JAMA : the journal of the American Medical Association
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The number of refugees and internally displaced persons in need of protection and assistance has increased from 30 million in 1990 to more than 43 million today. War and civil strife have been largely responsible for this epidemic of mass migration that has affected almost every region of the world, including Europe. Since 1990, crude death rates (CDRs) during the early influx of refugees who crossed international borders have been somewhat lower than CDRs reported earlier among Cambodian and Ethiopian refugees. ⋯ Although relief programs for refugees have improved since 1990, the situation among the internally displaced may have worsened. The international community should intervene earlier in the evolution of complex disasters involving civil war, human rights abuses, food shortages, and mass displacement. Relief programs need to be based on sound health and nutrition information and should focus on the provision of adequate shelter, food, water, sanitation, and public health programs that prevent mortality from diarrhea, measles, and other communicable diseases, especially among young children and women.
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We examined the tobacco industry's new strategy to defeat and then repeal tobacco control ordinances in California and the efforts of health professionals to pass and defend these ordinances. Case studies were conducted in California communities in 1991 and 1992, using published reports, public documents, attendance at public meetings, and interviews. The tobacco industry is spending millions of dollars to intervene in California communities to oppose legislation protecting nonsmokers from secondhand smoke. ⋯ If these efforts do not weaken or defeat an ordinance, the tobacco industry initiates a referendum petition drive to suspend it to pressure local elected officials to repeal or weaken it. If this tactic fails, the industry often finances an election campaign to repeal the ordinance by popular vote. Although the tobacco industry's new strategy has hindered the passage of some local tobacco control ordinances, when health professionals and elected officials remained active and committed, the industry's efforts have failed and the ordinances have been upheld.