Water pollution and human health in China.
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China's extraordinary economic growth, industrialization, and urbanization, coupled with inadequate investment in basic water supply and treatment infrastructure, have resulted in widespread water pollution. In China today approximately 700 million people--over half the population--consume drinking water contaminated with levels of animal and human excreta that exceed maximum permissible levels by as much as 86% in rural areas and 28% in urban areas. By the year 2000, the volume of wastewater produced could double from 1990 levels to almost 78 billion tons. These are alarming trends with potentially serious consequences for human health. This paper reviews and analyzes recent Chinese reports on public health and water resources to shed light on what recent trends imply for China's environmental risk transition. This paper has two major conclusions. First, the critical deficits in basic water supply and sewage treatment infrastructure have increased the risk of exposure to infectious and parasitic disease and to a growing volume of industrial chemicals, heavy metals, and algal toxins. Second, the lack of coordination between environmental and public health objectives, a complex and fragmented system to manage water resources, and the general treatment of water as a common property resource mean that the water quality and quantity problems observed as well as the health threats identified are likely to become more acute. (+info)
The urban environment, poverty and health in developing countries.
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The process of urbanization could be described as one of the major global environmental changes directly affecting human health today. Populations particularly affected are in developing countries where rapid urban growth has been accompanied by massive urban poverty. Urban environmental health impacts, particularly the impact on adults of an environment of poverty, are still poorly understood. Definitions of the urban environment tend to be physical, excluding the complex ramifications of a social setting of disadvantage. This paper provides a brief overview of existing knowledge on the links between environment, poverty and health in urban areas of developing countries, with an emphasis on the policy implications implied by research on health differential between groups within cities. The paper argues that urban poverty and inequalities in conditions between groups within cities present a central crisis confronting urban policy in terms of human health and quality of life. The paper suggests that definitions of the urban environment tend to consider only the physical, and not the social complexity of the urban setting. The review concludes that the scale and the complexity of the urban crisis in developing countries demands a real commitment to re-thinking the management of cities to address multiple deprivation. The paper suggests that this challenges urban professionals who continue to act with a bias towards unintegrated single sector solutions despite claims to the contrary. (+info)
A social systems model of hospital utilization.
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A social systems model for the health services system serving the state of New Mexico is presented. Utilization of short-term general hospitals is viewed as a function of sociodemographic characteristics of the population and of the supply of health manpower and facilities available to that population. The model includes a network specifying the causal relationships hypothesized as existing among a set of social, demographic, and economic variables known to be related to the supply of health manpower and facilities and to their utilization. Inclusion of feedback into the model as well as lagged values of physician supply variables permits examination of the dynamic behavior of the social system over time. A method for deriving the reduced form of the structural model is presented along with the reduced-form equations. These equations provide valuable information for policy decisions regarding the likely consequences of changes in the structure of the population and in the supply of health manpower and facilities. The structural and reduced-form equations have been used to predict the consequences for one New Mexico county of state and federal policies that would affect the organization and delivery of health services. (+info)
Variations in infant mortality rates among municipalities in the state of Ceara, Northeast Brazil: an ecological analysis.
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BACKGROUND: Infant mortality rates vary substantially among municipalities in the State of Ceara, from 14 to 193 per 1000 live births. Identification of the determinants of these differences can be of particular importance to infant health policy and programmes in Brazil where local governments play a pivotal role in providing primary health care. METHODS: Ecological study across 140 municipalities in the State of Ceara, Brazil. RESULTS: To determine the interrelationships between potential predictors of infant mortality, we classified 11 variables into proximate determinants (adequate weight gain and exclusively breastfeeding), health services variables (prenatal care up-to-date, participation in growth monitoring, immunization up-to-date, and decentralization of health services), and socioeconomic factors (female literacy rate, household income, adequate water supply, adequate sanitation, and per capita gross municipality product), and included the variables in each group simultaneously in linear regression models. In these analyses, only one of the proximate determinants (exclusively breastfeeding (inversely), R2 = 9.3) and one of the health services variables (prenatal care up-to-date (inversely), R2 = 22.8) remained significantly associated with infant mortality. In contrast, female literacy rate (inversely), household income (directly) and per capita GMP (inversely) were independently associated with the infant mortality rate (for the model including the three variables R2 = 25.2). Finally, we considered simultaneously the variables from each group, and selected a model that explained 41% of the variation in infant mortality rates between municipalities. The paradoxical direct association between household income and infant mortality was present only in models including female illiteracy rate, and suggests that among these municipalities, increases in income unaccompanied by improvements in female education may not substantially reduce infant mortality. The lack of independent associations between inadequate sanitation and infant mortality rates may be due to the uniformly poor level of this indicator across municipalities and provides no evidence against its critical role in child survival. CONCLUSIONS: These results suggest that promotion of exclusive breastfeeding and increased prenatal care utilization, as well as investments in female education would have substantial positive effects in further reducing infant mortality rates in the State of Ceara. (+info)
Income inequality and homicide rates in Rio de Janeiro, Brazil.
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OBJECTIVES: This study determined the effect of income inequality on homicide rates in the state of Rio de Janeiro, Brazil. METHODS: We conducted an ecological study at 2 geographical levels, municipalities in the state of Rio de Janeiro and administrative regions in the municipality of Rio de Janeiro. The association between homicide and income inequality was tested by multiple regression procedures, with adjustment for other socioeconomic indicators. RESULTS: For the municipalities of Rio de Janeiro State, no association between homicide and income concentration was found an outcome that can be explained by the municipalities' different degrees of urbanization. However, for the administrative regions in the city of Rio de Janeiro, the 2 income inequality indicators were strongly correlated with the outcome variable (P < .01). Higher homicide rates were found precisely in the sector of the city that has the greatest concentration of slum residents and the highest degree of income inequality. CONCLUSIONS: The findings suggest that social policies specifically aimed at low-income urban youth, particularly programs to reduce the harmful effects of relative deprivation, may have an important impact on the homicide rate. (+info)
Venereal syphilis in tropical Africa.
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A steady decline in the incidence of positive results to the Kahn test is reported in Malawian patients during the period 1968-75. Other studies have shown that the incidence of early and late syphilis in sub-Saharan Africa has dropped considerably over the past few decades. The number of reported cases of early syphilis in certain urban areas, however, appears to be high. It is suggested that the downward trend in the incidence of syphilis in Africa is related to the increased and often indiscriminate use of penicillin. (+info)
Cardiovascular risk factors emerging in Chinese populations undergoing urbanization.
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In this assessment of cardiovascular risk factors, we examined the association between dietary habits and blood pressure (BP) according to the World Health Organization (WHO) CARDIAC Study protocols in three Chinese populations aged 47-57 in Guangzhou prefecture (GZ group; 141 males, 158 females), Guiyang prefecture (GY group; 101 males, 103 females) and Taiwan (TW group; 102 males, 98 females). The same survey was repeated 10 yr later in the GY group to follow-up the past trends (MONALISA study). The observed systolic BP (SBP), diastolic BP (DBP), and body mass index (BMI), as well as the rates of hypertension, obesity and antihypertensive medication use were significantly higher in both genders in the TW group compared to the groups GZ and GY. There was no significant difference in SBP or DBP in either gender between groups GZ and GY. Blood analyses revealed that the levels of serum total cholesterol (T-CHO), and HbA1c, and the rates of hypercholesterolemia and high HbA1c were significantly higher in both genders in the TW than in the GZ and GY groups. No significant difference among the populations was observed in 24-h urinary sodium or magnesium excretion in either gender. In the combined total populations of men and women, however, significant positive correlations were observed between BMI and each of SBP, DBP, T-CHO, and glycohemoglobin in both genders. A food frequency analysis revealed significantly greater meat consumption and significantly less tea consumption and vegetable intake in the TW than in the GY and GZ groups. Both SBP and DBP have increased significantly over the past 10 yr in the GY group in both genders, and T-CHO as well as the rate of hypercholesterolemia increased over the same period in both genders. In conclusion, cardiovascular risk factors leading to hypertension, such as obesity, hypercholesterolemia and diabetes mellitus, are emerging in urbanized Taiwan and developing Guiyang due to the loss of traditional dietary habits. (+info)
Geographic variation in stroke risk in the United States. Region, urbanization, and hypertension in the Third National Health and Nutrition Examination Survey.
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BACKGROUND: In the United States, stroke mortality is higher in the south than in other regions. Hypertension is the main risk factor for stroke among older adults; however, few studies have examined group-specific regional and urbanization differences in hypertension prevalence. METHODS: Data from the Third National Health and Nutritional Examination Survey (NHANES III), 1988 to 1994, were analyzed to calculate the prevalence of hypertension (systolic >140 mm Hg and/or diastolic >90 mm Hg and/or taking antihypertensive medication) by region and urbanization for age (40 to 59 and 60 to 79 years), sex, and ethnic subgroups. Logistic regression models were fitted to estimate the association of hypertension with region and urbanization. RESULTS: With age and urbanization kept constant, southern residence was associated with hypertension among middle-aged non-Hispanic white men (odds ratio [OR], 1.49; 95% confidence interval [CI], 1.12 to 1.90; P<0.006), non-Hispanic black men (OR, 1.36; 95% CI, 1.05 to 1.66; P=0.019), and non-Hispanic black women (OR, 1.23; 95% CI, 1.01 to 1.45; P=0.034). Among older non-Hispanic white men, a significant interaction was noted between region and urbanization (P=0.01), with a higher prevalence in the south only for nonmetropolitan residents (OR, 1.32; 95% CI, 1.06 to 1.56; P<0.013). A similar but not statistically significant trend was also confirmed among non-Hispanic black men in logistic regression analysis (OR, 1.38; 95% CI, 0.97 to 1.68; P=0.061). No statistically significant association was observed for urbanization or region in the other subgroups. CONCLUSIONS: Southern residence was associated with increased hypertension prevalence among middle-aged non-Hispanic white men, non-Hispanic black men and women, and older non-Hispanic white men. (+info)