Good Health and Well-Being

Acquired immunodeficiency syndrome (AIDS) is the late clinical stage of infection with the human immunodeficiency virus (HIV). The first AIDS case in China was reported in 1985. By 1998, new HIV infections had spread to all provinces, autonomous regions and municipalities. It has been estimated that HIV/AIDS prevalence among adults rose from less than 0.002 per cent (10,000 cases) in the period 1990-1995 to about 0.2 per cent (1 million cases) in the period 2000-2001 (UNAIDS China, 2002; WHO, 2001). While the rate is still low in comparison with some other affected countries, there is no indication that the spread of HIV/AIDS in China will be controlled or will slow down in the near future (Zeng, 2001; UNAIDS and WHO, 2002).

Thai people’s life expectancy has risen from 59 to 72 years between 1964 and 2005 (Prasartkul and Vapattanawong, 2005), while the proportion of persons aged 60 years and over in Thailand has been dramatically increasing, from 4.6 per cent in 1960 to 9.5 per cent in 2000 (National Statistical Office (NSO), 1960 and 2000). It is expected that Thailand will face a “population ageing” crisis in the year 2017, when older persons will constitute approximately 14 per cent of the total population, an increase from 7 per cent in 1987 (Jitapunkul, 2000). In other words, the percentage of older persons will double within 30 years and will further increase to 25 per cent of the total in 2035, based on a recent population projection done by the Institute for Population and Social Research, Mahidol University (2006). This means that Thailand has only a relatively short time to prepare to respond to the various challenges brought about the greying of its population and in particular issues related to the health, welfare, housing and long-term care of older persons.

Every country in the Asian and Pacific region is in the midst of a demographic transition that is producing large changes in age structure with important implications for economic growth and standards of living. In the early stages of the transition, high fertility and declining infant and child mortality produce a bulge in the population at young ages. The middle of the transition is marked by an increase in the share of the population concentrated at the working ages as large cohorts of children reach adulthood and as the relative number of children are depressed by fertility decline. At the end of the transition, the share of the older population increases. In part, this is a consequence of continued reductions in mortality rates, but of greater consequence are the low fertility rates that characterize the final stages of the demographic transition.

As the result of a rapid decline recently in fertility levels, Viet Nam has largely completed the transition to low fertility. The total fertility rate (TFR) estimated in the 1999 Census was 2.3 children per woman. Previous demographic surveys indicated TFRs of 4.0 in 1987 (Viet Nam Demographic and Health Survey - VNDHS-I), 3.3 for the period 1989-1993 Intercensal Demographic Survey (ICDS 1994), and 2.5 for 1996-1997 Viet Nam Demographic and Health Survey (VNDHS-II). As might be expected, the rapid fertility decline in Viet Nam reflects the significant growth of contraceptive use. VNDHS II data indicate that the all method contraceptive prevalence rate (CPR) had reached 75 per cent by 1997 and the modern method rate 56 per cent.

Since the late 1970s, the Chinese Government has promoted the "one couple, one child" population policy to slow the rate of population growth. Couples with one child are encouraged to apply for a one-child certificate that is offered nationwide for those applicants who have signed a contract with a local family planning agency promising to have only one child. In return, they receive a monetary bonus and preferential assignment of housing and employment. Chen (1985:55) found that a total of 42 per cent of women with one child in the 1982 One-per-Thousand Population Fertility Sampling Survey had obtained a certificate; 78 per cent of those were in urban areas and 31 per cent resided in rural areas.

Structural changes necessitated by population ageing may demand a greater share of expenditure from the Government

Since the Second World War, censuses have been held in the Republic of Kiribati in 1947, 1963, 1968, 1973, 1978, 1985 and 1990. This paper presents an analysis of the 1985 census and compares projections made on the basis of that analysis with the 1990 enumeration. Comparison is made throughout with the estimates derived from 1978 census.

By enlisting the aid of the traditional authorities attending deliveries, important health messages for new mothers might be reinforced.

India is fast becoming a graying society as a result of its upcoming prospect to achieve an accelerating growth in the size of its ageing population. Two causal factors are: (a) a varying but persistent fertility-mortality decline across the country, and (b) added lifespan with increased survival chances, especially at the later end of the life cycle. Those changes, and in particular the added life years, have, however, been mired in the high prevalence of chronic diseases, affecting over half of the country’s population aged 60 and over (NSS 52nd round, 1995-1996). Such a situation - coupled with large-scale poverty and the poor financial status of the older persons (Alam, 2004) - is likely to pose many serious issues for the country. One of the more critical may indeed be the higher incidence of frailty, senescence, functional incapacitation and dependence of older men and women in activities of daily living (ADL) – raising questions for the caregivers, especially the families. With large-scale migration, declining family size and growing participation of women in economic activities, this traditional support mechanism is apparently on the verge of losing its sheen. Somewhat inexplicably, this aspect has been almost completely missed in the analytical literature on health and ageing in India. The analysis presented below is therefore a modest attempt to fill some of this void by looking into the following.

Since the end of the Second World War, the international migration of labour has grown in volume and changed in character (Castles and Miller, 1998). It has also been observed that there are two main phases in post-Second World War migration (Castles and Miller, 1998, p.67). In the first phase, from 1945 to the early 1970s, large numbers of migrant workers were drawn from less developed countries into the fast-expanding industrial areas of Western Europe and North America. However, the organized recruitment of migrant workers by industrialized countries ended in the early 1970s owing mainly to the fundamental restructuring of the global economy and the politicization of migration (Castles, 2001). The second phase began in Asia in the mid-1970s. The phenomenal rise in oil prices since the end of 1973 generated a huge demand for temporary migrants in Middle Eastern countries. This massive demand for temporary migrants resulted in an enormous flow of labour to oil-rich Arab countries. In addition, since the mid-1980s the demand for temporary migrants grew in the prosperous countries of East and South-East Asia and a large number of migrants migrated to these countries for temporary employment. Bangladeshi migrants are found in both destinations.

Many developed countries across the world have populations that are rapidly ageing. In East and South-East Asia, Singapore, together with Japan, the Republic of Korea and Thailand, has the fastest growing 65 years and older population (Westley, 1998: 1; Gubhaju, 2003: 3). While Japan has doubled its proportion of elderly persons from 10 to 20 per cent over 28 years, Singapore will reach this demographic leap in 17 years. In 2003, 7.6 per cent of the Singapore population was over 65 years of age (Ministry of Community Development and Sports (MCDS)**, 2004a). Owing to improved health care, health insurance and socio-economic conditions, life expectancy has increased in Singapore with large numbers of people from the pre-war baby boom era surviving into their 60s and forming the country’s growing elderly population. According to estimates for 2004, life expectancy at birth for men stands at 76.9 of age and for females at 80.9 (Department of Statistics, 2004). As such, demographers have attested to Singapore having the fastest ageing population in the world (Ogawa, 2003: 95-96; Mehta and Vasoo, 2001: 186; ESCAP, 2002); it has been projected that its ageing population is growing at an unprecedented rate of 3.7 per cent annually (MCDS, 2004b), with the oldest-old cohort (aged 85 and above) growing the fastest (Chan, 2001: 3).

China currently is the country with the largest population in the world. The Fifth National Population Census in 2000 reports that the total population of mainland China stands at 1.27 billion (Zhuang and Zhang, 2003), while the 1 Percent National Population Sample Survey (mini-census) carried out in November 2005 reports the total population to be at 1.31 billion (National Statistics Bureau (NSB), 2006).1 China is also the country with the most stringent and government-directed family planning programme and fertility policy, having experienced a dramatic decline in fertility from 5 to 6 children per woman in the 1950s to less than 2 in recent years. The 2000 census reports China’s total fertility rate (TFR) to be at 1.4 (NSB, 2003). The rapid changes occurring in China’s population dynamics call for a review of the fertility transition in China in terms of trends, policy and impact. This article will first discuss the population dynamics ongoing in China in terms of growth, birth rate and fertility and then examine the fertility policy implemented by the Government of China, before exploring the impact of fertility decline in terms of population ageing, gender equality, sex ratio at birth and labour supply.

In the 1960s, demographers projected that the world’s population would reach 16 billion people by 2050, if the then very high fertility rates in most countries were not brought under control. Today, the projected population in 2050 is around 9 billion. This reduction of the world’s population by 7 billion people from what might have been is one of the most remarkable but least heralded achievements of humankind. Most of the success, in numerical terms, can be attributed to falls in birth rates in Asian countries. In China alone, if fertility had remained at its late 1970s, relatively low level of 2.6 births per woman, the Chinese population in 2050 would be 1 billion more than is now projected.

Death is a major factor affecting a country’s population structure. Evidence shows that death rates tend to decrease continuously and rapidly as a consequence of continued improvements in medical care and the public health system along with socio-economic development. Infant, child and maternal mortality are, therefore, often used as indicators, reflecting the effectiveness of the public health system and improvements in the quality of life. In Thailand, such improvements have been evident. From 1964-1965 to 1995-1996, male and female life expectancy at birth increased from 59.9 to 69.9 years and 62 to 74.9 years, respectively.

This article discusses the 23-year history of the Cebu Longitudinal Health and Nutrition Survey (CLHNS), which was started in 1983 in collaboration with the Carolina Population Center of the University of North Carolina at Chapel Hill (CPC-UNC), the Office of Population Studies of the University of San Carlos (OPS-USC) and the Nutrition Center of the Philippines (NCP). After briefly presenting information on its origins and development in this introductory section, the methodologies and strategies used in the research and some of its major findings and contributions are discussed, before analysing the challenges and lessons learned from the study. The article ends by identifying some best practices and offering some recommendations for other longitudinal studies.

Increasing attention is being paid to the collection of longitudinal data. This attention is, in part, a response to the difficulties faced in establishing causal relations with cross-sectional data. However, the collection and use of longitudinal data has brought with it a series of challenges that are not faced by researchers manipulating cross-sectional data. In this article we describe how initial data management models, based on cross-sectional data storage and manipulation used in the Kanchanaburi Demographic Surveillance System (KDSS), were found to be inadequate and were replaced by a database system that is consistent with longitudinal data collection, storage and manipulation.

Finally, at the turn of the century and after decades of stagnancy, there was definite evidence of a decline in fertility in Pakistan. Fertility in Pakistan probably began to decline in the early 1990s or even in the late 1980s. Significantly, all estimates for the 1990s for the first time fell below 6.0 births per woman to a little less than five. This is in contrast to numerous surveys that indicated that the TFR remained above six births per woman in the 1980s. Furthermore the last census held finally in 1998, indicated that the average population growth rate for the period 1981-1998 was 2.6 per cent per annum, a decline from previous intercensal rates, consistent with a decline in fertility in the 1990s. While this trend in fertility decline has continued even touted as one of the “fastest declines in Asia” (Feeney and Alam, 2003) the latest Pakistan Demographic and Health Survey (PDHS) indicates a stall in fertility at four children per woman.

My name is Jacque, I come from Fiji and I am 23 years of age. In addition to being a university student I have been a youth advocate/volunteer for several years now in different capacities. I would first like to congratulate all the players driving the ICPD agenda – I can imagine that the process has not been an easy one, trying to translate recommendations into actions and ensuring that those actions have an impact on the ground. Today’s review, 15 years after the adoption of the ICPD Programme of Action really displays commitment and perseverance of the people and organizations driving the ICPD agenda. As a peer of mine back home used to say – we need to “walk on, walk strong”. Walk on, walk strong.

India embarked on its new economic policy, popularly known as the liberalization of the Indian economy, in 1991. The basic features of the new economic policy were a reduction in government expenditures in order to reduce fiscal deficit, an opening up of the economy for export-oriented growth, the removal of government control and licensing, and a push for private participation to enhance competition and efficiency. Both supporters and critics of the new economic policy believed that economic reforms would increase internal migration. Proponents believed that the new impetus would boost the economy and job opportunities, leading to increased pull factors conducive to accelerated rural-to-urban migration. By contrast, the opponents of this policy were of the view that economic reforms would adversely affect the village and cottage industries and impoverish rural populations, leading to increased rural-tourban migration (Kundu, 1997). Although there was considerable success in achieving economic growth, from 2 to 3 per cent of growth in gross domestic product in the pre-reform era to over 6 per cent during the period 1991-2001, the impact of this enhanced growth on internal migration in general and rural-to-urban migration, in particular, has not been assessed. The latest census of 2001 reveals several interesting results in relation to internal migration, its regional pattern and the contribution of rural-to-urban migration to urban growth, as discussed by Bhagat and Mohanty (2009). They argue that the push factor has not significantly influenced internal migration. As a result, it appears inaccurate to state that the poor and disadvantaged are migrating more than those that are more well off.

Despite their importance, longitudinal methods of data collection are complex, time-consuming and expensive. With longer periods of observation, the problems of population movement and loss to follow-up become important. This is particularly the case in developing countries with high rates of rural-to-urban migration and residential mobility within major urban centres. A more practical alternative involves repeated data collection on well-defined communities on a regular monthly or annual basis. Combining such data-gathering exercises with a practical programme of intervention or service delivery can justify the expense involved and ensure the viability of the project.

The Pacific region is comprised of 22 island countries and territories - featuring some 7,500 islands of which around 500 are inhabited-spread over an area of 30 million square kilometres and stretching from the Northern Marianas Islands in the north-west Pacific Ocean to Pitcairn in the south-east. Representing an enormous diversity in physical geography and culture, languages and socio-political organization, size and resources endowment, some countries and areas such as Nauru and Niue, consist just of one coral island, whereas others, like Papua New Guinea and the Federated States of Micronesia comprise literally of hundreds of islands. Melanesia comprise large, mountainous and mainly volcanic islands, endowed with natural resources, rich soil and an abundant marine life. Micronesia and Polynesia, by contrast, comprise of much smaller islands and their natural resources are limited to the ocean; they mostly comprise of small atolls with poor soil, with elevations usually between one and two metres (Kiribati, Marshall Islands, Tokelau and Tuvalu). There are also some islands of volcanic origin with more fertile lands (such as Samoa, Tonga, the Federated States of Micronesia and the Cook Islands).

Reliable and timely information is a central pillar of well-functioning health systems. In fact, much of the progress in improving human health is “due to technical progress, including advances in knowledge about diseases and about appropriate, cost-effective responses” (Jamison and others, 2006; p. 155). Developing health technology requires sound research and the precise information that is needed for gauging the efficacy of interventions. Moreover, comprehensive sociodemographic and health information is needed to guide policy deliberations. The need for such information is particularly acute in developing countries because policy that lacks empirical grounding can be more damaging to public welfare in such settings than is the case in relatively prosperous countries where the public enjoys multiple service options and individuals have resources for financing personal choices.

It is now mid-2008, just seven years away from 2015, the target year for the realization of the International Conference on Population and Development (ICPD) Programme of Ac tion and the eight Millennium De velopment Goals.