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Issue 95

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[image, unknown] CHILDREN[image, unknown]

Cheating Destiny

[image, unknown] Of the 122 million children born last year - the International Year of the Child - one in every ten is now dead. Most of them were the children of the ,absolute poor'. Three out of every ten of their children die before the age of five. Not even one in ten is ever seen by a health worker or immunised against the common killer-diseases of childhood. Probably only half will ever learn to read and write.

It is against this bleak background that the UN Children's Fund (UNICEF) has set its goals for the end of the century. `Perhaps for the first time' argues UNICEF's State of the World's Children Report, `The world stands poised to mount a decisive push against mass hunger, ill-health and illiteracy'.

`On present trends', says the Report, `the numbers of the absolute poor will rise by the end of the century. But trends are functions of present policy and not expressions of inevitable destiny. And the task before us now is to find out where and how the `points can be switched' in order to arrive at a new and better future'.

Specifically, UNICEF suggests that by the year 2000, all countries could achieve an infant mortality rate of 50 or less, an average life expectancy of 60 or more, and a literacy rate of at least 75 per cent.

These are ambitiously clear targets given the dark economic horizons pictured in the Report. By 2000 AD, the world's wealth gaps will have widened further. Most of Latin America, for example, will reach a per capita GNP of $2,000 by the end of the century - about the same as Europein 1960. But the poorest countries, mainly in South Asia and sub-Saharan Africa, will achieve a per capita GNP of less than 300 a year. `The message of these estimates is clear', says UNICEF, ,the poorest nations and the poorest peoples stand to be by-passed by the next twenty years of development just as surely as they have been by the last'.

As evidence that the `destiny' of economic extrapolations can be cheated, the Report cites the examples of China, Sri Lanka, and the Indian State of Kerala - all of which have achieved dramatic reductions in infant mortality, and steep increases in life expectancy and literacy. Yet income per head in these regions, says UNICEF, is less than the $300 which the poorest nations can expect to reach over the next 20 years.

Kerala, in South India, is singled out as an example of how much can be achieved on how little. With a per capita GNP of $135 a year and a population the size of Zaire or Argentina, Kerala is one of the poorest states in one of the poorest nations of the world. Yet its infant mortality rate is only half that of the developing world in general, its life expectancy is already over 60 years, 75 per cent of its adults are literate, and almost all of its 6-11 year olds are enrolled in school.

Drawing on these examples, the Report discusses particular strategies which might change the `gearing' between resources available and improvements possible. Pre-eminent among such strategies is the idea of primary health care. `It requires neither seven years training nor costly pieces of technology to prevent or cure most cases of ill-health. It is estimated for example, that four-fifths of all child ailments can be treated by community health workers'.

This is the method by which China, with its 1.6 million `barefoot doctors' has made such dramatic gains in public health. But if primary health care is not to be seen as a second-class service for the poor, the Report warns, then it must be backed by training and referral systems linking community health workers to national health services.

On the food front, the Report claims that the `major lesson of the last 20 years is that reductions in malnutrition cannot be achieved only by increases in food production'.

`As economic growth has failed to substantially increase the incomes of the poorest, and as the training of doctors and the building of hospitals has failed to significantly improve their health, so increases in food production have failed to significantly alleviate their hunger'.

As evidence that wiping out mass-malnutrition is a realistic goal - even in the poorest countries - the Report cites the example of Sri Lanka, where approximately one-third of the available food has been distributed through `fair price' shops and public food programmes. The result is a much higher general level of nutrition - and a much lower level of infant mortality - than would normally be expected in a country with a GNP of less than $200 per person.

Given that kind of commitment, concludes the Report, `there is no physical reason why the global village of the year 2000 should contain one malnourished child'.

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[image, unknown] DISASTERS[image, unknown]

For the slimmer refugee

A response from the heart should not be scorned, but the head should be there somewhere. Yet much of the relief for the one million Afghan refugees arriving in Pakistan since the Soviet invasion of their country, has been quite senseless.

Weight-reducing powder, high heeled shoes and used cocktail dresses have been amongst the bales of relief aid sent from the US, according to a report in the International Herald Tribune. Despite guidelines established by the Pakistani government and the United Nations High Commission for Refugees, American organisations have still been shipping first and checking later.

Tempers became frayed when crates of used clothing were opened to find skimpy dresses. But probably the most inappropriate item received so far has been eight tons of weight loss powder, eaten to depress the appetite. The 16,000 cans came from the Detroit based World Medical Relief Inc. Their president when questioned about this maintained the weight loss powder had 'a whole slew of vitamins in it'.

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[image, unknown] HEALTH[image, unknown]

The healing flow

[image, unknown] Aid from the underdeveloped world to the West is turning the concept on its head. Yet the costs to the poor world of all the doctors and nurses it educates who promptly move to greener pastures, adds up to more than all the overseas aid annually given by Western donors.

India has suffered most from this desertion by its medics, with an estimated 15,000 doctors abroad. They represent about 13 per cent of the number that are practising in the country. As it costs about $9,000 to train a doctor in India, these departing physicians represent a lost investment of $144 million reports a recent World Health Organisation study Physician and Nurse Migration: Analysis and Policy Implications.

The second largest aid-giver of doctors, the Philippines, has found the money spent on educating disappearing doctors amounted to a national loss of $100 million, for there are more than 9,500 practising outside the country. As for migrating nurses, the Philippines tops the charts with an estimated 2,400 leaving annually.

It makes no sense, the World Health Organisation study suggests, to train doctors and nurses where people cannot afford private medical care and hospitals are few. Instead more humble paramedics could be trained to work in the villages, and eight of them could be educated for the cost of one physician.

The migrant doctors Mecca, not surprisingly is the US, where in 1974 20 per cent of all practising physicians were foreign. The next most popular destinations were the United Kingdom, Canada, West Germany, Australia and New Zealand.

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[image, unknown] AID[image, unknown]

Nothing to bank on

Perhaps it's only fitting in the midst of growing neo-conservatism that when Robert McNamara steps down as head of the World Bank next June his replacement will be a man who has the reputation of a `banker's banker'.

A. W. (`Tom') Clausen, 57, is currently president of the Bank of America Corporation. With assets of nearly $150 billion it's the largest bank in the world. Clausen's nomination, coming just before Jimmy Carter's stunning election defeat was seen as a compromise palatable to both Reagan and Carter camps. Washington Post columnist Hobart Rowen calls him a George Bush Republican, a conservative but broad-gauged man, sensitive to the need for maintaining the fiscal integrity of the bank yet not oblivious to the massive needs of the Third World,'

The US business community needless to say is thrilled to have one of its own at the helm of the bank which, along with the International Monetary Fund (IMF), is one of the pillars of the world's financial system. The effusive Mr. McNamara has led the bank for the last 12 years and become more liberal, at least in rhetoric, as he approaches retirement. In the process he has been criticized by the right as being 'soft' on communism (the bank's loans to Vietnam for reconstruction caused a furor in the US Senate), And by the left as the examplar of corporate-style liberalism paving the way for Third World capitalism.

Under McNamara's tutelage the World Bank blossomed into a major Third World lending agency. Loans totalled nearly $12 billion in 1979 and the bank's capital base was recently doubled from $40 billion to $80 billion. In a parting policy gesture McNamara called for a new $25 billion lending programme geared entirely to financing energy projects in developing countries. Like the bank's soft-loan window, the International Development Association, the new programme will be separate but affiliated.

Sounding like he had read the New Internationalist's last issue on aid (see NI No. 82 Keeping the Patient Alive p5) but not quite got the point, Mr. Clausen said after his nomination: 'We're the richest nation on earth and we're dragging our heels. The kind of assistance we're talking about is in our vested interest. Helping keep patients alive is what keeps the US alive economically.'

A key concern for the Bankamerica Corporation chief and other multinational bankers is how the world will survive last year's massive OPEC oil price hikes that are now working their way through the system. Unlike 1973-75 when the private banks absorbed Arab petrodollars, then loaned them back to Third World nations with balance-of-payments problems, the big private lenders are no longer as willing to step into the breach. From 1970 to 1979 Third World debt ballooned from $64 billion to $376 billion while the cost of servicing the ponderous debt load grew from $8.2 billion to nearly $70 billion. Much of the new debt taken on over the next few years will be used just to meet interest payments on past debt. Third World countries still seen as good credit risks are becoming rarer all the time as export earnings sputter in the face of continuing global recession.

If opening remarks area signal, the World Bank's new head is acutely aware of the recycling problem and will be searching for ways to help bankers overcome their reluctance to underwrite faltering Third World economies. One way, according to Mr. Clausen, would be for World Bank resources to support investment guarantees or an `insurance pool' for private lenders.

Mr. Clausen's suggestions will give his fellow multinational bankers plenty to cheer about. On the one hand they'll have the IMF to select credit-worthy nations by granting its 'seal of approval' to those willing to re-structure their economies according to the dictates of the 'bottom line'. On the other they'll have a World Bank ready to underwrite their risk in countries the IMF may not have got around to yet. Somehow using public funds to make it easier and safer for private investors seems a long way from the World Bank's stated aim of alleviating world poverty. But then as Mr. McNamara's critics were fond of saying, what's good the bank is not necessarily good for development.

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[image, unknown] HEALTH[image, unknown]

Table 1 - Insecticide imports into Malaysia DDT in Malaysia

Trigger happy, uncontrolled use of DDT and other organochlorine (OC1) pesticides in Malaysia - banned in most Western countries - has led to extraordinary high levels of OC1 in the blood serum of the rice paddy farmers and rubber tappers. Recent research by Wong Kien Keong of Malaysia's University of Agriculture disclosed at the November seminar of the Consumers Association of Penang showed:

• Because of the increasing ineffectiveness of pesticides in controlling the brown hopper invasions in the prolific rice growing regions, more and more pest killing chemicals are used.

• Detrimental effects include the poisoning of fish in the flooded paddy fields and the rubber estate drains.

• Increasingly pesticide-resistant strains of insects are breeding in the chemical-soused fields.

• Paddy farmers and rubber estate workers have gravely high levels of OC1 in their bodies, due to direct handling of pesticides and the eating of fish caught in DDT-infected water.

The dependence of Malaysia on insecticide imports is shown by the climbing zig zag line of table 1. Each new high is prompted by recurring invasions of brown hoppers and other bugs. Each lull shows temporary success before the next storm. More of the same has been the only answer.

Not much is known about DDT poisoning. In a 1958 US court Dr. Hargreaves, a Mayo Clinic bloodspecialist testified that DDT caused leukemia, Hodgkins disease, anaemia and other blood disorders. Since then leukemia sufferers have found to be highest in the farm states sprayed with the most DDT. Nevertheless this is not conclusive and the more cautious World Health Organization believes; `The possibility that (the bodily accumulation of DDT) might have deleterious consequences later in life cannot be ruled out'.

Whatever the effects on humans, there is no doubt that DDT besides killing bugs also kills their natural predators like spiders and birds. And that was worrying enough for US legislators to ban the use of organochlorine pesticides.

Table 2 However, it is still used with haphazard abundance in many Third World countries like Malaysia. DDT advocates would argue the cost benefit equation is different where many die from malaria, typhus, cholera and malnutrition. Pesticides which stop harvests being hit by blight or kill malaria carrying mosquitoes might be worth the possible long-term risks.

What those risks are, no one is sure. But one of DDT's most insidious characteristics is that it contains organochlorine (OC1) which doesn't break down in water. It accumulates in human food: vegetables, fruit, fish, meat and ends up in the `fatty' tissues of the body - the ultimate `sink'.

The bottom line of the Malaysian research shows organochlorine in the blood serum of the paddy farmers, rubber tappers and general populace tested - see table 2. The far lower comparative levels for North Americans leave nagging doubts about the effects of the high OC1 concentrates on smaller, slighter and less well-nourished Malaysians.

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[image, unknown] NATURAL RESOURCES[image, unknown]

Precious investment

Forget gold. Dig out that sock full of pennies and put it into tantalum, manganese or chromium. According to Newsweek at least one US precious-metals expert is encouraging clients to invest 15 per cent of their portfolios in `strategic minerals', predicting they will become the `gold of the 1980s'.

The US government lists 36 minerals as `strategic' - that is essential to US industry and defense. Most of those are imported from the Third World, largely from sub-Saharan Africa and southeast Asia. Both areas are considered political flashpoints and potential zones of superpower conflict.

The US believes it can't afford to fall behind in efforts to counter Soviet influence in those mineral-rich nations. Former NATO commander General Alexander Haig recently warned the US

House subcommittee on Mines and Mining of the danger of a `resource war'. The old cold warrior noted that if African countries with vast mineral deposits ever allied themselves with the USSR, the Soviets would control 90 per cent of the world's key minerals.

A focus of particular attentionis Zaire, whose corrupt leader General Sese Seke Mobutu has been propped up time and time again by Western loans, troops and technical assistance. Most the of US's cobalt used in the fabrication of jet engines and computer hardware, comes from the former Belgian colony.

The US imports 90 per cent of its chromium, vital for stainless steel, oil refineries and power plants. More than 95 per cent of the world's supplies are in Zimbabwe and South Africa. Manganese, an essential ingredient in steelmaking, comes almost exclusively from South Africa. Its role as chief supplier of these important metals is one reason why that bulwark of apartheid keeps it head above water despite a torrent of international approbium.

Meanwhile the US is hedging its bets by broadening its choice of suppliers. What Canada, Brazil and Australia can't supply, American corporations will do their best to find under the sea. The US is forging ahead with the development of deep-sea mining technology in an attempt to get first bids on the knobby manganese nodules that dot the ocean floor. The nodules are self-contained storehouses of minerals, many of them the strategic variety catalogued by Washington. America's intention to sweep the seabed of its riches has been likened to poaching on the global commons, an act which Third World nations, particularly those without access to the oceans, see as yet another example of brazen American imperialism.

Investment counsellors are soon likely to advise their clients to broaden their investments to include both `strategic' minerals and those exploration companies that are scrambling to mine the ocean floor.

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