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WHO report urges larger health role in plans for development
as these, and the integration of women in rural development as a whole, will be among the major themes of activities marking World Food Day on 16 October 1981. As the anniversary of the founding of FAO is celebrated around the world, progress toward equality for women in food production and consumption will be
noted, and plans made for further advances toward that goal, FAO has announced. At this time, the discussion paper concludes, it is not at all clear how a sex-based reform of the agrarian structure should be designed, and what women's gains and losses are in different kinds of agrarian reform. []
WHO Report Urges Larger Health Role in Plans for Development * Health is prerequisite to a country's development, according to the World Health Organization (WHO). This is particularly true for the 31 countries designated by the United Nations as 'least developed', with populations among the world's least provided with health services. Too often, however, plans for development turn exclusively on the consideration of such issues as trade and tariffs, raw material and e n e r g y - - t o the neglect of health. Indeed, the role of health is "often under-estimated or ignored by policymakers" even though a healthy worker is indispensable to the attainment of economic goals, WHO contends in a report presented to the UN Conference on the Least Developed Countries, held in Paris from September 1st to 14th, 1981. Stressing that the UN General Assembly, in a resolution (34/58) adopted in November 1979, urged that health be considered as an integral part of development, and not separately from it, the WHO report calls for support of health programmes through allocating to them a larger share of development funds. "It is unrealistic to plan the development of a country without taking into account the health of those who must implement that development", the WHO report states. The population of the LDCs total some 280 million. Those in dire straits --essentially the population without access to safe water supply systems, or to health care--are estimated at about 200 million. According to WHO estimates, almost $164,000 *Courtesy of Peter Ozorio, Information Officer, WHO Division of Public Information. 320
million are required to provide that target population with primary health care, $61,200 million for the eighties, and $102,500 million for the nineties. "It may be assumed, as a working hypothesis", the WHO report adds, "that the LDCs are able to provide 80 per cent of the resources needed" for improving their health situation. Thus, funding sought from multi- and bi-lateral sources amount to $32,750 million, or $12,250 million for the eighties, and $20,500 million for the following ten years.
The LDCs: a profile The following countries have been designated as LDCs: In Africa: Benin, Botswana, Burundi, Cape Verde, Central African Republic, Chad, Comoros, Ethiopia, Gambia, Guinea, Guinea Bissau, Lesotho, Malawi, Mali, Niger, Rwanda, Somalia, Sudan, Uganda, United Republic of Tanzania, and Upper Volta. In Asia and Oceania: Afghanistan, Bangladesh, Bhutan, Democratic Yemen, Laos, Maldives, Nepal, Western Samoa, and Yemen. In Latin America: Haiti. The report attributes the low standard of health in the countries to a combination of economic, geographic, political, and administrative factors. Not only are material and financial resources of the LDCs inadequate for improving health, WHO says, but also inflation and rapid population growth aggravate the economic condition of the countries. In addition, the terrain of most of the LDCs is rugged; half of the countries are land-locked, and five are islands, thus making transport and
TABLE 1. Health and related socioeconomic indicators Least developed countries Number of countries Total population (millions) Infant mortality rate (per 1000 liveborn) Life expectancy (years) Birth weight 2500 g or more (%) Coverage by safe water supply (%) Adult literacy rate (%) GNP per capita ($) Per capita expenditure on health ($) Public expenditure on health as % of GNP Population per doctor Population per nurse Population per health worker (any type, including traditional birth attendant)
Other developing countries
Developedcountries
31 283
89 3001
37 1131
160
94
19
45 70
60 83
72 93
31
41
100
28 170 1.7
55 520 6.5
1.0
1.2
17,000 6,500 2,400
2,700 1,500 500
98 6,230 244 3.9 520 220 130
Note: Figures in the table are weighed averages, based upon estimates for 1980 or for the latest year for which data are available. The Environmentalist
communication difficult, the report says, particularly at times of seasonal rains or floods. Many are situated in the world's 'disaster belt', with a high risk of natural catastrophes that "destroy in one fell swoop" years of work. Another point made by the WHO report is that "military expenditure per capita is several times greater than public health expenditure", with the ratio being $5.5 to $i.7 respectively in some countries. Moreover, many are afflicted by civil strife. Added to the foregoing is the fact that all LDCs are "deficient in all categories of health personnel". For example, the report shows that there is but one health worker for 2,400 people in the countries, many of them being 'inadequately trained'. Even worse is the doctor-topopulation ratio. According to the report, there is one physician for 17,000 in the LDCs, as compared to one per 2,700 for the other develophag countries. The average ratio is one for 520 in the industrialized world. Goals f o r the n e x t Decades
The report compares health and economic conditions in the least developed countries not only with those prevailing in the industrialized world, but also with conditions in other developing countries. It finds, not unexpectedly, a gap between developing and developed countries, but also between the LDCs and the other developing countries. Among the proposed goals to bridge that gap over the next two decades are the following: - I n f a n t mortality: A decrease in the infant mortality rate to less than 50 deaths per 1,000 live births. The figure now is 160 per 1,000. By comparison, the rate in other developing countries is 94 deaths per 1,000 live births, while it is 19 in the industrialized world. - Life expectancy: An increase in the life expectancy rate to at least 60 years, from 45 now. By comparison, life expectancy is now 60 in the other developing countries, and 72 in the industrialized world. - B i r t h weight: An increase to at least 90 per cent in the numbers of babies weighing a minimum of 2,500 g (51bs 8oz) at birth. The figure is Vol. 1 , N o . 4 (1981)
70 per cent now, as compared to 83 per cent for other developing countries, and 93 per cent in the industrialized world. The report also shows that in the LDCs the average per capita intake is 2,000 calories daily, as compared to 2,400 in the other developing countries, and 3 , 4 0 0 - - " f a r in e x c e s s " - in the industrialized world. "Malnutrition is a major contributing factor to the very high rates of infant and young child mortality", the WHO report notes. - A d u l t literacy: An increase to over 70 per cent of the literacy rate combined for men and women. It is but 28 per cent now among adults, and even lower, 13 per cent, for women alone. By comparison, it is 55 per cent for the other developing countries, and 98 per cent for the industrialized world. - GNP per capita: An increase in the GNP to at least $500 per capita, from $170. By comparison, it is now $520 in the other developing countries, and $6,230 in the industrialized world. - P u b l i c spending on health as % GNP: An increase of public
spending on health from the present 1 per cent of gross national product to 5 per cent at least. By comparison, the figure is 1.2 per cent for other developing countries, and 3.9 per cent for the industrialized world. - W a t e r supply and sewage systems: That a supply of safe
water be available in all homes, at a walking distance not exceeding 15 minutes, and that adequate sanitary facilities be available also in homes, or in the 'immediate vicinity'. At present, less than a third of the population in the least developed world can count on sure access to either. In the LDCs of Africa, the figure is even lower--less than 20 per cent have access to such systems. By comparison, in the other developing countries, 41 per cent of populations are now served, and in the industrialized world, coverage is virtually 100 per cent. -Primary
health care facilities:
That primary health care facilities, with at least 20 essential drugs available, be within an hour's walking distance from homes. - Immunizations: That all children be immunized against six child-
hood diseases, namely, measles, whooping cough (pertussis), tetanus, poliomyelitis, tuberculosis, and diphtheria. Even though vaccines have existed, for decades, not more than 10 per cent of the 80 million children born in all developing countries are estimated to be protected against the six children killers, with the rate of immunization even lower in the LDCs. "Such is the state of deprivation of the least developed countries that greater resources than for other developing countries will need to be directed" at them, the WHO report goes on to say. "The special nature of their problems will call for specific efforts and initiatives", it adds, and particularly in health which is fundamental to development. By way of example, the report cites WHO's region for the Eastern Mediterranean. There, the "more affluent countries have relinquished their share" of the regional budget thus freeing more funds for programmes in Afghanistan, Democratic Yemen, Somalia, Sudan, and the Yemen Arab Republic. In addition, Kuwait, Libyan Arab Jamahiriya, Qatar, Saudi Arabia, and the United Arab Emirates, "the richer countries of the region.., have contributed substantially ... to programmes in LDCs, notably for malaria control". It is, however, clear from the WHO report that world-wide efforts have so far been insufficient, and that more, much more, needs to be done if the least developed countries of the world are to reach the goal, set by the World Health Assembly in 1977, of "Health for All by the Year 2000". []
Toxic-Waste Seepage Problem Solved * When the Cotter Corporation, a large vanadium and uranium processor in Canon City, Colorado, U.S.A., decided to build a new tailings pond, it chose a membrane lining of Du Pont 'Hypalon' synthetic rubber. "We undertook one of the most sophisticated membrane lining projects in the world, and we wanted a *Courtesy Du Pont Industry News. 321
noted, and plans made for further advances toward that goal, FAO has announced. At this time, the discussion paper concludes, it is not at all clear how a sex-based reform of the agrarian structure should be designed, and what women's gains and losses are in different kinds of agrarian reform. []
WHO Report Urges Larger Health Role in Plans for Development * Health is prerequisite to a country's development, according to the World Health Organization (WHO). This is particularly true for the 31 countries designated by the United Nations as 'least developed', with populations among the world's least provided with health services. Too often, however, plans for development turn exclusively on the consideration of such issues as trade and tariffs, raw material and e n e r g y - - t o the neglect of health. Indeed, the role of health is "often under-estimated or ignored by policymakers" even though a healthy worker is indispensable to the attainment of economic goals, WHO contends in a report presented to the UN Conference on the Least Developed Countries, held in Paris from September 1st to 14th, 1981. Stressing that the UN General Assembly, in a resolution (34/58) adopted in November 1979, urged that health be considered as an integral part of development, and not separately from it, the WHO report calls for support of health programmes through allocating to them a larger share of development funds. "It is unrealistic to plan the development of a country without taking into account the health of those who must implement that development", the WHO report states. The population of the LDCs total some 280 million. Those in dire straits --essentially the population without access to safe water supply systems, or to health care--are estimated at about 200 million. According to WHO estimates, almost $164,000 *Courtesy of Peter Ozorio, Information Officer, WHO Division of Public Information. 320
million are required to provide that target population with primary health care, $61,200 million for the eighties, and $102,500 million for the nineties. "It may be assumed, as a working hypothesis", the WHO report adds, "that the LDCs are able to provide 80 per cent of the resources needed" for improving their health situation. Thus, funding sought from multi- and bi-lateral sources amount to $32,750 million, or $12,250 million for the eighties, and $20,500 million for the following ten years.
The LDCs: a profile The following countries have been designated as LDCs: In Africa: Benin, Botswana, Burundi, Cape Verde, Central African Republic, Chad, Comoros, Ethiopia, Gambia, Guinea, Guinea Bissau, Lesotho, Malawi, Mali, Niger, Rwanda, Somalia, Sudan, Uganda, United Republic of Tanzania, and Upper Volta. In Asia and Oceania: Afghanistan, Bangladesh, Bhutan, Democratic Yemen, Laos, Maldives, Nepal, Western Samoa, and Yemen. In Latin America: Haiti. The report attributes the low standard of health in the countries to a combination of economic, geographic, political, and administrative factors. Not only are material and financial resources of the LDCs inadequate for improving health, WHO says, but also inflation and rapid population growth aggravate the economic condition of the countries. In addition, the terrain of most of the LDCs is rugged; half of the countries are land-locked, and five are islands, thus making transport and
TABLE 1. Health and related socioeconomic indicators Least developed countries Number of countries Total population (millions) Infant mortality rate (per 1000 liveborn) Life expectancy (years) Birth weight 2500 g or more (%) Coverage by safe water supply (%) Adult literacy rate (%) GNP per capita ($) Per capita expenditure on health ($) Public expenditure on health as % of GNP Population per doctor Population per nurse Population per health worker (any type, including traditional birth attendant)
Other developing countries
Developedcountries
31 283
89 3001
37 1131
160
94
19
45 70
60 83
72 93
31
41
100
28 170 1.7
55 520 6.5
1.0
1.2
17,000 6,500 2,400
2,700 1,500 500
98 6,230 244 3.9 520 220 130
Note: Figures in the table are weighed averages, based upon estimates for 1980 or for the latest year for which data are available. The Environmentalist
communication difficult, the report says, particularly at times of seasonal rains or floods. Many are situated in the world's 'disaster belt', with a high risk of natural catastrophes that "destroy in one fell swoop" years of work. Another point made by the WHO report is that "military expenditure per capita is several times greater than public health expenditure", with the ratio being $5.5 to $i.7 respectively in some countries. Moreover, many are afflicted by civil strife. Added to the foregoing is the fact that all LDCs are "deficient in all categories of health personnel". For example, the report shows that there is but one health worker for 2,400 people in the countries, many of them being 'inadequately trained'. Even worse is the doctor-topopulation ratio. According to the report, there is one physician for 17,000 in the LDCs, as compared to one per 2,700 for the other develophag countries. The average ratio is one for 520 in the industrialized world. Goals f o r the n e x t Decades
The report compares health and economic conditions in the least developed countries not only with those prevailing in the industrialized world, but also with conditions in other developing countries. It finds, not unexpectedly, a gap between developing and developed countries, but also between the LDCs and the other developing countries. Among the proposed goals to bridge that gap over the next two decades are the following: - I n f a n t mortality: A decrease in the infant mortality rate to less than 50 deaths per 1,000 live births. The figure now is 160 per 1,000. By comparison, the rate in other developing countries is 94 deaths per 1,000 live births, while it is 19 in the industrialized world. - Life expectancy: An increase in the life expectancy rate to at least 60 years, from 45 now. By comparison, life expectancy is now 60 in the other developing countries, and 72 in the industrialized world. - B i r t h weight: An increase to at least 90 per cent in the numbers of babies weighing a minimum of 2,500 g (51bs 8oz) at birth. The figure is Vol. 1 , N o . 4 (1981)
70 per cent now, as compared to 83 per cent for other developing countries, and 93 per cent in the industrialized world. The report also shows that in the LDCs the average per capita intake is 2,000 calories daily, as compared to 2,400 in the other developing countries, and 3 , 4 0 0 - - " f a r in e x c e s s " - in the industrialized world. "Malnutrition is a major contributing factor to the very high rates of infant and young child mortality", the WHO report notes. - A d u l t literacy: An increase to over 70 per cent of the literacy rate combined for men and women. It is but 28 per cent now among adults, and even lower, 13 per cent, for women alone. By comparison, it is 55 per cent for the other developing countries, and 98 per cent for the industrialized world. - GNP per capita: An increase in the GNP to at least $500 per capita, from $170. By comparison, it is now $520 in the other developing countries, and $6,230 in the industrialized world. - P u b l i c spending on health as % GNP: An increase of public
spending on health from the present 1 per cent of gross national product to 5 per cent at least. By comparison, the figure is 1.2 per cent for other developing countries, and 3.9 per cent for the industrialized world. - W a t e r supply and sewage systems: That a supply of safe
water be available in all homes, at a walking distance not exceeding 15 minutes, and that adequate sanitary facilities be available also in homes, or in the 'immediate vicinity'. At present, less than a third of the population in the least developed world can count on sure access to either. In the LDCs of Africa, the figure is even lower--less than 20 per cent have access to such systems. By comparison, in the other developing countries, 41 per cent of populations are now served, and in the industrialized world, coverage is virtually 100 per cent. -Primary
health care facilities:
That primary health care facilities, with at least 20 essential drugs available, be within an hour's walking distance from homes. - Immunizations: That all children be immunized against six child-
hood diseases, namely, measles, whooping cough (pertussis), tetanus, poliomyelitis, tuberculosis, and diphtheria. Even though vaccines have existed, for decades, not more than 10 per cent of the 80 million children born in all developing countries are estimated to be protected against the six children killers, with the rate of immunization even lower in the LDCs. "Such is the state of deprivation of the least developed countries that greater resources than for other developing countries will need to be directed" at them, the WHO report goes on to say. "The special nature of their problems will call for specific efforts and initiatives", it adds, and particularly in health which is fundamental to development. By way of example, the report cites WHO's region for the Eastern Mediterranean. There, the "more affluent countries have relinquished their share" of the regional budget thus freeing more funds for programmes in Afghanistan, Democratic Yemen, Somalia, Sudan, and the Yemen Arab Republic. In addition, Kuwait, Libyan Arab Jamahiriya, Qatar, Saudi Arabia, and the United Arab Emirates, "the richer countries of the region.., have contributed substantially ... to programmes in LDCs, notably for malaria control". It is, however, clear from the WHO report that world-wide efforts have so far been insufficient, and that more, much more, needs to be done if the least developed countries of the world are to reach the goal, set by the World Health Assembly in 1977, of "Health for All by the Year 2000". []
Toxic-Waste Seepage Problem Solved * When the Cotter Corporation, a large vanadium and uranium processor in Canon City, Colorado, U.S.A., decided to build a new tailings pond, it chose a membrane lining of Du Pont 'Hypalon' synthetic rubber. "We undertook one of the most sophisticated membrane lining projects in the world, and we wanted a *Courtesy Du Pont Industry News. 321