- Email: [email protected]
Europe: Population concerns
605
companies. No matter. The few items that offend traditional sensibilities have hogged the news. Last fall, the White House suggested that it was time for Frohnmayer to leave, but he stayed on. Then, last month, Bush was badly stung in the New Hampshire primary by Pat Buchanan, the partly deodorised fascist of American politics. Going south for the next round of primaries, Buchanan accused Bush of "subsidising both filthy and blasphemous art"-serious words in church-going conservative territory. A few days later, the White House demanded Frohnmayer’s resignation. In a goodbye letter, the President credited him with integrity and decency, but protectively added that "some of the art funded by the NEA does not have my enthusiastic approval". Buchanan came back several days later with another pronouncement on the NEA: "When I get to be President, we’re going to shut that place down, then padlock it, and fumigate it". Daniel S.
Greenberg
Round the World WHO: Health and environment Coming generations, as well as this one, should surely thank the World Health Organisation for Our Planet, Our Health. The 22-member WHO Commission on Health and the Environment, set up two years ago, was invited to do a follow-up to the 1987 Our Common Future by the Brundtland Commission on environment and development, which itself had been linked to the 1980 Brandt Commission report on North/South issues. This latest report, published on March 4, is WHO’s main contribution to the UN Conference on Environment and Development, to be held in June in Rio de Janeiro. It is not likely to share the fate of so many UN conference documents-filed away and forgotten except by the few. On the contrary, it deserves to become the vademecum for all those, general public and experts alike, who are concerned with the future of the planet. The UN can find the funds, it is hoped, to ensure that a cheap, trimmed-down paperback version, in the main languages, soon becomes available. The 22 pages of the slim version (preface, summary, and annex 1), that WHO is now issuing free of charge does not do justice to the commission’s efforts. Reports of the four panels are being issued separately (as documents WHO/EHE/92.2-5). This book may well outperform Stephen Hawking’s A Brief History of Time on the non-fiction list. The report’s coverage of all aspects of the human predicament is down-to-earth, with graphic, even disturbing, illustrations of just how things are for most of the world’s 5000 million people. It shows what we are doing collectively-if no longer quite so unwittingly as in former years-to natural resources dependent on water, air, and soil. Given its two-year term, the commission had no opportunity to emulate the Brundtland procedure of inviting original submissions from several thousand people. Instead, it concentrated on presenting the quintessence of all information (carefully referenced and footnoted) available within UN agencies and from other bodies. The work was done by four panels, totalling some 80 people, on food and agriculture, energy, industry, and urbanisation. Heading the commission itself, which met only three times, was Simone Veil, member of the European
Parliament and former French Minister of Health. Not being a specialist in subjects the commission was covering, Mme Veil hesitated about accepting the appointment: "However, I realised there might be some advantage in entrusting this responsibility to someone who has no specific training in matters of environment and health, but with experience of seeking advice from specialists on technical questions in order to be able to reach fully informed decisions of a political order". While it is axiomatic that the more affluent "enjoy longer lives and better health than lower-income groups", the report also underlines-Mme Veil’s liberal (centre right) guiding hand?-the point that "countries with above-average health indicators relative to their per caput income level tend to be those with the most equitable distribution of income". It illustrates this with a table showing proportion of gross national product available to the poorest 40% of households and life expectancy. Top is Netherlands (22-4%, 77-2 years) followed by Japan (21-9%, 78-6 years). Britain is twelfth (18-5%, 75-7) and Peru (7%, 63) is at the bottom, just below Brazil (7%, 65-6). Introducing the report in Geneva, last week Dr Hiroshi Nakajima, director-general of WHO, noted that "An environmentally sound planet is wasted if the population is not healthy". "... protection of people now living must be first priority", he added and that meant focusing on reductions in population growth, overconsumption, and the generation of waste.
Alan
McGregor
Europe: Population concerns and demography come from the same root about the rights of individuals. European parliamentarians at a conference in London on Jan 31 and Feb 1 recommended that much more attention be given to international family planning so that a basic human freedom could be extended to hundreds of millions of the world’s citizens. The UK’s all-party Parliamentary group on population and development, which hosted the conference, has been active since 1979, and the gathering was attended by 38 parliamentarians from twenty European national parliaments and the European Parliament. The conference culminated in a European Agenda for Action on World Population. Recognising that global population is growing by 250 000 per day, the conference found convincing evidence that more and more people in developing countries did want smaller families; provided action were taken in the 1990s there was a real opportunity to contain the world’s population at 10 billion or less for the next century. The agenda was drafted by the parliamentarians after reviews of the current situation by Dr Nafis Sadik (UN under-secretary general and executive director, UN Population Fund), Dr Halfdan Mahler (secretary general, International Planned Parenthood Federation), and Prof Fred Sai (Ghana). Fertility is falling rapidly in many countries but there is a long way to go. The agenda deplores the fact that 1% or less of development assistance world wide is spent on population policies and family planning activities and that this proportion had dropped from 2% in the early 1970s. In response, the parliamentarians committed themselves to trying to persuade their governments to double their commitments by 1995, with a target of$4 billion a year by the year 2000. The relation between population and environmental problems was underscored by Joseph Wheeler, who is
Democracy
and both
are
606
director of the UN Conference
on
the Environment and
Development that is to be held in Rio de Janeiro later this year, and by Sir Crispin Tickell (warden, Green College, Oxford, and former UK representative at the UN). The conference did not play down the disproportionate contribution the industrialised nations make to environmental damage, but neither did it deny the importance of the threat of further population growth. A world with twice as many people would be pushing to the limit the capacity of the planet to sustain life and adjust to pollution-and a world with three times today’s population might damage irreversibly huge areas of the world. The agenda endorsed a Global Commission on Population, which would explore many aspects of population change in greater depth. This would be part of the preparation for the 1994 UN International Conference on Population and
Development. Malcolm Potts
El Salvador: Dental artisans On Jan 1, the UN Secretary-General Sr Perez de Cuellar, the end of his mandate, achieved an agreement between representatives of the FMLN (the guerilla liberation movement) and the Government to work for peace in 1992. With over 70 000 war casualties in the past ten years, and memories of the acts committed by death squads and by the army, reconciliation will present formidable difficulties. Moreover, in the years of struggle, the gap between the very rich minority and the poor majority has, if anything, widened. At this time of difficulties and opportunities, experience with a new kind of health care may help the country to reshape its future. Dental health is one of the worst provided areas of care. According to official estimates, up to 90% of adults in the lower social classes do not have a single healthy tooth, and even in children under ten years old half the teeth are defective. In 1987, a young Brazilian doctor arrived in El Salvador and initiated a scheme whereby young individuals (12-18 years old) from poor rural and urban marginal communities were to supply cheap and readily available dental help to their communities. Instruction in dental care theory and practical skills took only 3-4 months. The strategy was simple. The work was to be based in clinics equipped with simple apparatus put together from spare parts, or bought at low prices or provided via international aid; it was to be done by teams, with supervision by the "seniors", case discussion, and structured further training. The dental artisans were to remain full members of their communities, so that the way they used their resources would be clear to all; a subgroup of the more expert and committed artisans would have responsibility for training new recruits across the country; and support from visiting or invited professionals (mostly from abroad) would be welcomed, on the understanding that they would not interfere with the autonomous management of the system. This strategy, aimed at maximising independence, proved amazingly successful. Despite the early forced withdrawal of the promoter of the initiative (who was captured, tortured, and eventually banished from the country on charges of having set up "guerilla clinics"), over 200 dental artisans have now been trained. The turnover rate is low and drop-outs are rare; 12 clinics, each coordinating on average 6 decentralised dental units, have been established; a team of 10-12 "expert" community at
members is supervising the network. Each unit covers a population of about 10 000, providing each month about 4000 fillings, 1000 extractions, 2000 cleaning procedures, and 100 prostheses. "Clients" are asked to contribute little more than the cost of materials, so they pay one-tenth or less of the "official market" fees. Similar savings are also achieved for the equipment used: a high-speed dental drill costs about$70 compared with$500 on the regular market. Apart from the communities themselves, key support has come from various institutions, including the Catholic archdiocese of San Salvador. The community members of the project have formally established an association (Asociacion Promotora del Desarrollo Communitario para Centro America), which has gained respect in professional circles but has encountered strong opposition, not surprisingly, from dentists. Visiting professionals from the USA, France, and Switzerland have testified to the high quality of the care provided. In the past two years similar schemes have been started in Nicaragua, Guatemala, and
Honduras. The dental clinics of the communities in El Salvador have become training settings where university students go primarily to learn, rather than to grant some of their time to help. The project has illustrated how, by taking a hand in its own health services, a community gains not only in physical wellbeing but also in strength to face a risky future. Further information about the dental scheme can be had from Asociacion Promotora del Desarrollo Communitario para Centro America, apartado postal 01,183 San Salvador, El Salvador, or from me at Istituto di Ricerche Pharmacologische "Mario Negri", Via Eritrea 621, 20157 Milano, Italy.
Gianni
Tognoni
Germany: Unworkable gene technology legislation The cellars in the German Cancer Research Centre in Heidelberg must reserve space for the coming The reason? As with every other German research years. serum from all scientists or technicians who have institute, done gene technology experiments must be kept in a freezer at -70°C for 30 years. About 1500 people work at the DKFZ, and the high turnover of personnel will mean a huge demand for storage space over the years. The same storage rule applies to all the files on applications for gene technology experiments. "A huge storage graveyard with hardly any practical use", says Harald zur Hausen, head of the DKFZ, and he notes the huge costs of the exercise. These are only two of the demands imposed by Germany’s gene technology legislation, which has been heavily criticised by scientists. The law, which came into force in July, 1990, is now being scrutinised for changes. If the scientists have their way, bureaucracy will be reduced and the processing of applications will be streamlined, but if their opponents, the ecology pressure groups, succeed, experiments will be more restricted, even to the extent of a compulsory public discussion. Not all scientists are as open and straightforward in their criticisms as zur Hausen and his colleague Ernst Ludwig Winneker from Munich University. They spend a lot of time lecturing the public about gene technology and its enormous potential for medicine. Other scientists fear that such publicity will only provoke more protests against molecular biologists and their institutes, as has happened in the past. This public attitude stems from a fear of eugenic medicine, as practised by Nazi doctors, and from a confusion of reproductive medicine with gene technology.
(DKFZ)
companies. No matter. The few items that offend traditional sensibilities have hogged the news. Last fall, the White House suggested that it was time for Frohnmayer to leave, but he stayed on. Then, last month, Bush was badly stung in the New Hampshire primary by Pat Buchanan, the partly deodorised fascist of American politics. Going south for the next round of primaries, Buchanan accused Bush of "subsidising both filthy and blasphemous art"-serious words in church-going conservative territory. A few days later, the White House demanded Frohnmayer’s resignation. In a goodbye letter, the President credited him with integrity and decency, but protectively added that "some of the art funded by the NEA does not have my enthusiastic approval". Buchanan came back several days later with another pronouncement on the NEA: "When I get to be President, we’re going to shut that place down, then padlock it, and fumigate it". Daniel S.
Greenberg
Round the World WHO: Health and environment Coming generations, as well as this one, should surely thank the World Health Organisation for Our Planet, Our Health. The 22-member WHO Commission on Health and the Environment, set up two years ago, was invited to do a follow-up to the 1987 Our Common Future by the Brundtland Commission on environment and development, which itself had been linked to the 1980 Brandt Commission report on North/South issues. This latest report, published on March 4, is WHO’s main contribution to the UN Conference on Environment and Development, to be held in June in Rio de Janeiro. It is not likely to share the fate of so many UN conference documents-filed away and forgotten except by the few. On the contrary, it deserves to become the vademecum for all those, general public and experts alike, who are concerned with the future of the planet. The UN can find the funds, it is hoped, to ensure that a cheap, trimmed-down paperback version, in the main languages, soon becomes available. The 22 pages of the slim version (preface, summary, and annex 1), that WHO is now issuing free of charge does not do justice to the commission’s efforts. Reports of the four panels are being issued separately (as documents WHO/EHE/92.2-5). This book may well outperform Stephen Hawking’s A Brief History of Time on the non-fiction list. The report’s coverage of all aspects of the human predicament is down-to-earth, with graphic, even disturbing, illustrations of just how things are for most of the world’s 5000 million people. It shows what we are doing collectively-if no longer quite so unwittingly as in former years-to natural resources dependent on water, air, and soil. Given its two-year term, the commission had no opportunity to emulate the Brundtland procedure of inviting original submissions from several thousand people. Instead, it concentrated on presenting the quintessence of all information (carefully referenced and footnoted) available within UN agencies and from other bodies. The work was done by four panels, totalling some 80 people, on food and agriculture, energy, industry, and urbanisation. Heading the commission itself, which met only three times, was Simone Veil, member of the European
Parliament and former French Minister of Health. Not being a specialist in subjects the commission was covering, Mme Veil hesitated about accepting the appointment: "However, I realised there might be some advantage in entrusting this responsibility to someone who has no specific training in matters of environment and health, but with experience of seeking advice from specialists on technical questions in order to be able to reach fully informed decisions of a political order". While it is axiomatic that the more affluent "enjoy longer lives and better health than lower-income groups", the report also underlines-Mme Veil’s liberal (centre right) guiding hand?-the point that "countries with above-average health indicators relative to their per caput income level tend to be those with the most equitable distribution of income". It illustrates this with a table showing proportion of gross national product available to the poorest 40% of households and life expectancy. Top is Netherlands (22-4%, 77-2 years) followed by Japan (21-9%, 78-6 years). Britain is twelfth (18-5%, 75-7) and Peru (7%, 63) is at the bottom, just below Brazil (7%, 65-6). Introducing the report in Geneva, last week Dr Hiroshi Nakajima, director-general of WHO, noted that "An environmentally sound planet is wasted if the population is not healthy". "... protection of people now living must be first priority", he added and that meant focusing on reductions in population growth, overconsumption, and the generation of waste.
Alan
McGregor
Europe: Population concerns and demography come from the same root about the rights of individuals. European parliamentarians at a conference in London on Jan 31 and Feb 1 recommended that much more attention be given to international family planning so that a basic human freedom could be extended to hundreds of millions of the world’s citizens. The UK’s all-party Parliamentary group on population and development, which hosted the conference, has been active since 1979, and the gathering was attended by 38 parliamentarians from twenty European national parliaments and the European Parliament. The conference culminated in a European Agenda for Action on World Population. Recognising that global population is growing by 250 000 per day, the conference found convincing evidence that more and more people in developing countries did want smaller families; provided action were taken in the 1990s there was a real opportunity to contain the world’s population at 10 billion or less for the next century. The agenda was drafted by the parliamentarians after reviews of the current situation by Dr Nafis Sadik (UN under-secretary general and executive director, UN Population Fund), Dr Halfdan Mahler (secretary general, International Planned Parenthood Federation), and Prof Fred Sai (Ghana). Fertility is falling rapidly in many countries but there is a long way to go. The agenda deplores the fact that 1% or less of development assistance world wide is spent on population policies and family planning activities and that this proportion had dropped from 2% in the early 1970s. In response, the parliamentarians committed themselves to trying to persuade their governments to double their commitments by 1995, with a target of$4 billion a year by the year 2000. The relation between population and environmental problems was underscored by Joseph Wheeler, who is
Democracy
and both
are
606
director of the UN Conference
on
the Environment and
Development that is to be held in Rio de Janeiro later this year, and by Sir Crispin Tickell (warden, Green College, Oxford, and former UK representative at the UN). The conference did not play down the disproportionate contribution the industrialised nations make to environmental damage, but neither did it deny the importance of the threat of further population growth. A world with twice as many people would be pushing to the limit the capacity of the planet to sustain life and adjust to pollution-and a world with three times today’s population might damage irreversibly huge areas of the world. The agenda endorsed a Global Commission on Population, which would explore many aspects of population change in greater depth. This would be part of the preparation for the 1994 UN International Conference on Population and
Development. Malcolm Potts
El Salvador: Dental artisans On Jan 1, the UN Secretary-General Sr Perez de Cuellar, the end of his mandate, achieved an agreement between representatives of the FMLN (the guerilla liberation movement) and the Government to work for peace in 1992. With over 70 000 war casualties in the past ten years, and memories of the acts committed by death squads and by the army, reconciliation will present formidable difficulties. Moreover, in the years of struggle, the gap between the very rich minority and the poor majority has, if anything, widened. At this time of difficulties and opportunities, experience with a new kind of health care may help the country to reshape its future. Dental health is one of the worst provided areas of care. According to official estimates, up to 90% of adults in the lower social classes do not have a single healthy tooth, and even in children under ten years old half the teeth are defective. In 1987, a young Brazilian doctor arrived in El Salvador and initiated a scheme whereby young individuals (12-18 years old) from poor rural and urban marginal communities were to supply cheap and readily available dental help to their communities. Instruction in dental care theory and practical skills took only 3-4 months. The strategy was simple. The work was to be based in clinics equipped with simple apparatus put together from spare parts, or bought at low prices or provided via international aid; it was to be done by teams, with supervision by the "seniors", case discussion, and structured further training. The dental artisans were to remain full members of their communities, so that the way they used their resources would be clear to all; a subgroup of the more expert and committed artisans would have responsibility for training new recruits across the country; and support from visiting or invited professionals (mostly from abroad) would be welcomed, on the understanding that they would not interfere with the autonomous management of the system. This strategy, aimed at maximising independence, proved amazingly successful. Despite the early forced withdrawal of the promoter of the initiative (who was captured, tortured, and eventually banished from the country on charges of having set up "guerilla clinics"), over 200 dental artisans have now been trained. The turnover rate is low and drop-outs are rare; 12 clinics, each coordinating on average 6 decentralised dental units, have been established; a team of 10-12 "expert" community at
members is supervising the network. Each unit covers a population of about 10 000, providing each month about 4000 fillings, 1000 extractions, 2000 cleaning procedures, and 100 prostheses. "Clients" are asked to contribute little more than the cost of materials, so they pay one-tenth or less of the "official market" fees. Similar savings are also achieved for the equipment used: a high-speed dental drill costs about$70 compared with$500 on the regular market. Apart from the communities themselves, key support has come from various institutions, including the Catholic archdiocese of San Salvador. The community members of the project have formally established an association (Asociacion Promotora del Desarrollo Communitario para Centro America), which has gained respect in professional circles but has encountered strong opposition, not surprisingly, from dentists. Visiting professionals from the USA, France, and Switzerland have testified to the high quality of the care provided. In the past two years similar schemes have been started in Nicaragua, Guatemala, and
Honduras. The dental clinics of the communities in El Salvador have become training settings where university students go primarily to learn, rather than to grant some of their time to help. The project has illustrated how, by taking a hand in its own health services, a community gains not only in physical wellbeing but also in strength to face a risky future. Further information about the dental scheme can be had from Asociacion Promotora del Desarrollo Communitario para Centro America, apartado postal 01,183 San Salvador, El Salvador, or from me at Istituto di Ricerche Pharmacologische "Mario Negri", Via Eritrea 621, 20157 Milano, Italy.
Gianni
Tognoni
Germany: Unworkable gene technology legislation The cellars in the German Cancer Research Centre in Heidelberg must reserve space for the coming The reason? As with every other German research years. serum from all scientists or technicians who have institute, done gene technology experiments must be kept in a freezer at -70°C for 30 years. About 1500 people work at the DKFZ, and the high turnover of personnel will mean a huge demand for storage space over the years. The same storage rule applies to all the files on applications for gene technology experiments. "A huge storage graveyard with hardly any practical use", says Harald zur Hausen, head of the DKFZ, and he notes the huge costs of the exercise. These are only two of the demands imposed by Germany’s gene technology legislation, which has been heavily criticised by scientists. The law, which came into force in July, 1990, is now being scrutinised for changes. If the scientists have their way, bureaucracy will be reduced and the processing of applications will be streamlined, but if their opponents, the ecology pressure groups, succeed, experiments will be more restricted, even to the extent of a compulsory public discussion. Not all scientists are as open and straightforward in their criticisms as zur Hausen and his colleague Ernst Ludwig Winneker from Munich University. They spend a lot of time lecturing the public about gene technology and its enormous potential for medicine. Other scientists fear that such publicity will only provoke more protests against molecular biologists and their institutes, as has happened in the past. This public attitude stems from a fear of eugenic medicine, as practised by Nazi doctors, and from a confusion of reproductive medicine with gene technology.
(DKFZ)