Good Health and Well-Being

The Plan of Action on Population and Poverty, adopted in Bangkok in December 2002 by the members and associate members of the Economic and Social Commission for Asia and the Pacific (ESCAP), recognized that there remained major challenges in the areas of population, sustainable development and poverty; migration; ageing; gender; reproductive health including the need of adolescents; HIV and AIDS; and resource mobilization. They committed themselves to address these issues.

Over the past few decades, the world population has been ageing at a phenomenal pace. Some demographers claim that population ageing in the twentieth century represents a human success story, and that for the first time in the history of mankind, human populations have the luxury of ageing (Kinsella and Velkoff, 2001).

Different studies on variations of cause-specific mortality provide different policy implications and suggestions. Some findings mirror existing health care and services. Costantini and others (2000) concluded that differences in proportions of cancer patients dying at home across 13 provinces in Italy could not be explained by the known determinants, suggesting inappropriate hospital admission in the terminal phase of cancer. A study on geographical variations in breast cancer mortality in older American women by Goodwin and others (2002) suggested ways to improve the quality of breast cancer care. Some studies suggest further research in specific areas.

The rapid decline of fertility in China during the 1970s coincided with a rapid rise in the educational attainment of Chinese women. This coincidence raises questions about the role and importance of educational change in China’s fertility decline, which this article attempts to answer.

Information plays a critical role in changing people’s and Governments’ attitudes about population issues. Because information is considered one of the pillars upon which the success of population policies and programmes is based, the United Nations Economic and Social Commission for Asia and the Pacific (ESCAP) made it a priority area of its population activities since the formation of its Clearing-house and Information Section as part of the Population Division.

Worldwide, stigma and discrimination have been identified as tremendous barriers to addressing the HIV/AIDS epidemic, beginning with Jonathan Mann in the 1980s (Mann, 1987), and by others (UNAIDS, 2001, 2008; Reidpath, Brijnath and Chan, 2005; APN+, 2004). Stigma was defined by Goffman (1963) nearly half a century ago as a discrediting attribute about an individual or group that serves to devalue that person or group in the eyes of the society. More recent theoretical frameworks suggest that stigmatization and discrimination are manifest in a number of contexts, including within families, communities, schools, employment, travel/ migration opportunities, health-care settings and HIV/AIDS programmes (Parker and Aggleton, 2002), and in religion and the media (Malcolm and others, 1998). A study in four countries in Asia found pervasive discrimination, with 80 per cent of respondents having experienced AIDS-related discrimination, including nearly one in five facing discrimination within their families and in their workplaces (APN+, 2004). In a review of interventions to reduce HIV/AIDS stigma, Brown, MacIntyre and Trujillo (2003) noted that stigma affects prevention behaviours, test-seeking, care-seeking, quality of care provided to positive clients, and perceptions and treatment of people living with HIV and AIDS by communities and families. Parker and others (2002) contend that HIV/AIDS-related stigma is often layered upon other stigma, for example, the one associated with engaging in illegal behaviour, such as sex work and drug use. Furthermore, families with HIV-positive members often face stigma from the community. In order to combat stigma and the associated discrimination, it is important to understand the knowledge, beliefs and attitudes and how they vary across groups within a country. Such knowledge is critical for designing interventions to reduce stigma and discrimination.

One of the dramatic demographic changes that is taking place, in both developing and industrialized countries, is the increasing proportion of elderly (people 60 years of age and above) in the total population.

While health care is accorded priority by Asian and Pacific countries in addressing the rapid ageing of their populations, only some include long-term care as part of a continuum of care available in institutional and non-institutional settings with formal and informal caregivers. Measures for avoidable (preventive and amenable) mortality contribute towards preventive long-term care. The delivery of health care by health professionals, allied health professionals and auxiliary care workers is discussed in this review, with examples of the training of nurses and social workers to show the range and variety of training available in the region. Caregiving is increasingly undertaken by migrant domestic and care workers and by volunteer health workers, often as part of community organizations. Institutional care is often perceived as abandonment and de-institutionalization is thus pursued as an “asset-light” policy option. But it should be supported as ageing-in-place, community-based services and platforms, with the integration of health and social care, innovative approaches for engagement and participation, and technology, all of which require trained human resources with the necessary skills and competencies. Other measures to strengthen care provision and support to older persons include expanding filial piety to social piety, changing mindsets and combating ageism for social solidarity and collective responsibility. It also includes measurement and monitoring mechanisms for accountability and course correction.

The International Union for the Scientific Study of Population (IUSSP) held its Twenty-first International Population Conference at New Delhi from 20 to 27 September 1989. The Conference, which was organized at the invitation of the Indian Association for the Study of Population (IASP), was opened by India’s Prime Minister Rajiv Ghandi.

The 1988 Viet Nam Demographic Survey was the first country-wide demographic survey of Viet Nam. The sample was drawn according to the sample design recommended by the World Fertility Survey (WFS). It was a three-stage random probability sample of 4,800 households in 12 provinces and 151 communes.

Probably the most important demographic development to occur during the last quarter century has been the onset of fertility decline in a number of third world countries. While most Sub-Saharan African countries as well as a number in the Middle East and West Asia have yet to participate in this phenomenon, fertility in countries elsewhere in Asia and in much of Latin America has started down a path towards levels far lower than have ever prevailed in their modern histories. Given that mortality declines preceded the fall in fertility, and that most of these populations have been experiencing unprecedented rapid population growth rates at levels that would lead to extraordinary numbers of people in just decades, most observers concerned with population matters view the onset of fertility decline as a logical and welcome development.

Despite the well-documented benefits of breast-feeding for both infant and mother, breast-feeding has, until recently, been given little support. World Health Organization data (WHO, 1981) support the conclusion that, as countries undergo socio-economic development, there is a tendency for the incidence of breast-feeding to decline (Kent, 1981). Many factors contribute to such changes in breast-feeding behaviour. Whilst urbanization and industrialization have been associated historically with declines in breast-feeding (and indeed still appear to be in certain developing countries), the proportion of mothers now returning to breast-feeding in some industrialized countries, e.g. Sweden and the United States of America, is increasing.

Fertility behaviour is determined mainly by the characteristics of individuals, but also by social, cultural, community and institutional factors. The primary aim of this article is to investigate the influence of social and economic institutions on fertility and contraception.

This review examines telemedicine practices, which are separated into teleconsultations and telemonitoring, that have applied information and communication technologies (ICT) for the delivery of health-care services to older persons in the Republic of Korea, Japan, Australia and China. The practices featured from the Republic of Korea and Japan are telemedicine pilot projects to manage chronic disease patients more efficiently and at lower cost. The projects included a health management curriculum, with emphasis on nutrition and exercise guidance. The participants in each pilot project found the services to be helpful in managing their health; the project evaluation findings also indicated several meaningful medical improvements. In Australia, a Home Monitoring of Chronic Disease for Aged Care Project was designed in 2014 to manage ageing patients with chronic diseases at home through various telemedicine devices. In China, the Ningbo Cloud Hospital was established in 2015 to control increasing health-care expenses and to resolve difficulties for individuals to see a doctor. More than 2,000 patients are now registered for online video consultations and prescriptions. The featured examples illustrate how the application of telemedicine to a health-care system not only promotes accessibility between doctors and patients but can save on construction costs for new facilities and the cost of supplying medical personnel in remote areas, which thus can help reduce national medical expenses. However, to initiate ICT-based health-care service delivery, governments in Asia and the Pacific need to first establish related policies that promote telemedicine.

Singapore is one of the first Asian countries to have adopted a vigorous population programme as part of its socio-economic development strategy. In 1966, when the Singapore Government established the Singapore Family Planning and Population Board (SFPPB) to offer family planning services and to disseminate the small family norm, the population was growing at about 2 per cent per year and the total fertility rate (TFR) stood at 4.7. Having just separated from Malaysia, Singapore was trying hard to gain a firm political and economic footing. The withdrawal of foreign military personnel based in Singapore further aggravated the unsettling economic base. The need to curb rapid population growth was obvious, and population control was viewed as critical in balancing the available economic resources with the demands of an increasing population.

With the development of its family planning programme, China has achieved great success since the 1970s in slowing the growth of its population. This is evident in the rapid decline in fertility: the total fertility rate (TFR) declined from the 1960s average of 5.68 to 4.0 in the 1970s and to only 2.46 for the first eight years of the 1980s.

The populations of most developing countries have been growing rapidly in recent decades. During the 1970s and 1980s, the number of persons of working age has often grown even faster than total populations. The struggle to provide enough employment for a burgeoning labour force often fails, resulting in high unemployment plus a large part of the working population “visibly underemployed” (working fewer hours or days than they would like) or “invisibly underemployed” (doing work of extremely low productivity for low income or underutilizing skills).

Thailand is in a relatively advantageous position compared with most other countries in the region with respect to data to document trends and patterns of breast-feeding and related infant feeding practices. Relevant questions, even if not always strictly comparable, have been included in a series of nationally representative surveys conducted during the last two decades. The information provided by these surveys makes clear that a trend towards a decline in the duration of breast-feeding was underway during the decade of the 1970s, but that during the 1980s the decline halted. In addition, the proportion initiating breastfeeding was high throughout the two-decade period and appears to have recently increased to the point where, at the national level, it is now close to universal.

Myanmar is experiencing relatively high fertility and declining mortality rates. In 1973, the population size was nearly 29 million. It increased to 35 million in 1983 with an annual intercensal growth rate of 2.02 per cent (Union of Burma, 1986a; Part 1, p. 14). Since 1948, when it became independent, Myanmar has struggled for economic development and an improved quality of life. But there have been many obstacles and socioeconomic development remains the main challenge to be met. Successive attempts have been made by means of various short- and long-term plans.

The clinical efficacy of various contraceptive methods is well known. However, relatively little is known about their use-effectiveness (which refers to both technical failure of a method and the failure to use a method properly in actual life conditions, especially in developing countries). Use-effectiveness data for programme as well as non-programme methods are necessary for assessing the impact of contraceptive use on fertility (Bongaarts and Potter, 1983).

The population of Cambodia will reach 9.0 million in 1992. It is estimated to be currently growing at a rate near 2.5 per cent per annum, or an absolute increase of about 220,000 persons a year, according to the Department of Statistics (DOS), Ministry of Planning, Government of Cambodia.

Policy measures, in their dimensions, urgency and intensity, should differ between Bangladesh’s metrocities.

Differences in a country’s fertility levels can be attributed to the differences in the length of the reproductive life of women and differences in the length of time between births when women are exposed to the risk of conception. Analysis of those factors influencing the span and those affecting the spacing of fertility has proven useful, since in many cases they appear to vary quite substantially across populations (Rodriguez and others, 1984). In recent years, policy makers and planners have focused a great deal of attention on the birth interval and its determinants. The reasons are that not only does the number of births a women may have during her reproductive span depend on the spacing between the births but also there is a significant link between birth spacing and maternal and child health (Miller and others, 1992). Thus, the spacing of births through a deliberately prolonged interval between births and a delay in child bearing following marriage could be logical alternative strategies for fertility control.

The cost-effectiveness and proven contraceptive efficacy of the TCu 380A should be considered when selecting a long-term, safe and effective, but reversible method.

Since Viet Nam’s fertility has been falling sharply recently, there will be a future decline in the number of caregivers of the elderly

Adolescents, their parents and the community should be made more aware of the negative consequences of early marriage, early pregnancy and large family size

The last decade has seen increasing interest in population ageing, especially in the more developed countries of the world (Tinker, 1989). The explosion of books, journals and articles on ageing gives an indication of this growing interest. There are plenty of reasons for this interest: the profit motive, the debate about the provision of social services and health care, the involvement of elderly people themselves, and most importantly the changing age structure of the population, which will result in increasing dependency of the elderly on society.

The Asian and Pacific region can look forward to continuing to play a key role as a leader in strategic communication for better reproductive health.

Low fertility will make it easier to bring about needed improvements in the quality of social services.

Adolescents greatly outnumber the elderly, so care must be taken to ensure that policies towards them are not neglected

In many traditional Pacific societies the strange and unknown world is the domain of males, those who were thought to have the strength and confidence to face the odds likely to be met. The female arena is the known, the less dangerous, usually domestic surroundings (Ravuvu, 1992:330).

If unmarried youth had better reproductive health information and skills, their use of pregnancy termination could be reduced.

This article focuses on the introduction and establishment of family planning in Tonga and argues that family planning has been medicalized. In the process of institutionalizing family planning through the formal medical structure, what has occurred is that women - the focus of this national policy - have had their reproductive and sexual environments medicalized. Also, family planning at the macro level, aside from its clinical and medical objectives, has taken up a regulatory function for the socio-economic and developmental aspirations of the state.

Migration patterns and selectivity will probably parallel those in other developing countries of Asia and Africa.

One aspect of the ESCAP region’s unusually steep mortality decline has been the success of its fertility transition, assisted by national family planning programmes

The population census conducted in Cambodia in March 1998 was the first since 1962. During the 36-year interval, comprehensive population data needed for social and economic planning had been lacking.

The Government of Bangladesh attempts to provide reproductive health services that emphasize maternal and child health (MCH) and family planning at different service delivery tiers through a variety of service providers. For this purpose, it has established an extensive network of reproductive health services that reaches almost every village in the country. Female field workers, known as family welfare assistants (FWAs), work at the grassroots level and provide information and counselling on various aspects of reproductive health and refer clients when necessary to clinics. They also distribute oral contraceptives and condoms at the homes of married women of reproductive age, identify pregnant women and refer them to static points of service delivery, i.e. health and family welfare centres, for ante-natal care and for obtaining clinical contraceptives.

Sexual behaviour is one of the most central, yet mysterious aspects of human life. For many people, it is virtually taboo to discuss such matters in traditional Indian settings, where attitudes remain, by and large, conservative (Bang and others, 1989). Research into sexual behaviour in India has been almost entirely confined to urban populations, particularly among groups of people thought to be at high risk of HIV infection (Pachauri, 1992; National AIDS Control Organization, 1994). Little is known about the sexual behaviour of people in rural areas, who comprise nearly 70 per cent of the country’s population. An understanding of sexuality and gender-based power relations is important to issues of reproductive health because they underlie many relevant behaviours and conditions. Family planning policies and programmes should address a broader spectrum of sexual behaviour and consider questions of sexual enjoyment and risks, and confront ideologies of male entitlement that threaten women’s sexual and reproductive rights and health (Dixon-Muller, 1993).

It is well recognized that maternal health services have a critical role to play in the improvement of women’s reproductive health in developing countries (Magadi and others, 2000; Bhatia and Cleland, 1995; Becker and others, 1993; WHO, 1989). It is also well known that the utilization of maternal health services is undoubtedly influenced by the characteristics of the health delivery system such as the availability, quality and cost of the services. However, this does not necessarily mean that where there is a good supply of services, demand is created in and of itself, which will then lead to increased utilization. Thus, there has been considerable debate in the literature recently as to whether the mere provision of health services will lead to increased utilization (Magadi and others, 2000; Obermeyer, 1993; Basu, 1990). It may be true that, even under the same condition of availability, some women are more likely to use maternal health services than others. If so, characteristics of the health delivery system may not be the only explanatory factors for the utilization of maternal health services. Other factors such as the social structure and characteristics of individuals should also be considered in promoting the utilization of maternal health services.

The 1999 population and housing census of Viet Nam estimated the population to be 76 million people (CCSC, 1999). According to the 1994 intercensal survey, the total fertility rate (TFR) was 3.1 children per woman of reproductive age in 1993 (GSO, 1995). The estimate from the 1999 census was 2.3 children per woman in 1999. These estimates suggest that fertility has been falling rapidly in Viet Nam.

“Unmet need for family planning”, which refers to the condition of wanting to avoid or postpone childbearing but not using any method of contraception, has been a core concept in international population for more than three decades (Casterline and Sinding, 2000; Freedman, 1987). The importance of the unmet need for family planning or satisfying an individual’s reproductive aspirations as a rationale for formulating population programmes was further explicitly reiterated by the Programme of Action of the International Conference on Population and Development (ICPD), which states that “Government goals for family planning should be defined in terms of unmet needs for information and services” and that “all countries should, over the next several years, assess the extent of national unmet need for good-quality family planning services (United Nations, 1994). ICPD+5 has called for a 50 per cent reduction in the unmet need for contraception by 2005 and its total reduction by 2015.

“Pregnancy is special, let’s keep it safe” was the theme for World Health Day in 1998. Even if agreement existed on the best way to ensure a safe pregnancy in a resource-poor setting, provision is only half the story; the level and nature of the demand for a “safe” pregnancy also needs evaluating. How women themselves perceive the dangers of pregnancy and how they react to those dangers are important questions to answer.