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From National Public Radio


Global Economic Development Suffering Because of Disease and Poverty

DATELINE: July 29, 1999, Thursday



Last month, the world's wealthiest nations, the so-called Group of Seven, agreed 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 countries that 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 several diseases at once. The World Health Organization estimates 13 million people, many of them children, die each year from malaria, AIDS, tuberculosis, measles and pneumonia.

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 workers who 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, imagine, to >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 board. In 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 regime.

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, there 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 economic downturn.

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 health care.

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 budget 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 enforced. Many countries are so far in the hole, so far behind in their payments, reducing 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 THINGS CONSIDERED.

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