Suchergebnisse

Large dams have been an important component of infrastructure development in capitalist and communist countries alike. In 1998, changing world attitudes on large dams led to a two year World Commission on Dams and new global standards may soon insist that future projects pay fair compensation so that resettlement becomes voluntary. Now, 10 years after introduction of economic reforms, China is mobilizing its resources to build the world's largest dam. This fulfils a longstanding ambition to impound the Yangtze River in Central China at the Three Gorges and use the hydropower, improved navigation and flood control to develop the economy.
This paper examines the socio-economic impact of Three Gorges Dam on over 1.3 million people to be displaced while China is in transition to a market economy. We consider resettlement in terms of the decision-making structure, property rights and incentives to move, and how the project exacerbates problems created by market reforms, especially rising unemployment and deteriorating public health. We conclude the project is boosting economic expectations while adversely affecting large sections of the population, and this could provoke widespread social unrest and eventual changes in political institutions.

Background: Records in Western countries reveal that adult height has been increasing over the last 250 years. These height gains have been biologically associated with healthier childhoods, less illness, and longer life spans-a health-risk transition. To measure such progress in Thailand we studied height change over the last 3 decades. Methods: We analyzed height records for 33 000 21-year-old male military recruits, sampling 1000 per year from 1972 through 2006. We compared the height trend in Thailand to those noted in Europe, and discuss the former in the context of improvements in living circumstances in Thailand. Results: Over 35 years, mean height increased from 164.4 to 169.2 cm, an increment of nearly 5 cm. The height increase was negligible in the first decade (1972-1981), but substantially accelerated after that. In the period after 1990 the increase exceeded 3 cm. A similar overall height gain in Britain occurred over a much longer period (1750-1886). Conclusions: The increase in height among Thai men is biological evidence that a Thai health-risk transition-dened by both changing risks and outcomes-is well underway for height. Military recruits born during the 1960s through the 1980s had progressively healthier childhoods. Over this period child nutrition improved, infection and mortality rates declined, and preventive health services expanded. The combined effect of these factors is indicated by the increased adult height of Thai military recruits

Background: Records in Western countries reveal that adult height has been increasing over the last 250 years. These height gains have been biologically associated with healthier childhoods, less illness, and longer life spans-a health-risk transition. To measure such progress in Thailand we studied height change over the last 3 decades. Methods: We analyzed height records for 33 000 21-year-old male military recruits, sampling 1000 per year from 1972 through 2006. We compared the height trend in Thailand to those noted in Europe, and discuss the former in the context of improvements in living circumstances in Thailand. Results: Over 35 years, mean height increased from 164.4 to 169.2 cm, an increment of nearly 5 cm. The height increase was negligible in the first decade (1972-1981), but substantially accelerated after that. In the period after 1990 the increase exceeded 3 cm. A similar overall height gain in Britain occurred over a much longer period (1750-1886). Conclusions: The increase in height among Thai men is biological evidence that a Thai health-risk transition-dened by both changing risks and outcomes-is well underway for height. Military recruits born during the 1960s through the 1980s had progressively healthier childhoods. Over this period child nutrition improved, infection and mortality rates declined, and preventive health services expanded. The combined effect of these factors is indicated by the increased adult height of Thai military recruits

Background: There are no analytical studies of individual risks for Ross River virus (RRV) disease. Therefore, we set out to determine individual risk and protective factors for RRV disease in a high incidence area and to assess the utility of the case-control design applied for this purpose to an arbovirus disease. Methods: We used a prospective matched case-control study of new community cases of RRV disease in the local government areas of Cairns, Mareeba, Douglas, and Atherton, in tropical Queensland, from January 1 to May 31, 1998. Results: Protective measures against mosquitoes reduced the risk for disease. Mosquito coils, repellents, and citronella candles each decreased risk by at least 2-fold, with a dose-response for the number of protective measures used. Light-coloured clothing decreased risk 3-fold. Camping increased the risk 8-fold. Conclusions: These risks were substantial and statistically significant, and provide a basis for educational programs on individual protection against RRV disease in Australia. Our study demonstrates the utility of the case-control method for investigating arbovirus risks. Such a risk analysis has not been done before for RRV infection, and is infrequently reported for other arbovirus infections.

Background: There are no analytical studies of individual risks for Ross River virus (RRV) disease. Therefore, we set out to determine individual risk and protective factors for RRV disease in a high incidence area and to assess the utility of the case-control design applied for this purpose to an arbovirus disease. Methods: We used a prospective matched case-control study of new community cases of RRV disease in the local government areas of Cairns, Mareeba, Douglas, and Atherton, in tropical Queensland, from January 1 to May 31, 1998. Results: Protective measures against mosquitoes reduced the risk for disease. Mosquito coils, repellents, and citronella candles each decreased risk by at least 2-fold, with a dose-response for the number of protective measures used. Light-coloured clothing decreased risk 3-fold. Camping increased the risk 8-fold. Conclusions: These risks were substantial and statistically significant, and provide a basis for educational programs on individual protection against RRV disease in Australia. Our study demonstrates the utility of the case-control method for investigating arbovirus risks. Such a risk analysis has not been done before for RRV infection, and is infrequently reported for other arbovirus infections.

OBJECTIVE: To assist with strategic planning for the eradication of malaria in Henan Province, China, which reached the consolidation phase of malaria control in 1992, when only 318 malaria cases were reported. METHODS: We conducted a prospective two-year study of the costs for Henan's malaria control programme. We used a cost model that could also be applied to other malaria programmes in mainland China, and analysed the cost of the three components of Henan's malaria programme: suspected malaria case management, vector surveillance, and population blood surveys. Primary cost data were collected from the government, and data on suspected malaria patients were collected in two malaria counties (population 2 093 100). We enlisted the help of 260 village doctors in six townships or former communes (population 247 762), and studied all 12 325 reported cases of suspected malaria in their catchment areas in 1994 and 1995. FINDINGS: The average annual government investment in malaria control was estimated to be US$ 111 516 (case-management 59%; active blood surveys 25%; vector surveillance 12%; and contingencies and special projects 4%). The average cost (direct and indirect) for patients seeking treatment for suspected malaria was US$ 3.48, equivalent to 10 days' income for rural residents. Each suspected malaria case cost the government an average of US$ 0.78. CONCLUSION: Further cuts in government funding will increase future costs when epidemic malaria returns; investment in malaria control should therefore continue at least at current levels of US$ 0.03 per person at risk.

SummaryIn the last 50 years Thailand has achieved advanced demographic and health transitions. Many infectious diseases are controlled and infant and maternal mortality rates are among the lowest in the region. Within such a low mortality setting, however, substantial variations in health persist, with education being a major driver. This paper assesses the ongoing mortality transition in Thailand, examining relationships between risk factors and mortality outcomes among a large nationwide cohort of distance-learning Open University students, as well as examining the differential mortality benefit enjoyed by this educated group when compared with the general Thai population. The cohort comprised 87,151 participants, who in 2005 completed a questionnaire collecting detailed information on socio-demographics, health behaviours and health outcomes. Participants were aged 15–87 at baseline and lived in all regions of the country. Cohort members' citizen identification numbers were matched with official death registration records to identify mortality among participants. A total of 1401 deaths were identified up to November 2016. Results show cohort study participants experiencing mortality at approximately one-third of the rate of the general population in the same age and sex groups. The gap between the mortality rates in the two groups widened with increased age. Differential risk factor prevalence among the two populations, particularly lower overweight and obesity prevalence and lower cigarette smoking rates in the cohort, can explain some of this variation. The largely unmeasurable effect of aspiration for life improvement through distance education while embedded in their communities is shown by this study to have a powerful effect on mortality risk. With overall education levels, including higher education, rising in Thailand this growing group of educated aspirational Thais may represent future trends in Thai mortality. Identifying the drivers and characteristics of this mortality variation can help inform policies to provide health services and to help reduce mortality in the whole population.

Top-down industrial development strategies initially dominated the developing world after the second World War but were eventually found to produce inequitable economic growth. For a decade or more, governments and international development agencies have

China's health reforms of the 1980s led to privatization of rural health care with adverse impact on farmers. A decade later a new rural co-operative medical scheme (RCMS), was piloted throughout many provinces to promote better equity. Although many schemes later collapsed owing to inadequate funding, some continue to the present. This article compares such a scheme with the out-of-pocket system in Henan province. We study the township hospitals, focusing on cost of services, utilization rates and impact of RCMS on hospitals' financial sustainability. Our results derive from monthly hospital records and a survey of four hospitals in two adjacent counties, one county with low-premium RCMS and the other with the out-of-pocket system. All hospi tals charge for preventive activities (such as antenatal care, immunization), an unfortunate consequence of limited government support. It was not clear that on average, the total cost of individual patient visits in RCMS hospitals was lower than non-RCMS hospitals. Farmers were generally unaware of their insurance entitlements, except the catastrophic illness for which there was a real benefit from refund of US$100 or more. Although the effect of the RCMS on areas were twice those in non-RCMS. We conclude that RCMS hospitals were better funded b ecause of re-imbursements from the insurance scheme and therefore were more viable as sources of good health care. Thus, health care could become more equitable under RCMS than the out-of pocket system. China is now beginning to test a revised form of RCMS with pooling at the county level, increased premiums (10 yuan per person) and increased government funding. However, it must be followed closely to determine the effect on rural services and health care costs for farmers.

Top-down industrial development strategies initially dominated the developing world after the second World War but were eventually found to produce inequitable economic growth. For a decade or more, governments and international development agencies have

China's health reforms of the 1980s led to privatization of rural health care with adverse impact on farmers. A decade later a new rural co-operative medical scheme (RCMS), was piloted throughout many provinces to promote better equity. Although many schemes later collapsed owing to inadequate funding, some continue to the present. This article compares such a scheme with the out-of-pocket system in Henan province. We study the township hospitals, focusing on cost of services, utilization rates and impact of RCMS on hospitals' financial sustainability. Our results derive from monthly hospital records and a survey of four hospitals in two adjacent counties, one county with low-premium RCMS and the other with the out-of-pocket system. All hospi tals charge for preventive activities (such as antenatal care, immunization), an unfortunate consequence of limited government support. It was not clear that on average, the total cost of individual patient visits in RCMS hospitals was lower than non-RCMS hospitals. Farmers were generally unaware of their insurance entitlements, except the catastrophic illness for which there was a real benefit from refund of US$100 or more. Although the effect of the RCMS on areas were twice those in non-RCMS. We conclude that RCMS hospitals were better funded b ecause of re-imbursements from the insurance scheme and therefore were more viable as sources of good health care. Thus, health care could become more equitable under RCMS than the out-of pocket system. China is now beginning to test a revised form of RCMS with pooling at the county level, increased premiums (10 yuan per person) and increased government funding. However, it must be followed closely to determine the effect on rural services and health care costs for farmers.