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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.

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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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