Quality of life

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Quality of life (QOL) is defined by the World Health Organization as "an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns". [1]

Contents

Standard indicators of the quality of life include wealth, employment, the environment, physical and mental health, education, recreation and leisure time, social belonging, religious beliefs, safety, security and freedom. [2] [3] [4] QOL has a wide range of contexts, including the fields of international development, healthcare, politics and employment. Health related QOL (HRQOL) is an evaluation of QOL and its relationship with health. [5]

Engaged theory

One approach, called the engaged theory, outlined in the journal of Applied Research in the Quality of Life, posits four domains in assessing quality of life: ecology, economics, politics and culture. [6] In the domain of culture, for example, it includes the following subdomains of quality of life:

Under this conception, other frequently related concepts include freedom, human rights, and happiness. However, since happiness is subjective and difficult to measure, other measures are generally given priority. It has also been shown that happiness, as much as it can be measured, does not necessarily increase correspondingly with the comfort that results from increasing income. [7] As a result, standard of living should not be taken to be a measure of happiness. [2] [8] Also, sometimes considered related is the concept of human security, though the latter may be considered at a more basic level and for all people.

Quantitative measurement

Unlike per capita GDP or standard of living, both of which can be measured in financial terms, it is harder to make objective or long-term measurements of the quality of life experienced by nations or other groups of people. Researchers have begun in recent times to distinguish two aspects of personal well-being: Emotional well-being , in which respondents are asked about the quality of their everyday emotional experiences –the frequency and intensity of their experiences of, for example, joy, stress, sadness, anger and affection –and life evaluation, in which respondents are asked to think about their life in general and evaluate it against a scale. [9] Such and other systems and scales of measurement have been in use for some time. Research has attempted to examine the relationship between quality of life and productivity. [10]

There are many different methods of measuring quality of life in terms of health care, wealth, and materialistic goods. However, it is much more difficult to measure meaningful expression of one's desires. One way to do so is to evaluate the scope of how individuals have fulfilled their own ideals. Quality of life can simply mean happiness, which is the subjective state of mind. By using that mentality, citizens of a developing country appreciate more since they are content with the basic necessities of health care, education and child protection. [11]

According to ecological economist Robert Costanza:

While Quality of Life (QOL) has long been an explicit or implicit policy goal, adequate definition and measurement have been elusive. Diverse "objective" and "subjective" indicators across a range of disciplines and scales, and recent work on subjective well-being (SWB) surveys and the psychology of happiness have spurred renewed interest. [12]

Human Development Index

Perhaps the most commonly used international measure of development is the Human Development Index (HDI), which combines measures of life expectancy, education, and standard of living, in an attempt to quantify the options available to individuals within a given society. The HDI is used by the United Nations Development Programme in their Human Development Report. However, since year 2010, The Human Development Report introduced an Inequality-adjusted Human Development Index (IHDI). While the original HDI remains useful, it stated that "the IHDI is the actual level of human development (accounting for inequality), while the original HDI can be viewed as an index of 'potential' human development (or the maximum level of HDI) that could be achieved if there was no inequality." [13]

World Happiness Report

Map showing happiness of countries by their score according to the 2023 World Happiness Report World map of countries by World Happiness Report score (2023).svg
Map showing happiness of countries by their score according to the 2023 World Happiness Report

The World Happiness Report is a landmark survey on the state of global happiness. It ranks 156 countries by their happiness levels, reflecting growing global interest in using happiness and substantial well-being as an indicator of the quality of human development. Its growing purpose has allowed governments, communities and organizations to use appropriate data to record happiness in order to enable policies to provide better lives. The reports review the state of happiness in the world today and show how the science of happiness explains personal and national variations in happiness. [14]

Developed again by the United Nations and published recently[ when? ] along with the HDI, this report combines both objective and subjective measures to rank countries by happiness, which is deemed as the ultimate outcome of a high quality of life. It uses surveys from Gallup, real GDP per capita, healthy life expectancy, having someone to count on, perceived freedom to make life choices, freedom from corruption, and generosity to derive the final score. Happiness is already recognized as an important concept in global public policy. The World Happiness Report indicates that some regions have in recent years[ when? ] been experiencing progressive inequality of happiness. [15]

Other measures

The Physical Quality of Life Index (PQLI) is a measure developed by sociologist M. D. Morris in the 1970s, based on basic literacy, infant mortality, and life expectancy. Although not as complex as other measures, and now essentially replaced by the Human Development Index, the PQLI is notable for Morris's attempt to show a "less fatalistic pessimistic picture" by focusing on three areas where global quality of life was generally improving at the time, while ignoring gross national product and other possible indicators that were not improving. [16]

The Happy Planet Index, introduced in 2006, is unique among quality of life measures in that, in addition to standard determinants of well-being, it uses each country's ecological footprint as an indicator. As a result, European and North American nations do not dominate this measure. The 2012 list is instead topped by Costa Rica, Vietnam and Colombia. [17]

In 2010, Gallup researchers trying to find the world's happiest countries found Denmark to be at the top of the list. [18] For the period 2014–2016, Norway surpasses Denmark to be at the top of the list. [19]

A 2010 study by two Princeton University professors looked at 1,000 randomly selected U.S. residents over an extended period. It concludes that their life evaluations – that is, their considered evaluations of their life against a stated scale of one to ten – rise steadily with income. On the other hand, their reported quality of emotional daily experiences (their reported experiences of joy, affection, stress, sadness, or anger) levels off after a certain income level (approximately $75,000 per year in 2010); income above $75,000 does not lead to more experiences of happiness nor to further relief of unhappiness or stress. Below this income level, respondents reported decreasing happiness and increasing sadness and stress, implying the pain of life's misfortunes, including disease, divorce, and being alone, is exacerbated by poverty. [20]

Gross national happiness and other subjective measures of happiness are being used by the governments of Bhutan and the United Kingdom. [21] The World Happiness report, issued by Columbia University [22] is a meta-analysis of happiness globally and provides an overview of countries and grassroots activists using GNH. The OECD issued a guide for the use of subjective well-being metrics in 2013. [23] In the U.S., cities and communities are using a GNH metric at a grassroots level. [24]

The Social Progress Index measures the extent to which countries provide for the social and environmental needs of their citizens. Fifty-two indicators in the areas of basic human needs, foundations of wellbeing, and opportunity show the relative performance of nations. The index uses outcome measures when there is sufficient data available or the closest possible proxies.

Day-Reconstruction Method was another way of measuring happiness, in which researchers asked their subjects to recall various things they did on the previous day and describe their mood during each activity. Being simple and approachable, this method required memory and the experiments have confirmed that the answers that people give are similar to those who repeatedly recalled each subject. The method eventually declined as it called for more effort and thoughtful responses, which often included interpretations and outcomes that do not occur to people who are asked to record every action in their daily lives. [25]

The Digital Quality of Life Index - a yearly study on digital well-being across 121 countries created by Surfshark. It indexes each country according to five pillars that impact a population's digital quality of life: internet affordability, internet quality, electronic infrastructure, electronic security, and electronic government. [26]

Livability

The term quality of life is also used by politicians and economists to measure the livability of a given city or nation. Two widely known measures of livability are the Economist Intelligence Unit's Where-to-be-born Index and Mercer's Quality of Living Reports. These two measures calculate the livability of countries and cities around the world, respectively, through a combination of subjective life-satisfaction surveys and objective determinants of quality of life such as divorce rates, safety, and infrastructure. Such measures relate more broadly to the population of a city, state, or country, not to individual quality of life. Livability has a long history and tradition in urban design, and neighborhoods design standards such as LEED-ND are often used in an attempt to influence livability.

The Economist Intelligence Unit awarded Vienna the most livable city in 2019 Global Liveability Ranking. Stadtfest Wien 20090426 - Temporary picnic zone 'Burggarten' a.jpg
The Economist Intelligence Unit awarded Vienna the most livable city in 2019 Global Liveability Ranking.

Crimes

Some crimes against property (e.g., graffiti and vandalism) and some "victimless crimes" have been referred to as "quality-of-life crimes." American sociologist James Q. Wilson encapsulated this argument as the broken windows theory, which asserts that relatively minor problems left unattended (such as litter, graffiti, or public urination by homeless individuals) send a subliminal message that disorder, in general, is being tolerated, and as a result, more serious crimes will end up being committed (the analogy being that a broken window left broken shows an image of general dilapidation).

Wilson's theories have been used to justify the implementation of zero tolerance policies by many prominent American mayors, most notably Oscar Goodman in Las Vegas, Richard Riordan in Los Angeles, Rudolph Giuliani in New York City and Gavin Newsom in San Francisco. Such policies refuse to tolerate even minor crimes; proponents argue that this will improve the quality of life of local residents. However, critics of zero tolerance policies believe that such policies neglect investigation on a case-by-case basis and may lead to unreasonably harsh penalties for crimes.

In healthcare

Within the field of healthcare, quality of life is often regarded in terms of how a certain ailment affects a patient on an individual level. This may be a debilitating weakness that is not life-threatening; life-threatening illness that is not terminal; terminal illness; the predictable, natural decline in the health of an elder; an unforeseen mental/physical decline of a loved one; or chronic, end-stage disease processes. Researchers at the University of Toronto's Quality of Life Research Unit define quality of life as "The degree to which a person enjoys the important possibilities of his or her life" (UofT). Their Quality of Life Model is based on the categories "being", "belonging", and "becoming"; respectively who one is, how one is connected to one's environment, and whether one achieves one's personal goals, hopes, and aspirations. [28] [29]

Experience sampling studies show substantial between-person variability in within-person associations between somatic symptoms and quality of life. [30] Hecht and Shiel measure quality of life as "the patient's ability to enjoy normal life activities" since life quality is strongly related to wellbeing without suffering from sickness and treatment. [31] There are multiple assessments available that measure Health-Related Quality of Life, e.g., AQoL-8D, EQ5D – Euroqol, 15D, SF-36, SF-6D, HUI.

In international development

Quality of life has been deemed an important concept in the field of international development because it allows development to be analyzed on a measure that is generally accepted as more comprehensive than standard of living. Within development theory, however, there are varying ideas concerning what constitutes desirable change for a particular society. The different ways that quality of life is defined by institutions, therefore, shape how these organizations work for its improvement as a whole.

Organisations such as the World Bank, for example, declare a goal of "working for a world free of poverty", [32] with poverty defined as a lack of basic human needs, such as food, water, shelter, freedom, access to education, healthcare, or employment. [33] In other words, poverty is defined as a low quality of life. Using this definition, the World Bank works towards improving quality of life through the stated goal of lowering poverty and helping people afford a better quality of life.

Other organizations, however, may also work towards improved global quality of life using a slightly different definition and substantially different methods. Many NGOs do not focus at all on reducing poverty on a national or international scale, but rather attempt to improve the quality of life for individuals or communities. One example would be sponsorship programs that provide material aid for specific individuals. Although many organizations of this type may still talk about fighting poverty, the methods are significantly different.

Improving quality of life involves action not only by NGOs but also by governments. Global health has the potential to achieve greater political presence if governments were to incorporate aspects of human security into foreign policy. Stressing individuals' basic rights to health, food, shelter, and freedom addresses prominent inter-sectoral problems negatively impacting today's society, and may lead to greater action and resources. Integration of global health concerns into foreign policy may be hampered by approaches that are shaped by the overarching roles of defense and diplomacy. [34]

See also

Indices

Journals

Related Research Articles

<span class="mw-page-title-main">Human Development Index</span> Composite statistic of life expectancy, education, and income indices

The Human Development Index (HDI) is a statistical composite index of life expectancy, education, and per capita income indicators, which is used to rank countries into four tiers of human development. A country scores a higher level of HDI when the lifespan is higher, the education level is higher, and the gross national income GNI (PPP) per capita is higher. It was developed by Pakistani economist Mahbub ul-Haq and was further used to measure a country's development by the United Nations Development Programme (UNDP)'s Human Development Report Office.

<span class="mw-page-title-main">Capability approach</span> Normative approach to human welfare

The capability approach is a normative approach to human welfare that concentrates on the actual capability of persons to achieve lives they value rather than solely having a right or freedom to do so. It was conceived in the 1980s as an alternative approach to welfare economics.

The Human Poverty Index (HPI) was an indication of the poverty of community in a country, developed by the United Nations to complement the Human Development Index (HDI) and was first reported as part of the Human Development Report in 1997. It is developed by United Nations Development Program which also publishes indexes like HDI It was considered to better reflect the extent of deprivation in deprived countries compared to the HDI. In 2010, it was supplanted by the UN's Multidimensional Poverty Index.

<span class="mw-page-title-main">Human Development Report</span> Annual report by the Human Development Report Office of the United Nations Development Programme

The Human Development Report (HDR) is an annual Human Development Index report published by the Human Development Report Office of the United Nations Development Programme (UNDP).

<span class="mw-page-title-main">Satisfaction with Life Index</span> Index that attempts to show life satisfaction in different nations

The Satisfaction with Life Index was created in 2007 by Adrian G. White, an analytic social psychologist at the University of Leicester, using data from a metastudy. It is an attempt to show life satisfaction in different nations.

<span class="mw-page-title-main">Happy Planet Index</span> Index of human well-being and environmental impact

The Happy Planet Index (HPI) is an index of human well-being and environmental impact that was introduced by the New Economics Foundation in 2006. Each country's HPI value is a function of its average subjective life satisfaction, life expectancy at birth, and ecological footprint per capita. The exact function is a little more complex, but conceptually it approximates multiplying life satisfaction and life expectancy and dividing that by the ecological footprint. The index is weighted to give progressively higher scores to nations with lower ecological footprints.

The economics of happiness or happiness economics is the theoretical, qualitative and quantitative study of happiness and quality of life, including positive and negative affects, well-being, life satisfaction and related concepts – typically tying economics more closely than usual with other social sciences, like sociology and psychology, as well as physical health. It typically treats subjective happiness-related measures, as well as more objective quality of life indices, rather than wealth, income or profit, as something to be maximized.

<span class="mw-page-title-main">National Human Development Report</span>

The National Human Development Reports (NHDR) take the Global Human Development Report approach to the national level and are prepared and owned by national teams. More than 540 national and sub-national HDRs have been produced so far by 135 countries, in addition to 31 regional reports.

The Gender Development Index (GDI) is an index designed to measure gender equality.

<span class="mw-page-title-main">Where-to-be-born Index</span> Index by the Economist Intelligence Unit

The where-to-be-born index was an index last published by the Economist Intelligence Unit (EIU) in 2013, which aimed to measure which country would provide the best opportunities for a healthy, safe and prosperous life in the years after its publication.

<span class="mw-page-title-main">Legatum Prosperity Index</span> Annual ranking of countries by Legatum

The Legatum Prosperity Index is an annual ranking developed by the Legatum Institute, an independent educational charity founded and part-funded by the private investment firm Legatum. The ranking is based on a variety of factors including wealth, economic growth, education, health, personal well-being, and quality of life.

The self-perceived quality-of-life scale is a psychological assessment instrument which is based on a comprehensive theory of the self-perceived quality of life (SPQL) and provides a multi-faceted measurement of health-related and non-health-related aspects of well-being. The scale has become an instrument of choice for monitoring quality of life in some clinical populations, for example, it was adopted by the Positively Sound network for women living with HIV.

<span class="mw-page-title-main">Multidimensional Poverty Index</span> Range of poverty indicators

Multidimensional Poverty Indices use a range of indicators to calculate a summary poverty figure for a given population, in which a larger figure indicates a higher level of poverty. This figure considers both the proportion of the population that is deemed poor, and the 'breadth' of poverty experienced by these 'poor' households, following the Alkire & Foster 'counting method'. The method was developed following increased criticism of monetary and consumption based poverty measures, seeking to capture the deprivations in non-monetary factors that contribute towards well-being. While there is a standard set of indicators, dimensions, cutoffs and thresholds used for a 'Global MPI', the method is flexible and there are many examples of poverty studies that modify it to best suit their environment. The methodology has been mainly, but not exclusively, applied to developing countries.

The OECD Better Life Index, created in May 2011 by the Organisation for Economic Co-operation and Development, is an initiative pioneering the development of economic indicators which better capture multiple dimensions of economic and social progress.

Wikiprogress is a defunct online platform for sharing information on the measurement of social, economic and environmental progress. It is thought to facilitate sharing on ideas, initiatives and knowledge on "measuring the progress of societies". Like Wikipedia, it was open to all members and communities for contribution – anyone interested in "progress" could register.

Although for many decades, it was customary to focus on GDP and other measures of national income, there has been growing interest in developing broad measures of economic well-being. National and international approaches include the Beyond GDP programme developed by the European Union, the Better Lives Compendium of Indicators developed by the OECD, as well as many alternative metrics of wellbeing or happiness. One of the earliest attempts to develop such an index at national level was Bhutan's Gross National Happiness Index and there are a now a number of similar projects ongoing around the world, including a project to develop for the UK an assessment of national well-being, commissioned by the Prime Minister David Cameron and led by the Office for National Statistics.

<span class="mw-page-title-main">Social Progress Index</span>

The Social Progress Index (SPI) measures the extent to which countries provide for the social and environmental needs of their citizens. Fifty-four indicators in the areas of basic human needs, foundations of well-being, and opportunity to progress show the relative performance of nations. The index is published by the nonprofit Social Progress Imperative, and is based on the writings of Amartya Sen, Douglass North, and Joseph Stiglitz. The SPI measures the well-being of a society by observing social and environmental outcomes directly rather than the economic factors. The social and environmental factors include wellness, equality, inclusion, sustainability and personal freedom and safety.

International comparisons, or national evaluation indicators, focuses on the quantitative, qualitative, and evaluative analysis of one country in relation to others. Often, the objective is to compare one country's performance to others in order to assess what countries have achieved, what needs to change in order for them to perform better, or a country's progress in reaching certain objectives.

<span class="mw-page-title-main">World Happiness Report</span> Publication ranking national happiness based on respondent ratings of their lives

The World Happiness Report is a publication that contains articles and rankings of national happiness, based on respondent ratings of their own lives, which the report also correlates with various life factors. As of March 2024, Finland has been ranked the happiest country in the world seven times in a row.

References

  1. ↑ "WHOQOL: Measuring Quality of Life". World Health Organization. Archived from the original on 15 May 2020. Retrieved 22 May 2020.
  2. 1 2 Gregory, Derek; Johnston, Ron; Pratt, Geraldine; Watts, Michael; et al., eds. (June 2009). "Quality of Life". Dictionary of Human Geography (5th ed.). Oxford: Wiley-Blackwell. ISBN   978-1-4051-3287-9.
  3. ↑ Martha Nussbaum and Amartya Sen, ed. (1993). The Quality of Life, Oxford: Clarendon Press. Description and chapter-preview links. Archived 11 February 2019 at the Wayback Machine
  4. ↑ Barcaccia, Barbara (4 September 2013). "Quality Of Life: Everyone Wants It, But What Is It?". Forbes/ Education. Archived from the original on 22 May 2019. Retrieved 10 May 2016.
  5. ↑ Bottomley, Andrew (2002). "The Cancer Patient and Quality of Life". The Oncologist. 7 (2): 120–125. doi: 10.1634/theoncologist.7-2-120 . ISSN   1083-7159. PMID   11961195. S2CID   20903110.
  6. ↑ Magee, Liam; James, Paul; Scerri, Andy (2012). "Measuring Social Sustainability: A Community-Centred Approach". Applied Research in the Quality of Life. 7 (3): 239–61. doi:10.1007/s11482-012-9166-x. S2CID   145257262. Archived from the original on 29 January 2023. Retrieved 2 November 2017.
  7. ↑ Kahneman, Daniel; Deaton, Angus (4 August 2010). "High income improves evaluation of life but not emotional well-being" (PDF). PNAS. 107 (38): 16489–16493. Bibcode:2010PNAS..10716489K. doi: 10.1073/pnas.1011492107 . PMC   2944762 . PMID   20823223. Archived (PDF) from the original on 29 December 2011.
  8. ↑ Layard, Richard (6 April 2006). Happiness: Lessons from a New Science. London: Penguin. ISBN   978-0-14-101690-0.
  9. ↑ Kahneman, D.; Deaton, A. (2010). "High income improves evaluation of life but not emotional well-being". Proceedings of the National Academy of Sciences. 107 (38): 16489–16493. Bibcode:2010PNAS..10716489K. doi: 10.1073/pnas.1011492107 . PMC   2944762 . PMID   20823223.
  10. ↑ Federal Reserve Bank of Kansas City, The Increasing Importance of Quality of Life, October 2008 Archived 19 October 2012 at the Wayback Machine
  11. ↑ Singer, Peter (2011). "The Big Question: Quality of Life: What Does It Mean? How Shoulf We Measure It?". World Policy Journal. 28 (2): 3–6. doi:10.1177/0740277511415049. PMID   22165429. S2CID   22394600.
  12. ↑ Costanza, R.; et al. (2008). "An Integrative Approach to Quality of Life Measurement, Research, and Policy". S.A.P.I.EN.S. 1 (1). Archived from the original on 8 May 2011. Retrieved 5 May 2009.
  13. ↑ Human Development Index, "Composite indices – HDI and beyond" Archived 10 August 2016 at the Wayback Machine , Retrieved 16 January 2021.
  14. ↑ "World Happiness Report". Overview. Helliwell, J., Layard, R., & Sachs, J. (2016). World Happiness Report 2016, Update (Vol. I). New York: Sustainable Development Solutions Network. 2016. Archived from the original on 11 February 2021. Retrieved 12 May 2016.
  15. ↑ The Lancet (26 March 2016). "Health and Happiness". The Lancet. 387 (10025): 1251. doi:10.1016/S0140-6736(16)30062-9. PMID   27025416. S2CID   35328608.
  16. ↑ Morris, Morris David (January 1980). "The Physical Quality of Life Index (PQLI)". Development Digest. 1 (1): 95–109. PMID   12261723.
  17. ↑ "The Happy Planet Index 2.0". New Economics Foundation. 2012. Archived from the original on 26 September 2009. Retrieved 2 September 2012.
  18. ↑ Levy, Francesca (14 July 2010). "Table: The World's Happiest Countries". Forbes. Archived from the original on 3 March 2016.
  19. ↑ "The Happiest and Unhappiest Countries in the World". Gallup. 20 March 2017. Archived from the original on 3 August 2021. Retrieved 9 September 2021.
  20. ↑ "Higher income improves life rating but not emotional well-being". PhysOrg.com. 7 September 2010. Archived from the original on 5 August 2011. Retrieved 20 September 2010.
  21. ↑ "Measures of National Well-being". www.ons.gov.uk. Archived from the original on 3 December 2013. Retrieved 20 November 2013.
  22. ↑ John Helliwell; Richard Layard; Jeffrey Sachs (eds.). "World Happiness Report" (PDF). Columbia University. Archived (PDF) from the original on 10 April 2012.
  23. ↑ OECD Guidelines on Measuring Subjective Well-being (PDF). Organisation for Economic Co-operation and Development. 2013. doi:10.1787/9789264191655-en. ISBN   978-92-64-19165-5. Archived (PDF) from the original on 25 April 2013.
  24. ↑ "Happy Places | the Happiness Initiative". Archived from the original on 2 December 2013. Retrieved 20 November 2013.
  25. ↑ Derek, Boc (2010). The Politics of Happiness : What Government Can Learn from the New Research on Well-Being. United States: Princeton University Press. p. 32. ISBN   9781400832194.
  26. ↑ "What's the 'digital quality of life' level in your country?". weforum.org. 21 September 2023. Archived from the original on 30 October 2023. Retrieved 30 October 2023.
  27. ↑ "Vienna holds off Melbourne to top EIU ranking of most liveable cities". Reuters. 3 September 2019. Archived from the original on 16 October 2022. Retrieved 16 October 2022.
  28. ↑ "Quality of Life: How Good is Life for You?". University of Toronto Quality of Life Research Unit. Archived from the original on 14 June 2014. Retrieved 14 October 2009.
  29. ↑ "Begin Your Journey!". Quality of Life Care. Archived from the original on 25 July 2019. Retrieved 25 July 2019.
  30. ↑ van der Krieke; et al. (2016). "Temporal Dynamics of Health and Well-Being: A Crowdsourcing Approach to Momentary Assessments and Automated Generation of Personalized Feedback" (PDF). Psychosomatic Medicine. 79 (2): 213–223. doi:10.1097/PSY.0000000000000378. PMID   27551988. S2CID   10955232.
  31. ↑ McNally, James W. (2009). Encyclopedia of the Life Course and Human Development (vol. 3 ed.). US: Macmillan Reference. p. 317.
  32. ↑ "The World Bank" (PDF). The World Bank. 2009. Archived (PDF) from the original on 20 August 2011. Retrieved 2 November 2010.
  33. ↑ "Poverty - Overview". The World Bank. 2009. Retrieved 20 October 2009.[ permanent dead link ]
  34. ↑ Spiegel and Huish. Canadian Foreign Aid for Global Health: Human Security Opportunity Lost.

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