Health and Fitness | October 2007

______________________________________________________________________________

The Healthier Poor

BY JEFFREY SACHS *

This article was published in Project Syndicate, an international not-for-profit association of 327 newspapers in 132 countries dedicated to hosting a global debate on the key issues shaping our world.

In his exclusive Project Syndicate commentaries Jeffrey Sachs - legendary adviser to the governments of Poland, Russia, and other countries on three continents, as well as a leading critic of today's international economic architecture - monitors and makes comprehensible the social forces behind economic growth around the world.

Life expectancy in the world's high-income countries is now 78 years, while it is only 51 years in the least-developed countries, and as low as 40 years in some AIDS-ridden African countries. For every 1,000 children born in rich countries, seven die before their fifth birthday; for every 1,000 births in the poorest countries, 155 children die before their fifth birthday.

These deaths are not only human tragedies, but also calamities for economic development, systematically reducing economic growth and helping to keep the poorest countries trapped in poverty. But a growing number of programs around the world are proving that the death and illness of the poor can be reduced sharply and rapidly with targeted investments in public health programs.

Big victories in recent years have come through the Global Fund to Fight AIDS, Tuberculosis, and Malaria. The Fund, established six years ago, has provided financing to more than 130 countries to scale up their programs against these three killer diseases. Since then, Global Fund programs have helped roughly one million Africans to receive anti-retroviral medicines to treat AIDS, financed the distribution of around 30 million bed nets to combat malaria, and supported treatment of around two million people with TB.

Malaria can be brought under decisive control through bed nets, indoor spraying of insecticides, and making medicines freely available to poor people in malaria-prone villages. In just two days last year, Kenya's government distributed more than two million bed nets. Similar mass distribution programs have been implemented in Ethiopia, Rwanda, Togo, Niger, Ghana, and other places. The results are amazing. The poor use the bed nets effectively, and the burden of malaria comes down rapidly.

Likewise, a campaign led by Rotary International and several partners has nearly eradicated polio. The number of cases worldwide each year is now in the hundreds, compared to many tens of thousands when the campaign began. Success is being achieved in even the most remote and difficult places, such as the poverty-stricken states of northern India.

Indeed, India is doing much more with its remarkable National Rural Health Mission (NRHM), which is the single largest mobilization of public health measures in the world. An astounding half-million young women have recently been hired as health workers to link impoverished households and public clinics and hospitals, which are being improved, and to increase women's access to emergency obstetrical care in order to avoid tragic and unnecessary deaths in childbirth.

Another remarkable success in India is the safe home-care of newborn infants in the first few days of life. Currently, an alarming number of newborns die because of infection, mothers' failure to breastfeed during the first days, or other preventable causes.

By training community health workers, the NRHM has achieved a marked reduction in newborn deaths in Indian villages. All these programs refute three widely held myths.

The first is that the burden of disease among the poor is somehow inevitable and unavoidable, as if the poor are bound to get sick and die prematurely. In fact, the poor die of known and identifiable causes that are largely preventable and treatable at very low cost. There is no excuse for millions of deaths from malaria, AIDS, TB, polio, measles, diarrhea, or respiratory infections, or for so many women and infants to die in or after childbirth.

The second myth is that aid from rich countries is inevitably wasted. This fallacy is repeated so often by ignorant leaders in rich countries that it has become a major barrier to progress.

The rich like to blame the poor, partly because it lets them off the hook, and partly because it gives them a feeling of moral superiority. But poor countries are capable of establishing effective public health programs rapidly when they are helped. Recent success stories have been made possible through a combination of increased spending from poor countries' budgets, supplemented by aid from rich-country donors.

The third myth is that saving the poor will worsen the population explosion. But households in the least-developed countries have many children - an average of five per woman - partly because fear of high childhood death rates leads them to overcompensate with large families. When childhood death rates come down, fertility rates tend to decline even more, since families are now confident that their children will survive. The result is slower population growth.

It is time to make good on a basic global commitment - that everybody, poor and rich alike - should have access to basic health services.

If just 0.1% of rich-world income were devoted to life-saving health care for the poor, it would be possible to raise life expectancy, decrease child mortality, save mothers in childbirth, slow population growth, and spur economic development throughout the poor world.

The success stories in public health for the poor are multiplying. Given the low cost and the huge benefits of supporting such efforts, there is no excuse for inaction.