Feeding Latin America's children.

More than US $1.6 billion is spent annually on 104 programs in 19 Latin American and Caribbean countries to subsidize or provide food for people supposedly at risk of malnutrition. This amount constitutes only 0.2% of these countries gross national product. If there is no double-counting, these programs reach more than 80 million people, or 21% of the population, at a cost of $20/beneficiary or $4 per capita. Yet some 10 million children are malnourished, which suggests that the expenditures are poorly directed or ineffective. There is little hard evidence that these programs are preventing much malnutrition; even curative results are seldom measured. THe effort is too small in some countries with great needs, while other countries have nearly eliminated malnutrition. Where coverage is high, programs--although generally targeted and with sensible criteria--do not always reach the neediest. They may also fail to provide enough food or to combine food with the health care and nutritional education necessary to attack all 3 root causes of malnutrition: poverty, disease, and ignorance. The evidence, limited mostly to program inputs rather than results, suggests that greater progress against undernourishment is possible even with current spending levels.     

Women in development: Kenya's experience

In Kenya, the government has promoted economic policies, development programs, and a legal system geared to increase incentives and productive capacity for women. Economic strength, family health and population growth can be greatly effected by programs in women's education, health care, family planning and agriculture extension. There are 10 million women in Kenya and 60% are below 20 years of age. Women's groups have been successful in improving health and family planning practice. Women manage most small farms: 75% of the labor on the farms is provided by women. Kenya has introduced an extension system nationally focusing on women farmers as well as men. Women's demand for credit is strong and the government is considering helping expand credit through women's groups. Water is obtained by women and 9 of 10 spend more than an hour getting water each day for the family. By providing better access to water, more time can be spent on farming, family and other more important pursuits. There are many projects to improve community water supplies sponsored by both governmental and non- governmental organizations. About 1/3 girls and 2/5 boys complete primary school. Women that have more than 5 years of education have less than 3 children. There have been difficulties getting girls into later primary and secondary education, because fewer spots are allocated for girls in government-aided schools. The government it trying to improve this, but many girls drop out because of pregnancy. A third of the deaths of women between 15-35 is caused by maternal mortality. This high rate can be reduced with better prenatal care, better family planning, and more effective care at child birth. There are now about 100,000 new family planning acceptors each year. The World Bank and many international organizations have given support to the women's needs in the development process.     

Financial inclusion,financial inclusion policy and Islamic finance

Using a qualitative analysis, the paper examines the links between financial inclusion and the Islamic financial services industry in Muslim countries. The findings show that, despite growth in the financial sector in many Muslim countries over the past few decades, many individuals and firms are still financially excluded. An analysis of the use of and access to financial services by adults and firms also shows that most Muslim countries lag behind other emerging economies in both respects, with a rate of financial inclusion of only 27%. Cost, distance, documentation, trust, and religious requirements are among the important obstacles. In addition, not surprisingly, the extent of Islamic microfinance is very limited, small by international standards; it accounts for a small proportion of microfinance, about 0.5% of global microfinance, and lacks a cost-efficient service model. This study suggests that Islamic instruments for redistributing income such as awqaf, qard-al-hassan, sadaqa, and zakah, can play a role in bringing more than 40 million people, who are financially excluded for religious reasons, into the formal financial system. The Islamic financial services industry has a long way to go in improving financial inclusion in many Muslim countries due to the scale needed and its relatively weak infrastructure.     

Profits with a purpose: an interview with Tom Chapman. Interview by Nancy A. Nichols

Greater Southeast Community Hospital is located in the center of one of Washington, D.C.'s most troubled and isolated neighborhoods. Like so many inner-city hospitals, it serves a population struggling with high rates of poverty, crime, and illiteracy. As a result, the area suffers from the highest rates of infant mortality, cancer, and coronary disease in the D.C. area. When Tom Chapman joined the hospital in 1984, it was giving away roughly 11% of its care-or about $11.5 million worth of medical services to indigent residents. If things continued at that rate, the hospital would soon go out of business. His challenge: to keep Greater Southeast solvent while shoring up the community that surrounds it. Chapman, who grew up in a housing project himself, understands the problems of inner cities innately. Working in tandem with community residents, Greater Southeast has developed a broad range of preventive and supportive programs, such as housing, day care for children and the elderly, nursing home services, and literacy training. Last year, Chapman was promoted to CEO of Greater Southeast Health Care, a broad network comprising two hospitals, three nursing homes, a physician care network, and over 50 community programs. He remains true to his original mission: "I want to create a network of participants, stringing together various organizations and players, each of whom have something special to contribute to urban problems.... What we are really doing is creating a community."     

COMMUNITY CARE OF ELDERLY PEOPLE: BRINGING TOGETHER SCARCITY AND CHOICE, NEEDS AND COSTS

In response to ageing populations there are similar patterns of change in the organisation of community care for elderly people in many different countries. These changes may be characterised as firstly, a move away from institutional provision, secondly, the strengthening of home based care and thirdly, coordination and case management. Within care providing organisations issues of cost and allocation of service according to need have traditionally tended to be separate concerns. The development of case management with devolved budgets in community care offers one way in which the resolution of the tension between scarcity and choice, need and costs may be achieved. On the basis of previous studies of this approach some of the factors associated with more or less effective resolution of this tension within service organisations are considered.     

Population growth. Its magnitude and implications for development

A summary of the 1984 World Development Report is provided. The 3 major points stressed in the report were: 1) rapid population growth adversely affects development, 2) governments must adopt policies to reduce fertility, and 3) policies adopted by many countries have effectively reduced fertility. World population growth began accelerating at 0.5%/year in the 18th century, and by 1950 the annual acceleration rate was 2%. Most of the increase in population size is occurring in less developed countries, and this increase is due in part to the recent decline in mortality experienced by these countries. Of the 80 million individuals who will be added to the world's population in 1984, 70 million will be in the developing countries. Since 1965 the population growth rate for developing countries as a group declined from 2.4% to 2%. However, because of the high proportion of younger aged individuals in developing countries, the decline in fertility is expected to level off. According to World Bank population projections, the world population will stabilize at around 11 billion in 2150. During the interium, the population of developing countries will increase from its present level of 3.6 billion to 8.4 billion, and the population of developed countries will increase from 1.2 billion to 1.4 billion. These projections are probably overly optimistic. The adverse impact on development of rapid population growth is due to several factors. 1st, resources which could be used for investment must instead be used to fulfill the consumption needs of an increased number of people. 2nd, increases in the labor force must be absorbed by the agricultural sector, and this reduces agricultural productivity. 3rd, rapid population growth increases management problems. The adaption of policies by governments to reduce fertility is a necessary step in halting population growth. For poor families, children provide economic security. Therefore, governments must act to improve the economic conditions for poor families if they hope to reduce population growth. Education and job opportunities must be expanded and social security provided for the elderly. In the past it was assumed that fertility would only decline when urbanization, industrialization, and income reached a certain level. It is now known that appropriate policies can effectively reduce fertility even in the absence of economic advancement. Fertility declines are more closely related to increases in literacy and life expectancy than to increases in the gross national product. Family planning programs in China, Colombia, Egypt, India, Indonesia, Korea, Sri Lanka, and Tunisia have reduced fertility far below the level normally associated with the income levels prevailing in those countries.     

Weak Links in the Chain: A Diagnosis of Health Policy in Poor Countries

Recent empirical and theoretical literature sheds light on thedisappointing experience with implementation of primary healthcare programs in developing countries. This article focuseson the evidence showing two weak links in the chain betweengovernment spending for services to improve health and actualimprovements in health status. First, institutional capacityis a vital ingredient in providing effective services. Whenthis capacity is inadequate, health spending, even on the rightservices, may lead to little actual provision of services. Second,the net effect of government health services depends on theseverity of market failures—the more severe the marketfailures, the greater the potential for government servicesto have an impact. Evidence suggests that market failures arethe least severe for relatively inexpensive curative services,which often absorb the bulk of primary health care budgets.A companion paper, available from the authors (seep. 219), offersa perspective on how government funds can best be used to improvehealth and well-being in developing countries. It gives an alternativeview of appropriate public health policy, one that focuses onmitigating the characteristic market failures of the sectorand tailoring public health activities to the government's abilityto deliver various services.      

建立我国高风险家庭儿童监测保护体系研究

儿童监护不力、遭受伤害或侵害等事件在我国有显著增加的趋势。发达国家的儿童保护服务,日益倾向以科学化和标准化的方法来评估儿童所面临的危机;并且渐以此方法为研究的目标,建立对儿童面临风险的监测标准,以及建构某些标准化的风险预估与防治模式。基于完善家庭政策、保护儿童权益和社会文明发展需要,我国应建立高风险家庭儿童监测保护体系。现有的法律法规政策、社会共识和社区发展为我国建立高风险家庭儿童监测保护体系提供了支持平台。我国高风险家庭儿童监测保护体系建设应坚持重在预防、贵在标准和成在精细的建设方针。     

Environmental problems and developing countries

The status of environmental conditions for forests, soils, water, air, and atmospheric changes is presented for developing countries. Loss and degradation of forests continue. The rate of cutting of moist tropical forests is 17-20 million hectares/year. The consequences would be eventual total destruction within several generations, lost soil and watershed protection, local climate change, and habitat destruction. The human toll can also be great as seen by the flooding deaths of 5000 Philippine villagers. Soil erosion is a greater danger than desertification. In sub-Saharan Africa, total harvest and yields of important food crops have declined compared to increases elsewhere in the world. In countries such as Costa Rica, Malawi, Mali, and Mexico the soil losses approximate .5-1.5% of gross domestic product annually. Progress has been made in water purification, but there are still nearly 1 million people in the developing world without access to clean water for drinking and bathing. 1.7 billion have inadequate sanitation. Access to sanitation in urban areas is on the rise. Waterborne diseases are a result of poor sanitation: 900 million cases of diarrheal disease/year, 500 million with trachoma, 200 million with schistosomiasis, or bilharzia, and 900 million from hookworm. Other diseases resulting from improper sanitation are cholera, typhoid, and paratyphoid. Water scarcity is another problem. Air quality is threatened by dust and smoke pollution which contribute to respiratory illnesses, by indoor burning of wood and charcoal particularly in rural Africa and south Asia, and high levels of lead from automobile emissions. Hundreds of thousands of people are affected through increased illness and even loss of mental functioning as in the case of lead poisoning. Atmospheric changes such as ozone depletion or global warming may not show their impact until decades later. The consequences are high levels of ultraviolet radiation which cause cancers, cataracts, and possibly immune system damage, and temperature increases which will increase the levels of the seas.     

Weak Links in the Chain II: A Prescription for Health Policy in Poor Countries

In an earlier article, the authors outline some reasons forthe disappointingly small effects of primary health care programsand identified two weak links standing between spending andincreased health care. The first was the inability to translatepublic expenditure on health care into real services due toinherent difficulties of monitoring and controlling the behaviorof public employees. The second was the "crowding out" of privatemarkets for health care, markets that exist predominantly atthe primary health care level. This article presents an approach to public policy in healththat comes directly from the literature on public economics.It identifies two characteristic market failures in health.The first is the existence of large externalities in the controlof many infectious diseases that are mostly addressed by standardpublic health interventions. The second is the widespread breakdownof insurance markets that leave people exposed to catastrophicfinancial losses. Other essential considerations in settingpriorities in health are the degree to which policies addresspoverty and inequality and the practicality of implementingpolicies given limited administrative capacities. Prioritiesbased on these criteria tend to differ substantially from thosecommonly prescribed by the international community.      

The World Bank and poverty

During the 1970s it was World Bank policy to use its funds to raise the productivity and living standards of the poor. It has increased its lending for sector and subsectors considered to offer the most direct benefits to the poor such as rural development, population, health, and nutrition. Projects with particular emphasis on poverty have benefitted large numbers of poor people and have had good economic rates of return. Lending for rural projects increased in the 1970s from US$2.6 billion in 1969-73 to over US$13 billion in 1978-81; rural development projects audited in 1979 benfitted 660 small farmers for every US$1 million loaned compared with 47 farmers/US$1 million in other agricultural projects. Some problems are: 1) low-risk technical packages appropriate for poor farmers in semi-arid rainfed areas are not readily available; 2) the Bank's rural development strategy seeks mainly to raise the production of small farms, but other aspects need to be emphasized; 3) domestic pricing and postharvest policies often undermine the success of projects aimed at the rural poor; and 4) success in rural development often rests on sociological and cultural factors, difficult areas that deserve more attention. For urban areas the Bank has strongly endorsed providing "sites and sources" instead of structures; since 1972, 52 Bank projects centered on urban shelter involving US$1.6 billion have been undertaken. Cost recovery is established at 66-95%. About 5% of Bank lending is for education and despite the importance of population, health, and nutrition, these areas absorb less than 1% of the Bank's total lending program. Only US$400 million in population loans were made to 13 countries in the 1970s and only recently have separate health projects been started. Emphasis for the 1980s must be on rural development, urban shelter, primary education, health, education, and population.     

后发国家探索独立自主发展道路的优劣势表现与路径选择

后发国家的工业化进程受历史、社会结构以及要素禀赋等多重复杂因素影响,存在后发优势和后发劣势。准确理解后发优势和后发劣势的动态演进过程和内在逻辑关系极其重要。对此,发展经济学不仅应呼应和回答后发国家在后工业化时期的技术创新与制度变革的结构性问题,而且应重点研究后发国家不同阶段的后发优势和后发劣势的变化问题。以中国为代表的后发国家在工业化进程中充分发挥后发优势,经过艰辛探索与实践创新,走出了一条独立自主的发展道路,取得了令世界瞩目的经济发展成就,为其他后发国家技术创新、制度变革等具体路径提供了有益参考。本文结合前期研究,围绕中国三次比较有影响力的关于后发优势、后发劣势的争论,总结提炼中国的成功经验,提出后发国家应聚焦科技自主创新与制度改革,以结构性改革为突破口发挥自身优势,促进后发国家内生性增长,进而在未来发展过程中尽快补齐短板,加快探索适合国情特色、适应世界经济发展潮流的发展模式和发展道路。本文建议立足后发国家的成败案例和不同模式,深化后发优势与后发劣势的比较研究,构建新的发展经济学范式与实证研究体系。     

Single-payer health care systems: the roles and responsibilities of the public and private sectors

Health care systems all over the world are experiencing some change as they look for a new balance between supply and demand. This article provides context for the U.S. health care financing debate by examining the health care systems of five other countries: Canada, the United Kingdom, Australia, China and India. The authors show that, with few exceptions, countries around the world have seen an increase in both government and private health care spending between 1998 and 2002. The authors also demonstrate that employers throughout most of the world are becoming more, rather than less, involved in the funding and delivery of health care to employees and their dependents-even among nations with so-called single-payer health systems.     

Confronting the fear factor: the coverage/access disparity in universal health care

Since their introduction following World War II, single-payer health care systems and universally mandated health care systems have stumbled, but in their pratfalls are many lessons that apply to the universal health care proposals currently on the table in the United States. The critical and often-over-looked point is that universal coverage does not guarantee that individuals will receive needed care--In many cases guaranteed access to care is a false promise or available only on a delayed timetable. A more feasible alternative lies in providing a safety net for citizens who truly need care and financial support with an appropriate system of checks and balances--without disrupting the economic and actuarial fundamental principles of supply and demand and risk classification.     

Urbanization: the challenge for the next century

This article summarizes a new 1996-97 report from the World Resources Institute, the UN Environmental Program, the UN Development Program, and the World Bank, which describes a future with increased levels of urbanization that were reshaping the physical and social environment. Urbanization increased economic growth and environmental degradation. By the year 2000, 50% of the world population will live in urban areas. Cities are the center of economic activity. Consumption is the highest in cities. Cities produce the most pollution and waste. Three issues are particularly crucial to survival: the water supply, sanitation, and water resource management. Neglect of these and other environmental issues is likely to have important consequences in both developing and developed countries. The greatest growth in urban areas is occurring in developing countries. Cities in developing countries have huge populations living in poverty. The poor in either rural or urban areas are confronted with lack of access to clean water, to sanitation, and to housing. There is overcrowding and exposure to industrial wastes and air pollution. There is a need for policy reform, stronger institutions, and enlightened political leadership. Cities need to improve their environment and to strengthen local government and implement poverty reduction programs. Reform of urban policies must be accompanied by effective urban governance. Community-based approaches are essential. Broad-based support is needed for changes in strategies and practices and for attainment of a more sustainable environment.     

Defined contribution health plan to consumer driven health benefits: evolution and experience

Today, the idea of placing more choice on employees "consuming" health care and giving them more responsibility and incentive to control health care costs and utilization is alive and thriving in the form of consumer-driven health care. This article examines the evolution of consumer-driven health benefits--including the experience of the first generation of "defined contribution" health care participants (i.e., retirees) and the results of different approaches employers have taken to early consumer-driven plan designs. The author then describes what's needed to answer the question: "Can consumer-driven health care control health cost?"     

构建以社区系统为基础的老年护理保障体系——以上海为例

目前上海面临＂未富先老＂及家庭保障功能持续弱化的严重问题,应积极探索行之有效的社会化养老服务模式。在社区居家老年护理服务模式的探索中,上海建立了一批以社区为依托的老年服务中心,在实践中积累了社区居家养老的经验。未来构建以社区支持系统为基础的老年护理保障服务体系是上海提高养老服务水平的重要举措。     

Travelling risks: How did nanotechnology become a risk in India and South Africa?

India and South Africa have invested in nanotechnology since the early 2000s and have identified risks to human health and the environment as an important issue for governance. This is exemplary for a wider trend in which ‘developing countries’ play an increasingly prominent role in the development, production and use of emerging technologies. This validates the claim of the world risk society thesis that countries around the world are now confronted with the risks of emerging technologies. Little is known, however, about the way developing countries deal with the potential risks of emerging technologies. Starting from the observation that the risk colonization of nanotechnology in developing countries cannot be taken for granted, this article draws upon the relational theory of risk in order to investigate how nanotechnology became understood as an object of risk in South Africa and India. The article shows that nanotechnology was constituted as an object of risk in rather different ways in India and South Africa, demonstrating that the spread of risk discourses – and the emergence of a world risk society – cannot be understood without attending to the local context. The article shows that way risk is understood and dealt with changes as risk discourses travel around the world, giving many different faces to the world risk society.     

美国医疗保险扩面改革之路的里程碑

虽然美国有两大类三大层次的医疗保险体系,但没有实现如其他大多数发达国家那样的全民医保,缺乏一张覆盖全国的社会医疗网络,始终是美国近10年来备受诟病的社会问题.没有医疗保险的问题始终处于社会政策争议的前沿和核心.之前克林顿总统失败的改革方案核心就是实现全民医保,15年后,奥巴马新医改方案又明确将扩大覆盖面作为其改革的重中之重.然而,历经波折得以通过的奥巴马医改法案却依然面临诸多反对和抗议,其中最为核心的是关乎强制参险的条款.2012年6月28日,美国最高法院裁定奥巴马医疗保险改革的大部分条款合乎宪法,最具争议的强制参险也得以保留,这意味着美国在实现全民医保时代的进程中向前迈出了一大步.     

Child Labor: Lessons from the Historical Experience of Today's Industrial Economies

Child labor was more prevalent in 19th-century industrializersthan it is in developing countries today. It was particularlyextensive in the earliest industrializers. This pattern maybe a source of optimism signaling the spread of technologiesthat have little use for child labor and of values that endorsethe preservation and protection of childhood. Today and historically,orphaned and fatherless children and those in large familiesare most vulnerable. Efficient interventions to curb child laborinvolve fiscal transfers to these children and active policiestoward street children. Changes in capitalist labor markets(including technology), family strategies, state policies, andcultural norms are examined to shed light on the causes, chronology,and consequences of child labor.