Inter Press Service - July 28, 2005
Anja Tranovich

Last year, the region's Gross Domestic Product (GDP) grew 7.2 percent, but this rosy figure has little bearing on most of the 1.5-billion population's quality of life, according to a new U.N. report titled "Human Development in South Asia 2004: The Health Challenge".

"The statistics are shocking," said Rima Salah, deputy director of the U.N. children's agency UNICEF, which issued the report. "One out of every three child deaths occurs in South Asia."

Economic gauges like GDP have long been dismissed by development analysts in favour of more comprehensive statistics such as Human Development Indicators, but many policy-makers continue to judge countries by their GDP.

The report tries to shift that emphasis by stressing "the urgency of recognising the centrality of people" in designing policy for South Asia.

The result is a 265-page document that charts various development markers and introduces a new index to assess the health of the population more accurately than the commonly used marker of life expectancy.

The "health index" ranks countries by 13 different measures. Most countries in South Asia rank in the lowest 50 countries in the world.

The report found that overall health has not improved with economic growth. In spite of statistically lower levels of poverty, many of the neo-liberal economic reforms that boosted GDP have also promoted inequality. Cities have grown richer and villages poorer, and the gap between economic classes has widened.

While a great deal of attention has rightfully been directed toward sub-Saharan Africa's health problems, South Asia ranks just better or slightly worse by many markers, the report notes.

Two-thirds of the world's malnourished children are in South Asia, and although the adult HIV prevalence rate is below one percent, there are still 5.2 million people living with HIV/AIDS, with an estimated 5.1 million of them in India.

South Asia's health problems are worsened by a failing and under-funded public health sector. The region's governments spend about one percent of GDP on public healthcare, while the average in developing countries is 2.7 percent, and 6.3 percent in developed nations.

Dr. Ronald Waldman of the U.N. Millennium Project Task Force noted that "Health can be achieved before economic growth. In fact, improved health status is a precondition for sustained economic growth."

According to the Nobel laureate researcher Robert Fogel, improved nutrition may account for 30 percent of Britain's per capita growth over the last two centuries.

The poor quality of public healthcare in South Asia has resulted in a mass exodus of people to private doctors and unregulated clinics. In India and Pakistan, private sector health care accounts for 80 percent of outpatient services.

One-third of South Asia's population lives on less than a dollar a day, but most still have to pay for their own medical care.

"People incur catastrophic out-of-pocket costs," noted Waldman. "We call it iatrogenic poverty, or sickness-induced poverty."

But simply pouring funds into the existing system will not solve the problem, he added.

Experts stress that the linked problems of poverty and sickness need to be addressed holistically, taking into account differences between genders, classes and geographic regions.

UNICEF's Salah said the report's central message is that "a narrow focus on sectoral solutions is no longer a solution -- indeed, it may be part of the problem."

This is especially critical in light of the global campaign to achieve the U.N. Millennium Development Goals (MDGs), which include a 50 percent reduction in poverty and hunger; universal primary education; reduction of child mortality by two-thirds; cutbacks in maternal mortality by three-quarters; the promotion of gender equality; and the reversal of the spread of HIV/AIDS, malaria and other diseases -- all by 2015.

"Strategically, a focus on reducing neo-natal, child and maternal mortality in a sustainable manner can only be achieved by addressing and redressing the existing distribution of power and resources," Waldman said. "Business as usual will not get us there."

However, relatively simple programmes already exist that have had success at many levels. Most focus on primary care and prevention.

India, where almost half the children under age three are underweight, has expanded a school lunch programme launched in several states in 2002. The finance ministry doubled the budget to provide midday meals for primary school children and made it mandatory for all states. The meals provide an incentive for children to stay in school while improving their overall health.

"When schools provide midday meals, children often rush to the schools on their own," said Jean Dreze, an economist and member of the National Advisory Council. "There is strong evidence that midday meals have led to major increases in school attendance in many parts of India, especially among girls and disadvantaged children."

Santo Sahariya, mother of a nine-year-old student in Dataan, explained, "They only gave free food to the children who went to school, not those who were at home. So I sent my daughter back to school last year."

According to government statistics, 59 percent of Indian girls drop out of school before completing fifth grade in the state of Dataan. However, school records in Dataan show a 23 percent increase in girls' enrollment and attendance since the school lunch programme began three years ago.

"Nothing more than a change of priorities is needed to achieve an immense improvement in the health status of South Asia," said Khadija ul Haq, president of the Muhabub ul Haq Development Centre, which launched the report. "It is feasible, it is practical, it is simple -- yet we are failing."

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+UNICEF (http://unicef.org/)

+Millennium Development Goals (http://www.un.org/millenniumgoals/)

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