An unhealthy disaster

This year8217;s World Disaster Report released by the International Fedaration of Red Cross/Red Crescent Societies has been an annual addition to the well-produced tomes which some of the world8217;s largest developmental agencies bring out. Since 1993, the organisation has published status reports on disasters and their impact on society, including earthquakes, floods, environmental trends, cyclones. This year8217;s millennium-edge report8217;s premise is laid out in the very first chapter: 8220;Chronic health crises dwarf natural disasters.8221;

The report comes in an age where AIDS carries the same chilling finality that nuclear war does, when governments are diverting money that would have kept their citizens healthy to building airplanes and bombs, when new strands of infectious diseases mock the advances of science. 8220;Primary health care in the poorer parts of Asia, Africa and Latin America is deteriorating due to lack of resources drained by conflicts, debt and economic marginalisation as well as the misguided resource allocation and failed development.8221;

Good old malaria, for instance, continues to be a giant killer, slaying anything from 8220;1 million to 2.6 million people per year no one knows exactly how many, but three-quarters of them are children8221;. The blighted sub-Saharan Africa takes the lion8217;s share of the deaths, accounting for 90 per cent. 8220;WHO claims that 5,00,000 deaths a year could be prevented with US 1 billion spent on strengthening health systems,8221; continues the report.

Not surprisingly, the poor get the worst: 8220;58 per cent of those who die of infectious diseases are among the poorest 20 per cent of the world8217;s population, but only 7 per cent are among the richest 20 per cent.8221; Again, WHO points out that more the money spent on control, the lesser the human costs. Comments the report, 8220;Politicians and experts alike have often been heard to mutter that if malaria were as common in the US and Europe as it is in the subcontinent, there would probably be an effective vaccine against it by now.8221;

But even as poor health has been identified as 8220;the single-largest contribution to poverty8221;, the world8217;s poorer countries seem to be competing with the industrialised nations in cutting money to heal the dying.

8220;Research in the US suggests that investment in public health measures, such as improving personal hygiene and lifestyles, can reduce mortality by over 60 per cent,8221; says the report. Yet, government spending on health is losing priority even as deaths stack up. India, for instance, spends just 0.7 per cent of its GDP on health, a distinction it shares with Cambodia. In this respect, India is in the same league as Turkey, Eastern Europe and the countries which emerged out of the Soviet monolith.

Around 75 per cent of health care is reportedly controlled by the private sector; but for India8217;s 400 million people, those who 8220;fall through the net8221;, there8217;s no cure in sight.

A 1995 World Bank survey of 53 countries showed that over the course of structural adjustment, the average that governments spend on health per person dropped by 15 per cent. So-called cost recovery8217; also jargon for charging for health services has not been accepted too easily by experts who make a case for keeping market forces out of the dispensaries.

So what8217;s new? For one, the report documents success stories of countries which have managed a lot despite strapped resources. 8220;When cholera swept Latin America in 1991, Costa Rica rapidly deployed education and sanitation programmes which kept the disease at bay8230;Costa Rica spends 6 per cent of its GDP on public health measures 10 times more than it does on defence.8221;

The report strongly recommends spending on community health care, an investment that pays off heavily at times when even the efforts of governments and humanitarian organisations fail. 8220;On the cusp of the new millennium, earthquakes in Turkey, cyclones in India and torrential floods in Venezuela and Mozambique devastated hundreds of thousands of lives8230;The disaster-response resources of governments and relief organisations are being stretched beyond breaking point.8221; The report cites the example of the Turkey earthquake, where most of the rescue work in the first crucial hours after the quake was done by neighbours, 8220;digging with their bare hands8221;.

8220;We need to invest in people, not just in commodities,8221; stresses the foreword. Something to think about in a world where little and big disasters lurk around the corner every day.

Who8217;s paying what
Which of the world8217;s moneybags are giving their share to the international aid kitty? A pick of the nations contributing to Official Development Aid OAD simply put, nations putting their money where their mouths are is revealing: Japan is the topmost donor in absolute terms, followed by the US, France, Germany and the UK. But when aid is computed in terms of Gross National Product GNP, Nordic countries and Netherlands surpass the economic superpowers.

The only country that fulfilled the United Nation8217;s benchmark of 0.7 per cent of GNP was Denmark, at 0.9 per cent. This was followed by Norway, the Netherlands and Sweden. The mighty US shelled out just 0.1 per cent of its GNP towards development assistance.

8220;For the first time since 1994, total Official Aid Development for the world8217;s poorest nations rose during 19988230;However, the amount of ODA committed to health was the lowest since 1991, and the share directed towards basic health continues to fall,8221; observes the report.