Investing in health: the 1993 World Development Report of the World Bank.

s and Reports 285 governments to subsidize or promote actaneously to higher cost, poorer health, tivities providing substantial externaliand less equity. To do this requires that ties-instances in which the patient bengovernments concern themselves less with efits but others do also. The control of providing health care and far more with communicable diseases such as tubercuregulating providers and insurers to assure losis and STDs is the clearest example. quality and avoid inequities. They must The third argument is that governments also promote competitive provision and efhave a responsibility to control or offset ficiency in the use of both public and prithe “market failures” that readily occur vate resources. These responsibilities canin health care and particularly in health not be left to the market; it is vital that insurance, failures that can lead simulgovernments discharge them well. Good News on Inject&es Contmceptives The findings of two WHO meetings of experts provided encouraging news for women who use or would like to use injectable contraceptives. Meeting in Geneva in late May, a panel of epidemiologists, clinicians, and public health specialists concluded that the progestin-only contraceptive DMPA (widely known under the brand name DepoProvera) does not increase the overall risk of breast cancer, is not linked epidemiologically to either cervical or ovarian cancer, and may protect against endometrial cancer. At another meeting in early June, international experts in human reproduction, gynecology, and contraceptive delivery research concluded that two combination injectable contraceptives, known as Cyclofem and Mesigyna, were highly effective (nearly 100%) at blocking pregnancy and had a relatively low incidence of side effects. Unlike DMPA, which is administered every 3 months, these new preparations (which were developed by WHO’s Special Program of Research, Development, and Research Training in Human Reproduction) are injected once a month. Because they combine an estrogen with a progestin, they rarely cause the menstrual cycle irregularities that are commonly associated with DMPA and can result in discontinuation of that method. Large-scale clinical trials showed their high efficacy and good acceptance by users. Sources: World Health Organization, Press Release WHO/41, 1 June 1993, and Press Release WHO/43, 4 June 1993. 286 Bullefin of PAHO 27(3), 1993