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(Embargoed until 3 December 2002, 0001 GMT)

Poor Health and Poverty Feed Off Each Other

UNITED NATIONS, NEW YORK, 3 DECEMBER 2002 — Poor health makes people poor. A wage earner’s illness can push families over the edge into poverty, and poor families into destitution. Illness is most frequently cited by the newly poor as the cause of their slide, says The State of World Population 2002 report, published by UNFPA, the United Nations Population Fund.

The gap between rich and poor in access to health services is wider in poorer countries than richer ones, says the report. The gap in reproductive health is particularly alarming. For women in particular, poor reproductive health is a source of insecurity and a major factor in their poverty.

The poor are more often sick than the better off. They are more exposed to diseases, and they work mostly in physically demanding jobs in unsafe conditions. They lack full access to health care, and the services they get are often mediocre and do not respond to their needs. As a result, they live in constant fear of losing their jobs and income.

Poor health holds back economic growth at the national level as well. Annual losses from ill health in developing countries could reach $360 billion within two decades. In the 1990s, AIDS alone was responsible for slowing Africa’s per capita growth by an estimated 0.8 per cent. Two decades from now, economies of the worst-affected countries could be 20 to 40 per cent smaller than they would have been without AIDS.

The report, People, Poverty and Possibilities, says that reproductive health is a vital component of overall heath. More than one fifth of the burden of illnesses of women aged 15-49 relates to sex and pregnancy. Poor women are the most affected by discrepancies in getting health care services, with maternal mortality rates-reflecting the extent of women’s access to health resources and care-showing a great variation between rich and poor nations.

As a result, almost all of the half million women who die from maternal causes every year are in developing countries. The risk of a woman dying from such causes is less than 1 in 3,000 in developed countries; it is as high as 1 in 19 in Africa. Within developing countries the poorest women are most likely to give birth without an attendant trained to respond to complications.

Fertility levels of the poor are higher than those of the rich and a higher proportion of their births are unwanted. The gap between rich and poor is most profound and detrimental when it comes to adolescent fertility, says the report. Many young women know little about family planning and the choices available to them. As a result, any sexual encounter raises the risk of unwanted pregnancies and sexually transmitted infections, including HIV.

Reproductive health needs do not attain a priority for policy makers in poor countries, where pregnancy and childbirth are taken for granted. Attention to disease rather than health and lack of appreciation of the impacts of unwanted pregnancies on heath, employment and education further bias resource allocations.

The report cites child mortality data from 44 developing countries showing very wide differences between rich and poor within countries. Infant mortality in the poorest families could be twice as high as in the richest ones. Variations also exist between countries and regions, depending on income levels. Child deaths among the richest 20 per cent in sub-Saharan Africa and South Asia, which have the highest infant mortality, are higher than the average in other regions.

Gaps in accessing health care are not limited to poor countries. The United States is the highest per capita spender on health care services in the world, but inequalities in accessing these services are higher than in other industrialized countries. This translates into poor overall health performance, with U.S. infant mortality-at 7 deaths per 1,000 live births-surpassing that of most European Union countries and being equal to Cuba’s. Infant deaths in some poor U.S. communities rival those of Panama.

Low-income countries invest no more than $21 per person annually on health care, mostly on curative, rather than preventive, services. An additional $30 billion are estimated to be needed every year.

More governments are introducing health sector reforms to make the most effective use of available resources and improve the efficiency and quality of overall health services, including reproductive health. Such reforms, says the UNFPA report, should guarantee equal access to health services according to need, particularly in poor countries.

One way to achieving parity would be to promote services the poor could use, including family planning, safe motherhood and other aspects of reproductive health. Alternative approaches include changing the role of governments from providers to financers, providing subsidies, and letting the poor choose among providers in the private and non-governmental sectors.

A good example of successful health plans designed to promote equality is that of Viet Nam, which was able to reduce the rich-poor gap in most health care measures to less than one to two and provide its poorest with their proportional share of reproductive health services.

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UNFPA’s State of World Population report has been published annually since 1978. Each year, the report focuses on questions of current interest and concern for the future. The report is available online, at www.unfpa.org. For more information contact Micol Zarb, +1 212 297 5042, or zarb@unfpa.org.

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