From National Public Radio
Global Economic Development Suffering Because of Disease and Poverty
DATELINE: July 29, 1999, Thursday
SHOW: ALL THINGS CONSIDERED (8:00 PM ET)
ANCHORS: LINDA WERTHEIMER, Brenda Wilson
Last month, the world's wealthiest nations, the so-called Group of Seven,
to forgive poorer countries a substantial portion of their international debt.
In return, the developing countries promised to spend more on health, AIDS
prevention and education. Many of them currently spend more on their debt than
on social and medical programs. As NPR's Brenda Wilson reports, international
economists and health workers say global economic development is suffering
because of disease and poverty.
BRENDA WILSON reporting:
It's a vicious cycle of poverty undermining health and poor health hampering
development. Right now, malaria is one of the biggest killers in sub-Saharan
Africa, where more than a million people die of the disease each year. Nor is
death the only toll. Dr. Nils Daulaire of the Global Health Council says there
are other often overlooked costs.
Dr. NILS DAULAIRE (Global Health Council): Each person who gets infected gets
sick. They get sick for a period of several weeks. You don't work, you don't
take care of your family, you just try to live through it. This has huge
economic consequences. Those countries that have high levels of endemic malaria
and other tropical diseases have much slower economic growth than
are largely free of them.
WILSON: With the investment of just $ 4 per person, much of the billions of
dollars spent each year treating malaria could be saved. Something as simple as
bed nets sprayed with insecticide reduces mosquito bites, and this would slow
the spread of the disease. And poor countries often have to contend with
diseases at once. The World Health Organization estimates 13 million people,
many of them children, die each year from malaria, AIDS, tuberculosis, measles
Dr. GRO HARLEM BRUNDTLAND (Director, World Health Organization): The sum of the
problems, I think, sometimes can seem to political ears in those countries of a
dimension that they really don't know what to do.
WILSON: Since Dr. Gro Harlem Brundtland became the director of the World Health
Organization a year ago, she has promoted health care as essential to economic
development, in part, she says, because there can be no progress until the
stranglehold of disease is loosened and health improves. The AIDS pandemic has
magnified the problem. The disease is depriving many sub-Saharan countries of a
generation of young, educated professionals, the teachers and health
were counted on to build economies.
Dr. BRUNDTLAND: Having had a life expectancy, having increased it
gradually to a
level of above 60, and then because of the HIV/AIDS epidemic, seeing it, in the
next 20 years, falling to 40, in some cases even less than 40 years,
>have a life expectancy of the kind that we had 250 years ago in Europe. So it's
a social, economic and humanitarian catastrophe.
WILSON: A catastrophe compounded by fragile economies that were already in
trouble even before the AIDS epidemic. Revenues and resources not sunk in
ambitious building projects were soaked up by huge bureaucracies or mismanaged
and siphoned off by corrupt officials. Attempts by the World Bank, the
International Monetary Fund and international donors to push reform forced
governments to shrink the civil services and to cut budgets across the
most instances, the reforms worsened the economic situation, making it more
difficult to pay off debts.
Mozambique's prime minister, Pascoal Mocumbi, says that repaying a $ 5 billion
loan from the World Bank consumed more than a third of his country's gross
domestic product, leaving little for health or education.
Prime Minister PASCOAL MOCUMBI (Mozambique): If you tight so much the belt, you
end up breaking your spine. The effort that we are asking people to make should
be an effort to continue living and, hopefully, living better. And they have to
see this, not wait until they die to see the results.
WILSON: Prime Minister Mocumbi traces Mozambique's health problems to the
wholesale neglect of people in his country under the Portuguese colonial
Prime Min. MOCUMBI: We had 80-something percent of illiteracy rate in
Mozambique, and all our population was excluded, practically, from access to
health services. When we took over the responsibility of running our own state,
we decided this was the priority, taking care of education and health for all.
WILSON: A noble mission, perhaps, but costly one that was sidetracked by a
16-year civil war which pitted the Soviet-backed government against rebels
supported by white governments in southern Africa. Mozambique is beginning to
recover from the war. For the last two years, the country's economy has grown.
And because it has satisfied the World Bank's economic performance standards,
Mozambique qualifies for a new relief package that will reduce debt payments to
a tenth of current revenues. But for Mozambique, like many poor countries,
are so many problems, it's hard to know where to begin.
Daulaire of the Global Health Council would opt for family planning. As in
Thailand, he says, it would spare them the demands on the health system and an
Dr. DAULAIRE: They're now starting to bounce back. If they had not had a
foundation of reasonable health and with the large majority of their population
able to make their own decisions in terms of family size, it would be a much,
much slower recovery process.
WILSON: The World Health Organization has programs targeting malaria, AIDS and
tuberculosis. But just as important, says Director Brundtland, is good primary
Dr. BRUNDTLAND: It can be done without a very high percentage of a GDP of any
country. You don't need to use 14 percent, as in the United States. You can go
far in most countries by spending 4 or 5 percent of your GDP to reach everyone
with basic health care.
WILSON: Such as immunization and nutrition and good maternal and child health
care. But even that requires the commitment of political leaders in developing
countries, many of whom are only beginning to acknowledge that business
development, military security and infrastructure have suffered because large
sectors of the population are ailing. For years, the responsibility of health
care has been left to international foundations and Western governments.
Dr. BRUNDTLAND: It doesn't make sense that we have four countries in southern
Africa that finance by donors from the outside 70 percent of their health
while, at the same time, using a big part of their budget to repay debts.
WILSON: To ensure that savings under the new debt plan are actually spent on
social priorities, countries have to commit to spending on basic health care,
AIDS prevention and education. But some doubt such a commitment can be
Many countries are so far in the hole, so far behind in their payments,
the debt merely brings bills up to date. Brenda Wilson, NPR News, Washington.
LINDA WERTHEIMER (Host): The challenge of airport safety, next on NPR's ALL
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