issue 229 - March 1992
Discrimination against particular social groups jeopardizes their right to health - and In the case of women this indirectly undermines the health of children as well. Every year half a million young women who might have survived die from pregnancy and childbirth-related causes. One-third of all maternal deaths occur because the births are too close together, the mothers are too young or too old, or because they have too many children - and all of these deaths could have been prevented by education on contraception and birth spacIng.
Children benefit as their mothers' health improves. At present over 40 million children die every year before reaching their first birthday and a large proportion of these are girls who might have lived if they had had the same kind of access to health care and food as boys.
The developing countries which have most improved their people's right to health are those which make basic health care available to all, either free or at a cost that people can afford. They target the most vulnerable groups instead of spending their precIous money on prestIge Western-style hospItals that only serve an elite.
Botswana's concerted health programme is aimed at the most vulnerable people. For example, it has a nutritional surveillance scheme as part of its drought early-warning system; viliage health workers are widespread; almost 90 per cent of villagers have access to ciean water; and 85 per cent of primary-age children attend school, where their work includes a programme on basic skills called Education for Life. Au of these things combine to produce befter health care.
Costa Rica has an outstanding record of human development: its people live longer than those of some industrialized countries. Half its spending goes on social areas like health, nutrition, and education, and in the last decade it has dramaticaily improved the health of its children by extending basic services to deprived sections of the population. infant mortality and malnutrition continue to fall, although the rate of improvement has slowed as economic conditions have worsened.
The social reforms began in the 1940s after the army was abolished and institutions were created for health education and social insurance. The country's history of democracy has reinforced welfare policies, helped by increasing foreign-exchange earnings from coffee. Primary health care has been emphasized since the eariy 1970s. And by 1980 almost all Costa Ricans were covered by a combination of pensions, health insurance, sociai welfare and public health.
Chile has improved in all areas of human rights since its emergence from 17 years of military dictatorship in 1990. Today 64 per cent of its public health spending reaches the poorest.
VOTES OF CENSURE
Although child mortality rates in the Third World were cut in half between 1960 and 1989, the rates continue to be especially high for female children in most of Asia and North Africa. This is despite the fact that girl children are physiologically tougher than boys: given equal health care and nutrition more of them tend to survive.
Health statistics show Pakistan to be a particularly dismal example of discrimination against the female sex. Maternal mortality is a shocking 500 per 100,000 live births (compare Canada's 3 per 100,000 live births). Up to 80 per cent of pregnant or lactating mothers and 70 per cent of chiidren are malnourished even though the country has sufficient food for everyone. Female literacy is under 20 per cent and life expectancy for Pakistani females is the third lowest in the world.
Health has tended to be a low priority for the Pakistani Government. Between 1972 and 1986, the country cut its health budget from 1.1 per cent of overall spending to 1 per cent while defence spending rocketed to 39 per cent. The country is one of the worst in the world in its provision of clean water and sewage services; only six per cent of the rural population have sewage systems and less than half of all people have access to clean water. These are truly statistics of shame in a country with the resources to do better.
There are massive human-rights abuses of all kinds in Somalia. Hundreds of thousands of people are internally displaced with no access to food, shelter, water, sanitation or health care; an estimated 75 children die every day and over half a million people are totally denied food. Random killings are common and a state of near-chaos exists. Any more complete denial of a people's right to health would be difficult to imagine.
China's public health service has seriously deteriorated over the last decade as the country has adopted market-orientated economic reforms. In the past the collectivization of agriculture helped to fund medical services in rural areas. And in the 1960s Maoist China pioneered the use of barefoot doctors - partly trained medical workers who provided primary health care in rural areas. This provided a model for much of the developing world.
But since the communes were dismantled in the early 1980s the medical care system has largely collapsed in rural areas. Basic sanitation and health education. together with public health services like immunization and ante-natal care, have been steadily eroded. The poor now have to pay for health care and therefore all too often avoid visiting a clinic.
Sources: Human Development Report 1991, United Nations Development Programme; State ofthe World's Children, UNICEF, 1989 and 1991; National Health, Pakistan, February 1989; Human Rights Watch World Report 1990; consultations with experts in the field.