Work Of World Health Organization Research Articles

The World Health Organization's work and recommendations for improving the health of trans and gender diverse people.

The World Health Organization (WHO) is guided by its global programme of work and the goal that a billion more people have universal health coverage (UHC). To achieve UHC, access for those most vulnerable must be guaranteed and prioritized. WHO is committed to developing evidence-based guidance to work towards UHC for trans and gender diverse (TGD) people. This commentary describes WHO's work related to TGD people over the last decade. In 2011, WHO developed guidelines for the prevention and treatment of HIV and sexually transmitted infections (STIs) in men who have sex with men and TGD people. In 2013, the "HIV civil society reference group" called on WHO to provide specific guidance for TGD people. Values and preferences of TGD people were considered by WHO for the first time, which informed the development of the 2014 WHO Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations. The 2014 Guidelines included a comprehensive package of HIV-related health and enabling interventions with specific considerations for TGD people, as well as a specific policy brief in 2015. Regional WHO offices developed and/or supported the development of blueprints on transgender health and HIV in 2014 and 2016. A 2015 WHO report on sexual health, human rights and the law elucidated the harmful impacts of discriminatory laws on the basis of sexual orientation and gender identity. In 2019, the 11th edition of the international classification of diseases saw the removal of "transsexualism" as a mental and behavioural disorder. WHO's first guideline on self-care interventions, updated in 2021, included key considerations concerning TGD people. In 2022, WHO's updated key populations guidelines include a prioritized package of not just HIV, but also viral hepatitis and STI health interventions for TGD people. Still, a broader and more specific health approach and a greater focus on social issues are needed to better serve the health needs of TGD people. WHO's understanding and commitment to TGD people's health has evolved and improved over the past decade. Together with professional and community trans health organizations, WHO should now start developing evidence-informed global guidance on TGD health as part of its remit to support UHC to all.

Cora Du Bois' Brief Stint With the World Health Organization (1950-1951): Right Time, Wrong Place.

Brock Chisholm, director-general of the World Health Organization (WHO) in the early 1950s, was heard to say that "one cultural anthropologist [Cora Du Bois] was worth one hundred malaria teams." Paul Russell, the leading malariologist at the time, responded (privately in his diary) that Chisholm's remark was the sort that "one might expect from a psychiatrist planning a world health program." George Foster reported that Du Bois "was completely disgusted with" her stay at WHO. "They never asked her to do anything. She never followed up." Chisholm was not the only one who appreciated her contribution to the work of WHO; other WHO programs and offices would have welcomed her contribution. However, by operating out of WHO's South-East Asia Regional Office (SEARO), she found herself isolated with little chance of her work being reviewed favorably, i.e., the "wrong place."

Burden of disease studies in the WHO European Region-a mapping exercise.

BackgroundThe World Health Organization (WHO) and the Institute for Health Metrics and Evaluation (IHME) have produced numerous global burden of disease (GBD) estimates since the 1990s, using disability-adjusted life-years (DALYs). Here we attempt to identify studies that have either independent DALY estimates or build on the work of WHO and IHME, for the WHO European Region, categorize them by scope of disease analysis and geographic coverage, and briefly compare their methodology (age weighting, discounting and disability weights).MethodsGoogle and Google Scholar were used with the search terms ‘DALY’, ‘national burden of disease’, Member State names and researcher’s names, covering all years. Studies were categorized as: ‘specific’ (fewer than five disease categories or just risk factors for a single country), ‘specific, multicountry’ (fewer than five disease categories or just risk factors for more than one country), ‘extensive’ (covering five or more but not all disease categories for one country), ‘full, sub country’ (covering all relevant disease categories for part of one country) and ‘full, country’ (covering all relevant disease categories for one country).ResultsA total of 198 studies were identified: 143 ‘specific’, 26 ‘specific, multicountry’, 7 ‘extensive’, 10 ‘full, sub country’ and 12 ‘full, country’ [England (1), Estonia (2), France (1), Romania (1), Serbia (1), Spain (3), Sweden (2) and Turkey (1)]. About 5 (20%) of the 25 examinable ‘extensive’, ‘full, sub country’ and ‘full, country’ studies calculated DALYs using GBD 2010 methodology.ConclusionsIndependent burden of diseases studies in Europe have been located, and categorized by scope of disease analysis and geographic coverage. Methodological choices varied between independent ‘full, country’ studies.

Mapping actions to improve access to medicines for mental disorders in low and middle income countries.

In recent years a number of intergovernmental initiatives have been activated in order to enhance the capacity of countries to improve access to essential medicines, particularly for mental disorders. In May 2013 the 66th World Health Assembly adopted the World Health Organization (WHO) Comprehensive Mental Health Action Plan 2013-2020, which builds upon the work of WHO's Mental Health Gap Action Programme. Within this programme, evidence-based guidelines for mental disorders were developed, including recommendations on appropriate use of medicines. Subsequently, the 67th World Health Assembly adopted a resolution on access to essential medicines, which urged Member States to improve national policies for the selection of essential medicines and to promote their availability, affordability and appropriate use. Following the precedent set by these important initiatives, this article presents eleven actions for improving access and appropriate use of psychotropic medicines. A 4 × 4 framework mapping actions as a function of the four components of access - selection, availability, affordability and appropriate use - and across four different health care levels, three of which belong to the supply side and one to the demand side, was developed. The actions are: developing a medicine selection process; promoting information and education activities for staff and end-users; developing a medicine regulation process; implementing a reliable supply system; implementing a reliable quality-control system; developing a community-based system of mental health care and promoting help-seeking behaviours; developing international agreements on medicine affordability; developing pricing policies and a sustainable financing system; developing or adopting evidence-based guidelines; monitoring the use of psychotropic medicines; promoting training initiatives for staff and end-users on critical appraisal of scientific evidence and appropriate use of psychotropic medicines. Activating these actions offers an unique opportunity to address the broader issue of increasing access to treatments and care for mental disorders, as current lack of attention to mental disorders is a central barrier across all domains of the 4 × 4 access framework.

Policy and programme evaluation: principles and objectives

In May 2012, the World Health Assembly endorsed the World Health Organization (WHO) evaluation policy, emphasizing the fact that evaluation is an essential part of the work of the Organization. The evaluation policy intended to bring to fore a few important principles of WHO's work: further accountability, systematic provision of oversight of performance, and ensuring that the Organization continues to learn from its experiences. The endorsement of the policy was followed by important and immediate actions, most notably the publication of the WHO Evaluation Practice Handbook and the establishment of the WHO Evaluation Office.

Five years in action: strengthening public health in the Eastern Mediterranean Region and beyond

Five years ago I was appointed as the World Health Organization (WHO) Regional Director for the Eastern Mediterranean by the WHO Executive Board, during its 130th Session. When I addressed the Executive Board following my formal appointment, I pledged that the Regional Office would listen to and support Member States as well as build on their experiences. In fulfilling this, I set out my term undertaking, in close collaboration with Member States, a comprehensive situation analysis of the\ key challenges to health and development in the Region. Consensus was reached on five strategic priorities that became the focus of WHO's work in the Region over the next five years.

National public health law: a role for WHO in capacity-building and promoting transparency.

A robust health infrastructure in every country is the most effective long-term preparedness strategy for global health emergencies. This includes not only health systems and their human resources, but also countries’ legal infrastructure for health: the laws and policies that empower, obligate and sometimes limit government and private action. The law is also an important tool in health promotion and protection. Public health professionals play important roles in health law – from the development of policies, through their enforcement, to the scientific evaluation of the health impact of laws. Member States are already mandated to communicate their national health laws and regulations to the World Health Organization (WHO). In this paper we propose that WHO has the authority and credibility to support capacity-building in the area of health law within Member States, and to make national laws easier to access, understand, monitor and evaluate. We believe a strong case can be made to donors for the funding of a public health law centre or unit, that has adequate staffing, is robustly networked with its regional counterparts and is integrated into the main work of WHO. The mission of the unit or centre would be to define and integrate scientific and legal expertise in public health law, both technical and programmatic, across the work of WHO, and to conduct and facilitate global health policy surveillance.

Universal health coverage and the public health workforce.

universal health coverage (uHC), part of the post-2015 development agenda, is an aspiration widely shared across the world and promoted by numerous international organizations.In 2012 the united Nations General assembly adopted a resolution for uHC, which urges governments to move towards 'providing all people with access to affordable, quality healthcare services'. the World Health Organization (WHO), which has a leading role in supporting countries to respond to the challenge of uHC and monitors its implementation, describes global support for uHC as gathering momentum.1Margaret Chan, Director-General of WHO has said: I regard universal health coverage as the single most powerful concept that public health has to offer. It is inclusive. It unifies services and delivers them in a comprehensive and integrated way, based on primary health care.One of the challenges of uHC is the global shortage of all types of health workers, which has been a concern for many countries and forms a central plank of the work of WHO and many other global and regional organizations such as the World Bank, Bill & Melinda Gates Foundation and the Clinton Foundation. WHO's strategy on Human resources for Health (HrH)2 seeks to ensure that all people have equitable access to an adequately trained, skilled and supportive health workforce, in order to attain the highest possible level of health. the third Global Forum on HrH in Brazil in 2013 resulted in the bolstering of political commitments on HrH, based on technical evidence, in order to accelerate progress towards uHC, and it began the process of developing a global strategy.these are crucial developments, but despite uHC being a major public health concern confronting the world and the significant global effort to address health workforce concerns, the place of the public health workforce seems invisible in these discussions. this commentary presents a brief review of the public health workforce in the context of the uHC and HrH agendas, together with a consideration of the opportunities for greater intersection, and therefore greater success.UNIVERSAL HEALTH COVERAGEuHC - which is not a new concept - has been broadly defined as all people having access to needed service of appropriate quality without suffering financial hardship. the definition covers both individual and population health services - including promotion, prevention, acute treatment, rehabilitation and palliation.uHC is consistent with the definition of health in the WHO Constitution and the Declaration of alma ata,3 and has been more recently articulated in the Health Systems Knowledge Network of the Commission for Social Determinants of Health,4 and the World Health reports on renewal of Primary Care5 and Health Financing.6In practice, however, the differing understandings of uHC have either led to a focus on health insurance, or on delivery of individual health services. the monitoring indicators developed by WHO and the World Bank emphasize financial protection and impoverishment on the one hand, and service coverage for a variety of 'vertical' programmes, such as maternal and child health, on the other, albeit including some population-level health services.7 the financing and delivery of population-level health interventions seem to be largely sitting in the background, and the issue of public health system preparedness and public health system strengthening are largely absent from the discourse.HUMAN RESOURCES FOR HEALTHthe global HrH conversation has been concerned with addressing health worker migration, and promoting improved workforce planning and educational development at the national level. Labour market studies are increasingly being undertaken as part of understanding the dynamics of health workforce recruitment and retention.However, this workstream has some gaps. It is largely focused on countries experiencing HrH crisis - i.e. insufficient numbers of health workers to deliver healthcare. …

Association of Chiropractic Colleges Educational Conference and Research Agenda Conference 2012

Association of Chiropractic Colleges Educational Conference and Research Agenda Conference 2012

Include a Social Determinants of Health Approach to Reduce Health Inequities

Reducing health disparities, primarily those based on race/ethnicity and gender, has long been a public health priority in the United States, but the first official goal to eliminate health disparities came with Healthy People 2010.1 Recent developments led by the World Health Organization (WHO), however, have accelerated the thinking about the causes of health inequities—i.e., disparities that are systematic, avoidable, and unjust2—and how best to address their reduction.3,4 The WHO Commission on Social Determinants of Health concluded in 2008 that the social conditions in which people are born, live, and work are the single most important determinant of one's health status.3 Certainly, individual choices are important, but factors in the social environment are what determine access to health services and influence lifestyle choices in the first place. In addition to the WHO's work, state and local health departments, national government agencies (such as the Centers for Disease Control and Prevention and other divisions of the Department of Health and Human Services in the U.S.), and other national organizations have recognized the need to address health inequities in a systematic way by addressing more than individual behavioral factors.5–12 This global movement recognizes that to reduce health inequities, it will be necessary to incorporate a social determinants of health approach with existing approaches. Social determinants are defined as follows: “… the circumstances in which people are born, grow up, live, work and age, and the systems put in place to deal with illness. These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics.”13 Broadening our collective approaches to reducing health inequities by addressing the social and structural conditions needed for good health for all is urgently needed now. These social and structural conditions include education; housing; employment; living wages; access to health care; access to healthy foods and green spaces; justice; occupational safety; hopefulness; and freedom from racism, classism, sexism, and other forms of exclusion, marginalization, and discrimination based on social status. The inequitable distribution of these social conditions across groups contributes to persistent health inequities. While a social-determinants approach is important for people of all ages, it is critically valuable for children, whose positive early development can improve their health throughout the life span.14 As a former U.S. Surgeon General, I am committed to eliminating health disparities in the United States and providing care to vulnerable populations such as the indigent, foreign-born, and homeless. I urge a more broad-based and systematic approach to adequately address the health inequities that have been abundantly documented in the U.S. and which I have seen on a daily basis across the country. I call on people from all disciplines and sectors to come together and work toward achieving the Healthy People 2020 objectives, especially as they relate to social determinants of health. We need a new way of thinking, one where, as public health professionals, we lead by taking an interdisciplinary approach and collaborating across a wide range of disciplines, developing our own workforce to effectively address social determinants of health, and insisting health and non-health policies incorporate a social-determinants approach. We all have a role to play. The federal government should raise the profile of social determinants and communicate to the public what is meant by this somewhat unfamiliar approach. Public health and the work we do can be framed around health equity. Communities and local governments and organizations will have to be educated about the growing movement. Clear, concise language and concrete examples of how people can affect change will be needed. We should have “health in all policies” because nearly all social determinants are outside the direct control of the health sector. Although the goal of many social and economic policies may not be to affect health outcomes, the fact is they will.14 From funding opportunity announcements to accountability mechanisms, all facets of public health should include addressing social determinants. Our partnerships will have to be stronger if we are to have an impact. We must reach out to nontraditional partners in the private sector, industry, and other parts of government in the transportation, education, and justice sectors, for example. Analyses of equity effectiveness should be conducted alongside those of cost-effectiveness to ensure that the impact of various policies on health outcomes is given equal consideration.14,15 Finally, we must expand resources to address these underlying determinants. Public resources could be better leveraged and collaborations with the private sector and foundations should also be sought. In short, we must be proactive, collaborative, inclusive, and deliberate as we advance the use of a social-determinants approach to reducing health inequities among and between populations.

Global institutions: the World Health Organization (WHO)

This book is a short and very readable account of the origins and evolution of WHO as the United Nations specialized agency for global health. It will be of interest not only to scholars and practitioners of public health, but also to those interested in development and international relations. Starting with a brief review of the history of international cooperation aimed at prevention and control of the spread of communicable diseases across borders, the book traces the rise of social medicine and public health in response to recognition of social and economic determinants of the health of populations during the Industrial Revolution in Europe and subsequently into the 20th century on both sides of the Atlantic. Biomedical and social concepts of human health have led to tensions with regard to defining the scope and limits of public health and its amenability to scientific and technical or social and political action. The book discusses these tensions in relation to the foundation of WHO in the aftermath of the Second World War, starting with a definition of its mandate and constitution, which came into force on 7 April 1948. While the constitution adopts a broad notion of health, nevertheless the history of WHO in the subsequent 60 years reveals alternating and competing cycles that reflect ongoing debate and opinions on how best to promote the attainment by all peoples of the highest possible level of health. Following a brief review of the events leading up to WHO’s creation, the book analyses the structure, functions and governance of the Organization, all of which are intended to reflect universal membership as well as its role as the United Nations specialized agency for health. This chapter explains WHO’s unique regional and global structure that enables the Organization to carry out its dual normative and technical cooperation functions, the latter implemented through its 147 country offices. Two chapters are dedicated to analysing WHO’s approaches to competing pressures among its Member States on how best to improve and promote health. These pressures arise from two related dichotomies. The first relates to the relative effectiveness of focusing on specific diseases versus strengthening health systems. The second relates to the balance between focus on health and the health sector versus broader determinants of health and the need for health in all policies and intersectoral action. A chapter on global campaigns against specific diseases traces WHO action against malaria, smallpox, HIV/AIDS and poliomyelitis. It notes how disease control and eradication campaigns fire the public imagination and attract donors. For many people they epitomize the work of a world health organization. However, the author notes WHO’s mixed record and concludes that global disease campaigns are not in themselves an adequate fulfilment of WHO’s mandate to improve world health. A chapter on tackling the broad determinants of health examines attempts by the public health community to influence the work of WHO to better reflect its Constitution. It traces early work that focused on single factors such as water, sanitation, nutrition and housing before moving on to the primary health care movement of the 1970s and 1980s that drew international attention to health equity and the fundamental importance of ensuring universal access to services, including essential medicines. The author records the controversies and political tensions that have accompanied WHO’s work in these areas, including recent work on tobacco control, trade and health and prevention of chronic diseases in which strong vested interests have sought to oppose and undermine the work of the Organization. The final chapter describes pressure on WHO to respond to the realities of globalization by engaging with new stakeholders, beyond its member states, and addressing important cross-border health determinants. The author examines the pressures on the secretariat to embrace global health and the ensuing challenges to revisit WHO’s mandate, basic functions and even its underlying value system. In line with the higher-than-ever priority that has been accorded to public health in international affairs, WHO’s functions and governance have been the subject of repeated studies and calls for reform since the early 1990s. The book concludes that politics has been embedded in WHO throughout its history and is an obvious feature of an international organization mandated to promote the attainment of the highest possible level of health for all peoples. In that context, it is remarkably current at this juncture when human health and wellbeing face challenges as great as any since the Organization was established. ■

The prevalence and workplace costs of adult attention deficit hyperactivity disorder in a large manufacturing firm

Little is known about the effects of adult attention deficit hyperactivity disorder (ADHD) on work performance or accidents-injuries.MethodA survey was administered in 2005 and 2006 to employees of a large manufacturing firm to assess the prevalence and correlates of adult ADHD. Respondents (4,140 in 2005, 4,423 in 2006, including 2,656 in both surveys) represented 35-38% of the workforce. ADHD was assessed with the World Health Organization (WHO) Adult ADHD Self-Report Scale (ASRS), a validated screening scale for DSM-IV adult ADHD. Sickness absence, work performance and workplace accidents-injuries were assessed with the WHO Health and Work Performance Questionnaire (HPQ). The estimated current prevalence (standard error) of DSM-IV ADHD was 1.9% (0.4). ADHD was associated with a 4-5% reduction in work performance (chi12=9.1, p=0.001), a 2.1 relative-odds of sickness absence (chi12=6.2, p=0.013), and a 2.0 relative-odds of workplace accidents-injuries (chi12=5.1, p=0.024). The human capital value (standard error) of the lost work performance associated with ADHD totaled USD 4,336 (676) per worker with ADHD in the year before interview. No data were available to monetize other workplace costs of accidents-injuries (e.g. destruction of equipment). Only a small minority of workers with ADHD were in treatment. Adult ADHD is a significantly impairing condition among workers. Given the low rate of treatment and high human capital costs, in conjunction with evidence from controlled trials that treatment can reduce ADHD-related impairments, ADHD would seem to be a good candidate for workplace trials that evaluate treatment cost-effectiveness from the employer's perspective.

Non-communicable diseases and global health governance: enhancing global processes to improve health development.

This paper assesses progress in the development of a global framework for responding to non-communicable diseases, as reflected in the policies and initiatives of the World Health Organization (WHO), World Bank and the UN: the institutions most capable of shaping a coherent global policy. Responding to the global burden of chronic disease requires a strategic assessment of the global processes that are likely to be most effective in generating commitment to policy change at country level, and in influencing industry behaviour. WHO has adopted a legal process with tobacco (the WHO Framework Convention on Tobacco Control), but a non-legal, advocacy-based approach with diet and physical activity (the Global Strategy on Diet, Physical Activity and Health).The paper assesses the merits of the Millennium Development Goals (MDGs) and the FCTC as distinct global processes for advancing health development, before considering what lessons might be learned for enhancing the implementation of the Global Strategy on Diet. While global partnerships, economic incentives, and international legal instruments could each contribute to a more effective global response to chronic diseases, the paper makes a special case for the development of international legal standards in select areas of diet and nutrition, as a strategy for ensuring that the health of future generations does not become dependent on corporate charity and voluntary commitments. A broader frame of reference for lifestyle-related chronic diseases is needed: one that draws together WHO's work in tobacco, nutrition and physical activity, and that envisages selective use of international legal obligations, non-binding recommendations, advocacy and policy advice as tools of choice for promoting different elements of the strategy.

Prevalence and Effects of Mood Disorders on Work Performance in a Nationally Representative Sample of U.S. Workers

Objective: Research on the workplace costs of mood disorders has focused largely on major depressive episodes. Bipolar disorder has been overlooked both because of the failure to distinguish between major depressive disorder and bipolar disorder and by the failure to evaluate the workplace costs of mania/hypomania. Method: The National Comorbidity Survey Replication assessed major depressive disorder and bipolar disorder with the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) and work impairment with the WHO Health and Work Performance Questionnaire. A regression analysis of major depressive disorder and bipolar disorder predicting Health and Work Performance Questionnaire scores among 3,378 workers was used to estimate the workplace costs of mood disorders. Results: A total of 1.1% of the workers met CIDI criteria for 12-month bipolar disorder (I or II), and 6.4% meet criteria for 12-month major depressive disorder. Bipolar disorder was associated with 65.5 and major depressive disorder with 27.2 lost workdays per ill worker per year. Subgroup analysis showed that the higher work loss associated with bipolar disorder than with major depressive disorder was due to more severe and persistent depressive episodes in those with bipolar disorder than in those with major depressive disorder rather than to stronger effects of mania/hypomania than depression. Conclusions: Employer interest in workplace costs of mood disorders should be broadened beyond major depressive disorder to include bipolar disorder. Effectiveness trials are needed to study the return on employer investment of coordinated programs for workplace screening and treatment of bipolar disorder and major depressive disorder.

Prevalence and Effects of Mood Disorders on Work Performance in a Nationally Representative Sample of U.S. Workers

Research on the workplace costs of mood disorders has focused largely on major depressive episodes. Bipolar disorder has been overlooked both because of the failure to distinguish between major depressive disorder and bipolar disorder and by the failure to evaluate the workplace costs of mania/hypomania. The National Comorbidity Survey Replication assessed major depressive disorder and bipolar disorder with the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) and work impairment with the WHO Health and Work Performance Questionnaire. A regression analysis of major depressive disorder and bipolar disorder predicting Health and Work Performance Questionnaire scores among 3,378 workers was used to estimate the workplace costs of mood disorders. A total of 1.1% of the workers met CIDI criteria for 12-month bipolar disorder (I or II), and 6.4% meet criteria for 12-month major depressive disorder. Bipolar disorder was associated with 65.5 and major depressive disorder with 27.2 lost workdays per ill worker per year. Subgroup analysis showed that the higher work loss associated with bipolar disorder than with major depressive disorder was due to more severe and persistent depressive episodes in those with bipolar disorder than in those with major depressive disorder rather than to stronger effects of mania/hypomania than depression. Employer interest in workplace costs of mood disorders should be broadened beyond major depressive disorder to include bipolar disorder. Effectiveness trials are needed to study the return on employer investment of coordinated programs for workplace screening and treatment of bipolar disorder and major depressive disorder.

Historical Perspectives

Fifty years ago, Professor Paul Polani and colleagues described young women who had Turner syndrome and were found to have apparently male “chromosomal sex.” (1) At that time, the generally accepted number of chromosomes in humans was 48. Five years earlier, Barr and Bertram described the presence of a prominent mass of chromatin lying close to the nucleolar membrane in neurons of some female cats. (2) This “sex-chromatin” was not found in the males. These “Barr bodies” later were detected in cells grown from skin biopsies. (3) Then, in 1956, Tjio and Levan reported that the number of diploid chromosomes was 46, (4) which rapidly was confirmed by others. (5) From this ripple, a wave soon developed. Three years later, the first association of a clinical syndrome with an abnormal number of chromosomes was reported from France (6) and quickly confirmed in Scotland. (7) This was the association of Down syndrome (mongolism) with an extra chromosome number 21 (trisomy 21), although this was called chromosome number 22 at the time. Not long afterward, translocation was noted in a girl who had Down syndrome born to a 21-year-old mother, (8) and translocation was described as a cause of familial mongolism. (9) Other trisomies soon were described. (10)(11) Based on the realization that the number of sex-chromatin bodies was one less than the number of X chromosomes present, the chromosomes of women who had Turner syndrome and appeared to be chromosomally “male” were investigated. They were found to have 45 chromosomes, with the sex chromosomes being XO. (12) Many of these exciting chromosomal discoveries were made by Professor Polani and his colleagues. Elsewhere, Professor Polani (now 90 years old) has described in detail the origins and evolution of clinical cytogenetics. (13) In this issue of NeoReviews , …

Obesity in children and young people: a crisis in public health.

Ten per cent of the world’s school-aged children are estimated to be carrying excess body fat (Fig. 1), with an increased risk for developing chronic disease. Of these overweight children, a quarter are obese, with a significant likelihood of some having multiple risk factors for type 2 diabetes, heart disease and a variety of other co-morbidities before or during early adulthood. The prevalence of overweight is dramatically higher in economically developed regions, but is rising significantly in most parts of the world. In many countries the problem of childhood obesity is worsening at a dramatic rate. Surveys during the 1990s show that in Brazil and the USA, an additional 0.5% of the entire child population became overweight each year. In Canada, Australia and parts of Europe the rates were higher, with an additional 1% of all children becoming overweight each year. The burden upon the health services cannot yet be estimated. Although childhood obesity brings a number of additional problems in its train – hyperinsulinaemia, poor glucose tolerance and a raised risk of type 2 diabetes, hypertension, sleep apnoea, social exclusion and depression – the greatest health problems will be seen in the next generation of adults as the present childhood obesity epidemic passes through to adulthood. Greatly increased rates of heart disease, diabetes, certain cancers, gall bladder disease, osteoarthritis, endocrine disorders and other obesityrelated conditions will be found in young adult populations, and their need for medical treatment may last for their remaining life-times. The costs to the health services, the losses to society and the burdens carried by the individuals involved will be great. The present report has been written to focus attention on the issue and to urge policy-makers to consider taking action before it is too late. Specifically, the report:

Replacing the Default Values of 10 With Data-Derived Values: A Comparison of Two Different Data-Derived Uncertainty Factors for Boron

A “safe” or sub-threshold dose is often estimated for oral toxicity of substances in order to protect humans from adverse health effects. This dose is referred to by several terms: reference dose (RfD), tolerable daily intake (TDI), and acceptable daily intake (ADI). Similarly, tolerable concentration (TC), and reference concentration (RfC) are commonly used terms for a “safe” concentration for inhalation. The process of deriving these doses generally involves identifying a no observed, or lowest observed adverse effect level (NOAEL or LOAEL) in animals, or humans, and application of uncertainty factors to account for the extrapolation from laboratory animals to humans and/or from an average human to a sensitive human. Public health agencies have begun to consider using a data derived approach, which uses available toxicokinetic and toxicodynamic data in the determination of uncertainty factors, rather than relying on the standard default values. Recently two different tolerable daily intake risk values were derived by two different World Health Organization (WHO) work groups. The International Programme on Chemical Safety, and the Working Group on Chemical Substances in Drinking Water both used the approach developed by Renwick (1993); however, the two groups interpreted and used the available data differently. The result was a difference of over twofold in the total uncertainty factor used. This review compares and contrasts the two approaches used by these WHO work groups.

More on International Medical Aid (I); More or Less on International Medical Aid (II); Socialism, Capitalism and Inequality; Comment by Paul Sweezy

Meredeth Turshen and Annie Thebaud, the authors of "International Medical Aid" (Monthly Review, December 1981), correctly point out that most disease problems are rooted in the social environment in which we live and, consequently, the limitations of essentially technical-medical solutions. They also point out the links between capitalist ideology and development and the bias in favor of these technical-medical means. In addition, they hold the World Health Organization (WHO) ideologically responsible for accepting and spreading these solutions to the exclusion of others. I believe them, however, to be in error, or at least overly simplistic, in equating the work of WHO almost exclusively with this narrow view of health and disease.This article can also be found at the Monthly Review website, where most recent articles are published in full.Click here to purchase a PDF version of this article at the Monthly Review website.

World Health Organization

Sixteenth Assembly: The sixteenth session of the Assembly of the World Health Organization (WHO) met in Geneva on May 7–23, 1963, under the presidency of Dr. M. A. Majekodunmi (Nigeria). During the discussion of the Director-General's report on the work of WHO in 1962, delegates expressed agreement on the importance of the planned development of health services, medical education, and the training of auxiliary staff. Endorsing the Organization's medical research program, some members suggested its extension to other fields. Other members felt, however, that WHO was devoting too much time and money to work that could be carried out by national research institutes. Several delegations appealed for a more flexible approach in providing aid to less developed countries. Dr. Candau, the Director-General, spoke of the efforts that had been made to secure staff from a wider range of countries.