Int J Health Serv
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Comparative Study
Do nutrition programs make a difference? The case of Brazil.
Four Brazilian food and nutrition programs operating during some part of 1974-86 are evaluated for their effectiveness in curing or preventing infant and child malnutrition, including low birth weight when pregnant women were beneficiaries. Two programs distributed free food to identified clients: traditional commercial foods in one case and specially formulated supplements in the other. The other two programs subsidized four or more basic foodstuffs: one experiment quantitatively restricted a subsidy to identified families, and the other was unrestricted and open to all families patronizing certain shops. ⋯ Donation programs including medical and educational components proved more effective than pure subsidies, showing that while poverty may be the chief cause of malnutrition, the problem should be seen as poor health rather than simply low food consumption. Evaluation also shows that programs were inefficient in transferring benefits, and that clients were deterred from participating by the costs of obtaining the food and its poor quality and small volume. Longer participation improved results, but more frequent participation in a given interval did not necessarily do so.
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This article uses the current controversies in the British debate about health to illustrate the need to theorize, and therefore critically evaluate, the links between medicine and health policies, including health care policies. The medical model of health is deeply embedded in institutional practices in many countries, and while this model has attracted deserved criticism in recent years, an alternative social model, or one that incorporates indispensable aspects of the medical model, has attracted much less attention and requires sustained development. Comparative study of patterns of inequality in health, and especially of the correlation between material deprivation and premature mortality, necessarily reveals causal determinants of both health and ill-health in populations and invites ambitious programs to develop a social model.
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In developing countries is medical technology transfer reaching women? Do women control new technologies or are they only passive recipients? What is the impact of these new technologies on women's health and welfare? To answer these questions this article explores concepts of health, technologies, and women, then gives findings from an extensive literature search on contraception, childbirth, immunization, essential drugs, oral rehydration therapy, water, sanitation, and breast-feeding. The article concludes with recommendations on pre-project planning studies, monitoring, and evaluation.
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In July 1979, a coalition of social forces in Nicaragua, under the leadership of the Sandinistas, toppled the discredited 43-year Somoza dictatorship. In addition to revolutionary Nicaragua's own substantial efforts, since 1979 international forces and developments have had profound impacts on the nation's ambitious social programs. This article investigates the impact of foreign nations and international organizations on Nicaragua's health conditions since 1979. ⋯ Since 1981, counter-revolutionary guerilla forces, known as contras, have fought the Nicaraguan government troops in a disastrous conflict, involving substantial international assistance for each side. The United States and several other nations have provided some form of aid to the contras. The war in Nicaragua has resulted in enormous human and material losses, and, of course, has adversely affected health conditions.