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Introduction: Health and development

2023, Yearbook for the History of Global Development, vol.2

It makes intuitive sense that health and development require one another: there can be no development without a critical mass of people who are sufficiently healthy to do whatever it takes for development to occur, and people cannot be healthy without societal developments that allow maintaining - or ideally improving - health. However, while this mutual dependence seems clear enough when presented in these simple terms, even minimal scratching of the surface reveals many complex and contested histories. Both "health" and "development" entail complex problems of conceptualisation, definition, and measurement.

Related Papers

The Routledge Handbook on Development

Iris Borowy

Health constitutes a major success story of global development. All over the world, human health has improved substantially over the last 150 years. People everywhere live longer, healthier lives and grow taller than they did a few generations ago. Health also shows the major shortcoming of development, as millions of people still suffer substandard health in the midst of the wealthiest world humanity has ever seen. Despite dramatic improvements, global health differentials have remained high. The congruence of development and health is not accidental. They are closely interwoven: without a healthy population, no country can develop, and without development, the people in a given country are unlikely to enjoy good health. The health-development nexus has profoundly shaped human history connecting people beyond times and places. All development efforts of one generation necessarily build on the legacy of the preceding generation. These can be positive, such as material wellbeing, social welfare and physiological capabilities. They can also be negative, such as environmental toxins, social and economic inequality and climate change. International organizations have contributed in important ways to the improvement of global health by promoting programs directed at disease mitigation or at social determinants of health. They have also taken an active role in trying to understand the underlying dynamics of health promotion.

Journal of Public Health Policy

Cesar Vieira

Springer eBooks

Arachu Castro

Deborah Eade

After World War II, health was firmly integrated into the discourse about national development. Transition theories portrayed health improvements as part of an overall development pattern based on economic growth as modeled by the recent history of industrialization in high-income countries. In the 1970s, an increasing awareness of the environmental degradation caused by industrialization challenged the conventional model of development. Gradually, it became clear that health improvements depended on poverty-reduction strategies including industrialization. Industrialization, in turn, risked aggravating environmental degradation with its negative effects on public health. Thus, public health in low-income countries threatened to suffer from lack of economic development as well as from the results of global economic development. Similarly, demands of developing countries risked being trapped between calls for global wealth redistribution, a political impossibility, and calls for unrestricted material development, which, in a world of finite land, water,air, energy, and resources, increasingly looked like a physical impossibility, too.Various international bodies, including the WHO, the Brundtland Commission, and the World Bank, tried to capture the problem and solution strategies in development theories. Broadly conceived, two models have emerged: a “localist model,” which analyzes national health data and advocates growth policies with a strong focus on poverty reduction, and a “globalist” model, based on global health data, which calls for growth optimization, rather than maximization. Both models have focused on different types of health burdens and have received support from different institutions. In a nutshell, the health discourse epitomized a larger controversy regarding competing visions of development.

Understanding the Global Dimensions of Health

Socrates Litsios

Social science & medicine. Medical economics

James C Knowles

Stephen Marks

This chapter examines the evolution of sustainable human development as applied to health governance with grounding in a human-rights based approach (HRBA), drawing on international human rights norms and standards. Part 1 contextualizes the discernible paradigm shifts along this trajectory with an introductory historical overview, mapping the progression of the relevant development agenda and theories. Part 2 discusses the current state of the right to development, the 2030 Sustainable Development Agenda, and a rightsbased approach to international development assistance. Part 3 is forward-looking, proposing the potential value for global health of a HRBA to development. A global commitment to sustainable human development, with explicit human rights content in institutional policies and practices is vital to address the challenges of climate change, poor governance, unjust power relations and political inertia, and to collectively build on the mutually reinforcing goals of health,...

Journal of health and human services administration

David Mirvis

This symposium explores the role of health as an 'economic engine' in the lower Mississippi River Delta region of the United States. The health as an economic engine model proposes that health is an important and perhaps critical determinant of economic growth and development. This model is the reverse of the more commonly considered paradigm in which economic conditions are major determinants of health status. This reframing of the conventional pathway draws upon an existing and extensive internationally-based body of knowledge, predominantly from research done in Africa and Asia. We suggest, in this symposium, that the health as an economic engine model can also be applied within the United States, particularly in regions that are economically underdeveloped and have poor health. This reframing has significant implications for population health policy as public health advancement can be legitimately argued to be an investment rather than just an expense. Viewing health as ...

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Department of Medicine, Division of General Medical Sciences, Washington University School of Medicine, St Louis, MO 63110, USA ( ude.ltsuw.mi@regurj )

In one of her last public speeches as Director-General of the WHO on May 19, 2003, Gro Harlem Brundtland reiterated her constant message that “health is central to development”. Since her nomination as Director-General, Brundtland has advocated increased health sector investment in developing countries by demonstrating a strong link between health and economic development. A 2001 report by the WHO Commission on Macroeconomics and Health set specific goals for health investments as a means to promote economic development. Having spent a decade as Norway's prime minister, Brundtland knew that the audience for this key message would ultimately be prime ministers, donors, and finance ministers who can mobilise or reallocate resources for health.

Viewing good health as a means to further economic development is a useful strategy for elevating the status of health-related investment. However, this view also has limitations, particularly in acknowledging the intrinsic value of health and understanding development more broadly. An alternative view of health and economic development sees health as both intrinsically and instrumentally valuable but takes health as an end in itself. This viewpoint sees the opportunity for health and health care as “constituent components of development”, 1 obviating the need to justify their importance in terms of their indirect contribution to the growth of gross national product or personal income. It also recognises the interrelatedness among health and other valuable social ends (eg, education) and at the same time emphasises health's importance for individual agency—ie, people's ability to live a life they value.

Good health enables individuals to be active agents of change in the development process, both within and outside the health sector. Increased investment in health requires public action and mobilisation of resources, but it also brings individuals opportunities for social and political participation in health-system reform and implementation. Agency is critical for development overall and for the development and sustainability of effective health systems, and individuals should have the opportunity to participate in political and social choice about public policies that affect them. These key elements are part of an alternative way of thinking about health and development, and several points are relevant to this view.

First, this alternative viewpoint appeals to a particular vision of the good life that is derived from Aristotelian political philosophy 2 – 6 and Amartya Sen's capability approach. 1 , 7 , 8 According to Aristotle, society's obligation to maintain and improve health is grounded in the ethical principle of human flourishing, 2 – 6 which holds that society is obligated to enable human beings to live flourishing, and thus healthy, lives. Certain aspects of health, in particular, sustain all other aspects of human flourishing because without being alive no other human functionings, including agency, are possible. Therefore public policy should focus on individuals’ capacity to function, and health policy should aim to maintain and improve this capacity by meeting health needs. This view sees development as expan sion of individual freedom instead of judging development by gross national product or personal income. 1 , 7 , 8

Second, the link between health and economic development is two-directional because health depends on economic development in the same way that economic development depends on health. For example, health and demography can affect income through their impact on labour productivity, savings rates, investments in physical and human capital, and age structure. In the other direction, income can affect health and demography by, for example, improving the ability to obtain food, sanitation, housing, and education and providing incentives to limit family size. 9 However, inequalities in income and social position can also harm the health of the underdog, as Marmot's work demonstrates. 10 It is therefore important to integrate strategies for improving health and economic opportunities rather than assuming a one-directional relation going from health to increased affluence.

Third, health improvement and economic development are both linked to individuals’ opportunities to exercise their agency and participate in political and social decision making. Political and civil rights, especially the right to open discussion and dissent, are central to informed choice. 1 Agency is important for public policy because it supports individuals’ participation in economic, social, and political actions and enables individuals to make decisions as active agents of change. This view contrasts with the perspective that individuals are passive recipients of health care and decisions about health expenditure or other development programmes. An agency-centred view promotes individuals’ ability to understand and “shape their own destiny and help each other”. 1 Development of institutions that aim to improve health and create economic opportunities should therefore be influenced by the “exercise of people's freedoms, through the liberty to participate in social choice and in the making of public decisions that impel the progress of these opportunities”. 1 It is important that any discussion of health and economic development take note of the significance of participation for effective and sustainable reforms. Active agency is critically important for both health and economic development as indeed they are important for each other.

Acknowledgments

I thank Amartya Sen for helpful comments. Supported in part by grant 1K01DA016358-01 from the National Institutes of Health.

Health Promotion and Sustainable Development Essay

Introduction, opportunities and benefits.

The concept of sustainable development emerged as a guiding principle in the formulation of policies to address health and development issues around the world. Health is an international development agenda, and different steps have been taken to reduce mortality and morbidity by employing disparate strategies. For instance, the Rio Declaration of 1992 puts human beings at the centre of sustainable development (Nunes, Lee, & O’Riordan, 2016). Similarly, Chapter six of Agenda 21 by the United Nations (UN) shows the commitment by the world governments to protect and promote health as part of the sustainable development agenda. In 2000, 8 Millennium Development Goals (MDGs) were adopted, and three of them covered health objectives to be achieved by 2015. Goal 4 sought to reduce mortality for children less than 5 years old, while Goal 5 intended to reduce maternal mortality and improve access to reproductive care (Galvao et al., 2016).

On the other hand, Goal 6’s objective was to reverse the spread of malaria, tuberculosis, and HIV/AIDS. However, the majority of countries, especially in the developing world, did not achieve these goals. Therefore, in 2015 when the set period of MDGs elapsed, the international community came up with the Sustainable Development Goals (SDGs), which should be realised by 2030. The SDGs were formulated to address the evident gaps in MDGs. While all the SGDs will affect health indirectly, Goal 3 seeks to “ensure healthy lives and promote well-being for all at all ages” (Chapman, 2017, p. 1099). Despite the failure of different attempts to achieve global health objectives under sustainable development, important progress has been achieved. Additionally, there are numerous opportunities that can be exploited to realise the benefits of pursuing global health goals within the framework of sustainable development. However, the available opportunities and benefits come with equal challenges as addressed in this commentary.

In the context of sustainable development, health means more than the absence of diseases (Koivusalo, 2017). Health is a social dynamic component that entails lifestyles, social organisation, and patterns of consumption. All these factors are subject to the biophysical environment, socioeconomic systems, and personal behaviours. Therefore, health promotion under this context integrates socio-ecological understanding into the bio-medical approach to health. In order to understand this line of argument, there needs to be a clear definition of sustainable development. According to Kjaergard, Land, and Pedersen (2014), sustainable development “is a process towards a new normative horizon, and it implies a paradigm shift from a development based on inequity and overexploitation of natural resources and environmental services, to one that requires new forms of responsibility, solidarity, and accountability” (p. 559). This understating opens up the opportunities and benefits of addressing sustainable development by different players in the health promotion sector.

The number of national and international initiatives undertaken to promote health and sustainable development has been on the rise. However, Pettigrew, De Maeseneer, Anderson, and Haines (2015) argue that there is an exponential increase in the prevalence of chronic diseases, mental health problems, and other health conditions. Kjaergard et al. (2014) posit, “The simultaneous deterioration of public health and the state of the environment is partly linked to the inadequate integration of health promotion and sustainability dimensions at local, regional, and global levels” (p. 558). This assertion provides the first opportunity for the health promotion sector to address sustainable development.

For instance, in Malaysia, Colombia, Nigeria, Cameroon, and Indonesia, tropical rainforests are being cleared to advance the production of palm oil, which is used as cooking oil and fuel (Kjaergard et al., 2014). In this case, the intention has been to address health problems because palm oil is affordable food oil, and it lacks trans-fats. However, clearing rainforests leads to soil degradation and loss of biodiversity, which is ultimately unsustainable. Therefore, the health promotion sector should focus on how to mitigate the unintended negative effects, and thus foster sustainable development, while at the same time addressing health needs for the involved communities (Nabyonga-Orem, 2017). The benefits of this approach are many because communities will achieve reasonable health standards without advancing practices that threaten the sustenance of future generations.

Another opportunity for the health promotion sector is to use convergent and integrative strategies to address sustainable development (Buse & Hawkes, 2015). This strategy will allow the application of the model of human development. This model captures the three arms of sustainable development, which include health, economy, and the environment (Kjaergard et al., 2014). These three factors converge to create a form of interdependence that results in human development as opposed to the conventional economic development driven by capitalistic endeavours. Votruba, Eaton, Prince, and Thornicroft (2014) point that based on this model, any form of economic development must ensure the preservation of the environment sustainably, and at the same time factor in social sustainability.

Therefore, in the distribution of world resources and wealth, the equity should be observed to meet the objective of health for all, which is part of the SDGs (Buss, Fonseca, Galvao, Fortune, & Cook, 2016). As such, health promotion and sustainable development are placed at the core of the model. One of the best examples of how such models can be applied is the Healthy Cities Project. According to Cole et al. (2017), this project places different health aspects at the centre of urban interventions. The benefit of such an approach is the creation of cities with adequate housing, transportation, secure spaces for exercise and play, and quality health care. Ultimately, sustainable development is taken care of, while at the same time addressing health issues. Unfortunately, the majority of these models and strategies have failed in different areas around the world. Therefore, the health promotion sector should take this failure as an opportunity to strategize again by addressing the gaps that have been noted in the earlier projects.

One of the ways that can be used to maximise health outcomes within the framework of the existing sustainable development is address gaps in previous strategies, and ensure that the involved stakeholders understand and execute their roles (Marimuthu & Paulose, 2016). The majority of opportunities for the healthcare promotion sector to address sustainable development are in the present challenges and previous failures. For instance, the world governments did not achieve the objectives for Health for All 2000, which were stated in 1978 at the Alma Ata Declaration (Warren et al., 2017). Similarly, the majority of the healthcare goals of the MDGs that expired in 2015 were not achieved. In the same way, the SDGs’ objectives for 2030 are unlikely to be realised due to challenges that faced previous attempts to address the issue. One of the problems has been the vertical integration of health services.

According to Carlin, Dowd, and Feldman (2015), while vertical integration has several benefits, it hinders sustainable development, especially in the healthcare sector, due to the short-term nature of the realised results. Liaropoulos and Goranitis (2015) posit that the current vertical programs target polio, malaria, tuberculosis, HIV/AIDs, and other preventable diseases. However, such programs stop the moment funding runs out. For instance, Oleribe, Crossey, and Taylor-Robinson (2015) argue that the Roll Back Malaria program failed, and thus it could not achieve the intended objectives. Therefore, players in the health promotion sector should seize the opportunity to remove vertical health programs in places where they hinder sustainable development and embrace the integrated approach, which views health as a single holistic issue (Morgon, 2015). The benefits and implications of this move will be the destruction of vertical walls and the dismantling of standalone programs, which clears the way for integrative healthcare for all.

The foregoing argument highlights the need to have healthcare policies that promote sustainable development. Any health policy seeking to address sustainable development should focus on the duality of the two elements. According to Pedersen, Land, and Kjaergard (2015, “The concept of duality allows for an understanding of, and for developing a conceptual framework for, the integration of strategies for health promotion with strategies for sustainable development” (p. 6). As such, healthcare promotion and sustainable development should be tied together and addressed as one factor. Kjaergard et al. (2014) warn that the separation of the two ideas may have unintended socio-environmental consequences. In the worst cases, such a move could create new health problems.

For instance, in a bid to address food security in the developing world, the UN, in collaboration with the Food and Agriculture Organisation (FAO), came up with the Green Revolution initiative. In India, for example, this initiative meant the adoption of modern agricultural practices using herbicides, pesticides, and other inputs (Pingali, 2013). Additionally, the traditional varieties of grain were replaced by hybrid but barren seeds. Consequently, peasant farmers could not reproduce their native species, and those who could not afford the hybrid varieties were not in a position to farm after a few seasons. On the other hand, the health risks of exposing people to pesticides increased significantly. Carvalho (2017) argues that hundreds of thousands of individuals die annually from exposure to agrochemicals. Therefore, some policies have unintended negative consequences due to the failure to tackle critical issues.

The impact and benefit of addressing the duality of health promotion and sustainable development will be the elimination of inadvertent results (Dugani, Bhutta, & Kissoon, 2017). Consequently, communities will experience improved health outcomes by carrying out activities that are within the sustainable development framework.

The main challenge facing healthcare promotion in addressing sustainable development is the failure to integrate the two aspects. Jelsoe et al. (2018) posit, “The strategies for health promotion are not sufficiently integrated with strategies for sustainable development, and that political strategies directed at solving (public) health problems or (environmental) sustainability problems may cause new, undesired and unforeseen environmental or health problems” (p. 103). This assertion is evident in the Green Revolution initiative discussed earlier in this paper. Conceptually, sustainable development has been loosely translated to mean environmental sustainability, which deprioritises the role of healthcare promotion (Rodgers, 2017). The other problem is the definition of health as the absence of diseases. This worldview has created a complex challenge in establishing the important relationship between healthcare promotion and sustainable development. Another challenge has been the inability to provide evidence about the positive outcomes of integrating health promotion initiatives and sustainable development (Shapovalova, Meguid, & Campbell, 2015). Finally, in most political and administrative sectors, sustainable development, which mainly focuses on environmental sustainability, and health promotion have functional divisions (Van de Pas, 2017). As such, attempts to come up with broad crosscutting objectives are hindered, and thus the integration of the two aspects becomes a challenge.

The concept of sustainable development seeks to address different issues including health, economy, and environment. Different attempts have been made to put health promotion in the context of sustainable development. However, the majority of these strategies, such as the Health for All and the MDGs, have failed to achieve the desired objectives. Nevertheless, players in the health promotion sector can capitalise on some opportunities to tackle this issue. The first opportunity for the health promotion sector is to use convergent and integrative strategies to address sustainable development. Similarly, bridging the gaps that have been highlighted in previous strategies will yield positive outcomes moving forward.

Finally, players in the health promotion sector should focus on making policies that tie health and sustainable development together, and thus address the two elements as one. The implications of these proposals would be the integration of health promotion into sustainable development to achieve the desired results. The main limitation of these suggestions is the conventional definition of health as the absence of diseases. This perception eliminates the possibility of integrating healthcare into sustainable development. Additionally, the traditional assumption that sustainable development means environmental sustainability hinders the chance to incorporate the health aspect into policymaking. Finally, the inability to give evidence of positive outcomes of addressing health promotion in the context of sustainable development is another limitation. Moving forward, future directions for research and practice should focus on addressing the duality and the politics of integration of health promotion and sustainable development.

Buse, K., & Hawkes, S. (2015). Health in the sustainable development goals: Ready for a paradigm shift? Globalisation and Health, 11 (13), 1-8. Web.

Buss, P. M., Fonseca, L. E., Galvao, L. A. C., Fortune, K., & Cook, C. (2016). Health in all policies in the partnership for sustainable development. Pan American Journal of Public Health, 40 (3), 186-191.

Carlin, C. S., Dowd, B., & Feldman, R. (2015). Changes in quality of health care delivery after vertical integration. Health Services Research, 50 (4), 1043-1068.

Carvalho, F. P. (2017). Pesticides, environment, and food safety. Food and Energy Security, 6 (2), 48-60.

Chapman, A. R. (2017). Evaluating the health-related targets in the Sustainable Development Goals from a human rights perspective. The International Journal of Human Rights, 21 (8), 1098-1113.

Cole, H., Shokry, G, Connolly, J. T., Pérez-Del-Pulgar, C., Alonso, J., & Anguelovski, I. (2017). Can Healthy Cities be made really healthy? The Lancet, 2 (9), 394-395.

Dugani, S., Bhutta, Z. A., & Kissoon, N. (2017). Empowering people for sustainable development: The Ottawa Charter and beyond. Journal of Global Health, 7 (1), 1-4. Web.

Galvao, L. A., Haby, M. M., Chapman, E., Clark, R., Câmara, V. M., Luiz, R. R., & Becerra-Posada, F. (2016). The new United Nations approach to sustainable development post-2015: Findings from four overviews of systematic reviews on interventions for sustainable development and health. Pan American Journal of Public Health, 39 (3), 157-165.

Jelsoe, E., Thualagant, N., Holm, J., Kjærgård, B., Andersen, H. M., From, D. M., Pedersen, K. B. (2018). A future task for health-promotion research: Integration of health promotion and sustainable development. Scandinavian Journal of Public Health, 46 (20), 99-106.

Kjaergard, B., Land, B., & Pedersen, K. B. (2014). Health and sustainability. Health Promotion International, 29 (3), 558-568.

Koivusalo, M. (2017). Global health policy in sustainable development goals. Global Social Policy, 17 (2), 224-230.

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Marimuthu, M., & Paulose, H. (2016). Emergence of sustainability based approaches in healthcare: Expanding research and practice. Procedia – Social and Behavioural Sciences, 224, 554-561.

Morgon, P. (2015). Sustainable development for the healthcare industry: Reprogramming the healthcare value chain. New York, NY: Springer.

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Nunes, A. R., Lee, K., & O’Riordan, T. (2016). The importance of an integrating framework for achieving the sustainable development goals: The example of health and well-being. BMJ Global Health . Web.

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Rodgers, S. (2017). Fostering the future of health promotion as seen through the message from youth delegates on health promotion and sustainable development. Global Health Promotion,24 (1), 62-65.

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Bibliography

IvyPanda . "Health Promotion and Sustainable Development." December 14, 2020. https://ivypanda.com/essays/health-promotion-and-sustainable-development/.

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Health and disease concepts: an approach to health development

Journal of Health Research

ISSN : 2586-940X

Article publication date: 14 September 2018

Issue publication date: 7 November 2018

Health for all is an ideal goal that all governments aspire to reach. The purpose of this paper is to assess the definitions of the key terms used to better appreciate the role of the WHO member states in their efforts to achieve improved healthcare systems that suit each nation’s particular needs.

Design/methodology/approach

Definitions of the terms disease, illness and health are discussed against health concepts as a means of assessing the most effective approach toward achieving an effective universal healthcare system.

Universal health and treatment of sickness and disease have improved globally, but the target of achieving total wellness still remains as a goal for the future and may be impeded by diseases that have not yet evolved. The implementation of a universal health coverage system is a positive step toward achieving the goals of health and wellness for the present times.

Originality/value

This is a commentary piece.

Health development

Plianbangchang, S. (2018), "Health and disease concepts: an approach to health development", Journal of Health Research , Vol. 32 No. 5, pp. 384-386. https://doi.org/10.1108/JHR-08-2018-045

Emerald Publishing Limited

Published in Journal of Health Research . Published by Emerald Publishing Limited. This article is published under the Creative Commons Attribution (CC BY 4.0) licence. Anyone may reproduce, distribute, translate and create derivative works of this article (for both commercial and non-commercial purposes), subject to full attribution to the original publication and authors. The full terms of this licence may be seen at http://creativecommons.org/licences/by/4.0/legalcode

Concepts of disease, illness and health

In public health, the question of how to measure health is a difficult topic. In a disease-ridden society, when the level of disease or illness is determinable, health becomes measurable. However, when a society is healthy, disease or illness becomes less determinable and health becomes less measurable. Additionally, the three basic elements in the field of public health: people, disease or illness and health in the context of their environment are worth examining. The classical definition of illness: “an unhealthy condition or unhealthy state of body or mind” [1] contrasts with illness “as bad moral quality, a condition of wickedness, disagreeableness, troublesomeness, hurtfulness and badness”; while “disease is a corruption of the body, and by extension a corruption of spirit and/or mind” [2] .

Disease may also be defined as “a failure of the adaptive mechanisms of an organism to counteract adequately the stimuli and stresses to which it is subject, resulting in a disturbance in function or structure of some part of the body” [3] . This definition is similar to Meerlo’s definition: [4] “a failure reaction to a noxious stimulus,” and disease defined as “an unsuccessful reaction interfering with normal life.” Meanwhile, Clark [5] states that “there are no diseases, there are only sick people.” Another ecological definition is that “disease is an impairment of the normal state of the living animal” [1] .

From the ecological standpoint, disease and illness are closely related resulting in Wylie [6] defining health as “the perfect adjustment of an organism to its environment.” Health in this context is an expression of adaptability, and disease is the failure thereof. This can be compared to Webster’s Dictionary definition, [l] “health is the condition of an organism or one of its parts in which it performs its vital functions normally or properly.” However, a more satisfactory definition of disease is needed. The real problem of health measurement is the problem of measurement of disease or illness (morbidity). Health is measurable as long as disease or illness is measurable but when disease or illness becomes immeasurable and imperceptible, then health also becomes immeasurable.

Among health definitions, the most widely used is from the World Health Organization namely, “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” [7] . This definition has been regarded as an attainable goal whilst others criticize it as being too ideal and unrealistic. Also, a range of conditions keep people at some point short of positive health [8] . Nonetheless, the above variation of the concepts of health are commonly accepted as statements of an ideal, or as Besson [9] described it, “optimum health.”

Whatever definitions of health might be used, only one that is realistic, practical and quantifiable should be accepted for operational purposes because the concepts of health, disease or illness will change according to advancement in health science, technology and financial investment.

Health development perspective: an approach

The WHO defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” [7] and its objective of “The attainment by all people of the highest possible level of health” [10] has already provided a broad-based foundation for the developmental approach toward positive health as a mandatory function of its member states and other stakeholders.

Initially, the WHO had to assist its member countries to fight against diseases stemming from the low levels of development, poverty, lack of education and many other prevailing environmental and ecological problems. It was realized that it is not yet possible for everyone to fully enjoy complete physical, mental and social well-being, and not merely the absence of disease or infirmity. In 1977, the World Health Assembly of the WHO resolved to set the main social target/goal for the governments and the WHO “toward the attainment by all people of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life” [11] .

Additionally, at the International Conference on Primary Health Care (PHC) held in Alma Atar, USSR in 1978, there was consensus that a PHC approach is the key to attaining the social goal of “Health for All” by the year 2000. However, it was evident by the year 2000, that the achievements of the targets were not at all uniformly met, and yet, it was equally noted that more global health resources were indeed mobilized and made available for supporting worldwide efforts in health development. Furthermore, the general health conditions of people around the world were perceptibly improved, especially in developing countries, even though not uniform or equal. Evidently, PHC forms an integral part, both, of the country’s health system, of which it is the central function and main focus, and of the overall social and economic development of the community [12] .

Therefore, the World Health Assembly later agreed to keep the goal of “Health for All” without specifying the target date, and since 2000, the idea of a Universal Health Coverage system was conceived as an important step toward Health for All.

To move toward good health, investments in public health interventions, particularly health promotion and disease prevention as well as effective health care must be ensured throughout the life cycle of individuals and at the same time, people who are already sick must receive the best treatment and care to limit the degree of morbidity or disability. To stay healthy, people will have to ensure proper behaviors and lifestyles, and, as far as health is concerned, always keep in mind the influence of two broad areas of health determinants, i.e., environment and genetic endowment.

When the intervention moves forward into the area of secondary prevention, health becomes more negative with an increased degree of dependence of a person on others. It is indeed important to delay this pathological process through the most efficient and effective development and implementation of a public health policy program combined with an effective medical intervention system that complements a successful health care system.

1. Gove PB. Webster’s Third New International Dictionary . Springfield, MA : G&C Merriam Com ; 1968 .

2. Alland FA. Adaptation in Cultural Evolution: an Approach to Medical Anthropology . New York, NY : Columbia University Press ; 1970 .

3. Hoerr NL , Asol , A. Blakiston’s New Gould Medical Dictionary . 2nd ed. New York, NY : McGraw-Hill ; 1956 .

4. Meerloo JAM. Illness and Cure – Studies on the Philosophy of Medicine and Mental Health . New York, NY : Grune & Stratton ; 1964 .

5. Clark DW , MacMahon B. Preventive Medicine . Boston, MA : Little, Brown and Co. ; 1967 .

6. Wylie CM. The definition and measurement of health and disease . Public Health Reports . 1970 ; 85 ( 2 ): 100 - 4 .

7. World Health Organization [WHO] . WHO Basic Document: Preamble to WHO Constitution . Geneva : WHO ; 2009 .

8. Dunn HL. Postscript: Health and Demography . New York, NY : Bureau of Statistical Services; National Office of Vital Statistics ; 1956 .

9. Besson G. The health-illness spectrum . Am J Public Health Nations Health . 1967 ; 57 ( 11 ): 1901 - 5 .

10. World Health Organization [WHO]. WHO Basic Document: Article 1 of WHO Constitution . Geneva : WHO ; 2009 .

11. World Health Organization [WHO]. World Health Assembly Resolution . WHA 32.30 . Geneva : WHO ; 1977 .

12. World Health Organization [WHO]. Alma-Ata 1978, Primary Health Care . Health for All Series, No. 1 . Geneva : WHO ; 1978 .

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2021 Theses Doctoral

Essays in Health, Development and the Environment

Aguilar Gomez, Sandra

As multiple regions in the global south urbanize and transform, their social-environmental challenges also reshape. Climate change and ecological degradation intertwine with these processes in ways that have an uneven impact on people and firms with various degrees of vulnerability. In this dissertation, I look at such issues through the lens of sustainable development, with a regional emphasis on Mexico. Standard economic analyses of environmental policy focus on either reducing pollution externalities through mitigation or reducing the harms from exposure by encouraging adaptation. In practice, these issues are both critical, particularly when looking at the health effects of local air pollutants, which can be acute, and policymakers often pair information provision with short and long-run mitigation actions. In Chapter 1, I explore whether, in the context of the Mexico City air quality alert program, information policy is more effective when paired with mitigation. I find that the policy did not improve air quality or health outcomes until the mitigation component, which limited transport emissions, was introduced. I also use sensor-level traffic data, geo-tagged accident reports, and search data as a measure of awareness of the policy to unveil the mechanisms through which considerable short-run improvements in air quality and health are achieved after issuing an alert. I find that the alert reduces car usage even before the driving restrictions enter into place, suggesting that, due to an increased awareness of pollution, people reduce their trips. Chapter 2 studies the effects of regional exposure to extreme temperatures on credit delinquency rates for firms in Mexico. Our exposure variable is defined as the number of days in a quarter that minimum and maximum temperature are below 3°C and above 36°C, respectively, which correspond to the bottom 5 percent and top 5 percent of daily minimum and maximum temperature distribution in the country. We find that extreme temperatures increase delinquency. This effect is mostly driven by extreme heat, and it is concentrated on agricultural firms, but there is also an effect on non-agriculture firms. The impact on non-agricultural firms seems to be driven by general equilibrium effects in rural areas. Chapter 3, provides the first estimation of child penalties in the Mexican labor market. Using an event study approach and an instrumental variable as a robustness check, we estimate the impact of children on employment and wages, unpaid labor, and transitions between informal and formal sectors. We are the first to show that a child’s arrival significantly affects mothers’ paid and unpaid work, and it impacts members of the extended family unevenly, reinforcing traditional gender roles. While low- and middle-income women account for most of the effect of childbirth on wages, all mothers increase time spent on unpaid work.

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Mexico--Mexico City
Sustainable development
Sustainable agriculture
Air--Pollution
Working mothers
Wages--Working mothers

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Health and child development

All children, including those with developmental delays and disabilities, have the right to lead healthy lives.

Two parents walking down a dirt path near the woods play with their young son.

Child and adolescent health and well-being

To reach their full potential, children need high-quality health care and services – especially in life’s early moments.

The time between pregnancy and age 3, when the brain is most susceptible to environmental influences, is critical for a child’s growth and development . All children – including those with disabilities and developmental delays, those living in poverty or deprivation, and those affected by conflict or displacement – need nurturing care and health services to survive and thrive.

But millions do not receive them.

In many places, health systems are not equipped to support routine health interactions among children, families and caregivers. Without regular monitoring, some children miss out on specialized health services and developmental support that could help them fulfil their potential.

Early interventions are especially crucial to children with developmental delays and disabilities, but many do not have access to primary health care systems that provide them.

Globally, 93 million children 14 years old and younger experience moderate or severe developmental delays or disabilities.

Because children with developmental delays and disabilities are more likely to be invisible in government statistics, they are often excluded from policy decisions that could improve their well-being. As a result, the quality of the health services they receive can be severely compromised – largely due to limited capacity, inadequate training of service providers, or lack of coordination between public authorities and community practitioners.

UNICEF’s response

In 2018, UNICEF co-led the creation of the Nurturing Care Framework for Early Childhood Development . This framework outlines relevant policies, interventions and strategies needed across sectors – including health, nutrition, education and child protection – to strengthen early childhood development and monitor progress towards associated goals.

The health sector plays a critical role in galvanizing Governments and partners to support children’s holistic health and well-being. It also serves as a platform for policy makers and practitioners across sectors to reach mothers, families and children with crucial early interventions.

UNICEF works around the world to support key components of nurturing care and seek opportunities to advance nurturing care through routine health interactions among children, families and caregivers.

We also focus on early identification and early interventions of developmental delays and disabilities among children, particularly during the first three years of life, while promoting universal coverage of responsive caregiving and early learning.

UNICEF, alongside the World Health Organization, develops global goods, disseminates learning, and convenes Governments and partners at global, regional and country levels to support the development of action plans, the mobilization of resources and the training of health-care professionals to ensure all children receive the nurturing care they need to thrive.

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Towards victory over the vicious cycle of poverty and ill-health

by UCHIMURA Hiroko

The Mother-Child health training center in Bangladesh

Although health is an essential and important issue for the progress of developing countries, the definition and goals of health tend to be seen as being somewhat amorphous. According to the World Health Organization’s (WHO) definition, health is “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” Health development encompasses all the elements that are necessary for the achievement of such a state of being. In this context, a wide variety of disciplines have some relation to health; specifically, these disciplines include epidemiology, biology, public health and medical science as well as demography, economics, and international health.

The Declaration of Alma-Ata of 1978 which introduced the concept of Primary Health Care (PHC) marked a turning point in the approach and goals of international aid in the field of health in developing countries. PHC made explicit the importance of primary health care in developing countries. In addition, it calls for prioritizing local health care needs and fully utilizing locally-available resources to provide health care services to meet those needs. This approach represents a dramatic departure from the previous goal of international aid which was to introduce health systems or models of developed countries into developing countries. In the Millennium Development Goals (MDGs) adopted by the United Nations in 2000 , three of the eight goals are directly related to health (reduction of child mortality, improvement of maternal health , and combat against HIV/AIDS malaria and other diseases). Underlying concern is the vicious cycle of poverty and ill-health in developing countries. Health is not only a result of, but also a contributing factor to, development. Poor people suffer from ill-health; at the same token, people are more likely to fall into poverty because of ill-health. Such vicious cycle of poverty and ill-health places a large burden on developing countries and hinders to development. The purpose of health development is to improve the health of individuals and to control the spread of disease, both of which are essential elements of development and poverty reduction. Although international concern about health in developing countries is increasing, there is a chronic shortage of resources (financial, human, and material resources) to deal with such issues. The question of how to increase resources remains a major challenge for international aid for developing countries. A further challenge, in the face of limited resources, is how local health services and health systems can be improved and strengthened to provide health services that meet local needs and are accessible, particularly to those living in poverty.

HIV/AIDS - Not just a health and medical problem

by MAKINO Kumiko

AIDS (Acquired Immune Deficiency Syndrome) is a disease resulting from infection by HIV (Human Immunodeficiency Virus). The three primary modes of transmission are sexual contact, blood transfusion, and transmission from a mother to child. Disease symptoms do not appear immediately upon infection (latent period) but after a gradual degradation of an individual's immune system that results in a lowering of the body's ability to defend against disease and ultimately leads to contracting multiple infections and malignancies. This condition is called AIDS. The disease, which later came to be known as AIDS, began to spread in the early 1980s among gay men in the United States. Today, however, HIV/AIDS has the greatest impact in Sub-Saharan Africa, with women representing more than half of people living with HIV in the region. According to a 2007 estimate, among about 33 million people living with HIV worldwide, more than two thirds (68%) are in Sub-Saharan Africa. Among the Sub-Saharan African countries, Southern African countries including Botswana, Swaziland, and South Africa, which experienced a rapid increase in infection since the 1990's, have been most affected by HIV/AIDS. In recent years, the increased use of intravenous drugs has led to a rapid increase in the infection rate in East and Central Asia as well as Eastern Europe.

HIV/AIDS not only prematurely takes the lives of young, working-age men and women, but also impoverishes surviving dependent family members. This impact is especially serious for children. Children who have lost their parents to AIDS ("AIDS orphans"), or who have to take care of their ill parents, are likely to face serious challenges, including high drop out rates from school and various discrimination throughout their lives. For businesses, HIV/AIDS can lower productivity and contribute significantly to increased labor costs by reducing the size of the labor pool. At the country level, HIV/AIDS may contribute to deterioration of a nation’s financial status by hindering economic growth and by reducing tax revenues, while increasing health care expenditures. In this manner, in countries where it is prevalent, HIV/AIDS can impact the country’s very economic and social foundations. For this reason, HIV/AIDS is an important factor, not only in health and medical research, but also in the study of economics, politics, and social sciences. HIV/AIDS programs span a wide variety of goals including prevention, testing and counseling, provision of treatment, care and support for people living with HIV, and ending discrimination and stigmatization. HIV/AIDS programs have changed drastically since the development of antiretroviral drugs (ARV) in the mid-1990s. Treatment with a cocktail of different ARVs can keep the amount of HIV in the body at a low level and enable the body’s immune system to recover significantly. However, at the time of their development, treatment with ARVs did not progress rapidly in developing countries due to their high costs. This led to increasing criticism that the high prices were the result of excessive protection of intellectual property rights , which ultimately helped precipitate a revision of the World Trade Organization ' s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS). In recent years, due to pressure from developing country governments and advocacy groups formed by people living with HIV and the availability of generic drug alternatives, the price of ARVs has dropped considerably. In addition, the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) was established to facilitate funding of programs focusing on the three major communicable diseases: AIDS, tuberculosis, and malaria. Despite the continuing challenges of insufficient human resources, insecure funding, instability of medical supplies, and the development of drug-resistant strains, there is increasing opportunity in developing countries for antiretroviral treatment.

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Prediction Models and Clinical Outcomes—A Call for Papers

1 Department of Medicine, University of Washington, Seattle
2 Deputy Editor, JAMA Network Open
3 Epidemiology, Rutgers The State University of New Jersey, New Brunswick
4 Statistical Editor, JAMA Network Open
5 Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
6 Editor, JAMA Network Open

The need to classify disease and predict outcomes is as old as medicine itself. Nearly 50 years ago, the advantage of applying multivariable statistics to these problems became evident. 1 Since then, the increasing availability of databases containing often-complex clinical information from tens or even hundreds of millions of patients, combined with powerful statistical techniques and computing environments, has spawned exponential growth in efforts to create more useful, focused, and accurate prediction models. JAMA Network Open receives dozens of manuscripts weekly that present new or purportedly improved instruments intended to predict a vast array of clinical outcomes. Although we are able to accept only a small fraction of those submitted, we have, nonetheless, published nearly 2000 articles dealing with predictive models over the past 6 years.

The profusion of predictive models has been accompanied by the growing recognition of the necessity for standards to help ensure accuracy of these models. An important milestone was the publication of the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis ( TRIPOD ) guidelines nearly a decade ago. 2 TRIPOD is a reporting guideline intended to enable readers to better understand the methods used in published studies but does not prescribe what actual methods should be applied. Since then, while the field has continued to advance and technology improve, many predictive models in widespread use, when critically evaluated, have been found to neither adhere to reporting standards nor perform as well as expected. 3 , 4

There are numerous reasons why performance of models falls short, even when efforts are made to adhere to methodologic standards. Despite the vast amounts of data that are often brought to bear, they may not be appropriate to the task, or they may have been collected and analyzed in ways that are biased. Additionally, that some models fall short may simply reflect the inherent difficulty of predicting relatively uncommon events that occur as a result of complex biological processes occurring within complex clinical environments. Moreover, clinical settings are highly variable, and predictive models typically perform worse outside of the environments in which they were developed. A comprehensive discussion of these issues is beyond the scope of this article, but as physicist Neils Bohr once remarked, “it is very difficult to predict—especially the future.” 5

Although problems with accuracy are well documented, hundreds of predictive models are in regular use in clinical practice and are frequently the basis for critically important decisions. Many such models have been widely adopted without subsequent efforts to confirm that they actually continue to perform as expected. That is not to say that such models are without utility, because even a suboptimal model may perform better than an unaided clinician. Nevertheless, we believe that a fresh examination of selected, well-established predictive models is warranted if not previously done. JAMA Network Open has published articles addressing prediction of relatively common clinical complications, such as recurrent gastrointestinal bleeding. 6 We think there remains considerable opportunity for research in this vein. In particular, we seek studies that examine current performance of commonly applied clinical prediction rules. We are particularly interested in studies using data from a variety of settings and databases as well as studies that simultaneously assess multiple models addressing the same or similar outcomes.

We also remain interested in the derivation of new models that address a clear clinical need. They should utilize data that are commonly collected as part of routine care, or in principle can be readily extracted from electronic health records. We generally require that prediction models be validated with at least 1 other dataset distinct from the development dataset. In practice, this means data from different health systems or different publicly available or commercial datasets. We note that internal validation techniques, such as split samples, hold-out, k -fold, and others, are not designed to overcome the intrinsic differences between data sources and, therefore, are not suited to quantifying performance externally. While the population to which the models apply should be described explicitly, ideally any such models should be applicable to patients from the wide range of races, ethnicities, and backgrounds commonly encountered in clinic practice. Most importantly, we are interested in examples of models that have been evaluated in clinical settings, assessing their feasibility and potential clinical benefit. This includes studies with negative as well as positive outcomes.

Please see the journal’s Instructions for Authors for information on manuscript preparation and submission. 7 This is not a time-limited call for studies on this topic.

Published: April 12, 2024. doi:10.1001/jamanetworkopen.2024.9640

Corresponding Author: Stephan D. Fihn, MD, MPH, Department of Medicine, University of Washington, 325 Ninth Ave, Box 359780, Seattle, WA 98104 ( [email protected] ).

Conflict of Interest Disclosures: Dr Berlin reported receiving consulting fees from Kenvue related to acetaminophen outside the submitted work. No other disclosures were reported.

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Fihn SD , Berlin JA , Haneuse SJPA , Rivara FP. Prediction Models and Clinical Outcomes—A Call for Papers. JAMA Netw Open. 2024;7(4):e249640. doi:10.1001/jamanetworkopen.2024.9640

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The Effects of Sensory Deprivation on a Child’s Cognitive and Socio Emotional Development

This essay about environmental deprivation explores how a lack of educational resources and exposure to pollutants can significantly impact intelligence. It outlines the crucial role education plays in cognitive development and how its absence can hinder intellectual growth. Furthermore, it discusses the adverse effects of environmental pollutants like lead and mercury on brain function, emphasizing their harmful impact during the early developmental stages. The essay highlights the interplay between genetic and environmental factors in shaping intelligence, stressing the importance of addressing these issues through comprehensive approaches to ensure every individual has the opportunity to achieve their full cognitive potential.

How it works

Environmental deprivation refers to the lack of environmental stimuli essential for the cognitive, emotional, and physical development of an individual. This deprivation can significantly impact various aspects of human development, intelligence being one of the primary areas affected. Intelligence, in this context, is not solely the ability to perform well academically but encompasses a broader spectrum of cognitive functions, including problem-solving, understanding complex ideas, and adapting to new situations. In this essay, we will explore two examples of environmental deprivation – lack of access to education and exposure to pollutants – and delve into how these factors can influence intelligence.

Firstly, let’s consider the impact of limited access to education. Education is a fundamental right and plays a crucial role in the development of cognitive abilities. It offers not just the acquisition of factual knowledge but also fosters critical thinking, creativity, and social skills. However, in many parts of the world, children grow up in environments where access to quality education is severely restricted due to economic, social, or political factors. This form of environmental deprivation can have long-lasting effects on intelligence. For instance, without the stimulation provided by educational activities, children miss out on developing vital cognitive skills at the crucial stages of their brain development. Moreover, the lack of educational resources and supportive learning environments can lead to reduced motivation and engagement in learning activities, further hindering intellectual growth.

Secondly, exposure to environmental pollutants represents another form of environmental deprivation with significant implications for intelligence. Pollutants such as lead, mercury, and particulate matter can interfere with brain development and function. For example, lead exposure in children has been linked to reduced cognitive performance, lower IQ, and behavioral issues. These pollutants can be found in water, air, and even the walls of homes, making them a pervasive threat to cognitive development. The neurotoxic effects of these substances can impair neural connectivity and neurotransmitter systems, which are critical for cognitive functions and intellectual performance. The impact is most severe when exposure occurs during the early years of life, a period characterized by rapid brain growth and development.

The influence of environmental deprivation on intelligence highlights the complex interplay between genetics and environment in human development. While genetic factors do play a role in determining an individual’s cognitive capabilities, the environment in which a person grows up can significantly modulate these inherent potentials. In the cases of lack of access to education and exposure to pollutants, we see how environmental factors can create a setting that either fosters or hinders the development of intelligence. It’s a stark reminder that intelligence is not a static trait but a dynamic one that can be shaped by external conditions.

Addressing environmental deprivation requires a multifaceted approach. Ensuring universal access to quality education is crucial. This not only means making education available but also making it relevant, engaging, and supportive of the diverse needs of learners. On the other hand, tackling pollution demands stringent environmental regulations, public health initiatives, and community education to reduce exposure and mitigate risks.

In conclusion, environmental deprivation in the form of lack of access to education and exposure to pollutants can have profound impacts on the development of intelligence. These examples illustrate the necessity of creating enriching environments that stimulate and support cognitive development. As we move forward, it’s imperative that society recognizes and acts on the importance of environmental factors in shaping intelligence, ensuring that every individual has the opportunity to reach their full cognitive potential.

Remember, this essay is a starting point for inspiration and further research. For more personalized assistance and to ensure your essay meets all academic standards, consider reaching out to professionals at EduBirdie.

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Authors: Ryota Noguchi and Milly Ishihara*

The essay entitled “ The Problems of Current Health Standards: Reviewing Loopholes of The SPS Agreement in WTO ” posted by Mr. Dollin Ardan, published in Modern Diplomacy on November 11, 2023, is a highly insightful piece. In this essay, he argues that public perspectives and opinions should be considered in in the context of scientific consensus, as public sentiment can legitimize scientific consensus. He also raises concerns about the exclusion of public sentiments in the decision-making process for adopting sanitary and phytosanitary (SPS) measures and its potential impact on chronic health issues like obesity.

However, we believe there are some inaccuracies in Mr. Ardan’s discussion around public sentiments. In sum, as opposed to his claims, we believe that when dealing with scientific issues, public sentiments should not be taken into consideration, while the SPS Agreement of the World Trade Organization (WTO) is structured to consider public sentiments in the context of “risk management” rather than risk assessment. In this article, we aim to critically examine Ardan’s arguments regarding the role that public sentiments should play in food safety regulations. Coincidentally, like Mr. Ardan, we are also undergraduate students specializing in international trade law, including various SPS issues , at the School of International Relations of University of Shizuoka, Japan . We are grateful for the opportunity through this magazine to engage in discussions on this important theme with like-minded students from other countries.

Distinction between Risk Assessment and Risk Management

In his essay, Mr. Ardan states as follows.

Despite the fact that it [the SPS Agreement] is a trade agreement, I contend that public perspectives and opinions matter, particularly in the context of scientific consensus. Science will be strongly justified when public sentiment contributes to the legitimacy of the science. The SPS Agreement’s technocratic nature of science may have resulted in the exclusion of public participation in the decision-making process for domestic measures.

In our view, however, his assertion that public perspectives and opinions are crucial in shaping scientific consensus may indicate a misinterpretation of the risk assessment concept within the SPS Agreement. Additionally, his argument that public participation is absent from the decision-making process in the SPS Agreement may also suggest a failure to grasp the concept of risk management within the Agreement.

In the SPS Agreement, WTO Members adopting SPS measures are required to base them on a risk assessment. A risk assessment for food safety is defined in the Agreement as “the evaluation of the potential for adverse effects on human or animal health arising from the presence of additives, contaminants, toxins or disease-causing organisms in food, beverages or feedstuffs”. For this purpose, it is required to assess how much of the food hazards at issue the average consumer is exposed to through regular diet and the probability of adverse health effects arising from the identified level of exposure. Thus, risk assessment is a scientifically driven process, and the SPS Agreement is not designed to consider “public perspectives and opinions” during this process, nor should it be considered there.

On the other hand, risk management involves examining how health risks identified through risk assessment should be managed, by what policy means, and to what extent. In such examinations, a policy objective needs to be set regarding how much the health risk in question should be protected, or in other words, to what extent the health risk can be acceptable. This is defined in the SPS Agreement as the “appropriate level of protection (ALOP)” or “acceptable level of risk”. WTO Members are required not to make their SPS measures more trade-restrictive than necessary to achieve their ALOP. In other words, if the policy objective (i.e., ALOP) can be achieved by measures that are less trade-restrictive, the WTO Agreement, being a trade agreement, requires that Members prioritize such measures.

According to Mr. Ardan, as noted before, public participation is excluded from the decision-making process for adopting SPS measures in the SPS Agreement. However, this observation appears to overlook the reality of how the ALOP as a policy objective in risk management is set. ALOP is a policy decision about how much health risk from consuming import food a WTO Member is willing to accept. And such a policy decision is strongly influenced by public sentiments or participation. Even if the scientific risk is considered low, the citizens of the Member may have an aversion to the risk for various reasons (such as national character, traditions, or the influence of media). In that case, governments may adopt extremely strict SPS measures to address such scientifically low risk in response to the public sentiments.

In sum, in contrast to risk assessment, it is normal for Members to actively consider public sentiments when setting their policy goals (i.e., ALOP) in the process of risk management. In WTO jurisprudence on SPS cases , the panels and the Appellate Body have persistently found that it is the prerogative of the importing Member to determine its ALOP.

The Issue of Obesity in the SPS Agreement

Moreover, understanding that the SPS Agreement excludes the perspective of public sentiments, Mr. Ardan suggests that as a consequence of such exclusion, the SPS Agreement may not effectively address chronic health issues like obesity. Then, he goes on to offer very intriguing suggestions regarding how the issue of obesity should be addressed within the SPS Agreement. While not explicitly stating so, he seems to suggest that the risk of obesity due to “[e]ating too much ‘safe’ food” should also be taken into account in a risk assessment in his writing below.

The exclusion of public and public health sentiments has also contributed to the gap in long-term health issues, such as obesity. This is in line with how the SPS Agreement ensures a health standard that addresses long-term health issues. Eating too much ‘safe’ food can lead to health problems.

However, this view is difficult to embrace. If the overconsumption of “safe food” leading to obesity is considered as a health risk associated with that food, then virtually all food in existence would be evaluated as having health risks. This is because overeating any kind of food leads to weight gain. As a result, WTO Members would likely take import restrictions on “safe food” based on the risk of obesity due to overeating.

For example, using butter as an example makes the shortcomings in the above discussion more evident. Butter is primarily composed of fat, and it is undisputed that excessive consumption of butter can lead to obesity. Butter itself is generally considered a safe food and thus is sold in markets worldwide based on such assessment. However, following Mr. Ardan’s argument, even such a safe product like butter could be evaluated as having a health risk of obesity due to overconsumption through a risk assessment, and WTO Members would be entitled to take import restrictions on butter under the SPS Agreement.

The fundamental question arises as to whether it is appropriate to address the issue of obesity through trade measures in the first place. Since the cause of obesity is clearly overeating and lack of physical exercise, we believe that instead of resorting to import restrictions on high-fat foods, governments should first engage in educational campaigns to emphasize the importance of dietary control and exercise their own citizens. In such circumstances, allowing WTO Members to take import restrictions of food are unlikely to make a significant contribution to the actual resolution of the obesity problem.

This essay revisits Dollin Ardan’s view on public sentiments in the WTO’s SPS Agreement, particularly highlighting the distinction between risk assessment and risk management. Contrary to Ardan’s argument, we emphasize that while risk assessment is strictly scientific and should not involve public opinions, risk management does allow for such considerations, particularly in determining an ALOP of importing Members. It should be emphasized that the accurate assessment of how public sentiments are considered within the SPS Agreement cannot be done without having such a conceptual distinction in mind. Furthermore, this essay discusses that allowing WTO Members to take import restrictions on scientifically safe food based on the risk of obesity due to overeating would lead to unjust conclusions. It is noted that issues of chronic diseases like obesity would be more effectively addressed by other domestic policies than trade measures.

*Milly Ishihara : I’m currently a sophomore at the University of Shizuoka, Japan, majoring in International Relations with a keen interest in Development Aid. I plan to specialize in International Law starting from my junior year onwards.

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In the womb, a brother's hormones can shape a sister's future.

Jon Hamilton

Credit: Lily Padula for NPR

The Science of Siblings is a new series exploring the ways our siblings can influence us, from our money and our mental health all the way down to our very molecules. We'll be sharing these stories over the next several weeks.

A sibling can change your life — even before you're born.

That's because when males and females share a womb, sex hormones from one fetus can cause lasting changes in the others.

It's called the intrauterine position phenomenon , or intrauterine position effects, and different versions of it have been observed in rodents, pigs, sheep — and, probably, humans.

"It's really kind of strange to think something so random as who you develop next to in utero can absolutely change the trajectory of your development," says Bryce Ryan , a professor of biology at the University of Redlands.

Special Series

The science of siblings.

The phenomenon is more than a scientific oddity. It helped establish that even tiny amounts of hormone-like chemicals, like those found in some plastics, could affect a fetus.

An oddity in ancient Rome

Cattle breeders in ancient Rome may have been the first people to recognize the importance of a sibling's sex.

They realized that when a cow gives birth to male-female twins, the female is usually sterile. These females, known as freemartins , also act more like males when they grow up.

Scientists began to understand why in the early 1900s. They found evidence that hormones from the male twin were affecting the female's development.

The effect is less obvious in other mammals, Ryan says. Female offspring in rodents, for example, can still reproduce, but they have measurable differences in sexual development and tend to be more aggressive.

These identical twins both grew up with autism, but took very different paths

These identical twins both grew up with autism, but took very different paths

The intrauterine position phenomenon occurs because the testes of male fetuses begin producing testosterone early in development. Meanwhile, at this stage, the ovaries in females "don't produce much of anything," Ryan says.

This makes no difference when all the fetuses in a womb are of the same sex. But when males and females are present, there can be some hormonal cross-talk, especially in rodents, which can carry litters of a dozen or more pups.

"Those fetuses are packed so tightly together in the uterus, the testosterone can travel through the amniotic fluid from pup to pup and can also be carried by the circulatory system," Ryan says.

Females squeezed between two males typically experience the most exposure to testosterone and are most likely to exhibit hormonal and behavioral differences throughout their lives.

BPA and other hormone-like chemicals

Usually, intrauterine position produces subtle changes that would matter only to a lab scientist or animal breeder.

But the phenomenon became part of a public debate in the early 2000s, thanks to a plastic additive called bisphenol A ( BPA ).

BPA acts like a weak version of the hormone estrogen, and studies showed that small amounts were leaching out of some plastics and into people.

Blended families are common. Here are tips to help stepsiblings get along

At one time, scientists might have assumed these low exposures were harmless. But research on the intrauterine position phenomenon had shown that even trace amounts of a sex hormone could affect a developing fetus.

"For a lot of people, this was a wake-up call — and maybe the first wake-up call — that plastics were not universally good," Ryan says.

So BPA became a lightning rod for debates about the safety of chemicals that can act like hormones in the body.

"As a physician, as a father, I would never on purpose expose my own children to BPA — I would not do it," pediatrician Alan Greene told a 2009 rally in California in support of a bill to ban BPA in products for young children.

The plastics industry responded with messages reassuring the public that "the trace amounts we are exposed to from materials that keep our food safe are safe for us."

Humans and hormones

Scientists remain divided on the safety of BPA, phthalates and many other chemicals that can act like sex hormones, and the intrauterine position phenomenon has contributed to that debate.

Early on, research suggested that a fetus's position in the uterus could affect the very experiments used to assess the safety of BPA.

One study in the 1990s, for example, found that female mouse pups that had developed between two males were much less sensitive to BPA compared with female pups that had gestated between two other females.

This meant that scientists needed to account for a mouse's place in the womb or they might miss any effects from BPA.

At the heart of this cozy coffee shop lies a big sister's love for her little brother

And if hormones from a sibling were enough to confound an experiment, so might lots of other subtle factors, like the mouse strain used in an experiment, the kind of test used to measure BPA or the possibility that trace amounts of BPA had contaminated an experiment.

Today, scientists are still trying to understand those factors.

They are also trying to figure out whether the hormonal changes related to intrauterine position can affect people.

"Some studies have shown that opposite-[sex] twins, especially the females, do show differences in behavior and may show differences in physiology as well, " Ryan says.

These differences include how many children they have, how their facial features develop and how their brains process language.

But it's difficult to know for sure, Ryan says, because it's really hard to study a species that lives in the world, not a lab.

More from the Science of Siblings series:

The order your siblings were born in may play a role in identity and sexuality
National Siblings Day is a celebration born of love — and grief
sex hormones
intrauterine position effects
Science of Siblings
fraternal twins

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Guest Essay

Anxious Parents Are the Ones Who Need Help

An illustration of a college campus where parents look distressed about their children while the children seem fine.

By Mathilde Ross

Dr. Ross is a senior staff psychiatrist at Boston University Health Services.

This month, across the country, a new cohort of students is being accepted into colleges. And if recent trends continue, the start of the school year will kick off another record-breaking season for anxiety on campus.

I’m talking about the parents. The kids are mostly fine.

Let me explain. Most emotions, even unpleasant ones, are normal. But the word is out about increasing rates of mental health problems on campus, and that’s got parents worrying. Fair enough. The statistics are startling — in 2022, nearly 14 percent of 18-to-25-year-olds reported having serious thoughts about suicide.

But parents are allowing their anxiety to take over, and it’s not helping anyone, least of all their children. If a child calls home too much, there must be a crisis! And if a child calls too little, there must be a crisis! Either way, the panicked parent picks up the phone and calls the college counseling center to talk to someone like me.

I am a psychiatrist who has worked at a major university’s mental health clinic for 16 years. Much of next year’s freshman class was born the year before I started working here. Technically, my job is to keep my door open and help students through crises, big and small. But I have also developed a comprehensive approach to the assessment and treatment of anxious parents.

The typical call from a parent begins like this: “I think my son/daughter is suffering from anxiety.” My typical reply is: “Anxiety in this setting is usually normal, because major life transitions like living away from home for the first time are commonly associated with elevated anxiety.” Parents used to be satisfied with this kind of answer, thanked me, hung up, called their children and encouraged them to think long-term: “This too shall pass.” And most everyone carried on.

But these days this kind of thinking just convinces parents that I don’t know what I’m talking about. In the circular logic of mental health awareness, a clinician’s reassurance that situational anxiety is most likely normal and time-limited leads a parent to believe that the clinician may be missing a serious mental health condition.

Today’s parents are suffering from anxiety about anxiety, which is actually much more serious than anxiety. It’s self-fulfilling and not easily soothed by logic or evidence, such as the knowledge that most everyone adjusts to college just fine.

Anxiety about anxiety has gotten so bad that some parents actually worry if their student isn’t anxious. This puts a lot of pressure on unanxious students — it creates anxiety about anxiety about anxiety. (This happens all the time. Well-meaning parents tell their kid to make an appointment with our office to make sure their adjustment to college is going OK.) If the student says she’s fine, the parents worry that she isn’t being forthright. This is the conundrum of anxiety about anxiety — there’s really no easy way to combat it.

But I do have some advice for parents. The first thing I’d like to say, and I mean it in the kindest possible way, is: Get a grip.

As for your kids, I would like to help you with some age-appropriate remedies. If your child calls during the first weeks of college feeling anxious, consider saying any of the following: You’ll get through this; this is normal; we’ll laugh about this phone call at Thanksgiving. Or, say anything that was helpful to you the last time you started something new. Alternatively, you could say nothing. Just listening really helps. It’s the entire basis of my profession.

If the anxiety is connected to academic performance — for instance, if your child is having difficulty following the professor and thinks everyone in class is smarter — consider saying, “Do the reading.” Several times a semester, a student I’ve counseled tells me he or she discovered the secret to college: Show up for class prepared! This is often whispered rather sheepishly, even though my office is private.

Anxiety about oral presentations is also quite common. You know what I tell students? “Rehearse your speech.” Parents, you can say things like this, too. Practice it: “Son, you wouldn’t believe how helpful practice is.”

I can prepare you for advanced topics, too. Let’s say your child is exhausted and having trouble waking up for class; he thinks he has a medical problem or maybe a sleep disorder. Consider telling him to go to bed earlier. Common sense is still allowed.

What if a roommate is too loud or too quiet, too messy or too neat? Advise your kid to talk to the roommate, to take the conversation to the problem’s source.

If your child is worrying about something more serious, like failing out of college: This is quite common in the first few weeks on campus. Truth be told, failing all of one’s classes and being expelled as a result, all within the first semester, is essentially impossible and is particularly rare among those students who are worrying about it. The administrative process simply doesn’t happen that fast. Besides, you haven’t paid enough tuition yet.

I’m making my job sound easy, and it’s not. I’m making kids sound simple, and they’re not. They are my life’s work. Some kids walk through my door in serious pain. But most don’t. Most just need a responsible adult to show them the way. And most of what I do can be handled by any adult who has been through a thing or two, which is to say, any parent.

I worry that the current obsession with mental health awareness is disempowering parents from helping their adult children handle ordinary things. People are increasingly fearful that any normal emotion is a sign of something serious. But if you send your adult children to a mental health professional at the first sign of distress, you deprive yourself of the opportunity to strengthen your relationship with them. This is the beginning of their adult relationship with you. Show them the way.

The transition to college is full of excitement and its cousin, anxiety. I enjoy shepherding young people through this rite of passage. Parents should try enjoying it, too.

Mathilde Ross is a senior staff psychiatrist at Boston University Health Services.

The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips . And here’s our email: [email protected] .

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April 12, 2024

Joseph Wallace appointed associate vice president for research development

Joseph Wallace has been named the associate vice president for research development and will spearhead new research endeavors for Purdue University in Indianapolis. Prior to this appointment, Wallace was serving in multiple roles simultaneously at IUPUI: interim dean of the School of Engineering and Technology since 2023, chair of the Department of Biomedical Engineering since 2020, a professor at IUPUI since 2010, and a researcher studying bone health and disease for two decades.

“Joey’s appointment to this position fills a critical need to advance Purdue’s research in Indianapolis,” said David Umulis, senior vice provost Purdue University for Indianapolis. Wallace’s outstanding research in biomedical engineering, in addition to his leadership and administrative capabilities, make him an excellent choice for this new position, Umulis said.

Karen Plaut, executive vice president for research in the Office of Research, said she is delighted that Wallace will be part of Purdue’s research leadership team.

“Under Dr. Wallace’s leadership, we will be able to shine a spotlight on the great research that is already taking place in Indianapolis, explore new opportunities and use the power of both campuses to continue to grow our research portfolio,” Plaut said.

Wallace said he is excited to expand those research areas in which Indianapolis already excels, including energy generation and storage, autonomous transportation, medicine, pharmaceuticals and innovative materials.

“Taking this brand-new position in the inaugural year of Purdue University in Indianapolis, having a voice and a vision and to be able to execute that voice and vision — that’s what’s most exciting,” Wallace said. “The goal will be to interface with local and state and federal sources and businesses that can bring resources and opportunities into the Indianapolis ecosystem here on campus to both bolster what people are doing in their labs and also create bigger initiatives that will drive the campus forward. For example, I’m thinking about how we can interface with the local biotech companies to get opportunities for our students that don’t exist right now.”

With a history of successful collaborations with other researchers across Indianapolis, nationally and internationally, Wallace plans to put his experiences to good use.

“For the 14 years I’ve been on this campus, I’ve been integrating with local researchers, hospitals and businesses that are focused on biomedically related things,” Wallace said. “I’ve got collaborations across this whole campus which will not go away with the realignment.”

A first-generation college student, Wallace became a researcher in biomedical engineering through “a circuitous path.” He majored in aerospace engineering at Georgia Tech before pursuing another strong interest, medicine, in that university’s brand-new biomedical engineering program. Wallace earned a PhD in biomedical engineering in 2007 from the University of Michigan and chose to stay for a National Institutes of Health-funded individual postdoctoral fellowship in the Department of Chemistry.

“I didn’t want to be a doctor, but I liked the idea of BME, a relatively new field at the time,” Wallace said. “I took a couple of classes — one of them taught me about bone and I was hooked.” His areas of research include bone mechanics, mechanobiology, mechanically-mediated skeletal adaptation, and collagen’s role in bone health and fracture resistance.

Wallace hopes his new position will provide pathways for many Purdue University students to follow and find their own love of research.

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Developing ash-free high-strength spherical carbon catalyst supports

Domestic Catalysts
Published: 28 June 2013
Volume 5 , pages 156–163, ( 2013 )

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V. V. Gur’yanov 1 ,
V. M. Mukhin 1 &
A. A. Kurilkin 1

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The possibility of using furfurol for the production of ash-free high-strength active carbons with spheroidal particles as adsorbents and catalyst supports is substantiated. A single-stage process that incorporates the resinification of furfurol, the molding of a spherical product, and its hardening while allowing the process cycle time and the cost of equipment to be reduced is developed. Derivatographic, X-ray diffraction, mercury porometric, and adsorption studies of the carbonization of the molded spherical product are performed to characterize the development of the primary and porous structures of carbon residues. Ash-free active carbons with spheroidal particles, a full volume of sorbing micro- and mesopores (up to 1.50 cm 3 /g), and a uniquely high mechanical strength (its abrasion rate is three orders of magnitude lower than that of industrial active carbons) are obtained via the vapor-gas activation of a carbonized product. The obtained active carbons are superior to all known foreign and domestic analogues and are promising for the production of catalysts that operate under severe regimes, i.e., in moving and fluidized beds.

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Optimization of the preparation conditions for cocoa shell-based activated carbon and its evaluation as salts adsorbent material

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Gur’yanov, V.V., Mukhin, V.M. & Kurilkin, A.A. Developing ash-free high-strength spherical carbon catalyst supports. Catal. Ind. 5 , 156–163 (2013). https://doi.org/10.1134/S2070050413020062

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Joseph Wallace appointed associate vice president for research development
Joseph Wallace has been named the associate vice president for research development and will spearhead new research endeavors for Purdue University in Indianapolis. Prior to this appointment, Wallace was serving in multiple roles simultaneously at IUPUI: interim dean of the School of Engineering and Technology since 2023, chair of the Department of Biomedical Engineering since 2020, a ...
Developing ash-free high-strength spherical carbon catalyst supports
The possibility of using furfurol for the production of ash-free high-strength active carbons with spheroidal particles as adsorbents and catalyst supports is substantiated. A single-stage process that incorporates the resinification of furfurol, the molding of a spherical product, and its hardening while allowing the process cycle time and the cost of equipment to be reduced is developed ...

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