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 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 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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