WASHINGTON (IPS/GIN) – More than one billion people worldwide are not getting essential health care, according to a report by the Population Reference Bureau (PRB), which calls for international donors to focus more on closing the growing health gap between the world’s wealthy nations and its poorest.

The 32-page report, “Improving the Health of the World’s Poorest People,” finds that per capita health spending in the world’s least developed countries, most of them in sub-Saharan Africa and South Asia, comes to only about $11 a year.

Improving the health system and access to health care is one important factor in addressing the problem, but is not sufficient by itself. Policies aimed at a comprehensive approach to reducing extreme poverty itself are key to improving health.

That compares with $1,900 per person in developed nations, or almost 150 times as much.


Based on dozens of recent studies, the report from the Washington-based bureau says the toll on families, communities and entire societies, resulting from disparities in health care, is not only rising steadily, but is often avoidable at very little cost. It calls the gaps fundamentally unfair, as they reflect different social and economic constraints and opportunities rather than individual choices.

Among countries, health disparities can be attributed to a variety of causes, including differences in spending on health care and health research, inequalities in local capacity and unequal access to technology and information. In many cases, dramatic advances in health and medical technology available in middle and high-income countries are not passed along to poor populations, it adds.

Moreover, diseases that most commonly affect the poor attract relatively little research and development spending. Citing a study by the Global Forum for Health Research, PRB found that only 13 of the 1,233 drugs–slightly more than one percent–that reached the global market between 1995 and 1997 were for tropical infectious diseases that afflict millions of people in low and middle-income countries.

Inequalities are also pervasive within countries, even in the richest nations of North America and Europe. The poorest in these countries generally die at a younger age than the rich and suffer higher rates of infant mortality.

But the problems that account for much of the global divide in health, including parasitic infections, nutritional deficiencies and complications in childbirth, are concentrated among the poorest people in the poorest countries, the latter defined as nations where per capita annual income was $760 or less in 1998.

The poor there are more vulnerable to poor health and disease not only because of their lack of access, but also for a variety of other reasons, such as lack of financial resources, limited knowledge of health matters and inadequate nutrition.

People living in rural or remote areas generally have less access to clean water, safe housing and efficient transportation, while governments often make disproportionate allocations from over-stretched health budgets to urban hospitals, rather than rural clinics.

Moreover, the rural poor are also more likely to follow social norms, including early marriage and large family size, associated with poor health. Similarly, their relative lack of educational opportunity, particularly in the case of girls and women, also has a generally adverse effect on health, according to the report.

Improving the health system and access to health care is one important factor in addressing the problem, but is not sufficient by itself, it adds. Policies aimed at a comprehensive approach to reducing extreme poverty itself are key to improving health.

Improving access to education and job training, enhancing the position and status of women and other marginalized groups, promoting public-health campaigns through a variety of media, reducing threats posed by environmental hazards, strengthening social safety nets, and promoting the participation of poor people in their own governance are all useful in tackling the basic problems, the report says.

The news is not all bad, the report concludes. Even some of the world’s poorest countries have achieved substantial gains in the health of their most vulnerable citizens, above all by promoting primary health care and providing intensive training of community-based health workers, including traditional healers.

The report also questioned the practice of user fees for health services in poor countries–a practice long encouraged by the International Monetary Fund (IMF) and the World Bank–because the poor tend to avoid essential and preventive care under those circumstances.

Some success has been achieved in establishing pro-poor financing systems that emphasize pre-payment for health care through taxes or insurance, with contributions tied to a person’s ability to pay rather than to health risk or actual use of services, the report adds.