AMERICAS: Economic Equality Good for Health – Report

By Jim Lobe Reprint | | Print |

Jim Lobe

WASHINGTON, Sep 22 2002 (IPS) - The wider the gap between rich and poor in societies of the Americas, the worse the health situation, both for rich and for poor, according to a major new report by the Pan American Health Organisation (PAHO) released here Monday.

The report, ‘Health in the Americas’, found a positive correlation between socio-economic equality within societies throughout the continent and better health.

“The healthier societies in the Americas are not necessarily those that are wealthier,” says the report, the latest in a series published every four years, but those “which are the most equitable in the distribution of their income, regardless of its amount”.

As a result, inhabitants of poor countries, such as Cuba, Guyana, Peru, and Jamaica – where the gap between the wealthiest 20 percent of the population and the richest 20 percent is relatively small – generally enjoy better health than those living in countries with similar income levels, such as Bolivia, Ecuador, the Dominican Republic, and most of Central America, where wealth is more polarised, according to the report.

The study reached similar findings in wealthier countries in the hemisphere.. The population’s health in countries such as Argentina, Costa Rica, Trinidad and Tobago, and Uruguay, compared favourably in such variables as infant mortality and life expectancy at birth to countries with much wider rich-poor gaps but comparable per capita income levels, including Brazil, Chile, Colombia, Mexico, and Paraguay.

Those findings were some of the more startling conclusions in the 426-page report, which reviews major studies conducted over the past decade on the health status of countries in the hemisphere.

Overall, it says, life expectancy at birth has increased substantially since 1980, from 66 to 72 years, while, over the same period, the death rate fell by almost 25 percent.

It credits at least half of the increase in life expectancy to declines in mortality caused by communicable diseases, such as tuberculosis (TB), and cardiovascular diseases.

The death toll caused by TB has been cut sharply as a result of the spread of the DOTS (directly observed treatment, short-course) programme, which currently boasts a cure rate of more than 85 percent, compared to only 46 percent in countries that do not use DOTS.

In 1999, a quarter of a million TB cases were reported in the region, nearly 140,000 of which were new.

The Global Malaria Control Strategy and the Roll Back Malaria Initiative, which was launched in 1998, have reduced the mortality rate from that mosquito-borne disease from 8.3 deaths per 100,000 in 1994 to 1.7 deaths per 100,000 in 1999, the study says.

It also credits sharp declines in the mortality rate among children under five to a stronger emphasis on maternal and pre-natal care and on mass immunisation drives that have been carried out since the mid-1980s.

Since 1980, most countries in the Americas have cut in half the rates at which infants die from communicable diseases. Measles, which has been fought through mass immunisation campaigns, is now close to total eradication from the region, says the report.

But the picture is not all positive. The HIV-AIDS pandemic continues to spread and has begun to seriously affect life expectancy in some countries, notably in the Caribbean region.

Acute respiratory infections and diarrhoeal diseases are still exacting a heavy toll among young children, especially in poor rural regions and in slum areas of cities, where 75 percent of the hemisphere’s population now lives.

Urbanisation itself has also brought new health problems that necessarily affect life expectancy, including deaths caused by motor vehicle accidents and violence, both of which tend to occur at a higher rate in urban settings..

The mushrooming growth of new and often unplanned communities around existing urban centres creates other health problems. Often, adequate sanitation and related water services are unavailable to these new communities, while poor diets, less exercise, tobacco and drug abuse, greater stress, depression and other mental health problems represent serious challenges to public-health systems.

Other major demographic changes sweeping the region are having an important impact on the health picture, according to the report.

Longer life expectancy has resulted in more older people: the number of people over 85 is increasing at a rate of three to five percent in some countries, while the over-65 set is growing by about two percent a year, significantly more than the overall annual population growth rate for the entire region – 1.3 percent.

As a result, such chronic maladies as cardiovascular disease, cancer, and physical disability are becoming much more widespread in the population, and have actually overtaken communicable diseases as the main cause of death.

Mortality from diabetes, which afflicts about 35 million people throughout the region, has also risen in recent years due primarily to rapidly rising rates in Latin America and the Caribbean. By 2025, nearly two thirds of diabetes sufferers in the Americas will be living in those sub-regions, the report found.

But PAHO said its most important and unexpected finding was the relationship between inequality and health within societies. “(T)he greatest inequalities in health in the region are not found when comparing the wealthiest nations with the poorest, as might be expected, but instead when comparing the income distribution of countries.”

In the mid-1990s, it says, the average life expectancy in low-income countries with small disparities in income levels was one year greater than in high-income countries that had significant income disparities. Moreover, the difference in life expectancy between the countries with the smallest rich-poor gap and those with the greatest was 8.2 years.

PAHO found that the risk of dying a violent death in countries with high-income disparities is double that of countries with low-income disparities, in rich and poor countries alike.

And it says that national per capita spending on health care is twice as high in countries with narrower gaps between rich and poor.