1
819 unsorted data and besieged by requests for information. No systematic mechanism existed for the exchange of informa- tion ; and the measures taken, though adequate to prevent any short-term risk to public health, were uneven and inconsistent. Public confidence suffered a serious blow, yet the number 4 reactor at Chernobyl had lost only 3-5% of its radioactivity content. As Ian Waddington, the director of the European region’s environmental health service pointed out, 25 countries, at various stages of socioeconomic development, now pro- duced nuclear power commercially. Yet the philosophy of radiation protection and the fixing of exposure levels had been derived from studies of evidence from the Hiroshima and Nagasaki explosions. It was time for a review. Environ- mental monitoring had not been well integrated: it was uneven and the data were inconsistent. There was con- siderable confusion in the scientific units used and in methods of expressing radiation doses. Epidemiology had a vital role to play in relation to residential areas adjoining nuclear installations. The importance of negative findings should not be overlooked. An early meeting of experts would review priorities for a thorough epidemiological follow-up and establish guideline protocols. There would also be a detailed study of trends in relation to food chains and their potential impact on public health. JILL TURNER Medical Association for Prevention of War The Medical Needs of Africa AT the Association’s conference in London on Sept 28, organised jointly with the United Nations Association, Dr Maurice King, formerly professor of social medicine in Zambia and now senior lecturer in community medicine at the University of Leeds, quoted the Archbishop of Sao Paulo: "The problem is not between capitalism and communism. We are not in an ideological struggle between East and West. We are hungry, we are ill, we are homeless, we are illiterate. We want our children to be nourished in mind and body." Dr King went on to pose several questions. Was UNICEF’s optimistic view on progress in child health care justified? What would be the outcome of its child survival revolution? Would it lead to an acceptable quality of life for the survivors or would it condemn them to poverty and malnutrition? He predicted a population crash as a result of the destruction of the ecosystem and an inability to support the rapid population expansion. Child survival by itself would not lead to a tolerable life, but, possibly, to an increase in the sum of misery. We needed a broader vision than any so far provided. Prof David Morley, head of the tropical child health unit at the Institute of Child Health, London, spoke of the needs of African children. Whereas 75 % of the world lived in the South, they received only 6 % of the world’s health expenditure. The South has five times as many children, yet only 11 % of what the world spends on education is available to them. An experiment in Cali, Colombia, had convinced him that to attain full development, physical and mental, the child needed not only health care but also adequate nutrition and educational stimulation. He made no confident predictions on the attainment of WHO’s aim of Health for All by 2000, but he suggested that much improvement could spring from wise policies and a change in political will. Politicians needed to be informed, preferably with the help of fewer words and more copious illustrations of suffering children. Dr George Cumper, senior lecturer in health economics, London School of Hygiene and Tropical Medicine, discussed the resources needed for basic health care, including basic hygiene, education, and the provision of safe water. He chose a modest target of health care, aimed to achieve a minimum level of health, as also envisaged in WHO’s proposals for Health for All by 2000. That target was an infant mortality rate of 50 per thousand. He calculated that, as a minimum, recurrent spending on health, sanitation, and education will need to increase by US$38 billion a year by the year 2000; and additional capital expenditure of US$75 billion would be needed during the period to 2000. In relation to the aggregate national income of the developed countries, these sums were not vast. The shortfall in hospital beds, physicians, and health workers in southern Africa was very great and the resource gap could be calculated. As for international assistance of all kinds, Dr Cumper thought that short-term emergency aid had been reasonably effective; medium-term aid was largely insufficient and poorly organised; and long-term assistance had so far been inadequate, erratic, and inconsistent. A rational integrated system might seem a remote prospect, but it could lead to a better distributed, more predictable, and higher level of world economic activity, which might do more for the improvement of health than any specific intervention. Miss Margaret Pollock, principal nursing and health services adviser, Overseas Development Administration, described assistance provided by the UK. It was clear that the principles guiding her department were progressive and constructive and in line with recent thinking in WHO and UNICEF. Many useful projects had been supported and the presence at the meeting of several nurses from Charing Cross Hospital, London, who had taken part in work in Africa funded by the ODA, testified to this progress. Spending by the ODA had been wisely directed, but the conference questioned the volume of aid. Did it match the vast need? A paper written by Dr Saadet Deger, economic and social research fellow, Birkbeck College, London, and read in her absence, due to illness, by Dr Sumnath Sen, a colleague and collaborator in her academic work, dealt with the possible transfers from military expenditures to health care. She emphasised the now accepted link between disarmament and development. Although defence spending may result in some economic benefits in some countries, it could be shown that on average it had a negative effect. But disarmament, by itself, will not necessarily mean that resources will be channelled to useful purposes, such as health care. Institutions and mechanisms had to be fashioned to achieve that end. She believed it was wishful thinking to plan the total satisfaction of minimal health needs, but a partial approach was realistic and could be achieved by modest transfers. The French proposal for an International Disarmament and Development Fund was discussed. A 1 % tax on defence expenditure would raise about$10 billion a year, sufficient to fund the partial approach to health care. The conference supplied valuable information and original ideas for anyone interested in pursuing the discussion and planning action. Copies of the papers will be available from the MAPW office (16B Prince Arthur Road, London NW3 6AY). International Diary 1987 Conference on Immunology and the Clinical Practice of Allergy: San Diego, California, Feb 11-14 (Dr R. N. Hamburger, UCSD/M009D, La Jolla, California 92093, USA). International conference on Childbearing and Perinatal Car Implications for Childbirth Education: Jerusalem, Israel, March 22-26 (Atzeret Ltd, 29B Keren Hayesod Street, PO Box 3888, Jerusalem 91037). 1 lth meeting of the International Association of Forensic Sciences: Vancouver, British Columbia, Aug 2-7 (International Association of Forensic Sciences, Suite 801, 750 Jervis Street, Vancouver, BC, Canada V6E 2A9). 4th European Conference on Clinical Oncology and Cancer Nursing: Madrid, Spain, Nov 1--4 (4th European Conference on Clinical Oncology and Cancer Nursing, Siasai Congresos, Paseo de la Habana 134, 28036, Madrid, Spain). International symposium on Toxic Shock Syndrome: Atlanta, Georgia, Nov 16-17 (TSS Program Committee, Joan B. Daniels, 180 Longwood Avenue, Boston, Massachusetts, 02115, USA).

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819

unsorted data and besieged by requests for information. Nosystematic mechanism existed for the exchange of informa-tion ; and the measures taken, though adequate to preventany short-term risk to public health, were uneven andinconsistent. Public confidence suffered a serious blow, yetthe number 4 reactor at Chernobyl had lost only 3-5% of itsradioactivity content.As Ian Waddington, the director of the European region’s

environmental health service pointed out, 25 countries, atvarious stages of socioeconomic development, now pro-duced nuclear power commercially. Yet the philosophy ofradiation protection and the fixing of exposure levels had beenderived from studies of evidence from the Hiroshima and

Nagasaki explosions. It was time for a review. Environ-mental monitoring had not been well integrated: it wasuneven and the data were inconsistent. There was con-siderable confusion in the scientific units used and inmethods of expressing radiation doses. Epidemiology had avital role to play in relation to residential areas adjoiningnuclear installations. The importance of negative findingsshould not be overlooked. An early meeting of expertswould review priorities for a thorough epidemiologicalfollow-up and establish guideline protocols. There wouldalso be a detailed study of trends in relation to food chainsand their potential impact on public health.

JILL TURNER

Medical Association for Preventionof War

The Medical Needs of Africa

AT the Association’s conference in London on Sept 28, organisedjointly with the United Nations Association, Dr Maurice King,formerly professor of social medicine in Zambia and now seniorlecturer in community medicine at the University of Leeds, quotedthe Archbishop of Sao Paulo: "The problem is not between

capitalism and communism. We are not in an ideological strugglebetween East and West. We are hungry, we are ill, we are homeless,we are illiterate. We want our children to be nourished in mind and

body." Dr King went on to pose several questions. Was UNICEF’soptimistic view on progress in child health care justified? Whatwould be the outcome of its child survival revolution? Would it leadto an acceptable quality of life for the survivors or would it condemnthem to poverty and malnutrition? He predicted a population crashas a result of the destruction of the ecosystem and an inability tosupport the rapid population expansion. Child survival by itselfwould not lead to a tolerable life, but, possibly, to an increase in thesum of misery. We needed a broader vision than any so far provided.Prof David Morley, head of the tropical child health unit at the

Institute of Child Health, London, spoke of the needs of Africanchildren. Whereas 75 % of the world lived in the South, theyreceived only 6 % of the world’s health expenditure. The South hasfive times as many children, yet only 11 % of what the world spendson education is available to them. An experiment in Cali, Colombia,had convinced him that to attain full development, physical andmental, the child needed not only health care but also adequatenutrition and educational stimulation. He made no confident

predictions on the attainment of WHO’s aim of Health for All by2000, but he suggested that much improvement could spring fromwise policies and a change in political will. Politicians needed to beinformed, preferably with the help of fewer words and more copiousillustrations of suffering children.Dr George Cumper, senior lecturer in health economics, London

School of Hygiene and Tropical Medicine, discussed the resourcesneeded for basic health care, including basic hygiene, education,and the provision of safe water. He chose a modest target of healthcare, aimed to achieve a minimum level of health, as also envisaged

in WHO’s proposals for Health for All by 2000. That target was aninfant mortality rate of 50 per thousand. He calculated that, as aminimum, recurrent spending on health, sanitation, and educationwill need to increase by US$38 billion a year by the year 2000; andadditional capital expenditure of US$75 billion would be neededduring the period to 2000. In relation to the aggregate nationalincome of the developed countries, these sums were not vast. Theshortfall in hospital beds, physicians, and health workers insouthern Africa was very great and the resource gap could becalculated. As for international assistance of all kinds, Dr Cumperthought that short-term emergency aid had been reasonablyeffective; medium-term aid was largely insufficient and poorlyorganised; and long-term assistance had so far been inadequate,erratic, and inconsistent. A rational integrated system might seem aremote prospect, but it could lead to a better distributed, morepredictable, and higher level of world economic activity, whichmight do more for the improvement of health than any specificintervention.

Miss Margaret Pollock, principal nursing and health servicesadviser, Overseas Development Administration, describedassistance provided by the UK. It was clear that the principlesguiding her department were progressive and constructive and inline with recent thinking in WHO and UNICEF. Many usefulprojects had been supported and the presence at the meeting ofseveral nurses from Charing Cross Hospital, London, who hadtaken part in work in Africa funded by the ODA, testified to thisprogress. Spending by the ODA had been wisely directed, but theconference questioned the volume of aid. Did it match the vastneed?A paper written by Dr Saadet Deger, economic and social

research fellow, Birkbeck College, London, and read in her

absence, due to illness, by Dr Sumnath Sen, a colleague andcollaborator in her academic work, dealt with the possible transfersfrom military expenditures to health care. She emphasised the nowaccepted link between disarmament and development. Althoughdefence spending may result in some economic benefits in somecountries, it could be shown that on average it had a negative effect.But disarmament, by itself, will not necessarily mean that resourceswill be channelled to useful purposes, such as health care.

Institutions and mechanisms had to be fashioned to achieve thatend. She believed it was wishful thinking to plan the totalsatisfaction of minimal health needs, but a partial approach wasrealistic and could be achieved by modest transfers. The Frenchproposal for an International Disarmament and DevelopmentFund was discussed. A 1 % tax on defence expenditure would raiseabout$10 billion a year, sufficient to fund the partial approach tohealth care.The conference supplied valuable information and original ideas

for anyone interested in pursuing the discussion and planningaction. Copies of the papers will be available from the MAPW office(16B Prince Arthur Road, London NW3 6AY).

International Diary1987

Conference on Immunology and the Clinical Practice of Allergy:San Diego, California, Feb 11-14 (Dr R. N. Hamburger, UCSD/M009D,La Jolla, California 92093, USA).

International conference on Childbearing and Perinatal CarImplications for Childbirth Education: Jerusalem, Israel, March 22-26(Atzeret Ltd, 29B Keren Hayesod Street, PO Box 3888, Jerusalem 91037).

1 lth meeting of the International Association of Forensic Sciences:Vancouver, British Columbia, Aug 2-7 (International Association ofForensic Sciences, Suite 801, 750 Jervis Street, Vancouver, BC, Canada V6E2A9).

4th European Conference on Clinical Oncology and Cancer Nursing:Madrid, Spain, Nov 1--4 (4th European Conference on Clinical Oncologyand Cancer Nursing, Siasai Congresos, Paseo de la Habana 134, 28036,Madrid, Spain).

International symposium on Toxic Shock Syndrome: Atlanta, Georgia,Nov 16-17 (TSS Program Committee, Joan B. Daniels, 180 LongwoodAvenue, Boston, Massachusetts, 02115, USA).