Globalization and Health: Exploring the opportunities and constraints for health arising from globalization

The tremendous benefits which have been conferred to almost 5 billion people through improved technologies and knowledge highlights the concomitant challenge of bringing these changes to the 1 billion people living mostly in sub-Saharan Africa and South Asia who are yet to benefit. There is a growing awareness of the need to reduce human suffering and of the necessary participation of governments, non-government organizations and industry within this process. This awareness has recently translated into new funding mechanisms to address HIV/Aids and vaccines, a global push for debt relief and better trade opportunities for the poorest countries, and recognition of how global norms that address food safety, infectious diseases and tobacco benefit all. 'Globalization and Health' will encourage an exchange of views on how the global architecture for health governance needs to changes in the light of global threats and opportunities

The role of business in addressing the long-term implications of the current food crisis

Before the onset of the current food crisis, the evidence of a severely neglected nutrition crisis was starting to receive attention. Increased food prices are having severe impacts on the nutritional status of populations. Our current food system has evolved over decades in a largely unplanned manner and without consideration for the complexity and implications of linkages between health, nutrition, agricultural, economic, trade and security issues. The underlying causes for the nutrition crisis include the above, as well as decades of neglect with regard to nutrition, and agricultural science (especially in emerging markets); a failure of governance with respect to the major players involved in nutrition, a weak response by government donors and Foundations to invest in basic nutrition (in contrast to growing support for humanitarian aspects of food aid), and a reluctance to develop private-public partnerships. The emergence of new business models that tackle social problems while remaining profitable offers promise that the long term nutrition needs of people can be met. Businesses can have greater impact acting collectively than individually. Food, retail, food service, chemical and pharmaceutical companies have expertise, distribution systems and customers insights, if well harnessed, could leapfrog progress in addressing the food and nutrition crises. While business can do lots more, its combined impact will be minimal if a range of essential government actions and policies are not addressed. Governments need to create innovative and complementary opportunities that include incentives for businesses including: setting clear nutritional guidelines for fortification and for ready-to eat products; offering agreements to endorse approved products and support their distribution to clinics and schools; eliminating duties on imported vitamins and other micronutrients; and providing tax and other incentives for industry to invest with donors in essential nutrition and agricultural research. Currently governments in developed countries provide a wide range of incentives to the pharmaceutical industry to develop medicated solutions to nutritional problems. We need equivalent effort to be given to the development of more sustainable agricultural and food based solutions. We now face a truly global set of interlinked crises related to food that affect all people. The same degree of urgency and high level leadership and partnership seen during the Second World War is required on a global basis. This time it will need to simultaneously address agricultural, environmental and health considerations with the aim being the attainment of optimal nutrition for all within a framework of sustainable development

Addressing Africa's health needs - time for strong South African involvement

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Meta-analysis in epidemiology

Meta-analysis is the structured and systematic qualitative and quantitative integration of the results of several independent studies (Le. the epidemiology of results). As in any epidemiological study, a meta-analysis needs to start with clearly stated aims and objectives. Attention needs to be paid to selection bias in selecting the study population (all publications on the topic). An initial qualitative assessment (conducted blinded to results) categorises projects on the basis of their methods, as unacceptable (dropped from later analysis) and acceptable or good. Further analysis could be conducted by stratifying or weighting independent studies according to preset quality criteria. The quantitative assessment involves deriving a pooled measure of outcome (usually the relative or attributable risk). Tests for heterogeneity are required before pooling. By pooling the results from many settings using different methods, the ability to generalise them in terms of their public health relevance is increased.S Afr Med J 1990; 78: 94·97

Tobacco advertising in South Africa with specific reference to magazines

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Epidemiological research methods. Part VII. Epidemiological research in health planning

CITATION: Yach, D. & Botha, J. L. 1987. Epidemiological research methods. Part VII. Epidemiological research in health planning. South African Medical Journal, 72:633-636.The original publication is available at http://www.samj.org.zaThe goal of epidemiology is to improve the health status of human populations. In our series thus far we have srressed the need to use the correct design for epidemiological studies, a sampling scheme that yields interpretable results, measurements that are both valid and reliable, and finally the appropriate analysis. These methodological considerations are of importance if the goal is to be reached. In this article we assume that most of these issues have been adequately dealt with and focus on how the results of epidemiological research can be used by health planners to improve the health status of regions and the country as a whole.Publisher’s versio

Epidemiological research methods. Part II. Descriptive studies

CITATION: Botha, J. L. & Yach, D. 1986. Epidemiological research methods. Part II. Descriptive studies. South African Medical Journal, 70:766-772.The original publication is available at http://www.samj.org.zaIn a descriptive study, therefore, the magnitude and distribution of a health problem in a specified population is studied in terms of TIME (when did it occur?), PLACE (where did it occur?) and PERSON (which groups are affected?). The design starts with an idea that occurs to the researcher about a particular problem. This is followed by selecting a group of individuals to be studied (sampling), considering which attributes to measure (measurement), describing the findings, and finally drawing conclusions on the basis of the findings. Commonly, new ideas or hypotheses are generated in this final stage, usually regarding possible explanations for the health problems described (cause-effect relationships). Such relationships may be attempts to explain the aetiology of diseases or the effect of preventive, curative or rehabilitative measures. Important issues affecting the reliability of the sampling and measurement processes are discussed, some descriptive statistical measures demonstrated and how conclusions are affected by these, are indicated.Publisher’s versio

Lessons from a small country about the global obesity crisis

Developed countries had high obesity rates before the problem was taken seriously and hence the genesis must be seen in retrospect. Developing countries offer a clear view of causal factors but also opportunities for prevention, which must focus on both food and physical activity environments

An evaluation of the national measles vaccination campaign in the new shanty areas of Khayelitsha

A local component of the national measles vaccination campaign was evaluated in an area undergoing rapid urbanisation near Cape Town. Four serial cross-sectional cluster samples were used. Proven vaccination coverage before the campaign was 55,8% (95% confidence interval (Cl) 46 - 66%), immediately afterwards it was 71,1% (95% Cl 65 - 77%), and 6 months later 73,6% (95% Cl 67 - 80%). The increase was not sustained among Transkei-born children. Significant determinants of vaccination coverage were: place of birth (X2 = 9,7; 2 df; P = 0,008); ≤6 months stay in Cape Town (odds ratio (OR) 2,22; 95% Cl 1,2 - 4,0%); and home birth (OR 3,21; 95% Cl 1,2 - 8,4%). The value of campaigns in controlling measles, as well as the role of a comprehensive health care service are discussed

Missed opportunities for immunisation at hospitals in the western Cape - a reappraisal

Immunisation practices were examined at 6 hospitals in the western Cape during the latter half of 1992 to determine whether these practices had improved subsequent to the February 1991 resolution of the Health Matters Committee (HMC) on immunisation in hospitals, and since a similar study was undertaken in 1990. Exit interviews were conducted with the escorts of all children aged 3 - 59 months who attended the study hospitals on the days designated for the study.In the second study, 88 of the 311 children studied (28,3%) were in need of immunisation on arrival, but only 12 of the 88 (13,6%) were immunised during the hospital visit. There was no evidence of an increase in requests to see children's Road-to-Health cards (37,1% compared with 35,2% previously). The  incidence of missed opportunities for measles immunisation in children aged 6 - 59 months remained unacceptably high (51,4% compared with 63,7% previously, when a strict definition was used; and 15,7% compared with 18,1% previously, when a lenient definition was used).Health authorities at all levels need to take urgent action to address the problem of missed opportunities for immunisation at hospitals