47th Session Issues
Access to Health Care and Nutrition
Health care and nutrition are two of the most important needs of people throughout the world. Without these two services it is almost impossible for that one-fifth of humanity. Poverty is the main reason why babies aren’t vaccinated, why clean water and sanitation are not provided, why medicine is not available, and it is the underlying cause of reduced life expectancy, disabilities, and starvation. The absolute poverty level is the income level below which a minimum nutritionally adequate diet plus the essential non-food requirements is not affordable. Between l980 and l989 the percentage of the population in urban areas below the absolute poverty level in the least developed countries was 55%, while in developing countries it was 27%. In rural areas 70% of the population in the least developed countries and 31% in developing countries were below the absolute poverty level.
As the gaps between the rich and the poor, between one population group and another grow, people face intolerable inequity as well as the burden of suffering and disease. For example, the number of deaths of children under five years old per 1000 live births ranged from 320 in Niger to 5 in Finland. These deaths are a result of unsafe sanitation, inadequate access to health services and an inability to meet nutritional needs. The percent of the population with access to adequate sanitation ranges from 3% in Madagascar and 6% in Nepal to 100% in the Republic of Korea. Those with access to health services, meaning that appropriate local health services can be reached by local transportation in no more than one hour, ranges from 18% of the population in Benin to 100% in the Republic of Korea. The daily per capita calorie supply as a percentage of healthy requirements from 1988 to 1990 ranged from 72% in Afghanistan and 73% in Ethiopia to 151% in Greece and 157% in Ireland. These statistics clearly illustrate the inequity between population groups and the suffering that accompanies poverty.
There are many specific problems that limit access to health care and nutrition within individual nation-states. These problems are related to the economy, wealth, and population size and disbursement within the nation-state. For example, the economic and social marginalization of poor nation-states and communities affects the ability of the population to access adequate nutrition and health care. For many millions of people in the poorest areas of the world, the consequences of economic factors, over which they have no control, such as falling commodity prices, rising military expenditures, and poor returns on investment programs, affect their lives drastically from day to day. Factors such as these can cause a family to be unable to provide adequate food, proper living standards, and can affect their health, strength, and opportunities for education.
In addition, the changing demographic picture across the world, along with the rapid shift towards urbanization, will have profound implications for the delivery of health services. Not only do changing demographics make access to health care and nutrition more difficult, they also add to problems, such as poor sanitation, which encourage the spread of infectious disease. This makes the lack of access to health care in these areas even more keenly felt.
Another cause of inadequate access to health care and nutrition is armed conflicts. All conflicts involve weapons which lead to short term physical suffering and over the long term harm the development of people and of nations. These conflicts wound and traumatize people and deny them the chance to develop properly because they interfere with food production, health services, and education. In many of the wars of this decade, many more children than soldiers have been killed or disabled. Approximately two million children have died due to wars in the last decade. Four to five million children were physically disabled, more than five million became refugees, and more than 12 million were made homeless.
Conflicts also create refugees who, in fear for their lives, flee their home country to find safety and shelter in another country. These people face unsanitary conditions, malnutrition, and disease in refugee camps. The World Health Organization (WHO) and the UN High Commission for Refugees (UNHCR), along with various intergovernmental, governmental, and nongovernmental organizations, try to provide proper conditions for the refugees. However, at times the burden is too much to bear unless taken on by the entire global community. As Boutros Boutros-Ghali has said, "A shared commitment to social progress is the answer to shared threats of poverty, unemployment, and social disintegration . . . It is time to shift from providing security through arms, to ensuring security through development."
In order to broaden access to health care and nutrition throughout the world, services must be integrated, become more cost-effective, and be provided as close as possible to where the people who need them are located. There are several organizations and programs currently working to help increase access to health care and nutrition. For example, The UN International Children’s Fund (UNICEF) is an organization committed to putting the needs and rights of children at the center of development. They are concerned with the minds and bodies of children being formed correctly due to proper health and nutrition, because even temporary deprivation in a child can cause lifelong damage. UNICEF is also concerned to offer adequate health care and nutrition at a cost people can afford.
Another example of an organization that is involved with the accessibility of adequate nutrition and health services is the World Health Organization (WHO). It is mainly geared to respond to the priority health problems of various age groups at national, regional and global levels. One of the major priorities of WHO is to at least sustain the accomplishments of previous years and to continue to strive for achievement of the 1992 World Summit for Children goal of immunization against the six vaccine-preventable diseases; diphtheria, pertussis, tetanus, measles, poliomyelitis, tuberculosis. WHO is also working in collaboration with the Food and Agriculture Organization (FAO) and UNICEF in activities to promote better nutrition in 62 countries.
Other programs that are concerned with prevention measures, such as widespread immunization, public education, safe drinking water, proper sanitation, reliable health services, adequate medical supplies, and other cost-effective public health measures, can protect millions of people from illness and death. Health economists have estimated that prevention is far less expensive than treatment. For example, every US dollar spent on the polio vaccine saves $6 in treatment costs; every dollar spent for measles, mumps, and rubella vaccine saves $21; and every dollar spent for diphtheria, tetanus, and pertussis vaccine saves $29. The goal of prevention may also lead to the worldwide eradication of diseases or illness. WHO predicts an annual global savings of $3 billion by the year 2000, based on current projections for the eradication of polio.
Problems that slow the process of disease eradication are the outbreak of epidemics due to a breakdown in health services, and the introduction of new strains of diseases that have developed an immunity to existing antibiotics and vaccines.
For example, in the former Soviet Union, an epidemic of diphtheria began in 1990. It was the result of the social and political upheaval of the late 1980’s, which caused a large portion of the population to lose access to medical care. This upheaval virtually halted immunization with the DPT vaccine for diphtheria. In another example, due to drug-resistant strains of malaria, the disease thought to be under control in the 1960’s has had a resurgence. The cases of malaria reported to WHO’s office between 1983 and 1988 jumped from 3 million to 23 million. Cases of malaria in the Americas went from 830,000 in 1983 to 1.1 million in 1992, while in Southeast Asia the number of cases rose from 300,000 to more than 3 million. These are just two examples of how political and social upheaval or poverty can drastically affect the world’s health status.
Questions
- Should the United Nations expand its role in providing more accessible health care and nutrition or should the job be turned over to regional organizations instead?
- Would it be appropriate for peace keeping troops to be used to provide access to health care and nutrition?
- Should the United Nations expand its population programs to slow the growth in the number of people who need health care and food?
- Paradoxically, in many countries the only time people have access to health care or nutrition is in emergencies, such as during epidemics and wars. How can we make health care and nutrition more accessible to these people on a regular basis?
Sources
- Grant, James P. The State of the World’s Children l995, New York: Oxford University Press, 1995.
- Platt, Anne E. Infecting Ourselves: How Environmental and Social Disruptions Trigger Disease, World Watch Institute, 1996.
- World Health Report l995- executive summary