International Health Assistance Research Articles

Trends of maternal health service coverage in the Democratic Republic of the Congo: a pooled cross-sectional study of MICS 2010 to 2018

BackgroundMaternal health services are essential for reducing maternal and newborn mortality. However, maternal health service status in the Democratic Republic of the Congo (DRC) remains poorly understood. This study aims to explore the trends of antenatal care (ANC) and skilled birth attendance coverage in the past decade in the DRC.Methods The 13,361 participants were from two rounds of Multiple Indicators Cluster Survey (MICS) conducted by the National Institute of Statistics of the Ministry of Planning of the DRC, in collaboration with the United Nations Children’s Fund (UNICEF), in 2010 and 2017-2018. A regression-based method was adopted to calculate adjusted coverage of ANC and skilled birth attendance. Subgroup analysis based on different socioeconomic status (SES) was conducted to explore the impact of domestic conflicts.ResultsFrom 2010 to 2018, the overall weighted ANC coverage in the DRC declined from 87.3 % (95 % CI 86.1–88.0 %) to 82.4 % (95 % CI 81.1–84.0 %), while the overall weighted skilled birth attendance coverage increased from 74.2 % (95 % CI 72.5–76.0 %) to 85.2 % (95 % CI 84.1–86.0 %). Adjusted ANC coverage and adjusted skilled birth attendant coverage both declined in Kasai Oriental, but increased in Nord Kivu and Sud Kivu. In Kasai Occidental, ANC coverage declined, but skilled birth coverage increased. In the Kasai region, the largest decline in adjusted coverage of ANC was found among the poorest women. However, in the Kivu region, both the adjusted coverage of ANC and skilled birth attendance increased among the poorest women.ConclusionsDue to ongoing conflicts, there has been a systemic deterioration of maternal healthcare coverage in some regions of the DRC, particularly among people with low SES. However, in other regions, maternal healthcare services were not severely disrupted possibly due to substantial international health assistance.

France's COVID-19 response: balancing conflicting public health traditions

Simmering beneath the surface of France's centrally coordinated response to COVID-19 is a long-standing tension between two French public health traditions. The first tradition has been the foundation of the French state's historical engagement with global humanitarian health, which we have previously described as state humanitarian verticalism.1 Instituted first in the French former colonies, it was widely used in France's international health assistance, including during epidemics, and is still part of France's global health assistance in low-income countries.

European aid and health system strengthening: an analysis of donor approaches in the DRC, Ethiopia, Uganda, Mozambique and the global fund

ABSTRACTBackground: In the field of international health assistance (IHA), there is a growing consensus on the limits of disease-specific interventions and the need for more health system strengthening (HSS). European donors are considered to be strong supporters of HSS. Nevertheless, little is known about how their support for HSS translates into concrete policies at partner country level. Furthermore, as development cooperation is a shared policy between the EU and its Member States, it remains unclear to what extent European donors share a similar approach.Objective: This article reviews a PhD thesis on European aid and HSS. The thesis investigated (1) the approaches of European donors towards IHA, and (2) the extent to which there are similarities or differences between them. An original analytical framework was developed to make a fine-grained analysis of European donors’ approaches in the DRC, Ethiopia, Uganda and Mozambique. In addition, the relation of European donors with the Global Fund was investigated.Methods: An abductive research approach was used during which literature review, data generation, analysis and research design mutually influenced each other. The research built on a wide range of empirical data, including semi-structured interviews with 123 respondents, policy documents and descriptive statistical analysis.Results and conclusion: Four ‘types’ of European donors were identified, which vary in their focus (issue-specific versus comprehensive) and their level of support to and involvement of recipient states. Despite this heterogeneity at a specific level, there is still a general degree of ‘unity’ among European donors, especially compared with the US. Yet, there are signs that the ‘transatlantic’ divide on HSS may be converging, as European donors tend to focus more explicitly on result-oriented approaches traditionally associated with the US and Global Health Initiatives. Consequently, European donors play a limited role in bringing HSS more to the forefront in IHA.

International Health Development Assistance of BRICS Countries

With the rapid growth of economy and social development among BRICS countries, the role of international health development assistance in state capacity building is becoming more and more significant. This paper described the management system, scale, recipient countries, mechanisms and characteristics of international health assistance among BRICS countries. Aims: Learn about health development assistance of BRICS countries by analyzing its amount, distribution, main characteristics and management system in order to improve the international health development assistance related to BRICS countries. Methods: Data analysis of health development assistance of BRICS countries by using data from 2005 to 2010 of AidData and literature review were the main methods used in this paper. Results: a) from the total amount of international health assistance from 2005 to 2010, China’s total amount of international health assistance ranked first among BRICS countries (excluding 2008), and peaked in 2010, while India and South Africa was slightly higher than the amount of international health assistance in Brazil; b) China's international health development assistance was mainly distributed in 9 countries in Africa; India's was mainly distributed in 16 countries of South Asia and Africa; Brazil’s in around 45 countries depending on language and cultural factors; almost all South Africa’s aid flowed to African countries; c) Brazil’s international health development assistance mainly through technical assistance and its own experience; Russia prefer multilateral financial assistance and cooperation; India conducted technology-based health development assistance to neighboring African countries; China developed a variety of forms of international health assistance; South Africa's international health assistance was mainly carried out through tripartite partnerships; d) the BRICS countries trends to establish unified management agency. Conclusions: a) it is necessary to set up a unified international assistance management agency; b) each BRICS country should use its own comparative advantages and development experience to carry out international health assistance; c) international health assistance data should be more transparent and open.

Development Aid and Solidarity Work: East and West German Health Cooperation with Low-Income Countries, 1945 to 1970

Between 1949 and 1989, both the Federal Republic of Germany (FRG) in the West and the German Democratic Republic (GDR) in the East, engaged in health-related relations with low-income countries in the global South. The strong position of the churches in West Germany and the dominant position of the state in the East provided the preconditions for diverging international health activities, as did differences in ideology and economic status. Activities entailed similarities (an initial focus on clinical therapy and material donations) and differences (in scale, composition of actors and conceptualization). Programs evolved gradually, reacting to circumstances rather than a master plan. By the late 1960s, international health assistance was mainly organized as a component of “development aid” in the FRG, while regarded as “solidarity” in the GDR, in both cases designed to spur changes in recipient countries according to the respective Northern models as components of a perceived direct, global East-West confrontation.

Syrian refugees in Lebanon: the search for universal health coverage.

The crisis in Syria has forced more than 4 million people to find refuge outside Syria. In Lebanon, in 2015, the refugee population represented 30 % of the total population. International health assistance has been provided to refugee populations in Lebanon. However, the current humanitarian system has also contributed to increase fragmentation of the Lebanese health system. Ensuring universal health coverage to vulnerable Lebanese, Syrian and Palestinian refugees will require in Lebanon to redistribute the key functions and responsibilities of the Ministry of Health and its partners to generate more coherence and efficiency.

Towards a global agenda on health security

On Oct 6, 2015, France commemorated the 70th anniversary of the Social Security Acts, one of the founding keystones of the social model inspired by the National Council of the Resistance. Achieving universal health coverage in France: policy reforms and the challenge of inequalitiesSince 1945, the provision of health care in France has been grounded in a social conception promoting universalism and equality. The French health-care system is based on compulsory social insurance funded by social contributions, co-administered by workers' and employers' organisations under State control and driven by highly redistributive financial transfers. This system is described frequently as the French model. In this paper, the first in The Lancet's Series on France, we challenge conventional wisdom about health care in France. Full-Text PDF State humanitarian verticalism versus universal health coverage: a century of French international health assistance revisitedThe French contribution to global public health over the past two centuries has been marked by a fundamental tension between two approaches: State-provided universal free health care and what we propose to call State humanitarian verticalism. Both approaches have historical roots in French colonialism and have led to successes and failures that continue until the present day. In this paper, the second in The Lancet's Series on France, we look at how this tension has evolved. During the French colonial period (1890s to 1950s), the Indigenous Medical Assistance structure was supposed to bring metropolitan France's model of universal and free public health care to the colonies, and French State imperial humanitarianism crystallised in vertical programmes inspired by Louis Pasteur, while vying with early private humanitarian activism in health represented by Albert Schweitzer. Full-Text PDF France: a philosophy for healthThe dominance of English as the language of science and, increasingly, global health too often closes the door on the history and experiences of others. In France's case, careful study of the nation's struggle to achieve universal health coverage, together with its distinctive approach to global health, has much to offer those who seek to understand the diversity of paths to achieve better health at home and abroad. The two Lancet Series papers1,2 on France's contribution to health, along with four comments from French or Francophone leaders,3–6 aim to correct this imbalance in the English-language literature on health. Full-Text PDF

State humanitarian verticalism versus universal health coverage: a century of French international health assistance revisited.

The French contribution to global public health over the past two centuries has been marked by a fundamental tension between two approaches: State-provided universal free health care and what we propose to call State humanitarian verticalism. Both approaches have historical roots in French colonialism and have led to successes and failures that continue until the present day. In this paper, the second in The Lancet's Series on France, we look at how this tension has evolved. During the French colonial period (1890s to 1950s), the Indigenous Medical Assistance structure was supposed to bring metropolitan France's model of universal and free public health care to the colonies, and French State imperial humanitarianism crystallised in vertical programmes inspired by Louis Pasteur, while vying with early private humanitarian activism in health represented by Albert Schweitzer. From decolonisation to the end of the Cold War (1960-99), French assistance to newly independent states was affected by sans frontièrisme, Health for All, and the AIDS pandemic. Since 2000, France has had an active role in development of global health initiatives and favoured multilateral action for health assistance. Today, with adoption of the 2030 Sustainable Development Goals and the challenges of non-communicable diseases, economic inequality, and climate change, French international health assistance needs new direction. In the context of current debate over global health as a universal goal, understanding and acknowledging France's history could help strengthen advocacy in favour of universal health coverage and contribute to advancing global equity through income redistribution, from healthy populations to people who are sick and from wealthy individuals to those who are poor.

Achieving universal health coverage in France: policy reforms and the challenge of inequalities

Since 1945, the provision of health care in France has been grounded in a social conception promoting universalism and equality. The French health-care system is based on compulsory social insurance funded by social contributions, co-administered by workers' and employers' organisations under State control and driven by highly redistributive financial transfers. This system is described frequently as the French model. In this paper, the first in The Lancet's Series on France, we challenge conventional wisdom about health care in France. First, we focus on policy and institutional transformations that have affected deeply the governance of health care over past decades. We argue that the health system rests on a diversity of institutions, policy mechanisms, and health actors, while its governance has been marked by the reinforcement of national regulation under the aegis of the State. Second, we suggest the redistributive mechanisms of the health insurance system are impeded by social inequalities in health, which remain major hindrances to achieving objectives of justice and solidarity associated with the conception of health care in France.

Liberté, égalité, fraternité…santé.

“We are not England, we are not France”, said Hillary Clinton about health-care insurance during a recent US presidential debate. European models of health care have their own history in which redistribution forms the cornerstone of social solidarity. Aiming to guarantee social cohesion, France's Etat Providence is rooted in models of a welfare state that developed in Germany and the UK. Ensuring universal health coverage and financed through payroll taxes, and increasingly through a general social contribution on all types of income, French health insurance is characterised by a strong redistributive scheme that benefits the poorest and the most sick. 1 Haut Conseil de la Santé PubliqueSanté en France: problèmes et politiques. La Documentation Française, Collection Avis et Rapport, Paris2015 Google Scholar Private and public health-care providers coexist in France and patients have the choice to be treated wherever they wish. Patients are reimbursed by the compulsory national insurance with any uncovered costs covered by private companies, half of which are non-profit insurers. This model is widely considered efficient. France was ranked first in WHO's World Health Report on health systems in 2000, although the report also highlighted health inequalities across the country. 2 WHOThe world health report. Health systems: improving performance. World Health Organization, Geneva2000 Google Scholar Achieving universal health coverage in France: policy reforms and the challenge of inequalitiesSince 1945, the provision of health care in France has been grounded in a social conception promoting universalism and equality. The French health-care system is based on compulsory social insurance funded by social contributions, co-administered by workers' and employers' organisations under State control and driven by highly redistributive financial transfers. This system is described frequently as the French model. In this paper, the first in The Lancet's Series on France, we challenge conventional wisdom about health care in France. Full-Text PDF State humanitarian verticalism versus universal health coverage: a century of French international health assistance revisitedThe French contribution to global public health over the past two centuries has been marked by a fundamental tension between two approaches: State-provided universal free health care and what we propose to call State humanitarian verticalism. Both approaches have historical roots in French colonialism and have led to successes and failures that continue until the present day. In this paper, the second in The Lancet's Series on France, we look at how this tension has evolved. During the French colonial period (1890s to 1950s), the Indigenous Medical Assistance structure was supposed to bring metropolitan France's model of universal and free public health care to the colonies, and French State imperial humanitarianism crystallised in vertical programmes inspired by Louis Pasteur, while vying with early private humanitarian activism in health represented by Albert Schweitzer. Full-Text PDF France: a philosophy for healthThe dominance of English as the language of science and, increasingly, global health too often closes the door on the history and experiences of others. In France's case, careful study of the nation's struggle to achieve universal health coverage, together with its distinctive approach to global health, has much to offer those who seek to understand the diversity of paths to achieve better health at home and abroad. The two Lancet Series papers1,2 on France's contribution to health, along with four comments from French or Francophone leaders,3–6 aim to correct this imbalance in the English-language literature on health. Full-Text PDF

'Big push' to reduce maternal mortality in Uganda and Zambia enhanced health systems but lacked a sustainability plan.

In the past decade, "big push" global health initiatives financed by international donors have aimed to rapidly reach ambitious health targets in low-income countries. The health system impacts of these efforts are infrequently assessed. Saving Mothers, Giving Life is a global public-private partnership that aims to reduce maternal mortality dramatically in one year in eight districts in Uganda and Zambia. We evaluated the first six to twelve months of the program's implementation, its ownership by national ministries of health, and its effects on health systems. The project's impact on maternal mortality is not reported here. We found that the Saving Mothers, Giving Life initiative delivered a large "dose" of intervention quickly by capitalizing on existing US international health assistance platforms, such as the President's Emergency Plan for AIDS Relief. Early benefits to the broader health system included greater policy attention to maternal and child health, new health care infrastructure, and new models for collaborating with the private sector and communities. However, the rapid pace, external design, and lack of a long-term financing plan hindered integration into the health system and local ownership. Sustaining and scaling up early gains of similar big push initiatives requires longer-term commitments and a clear plan for transition to national control.

Legalização de drogas e a saúde pública

The objective of this article is to: (1) evaluate the rationality and opportunity of this debate; (2) try to establish links with legal drugs; (3) evaluate the available data on the effect of legalization of a drug; and (4) propose an alternative drug police based on clear objectives to be reached; (5) describe how Sweden is dealing with the theme of drugs restriction as a social care. Methodologically the text constitutes in a summary of readings and elaborations of the author, placed to incite a discussion. It is concluded that four aspects need to be taken into consideration when a drug police of a country is analyzed, they are: (1) external factors influence the police: international agreements, health and social assistance police, individual rights, authority and autonomy of physicians and other professionals; (2) the objective established influence formal polices and its implementation; (3) the symbolic influence that excels the implementation. Influent people make declarations that strongly reach the legitimacy and adhesion to actions; (4) formal polices and their implementation receive direct influence to socially perceived damages by the drugs use, which could be independent of the real level of its use in a determined society.

International Development Assistance for Health: Ten Priorities for the Next President

As the fall elections near, the presidential candidates and many influential organizations are proposing fundamental reform of the health care system. However, apart from the reauthorization of the President's Emergency Plan for AIDS Relief (PEPFAR), which both candidates sponsored, senators McCain and Obama have barely uttered a word about presidential leadership to improve the health of the world's poorest people. (Obama does have a credible policy, but he rarely promotes it. (1)) But America has an important interest in international development assistance for health, and for more reasons than are commonly recognized. I offer ten priorities for the next president's agenda. Is America Truly Generous? Americans think of themselves as a generous people with a humanitarian commitment. In many ways, we are just that--witness the outpouring of concern in the aftermath of highly visible disasters such as the South Asia tsunami and the earthquake in China. Wealthy private philanthropists also contribute substantially to health assistance. The United States donates more official development assistance (ODA) in absolute terms than any other country--$21.8 billion in 2007--and its proportion of ODA devoted to health (5.6 percent) is higher than many Group of Eight countries. (2) America is also the clear leader on HIV/AIDS, and it is the only country projected to meet the 2005 G8 Gleneagles commitment to double aid to sub Saharan Africa by 2010. Nonetheless, the self-image of America as moral and generous does not stand up to scrutiny. In 1975, America and other developed countries pledged to give 0.7 percent of gross national income per annum to ODA. Yet the United States devotes only 0.16 percent of GNI to ODA, placing us last among G8 countries, excluding Russia. By contrast, peer countries such as France and the United Kingdom devote roughly 0.5 percent to ODA, and Norway devotes 0.9 percent--three to four times more than the United States. (3) Moreover, U.S. aid is spent ineffectively. Nearly 70 percent of America's aid budget for health is devoted to AIDS, primarily because of PEPFAR, badly neglecting critical areas of health such as health systems and maternal/ child health. The One Campaign, a nonpartisan organization that advocates for the elimination of poverty, ranks the United States as tied with Italy for last on the effectiveness of its aid, as measured against a set of ten critical indicators. (4) Worse yet, apart from PEPFAR, the vast preponderance of ODA is devoted to countries that have strategic military value to the United States, such as Afghanistan, Egypt, Iraq, Israel, and Pakistan. (5) Health Diplomacy The World Health Organization projects that if rich countries increased international aid even modestly, tens of millions of lives would be saved every year. Why should rich countries care? The traditional foreign policy answer has been that international health assistance is in a country's national interests. In a globalized world, infectious diseases readily spread across national boundaries. Beyond narrow self-interest, there are broader, enlightened interests in health because epidemic disease dampens tourism, trade, and commerce, as demonstrated by SARS, mad cow disease, and avian influenza. These are the traditional foreign policy responses, but if assistance is always tied to self-interest, then funding will always be skewed toward what the rich want to deliver, rather than toward the larger, systemic problems of the poor. The WHO now urges countries to think of global health diplomacy as a justification for enhanced assistance. Although the term is poorly defined, it means that health should become an instrument of foreign, trade, and security policy. It envisages that a country uses development assistance as a way of promoting its values and image in the world and demonstrating its commitment to the common good. …

Meeting the Survival Needs of the World's Least Healthy People

NTERNATIONAL HEALTH ASSISTANCE IS PROVIDED IN AN INeffective way that does not enhance the capability for human functioning. 1 Most funding is driven by emotional,high-visibilityevents,includinglarge-scalenatural disasters such as the Asian tsunami; diseases that capture the public’s imagination such as the human immunodeficiency virus and AIDS; or diseases with the potential for rapid global transmission such as hemorrhagic fever, severe acute respiratory syndrome, or pandemic influenza. These funding streams skew priorities and divert resources from building stable local systems to meet everyday health needs. A relatively small number of wealthy donors currently wield considerable influence in setting the global health agenda. Although well intentioned, rich countries and philanthropistsoftensetprioritiesthatdonotreflectlocalneeds and preferences. Sometimes donors exert control over the useoffundsthatdiscourageslocalleadersfromtakingownership over programs. Conditions attached to funding can evenbedetrimentaltothepublic’shealth,suchasthePresident’sEmergencyPlanforAIDSReliefrequirementthat33% of prevention funds must be spent on chastity and fidelity, whereas no funding can be used for clean needle programs. 2 Similarly, for years, development banks have encouraged or required poor countries to cap internal spending on health as a condition of loans or debt relief. 3 Donor countries often fund politically popular projects, ratherthanwhatismostlikelytoimproveglobalhealth,leading some experts to conclude, “... funding is skewed towards what people in the West want to deliver.” 4 International health assistance, moreover, is fragmented and uncoordinated. Nongovernmental organizations and relief agencies often establish programs that compete with each other and, still worse, compete with local government and businesses. Rather than integrating policies and programs within local hospitals, clinics, and health agencies, they set upstate-of-the-artfacilitiesthatovershadowanddetractfrom governmentandprivateefforts.Foreignphilanthropistscan offer salaries and amenities that are far more generous than those that can be offered locally. As a result, local innovation and entrepreneurship are stifled; talented individuals in business, health care, and community development migrate to foreign-run programs; and the local health industry cannot profit or easily survive. 5 In addition, massive infusion of humanitarian assistance into very poor countries can lead to reliance and dependency. If charity is the main vehicle for health improvement, local government and businesses lose the desire and ability to solve problems on their own. When the infusion of foreign cash, clinics, medicines, and aid workers ends, the least healthy will be no better and perhaps worse off, unless they gain the capacity to meet their own basic health needs.

Priorities in Global Assistance for Health, AIDS, and Population

This article makes three points regarding international assistance in health, AIDS, and population. First, despite growing attention in the development policy dialogue, the share of health (broadly considered) in total assistance is actually declining, not increasing, if assistance for the HIV/AIDS crisis is taken out of the picture. Second, interventions financed by international health assistance do not closely correspond to the burden of disease as conventionally calculated. HIV/AIDS receives a share of assistance in excess of its contribution to the global burden of disease, and reasons for this are adduced. Third, despite the emphasis on aligning international assistance to country priorities, a comparison of how health is treated in poverty-reduction strategies and the nature of health assistance reveals no clear relationship between the two. This suggests that there may be room for improvement in the process of preparing such strategies, the allocation of health assistance, or both.

Complex emergencies in Indonesia.

Recently, Indonesia has experienced six major provincial, civil, armed conflicts. Underlying causes include the transmigration policy, sectarian disputes, the Asian economic crisis, fall of authoritarian rule, and a backlash against civil and military abuses. The public health impact involves the displacement nationwide of > 1.2 million persons. Violence in the Malukus, Timor, and Kalimantan has sparked the greatest population movements such that five provinces in Indonesia each now harbor > 100,000 internally displaced persons. With a background of government instability, hyperinflation, macroeconomic collapse, and elusive political solutions, these civil armed conflicts are ripe for persistence as complex emergencies. Indonesia has made substantial progress in domestic disaster management with the establishment of central administrative authority, strategic planning, and training programs. Nevertheless, the Indonesian experience reveals recurrent issues in international humanitarian health assistance. Clinical care remains complicated by absences of treatment protocols, inappropriate drug use, high procedural complication rates, and variable referral practices. Epidemiological surveillance remains complicated by unsettled clinical case definitions, non-standardized case management of diseases with epidemic potential, variable outbreak management protocols, and inadequate epidemiological analytic capacity. International donor support has been semi-selective, insufficient, and late. The militia murders of three UN staff in West Timor prompted the withdrawal of UN international staff from West Timor for nearly a year to date. Re-establishing rules of engagement for humanitarian health workers must address security, public health, and clinical threats.

International health assistance for Eurasia.

EVIDENCE is accumulating of substantial deterioration in the health status of people living in the former Soviet Union and Eastern Europe.1 , 2 The public health system has degenerated in recent decades. Support for preventive services has been largely rhetorical. The Soviet health care system relied excessively on hospitals to provide primary care. The Soviet Union spent only one eighth the amount spent by the United States on health services, and less than half the average amount spent by other industrialized nations.3 The system was inefficient and inequitable and remains so. Although international health assistance need not be hugely expensive,4 , 5 even limited . . .

International health assistance in relief operations: preparing local health personnel to meet the challenge

Disasters are not merely very large accidents. They imply complex public health problems that must be resolved under difficult circumstances: society's normal coping mechanisms are disrupted; the high visibility and critical coverage provided by the mass media make the situation politically sensitive; logistic nightmares abound; the multi-agency response from outside the affected area is often poorly coordinated. In short, decision-making in a climate of uncertainty is the norm. Information management, not the medical management of patients, is often the main challenge facing health managers and volunteers in the initial or relief stage of a disaster.

INTERNATIONAL HEALTH ASSISTANCE PROGRAMS OF THE UNITED STATES AND THEIR RELATION TO PROBLEMS OF SANITATION.

INTERNATIONAL HEALTH ASSISTANCE PROGRAMS OF THE UNITED STATES AND THEIR RELATION TO PROBLEMS OF SANITATION.

TRENDS

THE President's January messages to Congress may be looked upon as a measure of the Administration's goals for the ensuing year. In the eighty-five billion dollar budget submitted to Congress on January 21, provision for medical care and public health activities add up to an estimated two billion one hundred million dollars, not counting the sizable but unpredictable sum to be spent next year on international health assistance under Point 4 program direction. Included within this sum is a Public Health Service budget somewhat over three hundred million dollars. Veterans Administration is down for slightly more than four billion dollars with about seven hundred million dollars earmarked for medical and hospital services (exclusive of construction projects). In the budget for Civil Defense nearly two million dollars is scheduled for stockpiling of medical supplies and equipment. A comparatively small figure, but one with important significance for the health of children, is an item of $250,000 for grants in aid to states for the development of a program for the fluoridation of community water supplies. For anyone interested in observing a 10 year trend in government spending in the field of public health, the following figures are most revealing. Here are the actual budget receipts and expenditures (expressed in millions) for the fiscal years 1944 through 1951 and the estimates for fiscal years 1952 and 1953, fiscal year 1952 being from July 1, 1951 through June 1952. For promotion of public health:[See Table In Source PDF] Along with the figures, the Budget Message is noteworthy for the health legislation which is recommended and even more interesting, perhaps, for certain omissions.