Hospitals & Asylums    

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Public Health Department

 

First Draft HA-2-8-05, First Annual Draft HA-7-4-06, Second HA-7-4-07

 

Amending Title 24 US Code Chapter 9 Hospitalization of Mentally Ill Nationals Returned From Foreign Countries

 

A. This Chapter of Hospitals & Asylums is re-titled, “Public Health Department (PHD)”, from Hospitalization of Mentally Ill Nations Returned from Foreign Countries, Title 24 US Code Chapter 9 §321- §329 and expanded upon to include a thorough study of federal and international public health to uphold the World Health Organization (WHO) objective, “for the people to achieve the highest possible level of health”.  

 

1. Although the public has not agreed on what reforms are needed according the Kaiser Family Foundation Health Tracking Poll for the 2008 Elections 44% of US respondents view health reform as one of the most important issues and 29% as the most important issue in the Presidential campaign. 

 

2. The theme for World Health Day 7 April 2007 is International Health Security.  The aim is to urge governments, organizations and businesses to; invest in health, build a safer future.

 

B. To make meaningful political reforms the health agenda from the perspective of the United States Congress can be summarized, as,

 

1. Changing the name of the US Department of Health and Human Services (DHHS) to the Public Health Department (PHD).

2. Transferring the Drug Enforcement Authority (DEA) to the Health Department and International Narcotics Control Board (INCB) to the World Health Organization (WHO).

3. Investing in universal single payer health insurance that is free for everyone thanks to taxation of income, including the richest, and pays for prevention, regular medical and dental check ups, community health and community mental health to reduce demand for expensive, dangerous and unnecessary hospitalization and treatment.

4. Creating a national Internet medical records system and improving public statistical reporting of health facilities.

 

C. There were an estimated 6.6 billion people in the world with an average life expectancy of 67.86 years in 2006 according the annually updated HA world vital statistics.  

 

1. The longest life expectancy can be found in Andorra where people live an average of 83.51 years, in Singapore people live 81.71 years, in Hong Kong 81.5 years and in Japan 81.25 years.  The US has an average life expectancy of 77.85 years, 40th amongst 222 nations, and 14th amongst nations with populations over a million.  The shortest life expectancies can be found in Sub Saharan Africa.  In Swaziland, where 38.8% of the population is infected with HIV/AIDS, the life expectancy is only 32.62 years.  In Botswana, with HIV/AIDS infection rate of 37.3%, the life expectancy is 33.74 years and in Lesotho, with an HIV/AIDS infection rate of 28.9%, the life expectancy is 34.4 years.  Angola also has a low life expectancy of 38.82 years but with an AIDS rate of only 3.9% this must be attributed to other chronic diseases and warfare.

 

2. The world population showed a 1.15% average growth rate with a birth rate of 30.53 and 13.32 deaths per 1,000.  The lowest growth rate was in Bulgaria at –0.86% that like 26 other nations showed a negative growth rate.  In Eastern Europe this can be attributed to migration in pursuit of better paying jobs.  In Southern Africa population loss in some countries can be attributed to people dying from HIV/AIDS that can be estimated to affect less than 1% of the world population but up to 38.8% in Swaziland.  The highest growth rate of 4.91% can be found in Liberia as the result of high birth rates and returning refugees much like Burundi, Kuwait and Montenegro where low mortality rates are fueling population growth.  The average infant mortality rate was 38.44 per 1,000 with a high of 185.36 in Angola and low of 2.29 in Singapore. 

 

3. It can be calculated that 56,597,030 people died around the world in 2004.  In 1998 the WHO Report on Leading Causes of Death, Globally that can be found in the Appendix to this Chapter, the most deadly diseases were, for all ages, Ischemic hear disease claiming 7,375,408 lives, Cerebrovascular disease claiming 5,106,125.  Acute lower respiratory infections claiming 3,452,178. HIV/AIDS claiming 2,285,229. Chronic obstructive pulmonary disease claiming 2,249,252.  Diarrhoeal diseases claming 2,219,032.  Perinatal conditions claiming 2,155,000.  Tuberculosis claiming 1,498,061.  Trachea/bronchus/ lung cancers claiming 1,244,407.   Road traffic injuries claiming 1,170,694.  Malaria claiming 1,110,293.  Self-inflicted injuries claiming 947,697.  Measles claiming 887,671.  Stomach cancers claiming 822,069.  Cirrhosis of the liver claiming 774,563

 

4. In the US, with a population of 295 million, it is estimated that 2,416,425 people died in 2001, 8.48 per 1,000.  The leading causes of death in the USA are diseases of the heart claiming 700,142 lives.  Malignant neoplasms (cancer) claiming 553,768.  Cerebrovascular diseases claiming 163,538.  Chronic lower respiratory diseases claiming 123,013.  Accidents (unintentional injuries) 101,537.   diabetes mellitus claiming 71,372.  Influenza and pneumonia claiming 62,034.  Alzheimer’s disease claiming 53,852.  Nephritis, nephritic syndrome and nephrosis claiming 39,480.  Septicema claiming 32,238.  Suicide claiming 30,622. Chronic liver disease and cirrhosis claiming 27,035.  Homicide claiming 20,308.  Hypertension and hypertensive renal disease claiming 19,250.  Pneumonities due to solids and liquids claiming 17,301.  All other diseases claiming 400,935 lives. In the US, not dissimilar to the rest of the world, in 2004 there were an estimated 250,000 deaths from what can loosely be construed as medical malpractice and product liability. 12,000 from unnecessary surgery, 7,000 from medication errors in hospitals, 20,000 from other errors in hospitals, 80,000 from infections in hospitals, 106,000 from non-error, negative effects of drugs making medical malpractice the third leading cause of death, ten times the homicide rate.  There are other estimates where medical malpractice is the leading cause of death.

 

D. WHO reports that in 2002 as a percentage of the GDP Equatorial Guinea had the lowest per capita expenditure on health at 1.8% and the United States of America the highest at 14.6% HA-30-7-05.  Whereas the theme for this World Health Day is International Health Security: invest in health, build a safer future, it is important to look at the problem of investment in health.  In developing nations health investment is much needed and public health concerns involving safe drinking water, sanitation, electrical power for refrigeration and access to health care make the most effective use of limited funds to provide maximum benefit for the lives of the people.  In industrialized nations the health insurance system is a mix of public and private insurance schemes that satisfy demand by health care professionals but has the problem of representing its own financial interests and policies must be shifted from public consolidation to private diversification in order to combat corruption.  The Medicare Prescription Drug Plan has made progress and there is hope to reign in high drug prices and improve the regulation of drugs to prevent adverse drug reactions.  Nearly 47 million Americans, more than 15 percent of our population, now go without health insurance, up 6.8 million since 2000.   Over 18,000 people in the U.S. die each year due to lack of access to medical treatment. The Medicare program is the second-largest social insurance program in the United States, with 42 million beneficiaries and total expenditures of $309 billion in 2004.  In 2004, 41.7 million people were covered by Medicare: 35.4 million aged 65 and older, and 6.3 million disabled. Total benefits paid in 2004 were $303 billion. Income was $318 billion, expenditures were $309 billion, and assets held in special issue U.S. Treasury securities grew to $289 billion.

 

1. The Healthy America Act of 2005 S-4 includes a number of measures to slow the growth of health care costs, expand health insurance coverage, and improve access to quality health care for millions of Americans.  Health care costs are growing rapidly, putting health insurance and needed care out of reach for too many Americans.  Reforming the medical liability system to ensure fair and rapid compensation to injured patients, reduce frivolous lawsuits, and limit excessive damage awards.  Promoting the rapid adoption and widespread use of individually owned, privacy protected electronic health records by fostering the development of standards through a public-private collaboration to enable the rapid and safe exchange of electronic patient information.  The dream is to increase the number of neighborhood community health centers; and to strengthen primary and preventive care networks in underserved communities. 

 

2. The Prescription Drug Plan derived from the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) makes the most dramatic and innovative changes to the Medicare program since it began in 1965.  The Act sets forth to amend title XVIII of the Social Security Act to provide for a voluntary corporately administrated program for prescription drug coverage under the Medicare Program Part

 

3. Executive Order 13335 Incentives for the Use of Health Information Technology and Establishing the Position of the National Health Information Technology Coordinator Signed: April 27, 2004 encourages medical records to be kept public unless a specific request by the patient, who must be informed of this right, has been made for the confidentiality of such records setting the stage for a national database of Internet medical records.

 

4.  The most ambitious health insurance plan is the National Health Insurance Act (or Expanded and Improved Medicare for All Act) H.R. 676 to provide all individuals residing in the United States and in U.S. territories with free health care that includes all medically necessary care, such as primary care and prevention, prescription drugs, emergency care, and mental health services. It is estimated that society would save close to $300 billion a year in healthcare costs--by eliminating private insurers and their wasteful bureaucracies, advertising, commissions, profiteering and multi-million dollar CEO salaries who would be assisted to find new work.  The USNHI Trust Fund would finance the Program with amounts deposited: (1) from existing sources of Government revenues for health care; (2) by increasing personal income taxes on the top 5% income earners; (3) by instituting a progressive excise tax on payroll and self-employment income; and (4) by instituting a small tax on stock and bond transactions.

E. Martin Luther King, Jr., who was assassinated by a gunman on 4 April 1968 said, "Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane”.  The first annual draft of this chapter reinforced this doctrine and the leader Director General Lee Jong-wook was poisoned the day the before the Health Assembly HA-22-5-06.  Besides health finance reform there are three major government reforms needed to redress institutionalized injustice in the health sector for which the philosophy of Hospitals & Asylums (HA) is helpful.   

 

1. The most glaring problem facing our public health service is found in the title of this Chapter, the renaming the Department of Health and Human Services (DHHS) to the Public Health Department (PHD) and Secretary of Health and Human Services (SHHS) to either Medical Director (MD) or Secretary of the PHD.  Establishing a PHD would fulfill the requirements for graduation from Department of Health, Education and Welfare (HEW) the utopian school of thought founded on 11 April 1953 that our nation dropped out of when DHHS was founded in PL96-88 on Oct. 17, 1979.  At first it was headed by a woman SHHS and there were few complaints.  Over time however the psychological brainwashing of the acronyms began to sink in and corruption, extortion, bio-terrorism and organized crime in regards to medical malpractice and judicial conspiracy typical of dysfunctional bureaucracies became endemic.  It is high time that our health department graduated from HEW with their PHD.   

 

2. The breech of security that seems to have elicited this declaration of DHHS is the Drug Enforcement Administration (DEA) that was founded under the Controlled Substances Act (CSA) of 1971 to regulate the drug trade.  The problem is that the ultimate authority of the DEA is given to the Attorney General who is neither competent to regulate the pharmaceutical drug trade or rehabilitate drug addicts.  Scrutiny of the regime in Independent Drug Enforcement Administration IDEA-9-11-01 has led to the conclusion that the DEA and CSA must be transferred to the Secretary of Health and Human Services where the agency could work in co-operation with the FDA and medical associations to better regulate the pharmaceutical drug trade whose mismanagement takes over 100,000 lives a year in comparison to the 3,000 lost to illicit drug overdoses.  The International Narcotics Control Board (INCB) is similarly seized by the UN Office of Drugs and Crime (UNODC) and needs to be transferred to the World Health Organization (WHO).  The ongoing civil wars in Colombia and Afghanistan and US prison population whose drug prisoners alone outnumber all prisoners in Western Europe demonstrate how futile it is to doubly finance the armed forces to redress the problem of unregulated drugs that needs to be regulated by health.  For a peaceful and free society drugs must be firmly regulated by the health sector where there is professional knowledge of drugs and treatment for adverse drugs reactions and addiction.

 

3. The World Health Organization (WHO) has two cosmetic reforms of lesser merit to psychological warfare than those in the United States, and one major betrayal of world peace, to debate.  First, the Health Assembly resolutions would be more beautiful if they would be indexed with the HA – number, whereas laughter is the best medicine.  Second, it might be counterproductive to name the leader of the organization Director “General” whereas the military title is certain to generate misunderstanding about the peaceful intentions of the organization that counts all the mortalities in the world.  Third, of major importance to world peace, the aforementioned transfer of the International Narcotics Control Board (INCB) to the World Health Organization (WHO) to regulate drugs with health and establish National Opium Agencies in war torn regions dependent upon prohibited crops, who were undermined by the treason against drugs. 

 

F. The World Health Report 2006 - Working together for health HA-14-4-06 contains an expert assessment focusing on all stages of the health workers' career lifespan from entry to health training, to job recruitment through to retirement, the report lays out a ten-year action plan in which countries can build their health workforces, with the support of global partners.  WHO estimates there to be a total of 59.2 million full-time paid health workers worldwide.  Almost all countries suffer from mal-distribution characterized by urban concentration and rural deficits, but these imbalances are perhaps most disturbing from a regional perspective. The WHO Region of the Americas, with 10% of the global burden of disease, has 37% of the world’s health workers spending more than 50% of the world’s health financing, whereas the African Region has 24% of the burden but only 3% of health workers commanding less than 1% of world health expenditure.  The report reveals an estimated shortage of almost 4.3 million doctors, midwives, nurses and support workers worldwide. The shortage is most severe in the poorest countries, especially in sub-Saharan Africa, where health workers are most needed and the life expectancy has actually reversed in the past two decades. 57 countries that fall below this threshold and which fail to attain the 80% coverage level are defined as having a critical shortage. Thirty-six of them are in sub-Saharan Africa.

 

1. In this first decade of the 21st century, immense advances in human well-being coexist with extreme deprivation. In global health we are witnessing the benefits of new medicines and technologies. But there are unprecedented reversals.  What is needed now is political will to implement national plans, together with international cooperation to align resources, harness knowledge and build robust health systems for treating and preventing disease and promoting population health.  At the heart of each and every health system, the workforce is central to advancing health. There is ample evidence that worker numbers and quality are positively associated with immunization coverage, outreach of primary care, and infant, child and maternal survival. The quality of doctors and the density of their distribution have been shown to correlate with positive outcomes in cardiovascular diseases.  Cutting-edge quality improvements of health care are best initiated by workers themselves because they are in the unique position of identifying opportunities for innovation. LEE Jong-wook Director General of the WHO at the High-Level Forum, Paris, November 2005 stated, “We have to work together to ensure access to a motivated, skilled, and supported health worker by every person in every village everywhere.”

 

2. Financing policies, technological advances and consumer expectations can dramatically shift demands on the workforce in health systems. Workers seek opportunities and job security in dynamic health labour markets that are part of the global political economy.  The spreading HIV/AIDS epidemic imposes huge work burdens, risks and threats.  Expanding labour markets have intensified professional concentration in urban areas and accelerated international migration from the poorest to the wealthiest countries. The consequent workforce crisis in many of the poorest countries is characterized by severe shortages, inappropriate skill mixes, and gaps in service coverage.  Based on these estimates, there are currently 57 countries with critical shortages equivalent to a global deficit of 2.4 million doctors, nurses and midwives to achieve the Health related Millennium Development Goals.  This crisis has the potential to deepen in the coming years. Demand for service providers will escalate markedly in all countries - rich and poor. Richer countries face a future of low fertility and large populations of elderly people, which will cause a shift towards chronic and degenerative diseases with high care demands.  In poorer countries, large cohorts of young people (1 billion adolescents) will join an increasingly ageing population, both groups rapidly urbanizing. Many of these countries are dealing with unfinished agendas of infectious disease and the rapid emergence of chronic illness complicated by the magnitude of the HIV/AIDS epidemic. The availability of effective vaccines and drugs to cope with these health threats imposes huge practical and moral imperatives to respond effectively.

 

G. This Chapter consolidates important issues for public health that are primarily to get trained health care professionals and supplies to people in need and to eliminate corruption in the health sector through parliamentary debate and literate dispute resolution to eliminate the dependency upon the courts that always leads to organized crime.  The statute that is already on the books pertaining to the Hospitalization of Mentally Ill National Returned from Foreign Countries makes great progress limiting the original sin of the health establishment, psychiatric hospitalization.  Hospital administrators and health professionals have the challenge of being adequately educated, financed and supplied to meet the demand for health care without being exortionate spreaders of disease and fake remedies.  In conclusion to this introduction US health gets a “D” for being corrupt in all cases, at all levels and cancerous in the spread bioterrorism and medical malpractice, the only consolation is that their buddy justice flunked out of school while health dropped out, after criticism the medical establishment can perform corporately but the individual is likely to be either ignored, victimized or have their moral consciounse tainted.  WHO gets a “B” for covering up the assassination of Lee Jong wook who we all mourn but we have come to doubt the security of international health.  Service to the US departments of health is terminated and they are charged to finance mental health reform (the PHD and DEA), lower cost community health, community mental health, emergency treatment, research, dental and medical check ups for the poor.

 

World Vital Statistics (scroll right to see rate of detention)

 

Country

Population

Growth

Births per ,000

Deaths per ,000

Migr

ation per ,000

Infant Mort

ality per ,000

Life

Expec

tancy

AIDS

rate

Literacy

Detain

ees Per 00,000

Afghanistan

31,056,997

2.67%

46.6

20.34

21.43

160.2

43.34

 

36%

32

Albania

3,581,655

0.52%

15.11

5.22

-4.67

20.75

77.43

 

86.5%

111

Algeria

32,930,091

1.22%

17.14

4.61

-0.35

29.87

73.26

0.1%

70%

127

Andorra

70,549

0.95%

9

6.07

6.53

4.05

83.51

 

100%

84

Angola

12,127,071

2.45%

45.11

24.2

3.55

185.36

38.62

3.9%

66.8%

44

Anguilla

13,254

1.77%

14.26

5.43

8.83

21.03

77.11

 

95%

 

Antigua & Barbuda

68,722

0.57%

17.26

5.44

-6.11

19.46

71.9

 

89%

176

Argentina

39,921,833

0.96%

16.73

7.55

0.4

14.73

76.12

0.7%

97.1%

140

Armenia

2,976,372

-0.19

12.07

8.23

-5.72

22.47

71.84

0.1%

98.6%

89

Aruba

71,566

0.47%

11.26

6.57

0

5.89

79.14

 

97%

231

Australia

20,264,082

0.85%

12.14

7.51

3.85

4.63

80.5

0.1%

99%

125

Austria

8,192,880

0.09%

8.74

9.76

1.94

4.6

79.07

0.3%

98%

105

Azerbaijan

7,961,619

0.66%

20.74

9.75

-4.38

79

64.41

<0.1%

98.8%

202

Bahamas

301,790

0.67%

17.87

8.97

-2.18

25.21

65.54

3%

95.6%

462

Bahrain

698,585

1.45%

17.8

4.14

0.82

16.8

74.45

0.2%

89.1%

95

Bangladesh

147,365,352

2.09%

29.8

8.27

-0.68

60.83

62.46

<0.1%

43.1%

50

Barbados

279,254

0.33%

12.83

9.17

-0.31

12.5

71.41

1.5%

97.4%

367

Belarus

10,293,011

-0.06%

11.16

14.02

2.3

13

69.08

0.3%

99.6%

426

Belgium

10,379,067

0.13%

10.38

10.27

1.22

4.62

78.77

0.2%

99%

91

Belize

287,730

2.31%

28.84

5.72

0

24.89

68.3

2.4%

94.1%

505

Benin

7,862,944

2.73%

38.85

12.22

0.67

79.56

53.04

1.9%

33.6%

75

Bermuda

65,365

0.64%

11.6

7.63

2.45

8.53

77.79

 

98%

464

Bhutan

2,279,723

2.1%

33.65

12.7

0

98.41

54.78

<0.1%

47%

 

Bolivia

8,989,046

1.45%

23.3

7.53

-1.22

51.77

65.84

0.1%

87.2%

83

Bosnia& Herzegovina

4,498,976

1.35%

8.77

8.27

13.01

9.82

78

0.1%

94.6% 

61

Botswana

1,639,833

-0.4%

23.08

29.5

6.07

53.7

33.74

37.3%

79.8%

348

Brazil

188,078,227

1.04%

16.56

6.17

-0.03

28.6

71.97

0.7%

86.4%

193

British Virgin Islands

22,643

2.06%

14.96

4.42

10.01

18.05

76.27

 

97.8%

105

Brunei

372,361

1.9%

19.01

3.42

3.45

12.61

74.8

<0.1%

93.9%

140

Bulgaria

7,385,367

-0.86%

9.65

14.27

-4.01

19.85

72.3

0.1%

98.6%

148

Burkina Faso

14,343,072

3%

44.62

15.6

0

91.35

48.85

4.2%

26.6%

23

Burma

47,382,633

0.81%

17.91

9.83

0

61.85

60.97

1.2%

85.3%

120

Burundi

8,090,068

3.7%

42.22

13.36

8.22[1]

63.13

50.81

6%

51.6%

106

Cambodia

13,881,427

1.78%

26.9

9.06

0

68.78

59.29

2.6%

73.6%

58

Cameroon

17,340,702

2.04%

33.89

13.47

0

63.52

51.16

6.9%

79%

125

Canada

33,098,932

0.88%

10.78

7.8

5.85

4.69

80.22

0.3%

99%

107

Cape Verde

420,979

0.64%

24.87

6.55

-11.99

46.52

70.73

0.035%

76.6%

178

Cayman Islands

44,270

2.64%

12.93

4.81

18.25[2]

8.19

79.95

 

98%

234

CentralAfrican Republic

4,303,356

1.53%

33.91

18.65

0

85.63

43.54

13.5%

51%

110

Chad

9,944,201

2.93%

45.73

16.38

-0.11

91.45

47.52

4.8%

47.5%

35

Chile

16,134,219

0.94%

15.23

5.81

0

8.58

76.77

0.3%

96.2%

249

China

1,313,973,713

0.59%

13.25

6.97

-0.39

23.12

72.58

0.1%

90.9%

118

Colombia

43,593,035

1.46%

20.48

5.58

-0.3

20.35

71.99

0.7%

92.5%

131

Comoros

690,948

2.87%

36.93

8.2

0

72.85

62.23

0.12%

56.5%

30

Congo, Republic of

3,702,314

2.6%

42.57

12.93

-3.62

85.29

52.8

4.9%

83.8%

22

Congo,Democratic Republic of the

62,660,551

3.07%

43.69

13.27

0.23

88.62

51.46

4.2%

65.5%

57

Cook Islands

21,388

 0

 

 

0

 

 

 

95%

126

Costa Rica

4,075,261

1.45%

18.32

4.36

0.49

9.7

77.02

0.6%

96%

193

Cote d’Ivoire

17,654,843

2.03%

35.11

14.84

0

89.11

48.82

7%

50.9%

49

Croatia

4,494,749

-0.03%

9.61

11.48

1.58

6.72

74.69

0.1%

98.5%

87

Cuba

11,382,820

0.31%

11.89

7.22

-1.57

6.22

77.41

<0.1%

97%

487

Cyprus

784,301

0.53%

12.56

7.68

0.42

7.04

77.82

0.1%

97.6%

76

Czech Republic

10,235,455

-0.06%

9.02

10.59

0.97

3.89

76.22

0.1%

99%

183

Denmark

5,450,661

0.33%

11.13

10.36

2.52

4.51

77.79

0.2%

99%

77

Djibouti

486,530

2.02%

39.53

19.31

0

102.44

43.17

2.9%

67.9%

61

Dominica

68,910

-0.08

15.27

6.73

-9.3

13.71

74.87

 

94%

419

Dominican Republic

9,183,984

1.47%

23.22

5.73

-2.79

28.25

71.73

1.7%

84.7%

143

East Timor

1,062,777

2.08%

26.99

6.24

0

45.89

66.26

 

58.6%

41

Ecuador

13,547,510

1.5%

22.29

4.23

-3.11

22.87

76.42

0.3%

92.5%

93

Egypt

78,887,007

1.75%

22.94

5.23

-0.21

31.33

71.29

<0.1%

57.7%

87

El Salvador

6,822,378

1.72%

26.61

5.78

-3.61

24.39

71.49

 

80.2%

174

Equatorial Guinea

540,109

2.05%

35.59

15.06

0

89.21

49.54

3.4%

85.7%

 

Eritrea

4,786,994

2.47%

34.33

9.6

0

46.3

59.03

2.7%

58.6%

 

Estonia

1,324,333

-0.64%

10.04

13.25

-3.2

7.73

72.04

1.1%

99.8%

333

Ethiopia

74,777,981

2.31%

37.98

14.86

0

93.62

49.05

4.4%

42.7%

92

Falkland Islands

2,967

2.44%

 

 

 

 

 

 

 

 

Fiji

893,354

1.4%

22.73

5.65

-3.04

12.62

69.53

0.1%

93.7%

131

Finland

5,231,372

0.14%

10.45

9.86

0.84

3.55

78.5

0.1%

100%

75

France

62,752,136

0.35%

11.99

9.14

0.66

4.21

79.73

0.4%

99%

85

French Guiana

199,509

1.96%

20.46

4.88

4.01

11.76

77.27

 

83%

315

Gabon

1,424,906

2.13%

36.16

12.25

-2.65

54.51

54.49

8.1%

63.2%

 

Gambia, The

1,641,564

2.84%

39.37

12.25

1.29

71.58

54.14

1.2%

40.1%

30

Georgia

4,661,473

-0.34%

10.41

9.23

-4.54

17.97

76.09

<0.1%

100%

276

Germany

82,422,299

-0.02%

8.25

10.62

2.18

4.12

78.8

0.1%

99%

94

Ghana

22,409,572

2.07%

30.52

9.72

-0.11

55.02

58.87

3.1%

74.8%

55

Greece

10,688,058

0.18%

9.68

10.24

2.34

5.43

79.24

0.2%

97.5%

90

Grenada

89,703

0.26%

22.08

6.88

-12.59

14.27

64.87

 

96%

265

Guadeloupe

448,713

0.92%

15.42

6.06

-0.15

8.6

77.9

 

90%

158

Guam

168,564

1.46%

19.03

4.41

0

6.94

78.4

 

99%

345

Guatemala

12,293,545

2.27%

29.88

5.2

-1.94

30.94

69.38

1.1%

70.6%

54

Guinea

9,690,222

2.63%

41.76

15.48

0

90

49.5

3.2%

35.9%

37

Guinea-Bissau

1,442,029

2.07%

37.22

16.53

0

105.21

46.87

10%

42.4%

 

Guyana

767,245

0.25%

18.28

8.28

-7.49

32.19

65.86

2.5%

98.8%

260

Haiti

8,308,504

2.3

36.44

12.17

-1.31

71.65

53.23

5.6%

52.9%

52

Holy See

932

0.01%

 

 

 

 

 

 

 

 

Honduras

7,326,496

2.16%

28.24

5.28

-1.39

25.82

69.33

1.8%

76.2%

161

Hong Kong

6,898,686

0.65%

7.23

5.98

5.24

2.97

81.5

0.1%

93.5%

168

Hungary

9,981,334

-0.25%

9.72

13.11

0.86

8.39

72.66

0.1%

99.4%

156

Iceland

299,388

0.87%

13.64

6.72

1.74

3.29

80.31

0.2%

99%

40

India

1,095,351,995

1.38%

22.01

8.18

-0.07

54.63

64.71

0.9%

59.5%

30

Indonesia

245,452,739

1.41%

20.34

6.25

0

34.39

69.87

0.1%

87.9%

45

Iran

68,688,433

1.1%

17

5.55

-0.48

40.3

70.26

0.1%

79.4%

214

Iraq

26,783,383

2.66%

31.98

5.37

0

48.63

69.01

<0.1%

40.4%

35

Ireland

4,062,235

1.15%

14.45

7.82

4.87

5.31

77.73

0.1%

99%

72

Israel

6,352,117

1.18%

17.97

6.18

0

6.89

79.46

0.1%

95.4%

209

Italy

58,133,509

0.04%

8.72

10.4

2.06

5.83

79.81

0.5%

98.6%

104

Jamaica

2,758,124

0.8%

20.82

6.52

-6.27

15.98

73.24

1.2%

87.9%

182

Japan

127,463,611

0.02%

9.37

9.16

0

3.24

81.25

<0.1%

99%

62

Jordan

5,906,760

2.49%

21.25

2.65

6.26

16.76

78.4

<0.1%

91.3%

104

Kazakhstan

15,233,244

0.33%

16

9.42

-3.33

28.3

66.89

0.2%

98.4%

340

Kenya

34,707,817

2.57%

39.72

14.02

0

59.26

48.93

6.7%

85.1%

130

Kiribati

103,092

2.25%

30.86

8.37

0

48.52

61.71

 

 

72

Korea, North

23,113,019

0.84%

15.54

7.13

0

23.29

71.65

 

99%

 

Korea, South

48,846,823

0.42%

10

5.85

0

6.16

77.07

<0.1%

97.9%

97

Kurdistan

36,200,000

1.4%

20.10

5.75

0

42.00

70.10

0.1%

75%

 

Kuwait

2,418,393

3.52%

21.94

2.41

15.66

9.71

77.2

0.12%

83.5%

130

Kyrgystan

5,213,898

1.32%

22.8

7.08

-2.5

34.49

68.49

<0.1%

98.7%

292

Laos

6,368,481

2.39%

35.49

11.55

0

83.31

55.49

0.1%

66.4%

69

Latvia

2,274,735

-0.67%

9.24

13.66

-2.26

9.35

71.33

0.6%

99.8%

292

Lebanon

3,874,050

1.23%

18.52

6.21

0

23.72

72.88

0.1%

87.4%

168

Lesotho

2,022,331

-0.46%

24.75

28.71

-0.68

87.24

34.4

28.9%

84.8%

156

Liberia

3,653,187[3]

4.91%

44.71

23.1

27.39

155.76

39.65

5.9%

57.5%

 

Libya

5,900,754

2.3%

26.49

3.48

0

23.71

76.69

0.3%

82.6%

207

Liechtenstein

33,987

0.78%

10.21

7.18

4.77

4.64

79.68

 

100%

29

Lithuania

3,585,906

-0.3%

8.75

10.98

-0.71

6.78

74.2

0.1%

99.6%

235

Luxembourg

474,413

1.23%

11.94

8.41

8.75

4.74

78.89

0.2%

100%

167

Macau

449,198

0.87%

8.04

4.23

4.86

4.39

82.12

 

94.5%

199

Macedonia

2,050,554

0.26%

12.02

8.77

-0.65

9.81

73.97

0.1%

96.1%

99

Madagascar

18,595,469

3.03%

41.41

11.11

0

75.21

57.34

1.7%

68.9%

107

Malawi

13,013,926

2.38%

43.13

19.33

0

94.37

41.3

14.2%

62.7%

74

Malaysia

24,385,858

1.78%

22.86

5.05

0

17.16

72.5

0.4%

88.7%

141

Maldives

359,008

2.78%

34.81

7.06

0

54.89

64.06

0.1%

97.2%

343

Mali

13,007,000[4]

2.63%

49.82

16.82

-6.6

107.58

49

1.9%

46.4%

33

Malta

400,214

0.42%

10.22

8.1

2.05

3.86

79.01

0.2%

92.8%

86

Marshall Islands

59,071

2.27%

33.52

4.88

-5.91

29.45

70.01

 

93.7%

73

Martinique

432,900

0.76%

14.14

6.44

-0.04

7.09

79.04

 

97.7%

163

Mauritania

3,177,388

2.88%

40.99

12.16

0

69.48

53.12

0.6%

41.7%

26

Mauritius

1,240,827

0.82%

15.43

6.86

-0.4

14.59

72.63

0.1%

85.6%

205

Mexico

107,449,525

1.16%

20.69

4.74

-4.32

20.26

75.41

0.3%

92.2%

196

Micronesia

108,105

-0.08%

25.11

4.87

-21.01

30.21

69.75

 

89%

79

Moldova

4,466,706

0.28%

15.7

12.65

-0.23

38.38

65.65

0.2%

99.1%

247

Monaco

32,409

0.43%

9.26

12.71

7.71

5.43

79.57

 

99%

102

Mongolia

2,832,224

1.46%

21.59

6.95

0

52.12

64.89

<0.1%

97.8%

269

Montenegro

630,548

3.5%

12.6

9.2

 

 

74

 

 

108

Montserrat

9,341

1.04%

17.56

7.17

0

7.35

78.71

 

97%

 

Morocco

33,241,259

1.55%

21.98

5.58

-0.87

40.42

70.94

0.1%

51.7%

161

Mozambique

19,686,505

1.38%

35.18

21.35

0

129.24

39.82

12.2%

47.8%

51

Namibia

2,044,147

0.59%

24.32

18.86

0.47

48.1

43.39

21.3%

84%

267

Nauru

13,048

1.83%

25.14

6.82

0

9.95

62.73

 

 

23

Nepal

28,287,147

2.17%

30.98

9.31

0

65.38

60.18

0.5%

48.6%

26

Netherlands

16,491,461

0.49%

10.9

8.68

2.72

4.96

78.96

0.2%

99%

128

Netherlands Antilles

219,958

0.82%

15

6.41

-0.4

10.03

75.83

 

96.7%

364

New Caledonia

216,494

1.28%

18.49

5.65

0

7.72

74.04

 

91%

131

New Zealand

4,076,140

0.99%

13.76

7.53

3.63

5.76

78.81

0.1%

99%

183

Nicaragua

5,570,129

1.89%

24.51

4.45

-1.17

28.11

70.63

0.2%

67.5%

114

Niger

12,525,094

2.92%

50.73

21.91

-0.61

118.25

43.76

1.2%

17.6%

46

Nigeria

131,859,731

2.38%

40.43

16.94

0.27

97.14

47.08

5.4

68%

30

Niue

2,166

 0

 

 

0

 

 

 

95%

 

Northern Mariana Islands

80,362

2.61%

19.51

2.3

8.92

7.11

75.88

 

97%

183

Norway

4,610,820

0.38%

11.46

9.4

1.73

3.67

79.54

0.1%

100%

66

Oman

3,102,229

3.28%

36.24

3.81

0.35

18.89

73.37

0.1%

75.8%

81

Pakistan

165,803,560

2.09%

29.74

8.23

-0.59

72.44

70.45

0.1%

48.7%

57

Palau

20,303

1.39%

18.37

6.85

2.36

14.84

70.14

 

92%

478

Palestine

3,889,249

3.385%

35.56

3.86

2.14

20.78

72.62

0.1%

91.9%

 

Panama

3,191,319

1.6%

21.74

5.36

-0.4

16.37

75.22

0.9%

92.6%

364

Papua New Guinea

5,670,544

2.21%

29.36

7.25

0

49.96

65.28

0.6%

64.6%

69

Paraguay

6,506,464

2.45%

29.1

4.49

-0.08

24.78

75.1

0.5%

94%

86

Peru

28,302,603

1.32%

20.48

6.23

-1.01

30.94

69.84

0.5%

87.7%

126

Philippines

89,468,677

1.8%

24.89

5.41

-1.48

22.81

70.21

<0.1%

92.6%

108

Poland

38,536,869

-0.05%

9.85

9.89

-0.46

7.22

74.97

0.1%

99.8%

237

Portugal

10,605,870

0.36%

10.72

10.5

3.4

4.98

77.7

0.4%

93.3%

120

Puerto Rico

3,927,188 

0.4%

12.77

7.65

-1.14

9.14

78.4

 

94.1%

356

Qatar

885,359

2.5%

15.56

4.72

14.12

18.04

73.9

 

89%

55

Romania

22,303,552

-0.12%

10.7

11.77

-0.13

25.5

71.63

0.1%

98.4%

157

Russia

142,893,540

-0.37%

9.95

14.65

1.03

15.13

67.08

1.1%

99.6%

613

Rwanda

8,648,248

2.43%

40.37

16.09

0

89.61

47.3

5.1%

70.4%

152

Saint Helena

7,460

0.59%

12.33

6.43

0

19

77.76

 

97%

 

Saint Kitts & Nevis

39,129

0.5%

18.02

8.33

-4.7

14.12

72.4

 

97.8%

547

Saint Lucia

166,312

1.28%

20.05

5.12

-2.19

13.53

73.61

 

67%

303

Saint Pierre

7,012

0.21%

13.83

6.7

-4.49

7.54

78.46

 

99%

 

Saint Vincent

117,534

0.27%

16.34

6

-7.61

14.78

73.62

 

96%

312

Samoa

177,287

-0.23%

15.95

6.54

-11.73

27.71

70.72

 

99.7%

123

Samoa, American

57,881

-0.11%

23.13

3.33

-20.89

9.27

75.84

 

97%

384

San Marino

29,251

1.26%

10.02

8.17

10.7

5.63

81.71

 

96%

 

Sao Tome and Principe

193,413

3.15%

40.25

6.47

-2.32

41.83

67.31 

 

79.3%

82

Saudi Arabia

27,019,731

2.18%

29.34

2.58

-4.94

12.81

75.67

0.01%

78.8%

132

Senegal

11,987,121

2.34%

32.78

9.42

0%

52.94

59.25

0.8%

40.2%

54

Serbia

9,396,411

 

 

 

 

 

74

 

96.4%

104

Seychelles

81,542

0.43%

16.03

6.29

-5.4

15.14

72.08

 

91.9%

239

Sierra Leone

6,005,250

2.3%

45.76

23.03

0.23

160.39

40.22

7%

29.6%

32

Singapore

4,492,150

1.42%

9.34

4.28

9.12

2.29

81.71

0.2%

92.5%

350

Slovakia

5,439,448

0.15%

10.65

9.45

0.3

7.26

74.73

0.1%

99.6%

158

Slovenia

2,010,347

-0.05%

8.98

10.31

0.88

4.4

76.33

0.1%

99.7%

65

Solomon Islands

538,032

2.68%

30.74

3.98

0

21.29

72.66

 

 

62

Somalia

8,863,338

2.85%

45.13

16.63

0

114.89

48.47

1%

37.8%

 

South Africa

44,187,637

-0.4%

18.2

22

-0.16

60.66

42.73

21.5%

86.4%

336

Spain

40,397,842

0.13%

10.06

9.72

0.99

4.37

79.65

0.7%

97.9%

145

Sri Lanka

20,222,240

0.78%

15.51

6.52

-1.23

13.97

73.41

<0.1%

92.3%

114

Sudan

41,236,378

2.55%

34.53

8.97

-0.02

61.05

58.92

2.3%

61.1%

36

Suriname

439,117

0.2%

18.02

7.27

-8.76

23.02

69.01

1.7%

88%

356

Swaziland

1,136,334

-0.23%

27.41

29.74

0

71.85

32.62

38.8%

81.6%

249

Sweden

9,016,596

0.16%

10.27

10.31

1.66

2.76

80.51

0.1%

99%

82

Switzerland

7,523,934

0.43%

9.71

8.49

3.12

4.34

80.51

0.4%

99%

83

Syria

18,881,361

2.3%

27.76

4.81

0

28.61

70.32

<0.1%

76.9%

58

Taiwan

23,036,087

0.61%

12.56

6.48

0

6.29

77.43

 

96.1%

259

Tajikstan

7,320,815

2.19%

32.65

8.25

-2.48

106.5

64.56

<0.1%

99.4%

164

Tanzania

37,445,392

1.83%

37.71

16.39

-3.05

96.48

45.64

8.8%

78.2%

113

Thailand

64,631,595

0.68%

13.87

7.04

0

19.49

72.25

1.5%

92.6%

256

Togo

5,548,702

2.72%

37.01

9.83

0

60.63

57.42

4.1%

60.9%

65

Tokelau

1,405

-0.01%

 

 

0

 

 

 

 

 

Tonga

112,422

1.98%

25.18

5.35

0

12.62

69.53

 

98.9%

114

Trinidad & Tobago

1,088,644

-0.74%

12.81

9.37

-10.87

24.31

68.91

3.2%

98.6%

296

Tunisia

10,175,014

0.99%

15.52

5.13

-0.5

24.77

75.12

<0.1%

74.3%

263

Turkey

70,413,958

1.06%

16.62

5.97

0

39.69

72.36

<0.1%

86.5%

91

Turkmenistan

5,042,920

1.83%

27.61

8.6

-0.75

72.56

61.85

<0.1%

98.8%

489

Turks & Caicos

20,556

2.9%

22.23

4.28

11.09

15.67

74.51

 

98%

 

Tuvalu

11,636

1.47%

21.91

7.22

0

20.03

68.01

 

 

60

Uganda

28,195,754

3.37%

47.35

12.24

-1.4

66.15

52.67

4.1%

69.9%

95

Ukraine

46,710,816

-0.6%

8.82

14.39

-0.43

9.9

69.98

1.4%

99.7%

350

United Arab Emirates

2,602,713

1.52%

18.96

4.4

0.66

14.09

75.24

0.18%

77.9%

288

United Kingdom

60,609,153

0.28%

10.71

10.13

2.18

5.08

78.54

0.2%

99%

135

United States

298,444,215

0.91%

14.14

8.26

3.18

6.43

77.85

0.6%

99%

737

Uruguay

3,431,932

0.46%

13.91

9.05

-0.25

11.61

76.33

0.3%

98%

193

Uzbekistan

27,307,134

1.7%

26.36

7.84

-1.5

69.99

64.58

<0.1%

99.3%

184

Vanuatu

205,754

1.52%

23.06

7.9

0

55.16

62.49

 

74%

65

Venezuela

25,730,435

1.38%

18.71

4.92

0

21.54

74.54

0.7%

93.4%

74

Vietnam

84,402,966

1.02%

16.86

6.22

-0.42

25.14

70.85

0.4%

90.3%

105

Virgin Islands US

108,708

0.07%

14.2

6.26

-8.64

8.03

78.91

 

 

596

Western Sahara

273,008

 

 

 

 

 

 

 

 

 

Yemen

21,456,188

3.46%

42.89

8.3

0

59.88

62.12

0.1%

50.2%

83

Zambia

11,502,010

2.11%

41

19.93

0

86.84

40.03

16.5%

80.6%

122

Zimbabwe

12,236,805

0.62%

28.01

21.84

0

51.71

39.29

24.6%

90.7%

139

 

Meca totals

725,605,829

1.94%

25.03

6.24

4.28

41.54

70.7

0.1%

79.3%

167

Sub-Saharan totals

751,055,142

2.12%

36.78

15.71

0.19

81.04

49.84

19.6%

62.27%

103

America totals

893,456,036

1.3%

38.49

7.5

0

13.5

73.68

0.5%

98%

258

Asia totals

3,454,822,612

1.9%

44.72

30.44

-0.64

51.96

70.34

0.1%

94%

138

Europe totals

738,425,494

0.33%

7.62

6.71

1.78

4.17

74.75

0.29%

98.29%

145

World totals

6,563,365,113

1.9%

30.53

13.32

1.22

38.44

67.86

2%

86.37%

162

 

Sanders, Tony J. Hospitals & Asylums. Chapter 9: Public Health Department. HA-7-4-07. 127 pgs. www.title24uscode.org/PHD.doc