Health, poverty and MDG
About 1 billion people globally live in extreme poverty on an income of just $1 a day, of whom 700 million live in Asia and the Pacific. Many of the poor lack access to basic health services.
The Millennium Development Goals (MDG) aim to cut poverty by half by the year 2015. As health is central to poverty reduction, three goals focus directly on health, covering maternal mortality, infant mortality, HIV/AIDS, malaria and tuberculosis. Other MDG concern issues related to health, such as nutrition, water and sanitation, and the environment.
Asia-Pacific nations will need to invest considerable action and resources to meet these goals. Governments also need to look beyond individual diseases. Major investments will need to be made in strengthening health systems, promoting equity, securing and managing resources and promoting partnerships with non-health sectors.
- More than 4 million children die before their fifth birthday in Asia and the Pacific every year, mostly from causes that can easily be prevented or treated, such as diarrhoeal diseases and pneumonia. In south Asia alone, 9 of 100 children die before five years.
- The number of child deaths globally every year is huge – twice as many children died in 2002 than all deaths among adults from AIDS, tuberculosis and malaria.
- Girls denied an education are more vulnerable to poverty, violence, abuse, death during childbirth and at the risk of disease, including HIV/AIDS.
- Reproductive problems are the biggest cause of ill-health for women. Pregnancy and child birth are the major causes of death for women of reproductive age, killing more than one half million every year.
- India accounts for more than one quarter of all maternal deaths worldwide.
- In most countries, women have limited access to reproductive health services. Nearly 40% of all births worldwide are not attended by a skilled health worker.
- Every minute, roughly four people die of TB and 15 others newly develop the disease worldwide. One third of these people live in Asia.
- TB is preventable and, in 90% of cases, can be completely cured for as little as $15 per course. Yet it accounts for 1 in 4 adult preventable deaths.
- About 40 million people are living with HIV/AIDS globally.
- AIDS is the leading cause of death of adults aged 15-49 worldwide, killing 3 million in 2003.
- Asia-Pacific countries have relatively low HIV prevalence rates, but large numbers of infected people. India has a prevalence one twentieth that of South Africa yet the same number of people infected. Similarly, Viet Nam and Swaziland have the same number of infected people yet have prevalence rates of 0.4% and 40%.
- Two thirds of people in Asia and the Pacific lack access to safe water, including 300 million in China alone.
- About 900 million people worldwide are estimated to live in slum-like conditions, which usually lack access to water and sanitation. In many south Asian cities, slum dwellers account for more than 70% of the urban population.
- Shortages of health workers in some countries are an acute problem, and in some Pacific nations are at a crisis level. Expansion of antiretroviral treatment for AIDS is currently being hampered by a lack of trained staff.
- Up to 15% of professional health workers have migrated from most Pacific islands in recent year. In Samoa, 5%-10% of doctors are leaving each year and in Tonga, half the doctors now work outside the country. The main reasons include: low salaries, poor working conditions and environment, and shortages of supplies.
- Better health information systems are urgently needed in Asia and the Pacific. Information needs to be disaggregated by sex, geographic area and ethnicity to enable analysis on health equity. Few countries have efficient information systems.
- An estimated $30-$40 per capita is needed annually to finance a minimum health service package, but many countries invest far less. Bangladesh, Cambodia, Mongolia, Pakistan and Viet Nam all spend less than $10 per capita per annum.
- Some 100 million people are driven into poverty due to "out-of-pocket" health expenditures every year.
- Some of the highest "out-of-pocket" payments, as a proportion of total health expenditure, are in this region. Such payments account for 80% of all health spending in Cambodia and India and about 50% or more in Bangladesh, Indonesia and the Philippines.
- In poor countries worldwide, roughly one third of the disease burden in 1990 could have been averted at a total cost per person of only $12.
Inequities in health
- Less than one third of the rural population in Cambodia, the Lao People’s Democratic Republic, Mongolia and Papua New Guinea had improved drinking water in 2000. In these countries, the percentage of households with an improved drinking water source was twice as high in urban areas compared to rural areas.
- In the Philippines, over 90% of women from the poorest quintile of the population gave birth at home while a mere 20% of the richest quintile had home births.
- Less than 20% of mothers from the poorest quintile of the population in Cambodia and the Philippines were assisted during delivery by trained health professionals, while more than 80% of mothers from the richest quintile in Cambodia and 90% in the Philippines received assistance.
- Most of the poor live in rural areas, yet these areas are often neglected. In Cambodia, only 13% of health professionals work in rural areas, where 85% of the population reside. In Nepal, only 20% of rural physician posts are filled compared with 96% in urban areas.
- The likelihood of a woman dying in pregnancy and childbirth is more than 50 times higher in India and Nepal than in Japan. The probability of a child dying before its 5th birthday is more than 100 times higher in Cambodia and Myanmar than in Japan.
Action in non-health sectors
- Mothers with more education are more likely to adopt appropriate health-promoting behaviors, such as having young children immunized
- A study of several countries found that child mortality declines by 3%-4% if access to drinking water is improved by 10%. Child mortality also declines by 3% if the years of schooling among mothers are increased by 10%.
- Gender inequalities in schooling and urban jobs accelerate the spread of HIV.
- Developed countries have been urged to give 0.7% of national income to aid to help uplift the world's poor. So far, only five countries have met that target.