2. Success in Addressing Priorities

In addition to the six cases selected for discussion in the text, other public health successes presented in DCP2 (chapter 8) include the following:

• Improved health among children and adults. In 1997, the Mexican government launched a new social welfare program design to help lift poor families out of poverty by providing cash payments in exchange for their participation in nutritional and supplementation programs, use of preventive and basic health care services, and children's school attendance. After five years, the children of participating families were 12 percent less likely to experience illness than those of nonparticipating families and their nutritional status had improved. Adult health indicators had also improved.

• Chagas disease control. In 1991, seven countries—Argentina, Bolivia, Brazil, Chile, Paraguay, Uruguay, and later Peru—joined forces as part of the Pan American Health Organization's Initiative for the Southern Cone Countries to combat Chagas disease through a combination of surveillance activities, house-to-house spraying, and other vector control methods. By 2000, disease incidence had fallen by 94 percent, and by 2001, disease transmission had been halted in Chile, Uruguay, and large parts of Brazil and Paraguay.

• Diarrheal treatment. In Egypt, the government launched a national program in the early 1980s to promote the use of locally manufactured oral rehydration salts by mothers by means of a four-part strategy that included: tailoring product design and branding to accommodate local preferences and customs; strengthening production and distribution channels, both public and private; training health workers; and engaging in social marketing and a mass media campaign. Between 1982 and 1987, infant and child mortality dropped by 36 and 43 percent, respectively. Mortality attributed to diarrhea fell 82 percent among infants and 62 percent among children.

• Guinea worm control. Twenty countries in Asia and Sub-Saharan Africa began a global campaign to eradicate guinea worm in the mid 1980s. Led by the Carter Center, the United Nations Children's Fund, the U.S. Centers for Disease Control and Prevention, and the World Health Organization, the campaign promoted improved water safety through deep well digging, environmental control, and the use of cloth filters for drinking water; health education programs; and case management, containment, and surveillance. By 1998, between 9 million and 13 million cases of guinea worm had been prevented, and global prevalence had dropped by 99 percent.

• Family planning. Since the 1970s, Bangladesh has promoted family planning through a door-to-door outreach program conducted by young, married women who provide information about limiting family size or spacing pregnancies and pertinent products. The outreach program is accompanied by an extensive media campaign. Contraceptive use among married women in Bangladesh is now approximately 50 percent, compared with only 8 percent in the mid 1970s, and the average number of children per family is 3.3, down from 7.0 during the same period.

• HIV/AIDS prevention. Thailand launched the 100 Percent Condom Use Program in 1991 to address the rising incidence of HIV/AIDS. The program provided boxes of condoms to brothels free of charge, mandated the use of condoms among sex workers, and threatened brothels with penalties and closure for noncompliance. Condom use in brothels rose from 14 percent in 1989 to more than 90 percent by 1992. The number of new sexually transmitted infections fell from 200,000 in 1989 to 15,000 in 2001, and the rate of new HIV infections fell five-fold between 1991 and 1993-95.

• Measles elimination. In 1996, the seven southern African countries agreed to a coordinated immunization strategy, supported by improved surveillance and laboratory capacity, to eliminate measles by including it as part of routine immunization for all nine-month old babies and organizing nationwide catch-up and follow-up campaigns for children age 9 months to 14 years. The number of measles cases reported annually in the region fell from 60,000 in 1996 to 117 in 2000. The number of deaths attributed to measles fell from 166 to none during the same period.

• Salt fluoridation. In Jamaica, a formal agreement between the Ministry of Health and the country's only salt producer introduced salt fluoridation in 1987 to prevent caries. By 1995, the prevalence of caries in children between the ages of 6 and 12 had fallen by more than 80 percent.

• Salt iodination. China launched the National Iodine Deficiency Disorders Elimination Program in 1993. The government requires producers to iodize salt and has stepped up its monitoring and enforcement capacity to ensure compliance. Total goiter rates among children between the ages of 8 and 10 fell from 20.4 percent in 1995 to 8.8 percent in 1999.

• Tobacco control. Poland passed groundbreaking legislation in 1995, imposing strong warning labels on cigarette packages, banning smoking from enclosed workplaces, and prohibiting tobacco sales to minors. South Africa passed similar legislation in 1999 to strengthen a previously imposed tax of 50 percent on the value of the retail price of cigarettes. Between 1990 and 1998, Poland experienced a 30 percent decline in lung cancer among men age 20 to 44, a nearly 7 percent decline in CVD, and a decline in the number of babies born with low birthweights. In the 1990s, South Africa witnessed a 30 percent decline in cigarette consumption, especially among youth and the poor.

• Tuberculosis control. In 1991, China launched a 10-year program in 13 of its 31 mainland provinces to apply the DOTS strategy to TB control. Peru, previously one of 23 high-burden countries that collectively account for 80 percent of the world's new TB cases each year, launched a similar effort the same year. Within two years of initiating its program, China had achieved a 95 percent cure rate for new cases and a cure rate of 90 percent for those patients whose treatment had previously been unsuccessful. Between 1999 and 2000, the number of people in these provinces with TB declined by more than 37 percent. In Peru, the DOTS program achieved a case detection rate of 70 percent and an 85 percent cure rate. As a result, disease incidence declined 6 percent a year.

Source: Adapted from DCP2, chapter 8.