Ch was not only characterised by chronic diseases but also by

Ch was not only characterised by chronic diseases but also by: low fertility, high life expectancy and ageing populations; economies articulated around technology and mass consumption; as well asrationality, nuclear GDC-0084 molecular weight families and high living standards (Omran, 1971, p.516?17). In contrast, `undeveloped’ societies, he posited, had yet to complete this transition and were still in the `Age of Pestilence and Famine’ defined not only by infectious diseases and malnutrition but also by: high fertility, high mortality and young populations; economies mixing subsistence farming with early industrialisation; as well as traditional values, extended families and poor, unsanitary living conditions (ibid.). These different disease patterns and development levels were further associated with differing healthcare systems. While surveillance medicine was the dominant paradigm in North America and Europe, the notion of primary health care (PHC) enshrined in the Declaration of Alma Ata prevailed across the Third World (Fassin, 2000; Cueto, 2004). After independence, developing countries quickly realised that the healthcare systems inherited from colonial times and based around the hospital and eradication campaigns against tropical diseases were not appropriate to their situation: hospitals, usually located in cities, were not accessible to the rural poor that made up most of their population; eradication campaigns were associated with authoritarian practices that jarred with the spirit of decolonisation; and Western medical technologies were too expensive. PHC was developed as an alternative model of healthcare tailored to the specific needs of the Third World. It promised to offer essential healthcare made accessible to all citizens via a network of rural health workers and centres and characterised by community participation, an emphasis on prevention and simple, cheap technologies. While the programmes put in place to operationalise the PHC ideal varied across the developing world, they tended to concentrate on communicable diseases and child and maternal health issues, including: oral rehydration therapy for diarhoea; family planning; nutrition; and mass immunisations against major infectious diseases like measles and diphtheria (Mull, 1990). This way of thinking, which deemed chronic diseases and the developing world as mutually exclusive and associated the latter with infectious diseases, maternal and child health, malnutrition and PHC remained predominant until the turn of the century. The Millennium Development Goals, for example, owed a lot to this style of reasoning, not least by U0126MedChemExpress U0126-EtOH viewing health as critical to development and by constraining its health-related efforts to maternal and child health, infectious diseases and malnutrition. But, from the late 1970s onwards, an increasing number of reports from physicians and mostly small, hospital-based epidemiological surveys in LMICs showing a growth in the number of patients suffering from NCDs began to challenge this way of thinking (Phillips, 1990; Reubi, 2013). Unsurprisingly, this gradually led to efforts to construe chronic diseases as a development issue. Of course, the WHO did some work on chronic diseases in the Third World, launching its Integrated Programme for Community Health in Non-Communicable Diseases in a small number of developing countries in the 1980s (Weisz, 2014a). But, it was the efforts of economists and epidemiologists at the World Bank ?especially Dean Jamison’s Health Sect.Ch was not only characterised by chronic diseases but also by: low fertility, high life expectancy and ageing populations; economies articulated around technology and mass consumption; as well asrationality, nuclear families and high living standards (Omran, 1971, p.516?17). In contrast, `undeveloped’ societies, he posited, had yet to complete this transition and were still in the `Age of Pestilence and Famine’ defined not only by infectious diseases and malnutrition but also by: high fertility, high mortality and young populations; economies mixing subsistence farming with early industrialisation; as well as traditional values, extended families and poor, unsanitary living conditions (ibid.). These different disease patterns and development levels were further associated with differing healthcare systems. While surveillance medicine was the dominant paradigm in North America and Europe, the notion of primary health care (PHC) enshrined in the Declaration of Alma Ata prevailed across the Third World (Fassin, 2000; Cueto, 2004). After independence, developing countries quickly realised that the healthcare systems inherited from colonial times and based around the hospital and eradication campaigns against tropical diseases were not appropriate to their situation: hospitals, usually located in cities, were not accessible to the rural poor that made up most of their population; eradication campaigns were associated with authoritarian practices that jarred with the spirit of decolonisation; and Western medical technologies were too expensive. PHC was developed as an alternative model of healthcare tailored to the specific needs of the Third World. It promised to offer essential healthcare made accessible to all citizens via a network of rural health workers and centres and characterised by community participation, an emphasis on prevention and simple, cheap technologies. While the programmes put in place to operationalise the PHC ideal varied across the developing world, they tended to concentrate on communicable diseases and child and maternal health issues, including: oral rehydration therapy for diarhoea; family planning; nutrition; and mass immunisations against major infectious diseases like measles and diphtheria (Mull, 1990). This way of thinking, which deemed chronic diseases and the developing world as mutually exclusive and associated the latter with infectious diseases, maternal and child health, malnutrition and PHC remained predominant until the turn of the century. The Millennium Development Goals, for example, owed a lot to this style of reasoning, not least by viewing health as critical to development and by constraining its health-related efforts to maternal and child health, infectious diseases and malnutrition. But, from the late 1970s onwards, an increasing number of reports from physicians and mostly small, hospital-based epidemiological surveys in LMICs showing a growth in the number of patients suffering from NCDs began to challenge this way of thinking (Phillips, 1990; Reubi, 2013). Unsurprisingly, this gradually led to efforts to construe chronic diseases as a development issue. Of course, the WHO did some work on chronic diseases in the Third World, launching its Integrated Programme for Community Health in Non-Communicable Diseases in a small number of developing countries in the 1980s (Weisz, 2014a). But, it was the efforts of economists and epidemiologists at the World Bank ?especially Dean Jamison’s Health Sect.