patterns — for their own sake as well as to accommodate 

 the justifiable needs and desires of developing 

 countries in a time of growing resource shortages. The 

 extravagance of current American resource consumption 

 patterns covers a broad spectrum, from medical 

 facilities to diets to modes of recreation and 

 transportation. The health benefits of a simpler diet, 

 with less meat, fat, and sugar, could be substantial 

 for the average American and additional benefits can be 

 expected from less re source -intensive life-styles in 

 other dimensions. The need for Americans to consume a 

 smaller proportion of the world's resources should be 

 taken as an opportunity to reap some of these benefits, 

 rather than as a threat to material well-being. We 

 recognize that changes in consumption patterns are 

 generally difficult to achieve. But with research to 

 clarify the anticipated benefits and with inspired 

 leadership it may be possible. 



In general, we support the widely held view that 

 technical and financial assistance from the 

 industrialized nations be directed to needs identified 

 by responsible developing country officials. In some 

 cases, however, such officials represent an elite whose 

 perspective may well not represent the needs of the 

 majority of the people. For example, a costly modern 

 hospital or a sophisticated, specialized piece of 

 medical equipment may benefit a few, but requests for 

 such items must be considered in context; the need for 

 support of rural primary care facilities is far more 

 urgent. Two closely related problems, which 

 unfortunately occur quite frequently, are (1) 

 inappropriate and/or inexpert advice offered by medical 

 and other foreign advisers, distinguished perhaps in 

 their own fields in the United States or elsewhere, but 

 inexperienced in international cross-cultural health 

 problems and priorities; and (2) inappropriate advice 

 from western commercial interests, which also may not 

 relate to the needs of the majority. 



In the health field, a large number of pilot and 

 demonstration projects have been conducted during the 

 past 25 years, and there is a need to continue such 

 projects. However, the success of pilot projects has 

 often been related more closely to motivation, 

 commitment, and dedicated local and foreign leadership 

 at the project level than to general advances in 

 organization, structure, or planning. Such commitment 

 on the part of the central political and/or ministerial 

 leadership is essential but often lacking. without it, 

 significant improvements are difficult, if not 

 impossible. Similar good faith and commitment are 

 necessary on the part of multilateral, bilateral, and 

 private assistance agencies. 



110 



