M.P.H. (Chair), * Executive Director,
Task Force on Child Survival, Carter Center, Emory University
Dean T. Jamison, Ph.D. * (Cochair), Staff Director,
The World Development Report 1993, The World Bank
David E. Bell, Professor of Population Sciences and International Health,
Emeritus, Harvard Center for Population and Development Studies
Jan E. G. Blanpain, M.D., * Professor and Chair,
European Health Policy Forum, School of Public Health, Leuven University
John H. Bryant, M.D., *
Moscow, Vermont
Margaret Catley-Carlson, President,
The Population Council
Richard G. A. Feachem, Ph.D., D.Sc., Dean,
London School of Hygiene and Tropical Medicine
Bernard N. Fields, M.D., *, ** Adele Lehman Professor and Chair,
Department of Microbiology and Molecular Genetics, Harvard Medical School
Julio Frenk, M.D., Ph.D., M.P.H., * Senior Researcher,
Mexican Health Foundation
Adetokunbo O. Lucas, M.D., D.P.H., * Professor of International Health,
Harvard School of Public Health
W. Henry Mosley, M.D., M.P.H., Director,
Institute for International Programs, Johns Hopkins School of Hygiene and Public Health
Adeline Wynante Patterson, M.D., M.P.H., Director,
Caribbean Food and Nutrition Institute
David P. Rall, M.D., Ph.D., * Director (retired),
National Institute of Environmental Health Sciences
Frederick C. Robbins, M.D., *, **
Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University
Timothy Rothermel, J.D., Director,
Division for Global and Interregional Programmes, United Nations Development Programme
Noel S. Weiss, M.D., D.P.H., * Professor and Chairman,
Department of Epidemiology, School of Public Health and Community Medicine, University of Washington
Barbara L. Wolfe, Ph.D., Professor,
Departments of Economics and Preventive Medicine, University of Wisconsin
IOM Staff
Polly F. Harrison, Ph.D., Director,
Division of International Health (April 1988–June 1994)
*Member, Institute of Medicine.
**Member, National Academy of Sciences.
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Global Health in Transition: A Synthesis: Perspectives from International Organizations
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Global Health in Transition: A Synthesis: Perspectives from International Organizations
BOARD ON INTERNATIONAL HEALTH
1995–PRESENT
Barry R. Bloom, Ph.D. (Cochair), * Investigator,
Howard Hughes Medical Institute, Albert Einstein College of Medicine
Harvey V. Fineberg, M.D., Ph.D. (Cochair), * Dean,
Harvard School of Public Health
John H. Bryant, M.D., *
Moscow, Vermont
Jacquelyne Campbell, Ph.D., R.N., Anna D. Wolf Endowed Professor,
Johns Hopkins University School of Nursing
Richard G. A. Feachem, Ph.D., D.Sc., Senior Adviser,
Population, Health and Nutritrion Department, The World Bank
Julio Frenk, M.D., Ph.D., * Executive Vice President,
Mexican Health Foundation
Dean T. Jamison, Ph.D., * Professor,
Center for Pacific Rim Studies, University of California at Los Angeles
Eileen T. Kennedy, D.Sc., Executive Director,
Center for Nutrition Policy and Promotion, U.S. Department of Agriculture
Arthur Kleinman, M.D., *
Maude and Lillian Presley
Professor of Medical Anthropology, Professor of Psychiatry, and Chairman,
Department of Social Medicine, Harvard Medical School
William E. Paul, M.D., * Chief,
Laboratory of Immunology, National Institute of Allergy and Infectious Diseases, and
Director,
Office of AIDS Research, National Institutes of Health
Patricia Rosenfield, Ph.D., Program Chair,
Strengthening Human Resources in Developing Countries, The Carnegie Corporation of New York
Thomas J. Ryan, M.D., Professor of Medicine, Senior Consultant in Cardiology,
Boston University School of Medicine
Susan C. M. Scrimshaw, Ph.D., * Dean,
University of Illinois at Chicago
Ex-Officio
William H. Foege, M.D., M.P.H., * Executive Director,
Task Force on Child Survival, Carter Center, Emory University
IOM Staff
Christopher P. Howson, Ph.D., Director,
Board on International Health
*Member, Institute of Medicine.
**Member, National Academy of Sciences.
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Global Health in Transition: A Synthesis: Perspectives from International Organizations
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Global Health in Transition: A Synthesis: Perspectives from International Organizations
Contents
Introduction
1
I
The Documents Reviewed: An Analysis
7
Disease Control Priorities in Developing Countries,
9
World Development Report 1993: Investing in Health,
14
The Health of Adults in Developing Countries,
20
Human Development Reports, 1993 and 1994,
25
Ninth General Programme of Work, 1996–2001, and Intensified Cooperation with Countries in Greatest Need,
30
The State of the World's Children, 1994 and 1995,
35
Health Research: Essential Link to Equity in Development,
39
Global Comparative Assessments in the Health Sector,
44
Partnerships for Global Development: The Clearing Horizon,
51
Strategies for Sustainable Development,
56
II
The Documents Considered: Reflections and Implications
61
Invitations to Further Inquiry,
63
Changing Dimensions: New Needs in Development,
63
Models and Methods: Going Beyond the Generic,
64
WDR Methodologies: Contributing to Global Mechanisms,
65
The Health Transition: Waiting for Attention,
67
Coping with Violence: Rising Problem, Complex Response,
67
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Global Health in Transition: A Synthesis: Perspectives from International Organizations
Strengthening Health Systems: The Necessary Pathway,
68
Universities and Nongovernmental Organizations: Essential Partners,
69
Ethics and Human Rights: Expanding Concerns,
69
External Assistance: Magnitude and Directions,
70
Health Research: Large Returns, Small Investment,
71
A Next Agenda: Convergence, Divergence, and Change,
72
Zones of Convergence,
73
Divergence: A World Awash with Change,
77
Implications for the United States,
79
A Final Note
Convergence on Uncertainty: The Paradox of the Next Agenda,
83
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Global Health in Transition: A Synthesis: Perspectives from International Organizations
DEDICATED TO
Bernard N. Fields, M.D.
So fine in every way,
so committed to the dream of global health,
so missed.
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Global Health in Transition: A Synthesis: Perspectives from International Organizations
Synthesis:
syn = with, together
the= to put, place
sis = process, condition
The combining of the constituent elements of separate material or abstract entities into a single or unified entity (opposed to analysis, the separating of any material or abstract entity into its constituent elements).
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Global Health in Transition: A Synthesis: Perspectives from International Organizations
Global Health in Transition: A Synthesis
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Global Health in Transition: A Synthesis: Perspectives from International Organizations
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