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Jump to Chapter 3 Sections:
>> Health, development and aid >> Broad progress, startling changes, persistent quandaries >> Health indicators: advances and obstacles >> Health systems and services >> To review the bidding >> Implications of trends for future directions >> Implications for the philosophy and pursuit of "foreign assistance" >> Notes >> Background paper >> References
The momentum of past health improvements will shift health patterns significantly in many developing
regions.
A majority of developing countries will experience declining dependency ratios, the time when
fewer children and elderly are dependent on the working age population for resources. These
countries will have greater opportunity to invest in productive endeavors. The demographic shifts
will be accompanied by changes in morbidity and mortality. Many countries have reached or will
soon reach the Summit of Children goal for infant mortality reduction. For them, the key
public health issues will include those which affect both the productivity of their labor forces
and the health costs of the elderly. This disease profile is predominantly noncommunicable and
chronic.
Even as the shift takes place, many traditional problems will persist, such as infectious diseases
resurging because of resistance. The future pattern will be one of a growing chronic disease
burden overlaid on top of a persisting reservoir of communicable diseases.
Simultaneously, some countries, many in southern Africa, will continue to have demographic and
disease patterns more characteristic of past trends-high infant mortality, low life expectancy, and epidemiology dominated by infectious diseases.
For both old and new problems, the central concern will be self-reliance so that economic progress can be tied to the maintenance of public health progress. In turn, a central concern of selfreliance
will be financial diversity, including private finance that already represents over half of all health resources. Political commitment is also key. For many developing countries, self-reliance
in such traditional concerns as immunizations is increasingly not a matter of inadequate resources.
It is more a matter of political will, commitment, and management.
Implications of trends for future directions
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