The Epidemiological Transition

POLICY AND PLANNING IMPLICATIONS FOR DEVELOPING COUNTRIES

WORKSHOP PROCEEDINGS

James N.Gribble and Samuel H.Preston, Editors

Committee on Population

Commission on Behavioral and Social Sciences and Education

National Research Council

NATIONAL ACADEMY PRESS
Washington, D.C.
1993



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The Epidemiological Transition: Policy and Planning Implications for Developing Countries - Workshop Proceedings The Epidemiological Transition POLICY AND PLANNING IMPLICATIONS FOR DEVELOPING COUNTRIES WORKSHOP PROCEEDINGS James N.Gribble and Samuel H.Preston, Editors Committee on Population Commission on Behavioral and Social Sciences and Education National Research Council NATIONAL ACADEMY PRESS Washington, D.C. 1993

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The Epidemiological Transition: Policy and Planning Implications for Developing Countries - Workshop Proceedings 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. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. 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. The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce Alberts is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Robert M.White is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I.Shine is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce Alberts and Dr. Robert M.White are chairman and vice chairman, respectively, of the National Research Council. Support for the meeting that is the subject of this report was provided by the Office of Health of the U.S. Agency for International Development. Library of Congress Catalog Card No. 93–84592 International Standard Book Number 0-309-04839-7 Additional copies of this report are available from: National Academy Press, 2101 Constitution Avenue, N.W., Box 285, Washington, D.C. 20055 Call 800–624–6242 or 202–334–3313 (in the Washington Metropolitan Area). B060 Copyright 1993 by the National Academy of Sciences. All rights reserved. Printed in the United States of America

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The Epidemiological Transition: Policy and Planning Implications for Developing Countries - Workshop Proceedings WORKSHOP ON THE POLICY AND PLANNING IMPLICATIONS OF THE EPIDEMIOLOGICAL TRANSITION IN DEVELOPING COUNTRIES November 20–22, 1991 Participant List Presenters NANCY BIRDSALL, World Bank ROBERT BLUM, University of Minnesota JAMES BLUMSTEIN, Vanderbilt University JOSE LUIS BOBADILLA, World Bank RODOLFO BULATAO, World Bank JOHN CALDWELL, Australian National University PAT CALDWELL, Australian National University CHANPEN CHOPRAPAWAN, National Epidemiology Board of Thailand RICHARD FEACHEM, London School of Hygiene and Tropical Medicine LARRY HELIGMAN, United Nations Population Division CLYDE HERTZMAN, University of British Columbia DEAN JAMISON, University of California, Los Angeles RUTH LEVINE, The Urban Institute DAVID MECHANIC, Rutgers University W.HENRY MOSLEY, Johns Hopkins University PHILIP MUSGROVE, World Bank ANNE R.PEBLEY, Princeton University SAMUEL H.PRESTON, University of Pennsylvania ANTHONY ROBBINS, Boston University ERIC STALLARD, Duke University JULIA WALSH, Harvard University Guests SUE ANTHONY, Office of Nutrition, U.S. Agency for International Development PETER BERMAN, Harvard University ROBERT BERNSTEIN, Office of Health, U.S. Agency for International Development RICHARD BISSELL, Bureau for Research and Development, U.S. Agency for International Development MARTIN BROCKERHOFF, Office of Population, U.S. Agency for International Development

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The Epidemiological Transition: Policy and Planning Implications for Developing Countries - Workshop Proceedings ROBERT CLAY, Office of Health, U.S. Agency for International Development ROBIN ESPENSCHADE, Office of Health, U.S. Agency for International Development JOHN FARRAR, International Clinical Epidemiology Network HOLLY FLUTY, Office of Health, U.S. Agency for International Development DIAA HAMMAMY, International Science and Technology Institute PAMELA JOHNSON, Office of Health, U.S. Agency for International Development KEVIN KINSELLA, Center for International Research, Bureau of the Census JAMES KOCHER, Center for Development Policy, Research Triangle Institute SUE KOLODIN, Office of Health, U.S. Agency for International Development TERRY LUCAS, Near East Bureau, U.S. Agency for International Development MIKE MALISON, International Health Program Office, Centers for Disease Control MELANIE MARLETT, Directorate for Policy, U.S. Agency for International Development ROY MILLER, International Science and Technology Institute ELLYN OGDEN, Statistica, Inc. MARGUERITE PAPPAIOANOU, Epidemiology Program Office, Centers for Disease Control TOM PARK, Latin America Bureau, U.S. Agency for International Development CRISTINA POSSAS, Takemi Fellow, Harvard University PETRA REYES, Office of Health, U.S. Agency for International Development RICHARD SUZMAN, Office of Demography of Aging, National Institute on Aging JOHN TOMARO, Office of Health, U.S. Agency for International Development BARBARA BOYLE TORREY, Center for International Research, Bureau of the Census DAVID WILLIS, Office of Demography of Aging, National Institute on Aging OLEH WOLOWYNA, Center for Development Policy, Research Triangle Institute JUN ZHU, Office of Population Research, Princeton University

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The Epidemiological Transition: Policy and Planning Implications for Developing Countries - Workshop Proceedings Committee on Population Staff LINDA G.MARTIN, Director CAROLE L.JOLLY, Program Officer JAMES N.GRIBBLE, Program Officer DOMINIQUE A.MEEKERS, Research Associate DIANE L.GOLDMAN, Administrative Assistant JOAN MONTGOMERY HALFORD, Project Assistant Division on International Health Staff POLLY HARRISON, Director CAROLYN HALL, Program Associate DANA HOTRA, Research Associate CHRISTOPHER HOWSON, Deputy Director VIOLAINE MITCHELL, Study Director NALINI PHILIPOSE, Research Assistant SHARON SCOTT-BROWN, Administrative Assistant DELORES SUTTON, Project Assistant

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The Epidemiological Transition: Policy and Planning Implications for Developing Countries - Workshop Proceedings COMMITTEE ON POPULATION SAMUEL H.PRESTON (Chair), Population Studies Center, University of Pennsylvania JOSE-LUIS BOBADILLA, World Bank, Washington, D.C. JOHN B.CASTERLINE, Department of Sociology, Brown University KENNETH H.HILL, Department of Population Dynamics, Johns Hopkins University DEAN T.JAMISON, School of Public Health, University of California, Los Angeles ANNE R.PEBLEY, The RAND Corporation, Santa Monica, California RONALD R.RINDFUSS, Department of Sociology, University of North Carolina, Chapel Hill T.PAUL SCHULTZ, Department of Economics, Yale University SUSAN C.M.SCRIMSHAW, School of Public Health, University of California, Los Angeles BETH J.SOLDO, Department of Demography, Georgetown University MARTA TIENDA, Population Research Center, University of Chicago BARBARA BOYLE TORREY, Population Reference Bureau, Washington, D.C. JAMES TRUSSELL, Office of Population Research, Princeton University AMY O.TSUI, Carolina Population Center, University of North Carolina, Chapel Hill LINDA G.MARTIN, Director BARNEY COHEN, Research Associate SUSAN M.COKE, Senior Project Assistant KAREN A.FOOTE, Research Associate JAMES N.GRIBBLE, Program Officer CAROLE L.JOLLY, Program Officer PAULA J.MELVILLE, Senior Project Assistant

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The Epidemiological Transition: Policy and Planning Implications for Developing Countries - Workshop Proceedings INSTITUTE OF MEDICINE BOARD ON INTERNATIONAL HEALTH WILLIAM H.FOEGE (Chair), Carter Center, Emory University, Atlanta DEAN JAMISON (Co-Chair), School of Public Health, University of California, Los Angeles DAVID E.BELL, Harvard Center for Population and Development Studies, Cambridge JAN E.G.BLANPAIN, School of Public Health, Leuven University, Leuven, Belgium MARGARET CATLEY-CARLSON, The Population Council, New York RICHARD G.A.FEACHEM, London School of Hygiene and Tropical Medicine, England BERNARD N.FIELDS, Harvard Medical School, Boston JULIO FRENK, National Institute of Public Health, Cuernavaca, Mexico, and Harvard Center for Population and Development Studies, Cambridge ADETOKUNBO O.LUCAS, Harvard School of Public Health, Boston W.HENRY MOSLEY, Johns Hopkins School of Hygiene and Public Health, Baltimore ADELINE WYNANTE PATTERSON, Caribbean Food and Nutrition Institute, Kingston, Jamaica DAVID P.RALL (retired), National Institute of Environmental Health Sciences, Washington, D.C. FREDERICK C.ROBBINS, Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland TIMOTHY ROTHERMEL, United National Development Programme, New York NOEL S.WEISS, School of Public Health and Community Medicine, University of Washington, Seattle BARBARA L.WOLFE, Departments of Economics and Preventive Medicine, University of Wisconsin, Madison POLLY HARRISON, Director DANA HOTRA, Research Associate CHRISTOPHER HOWSON, Associate Director VIOLAINE MITCHELL, Study Director NALINI PHILIPOSE, Research Assistant SHARON SCOTT-BROWN, Administrative Assistant DELORES SUTTON, Project Assistant

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