Social Policies and Investment in Health
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Development. Copyright © 2001 The Society for International Development. SAGE Publications (London, Thousand Oaks, CA and New Delhi), 1011-6370 (200103) 44:1; 44–50; 016555.
Health and Poverty in a Social Context
Social Policies and Investment in Health JAN VA N D E M O O RT E L E
ABSTRACT Jan Vandemoortele argues that universal coverage of an integrated package of good quality basic social services is one of the most effective and least expensive ways for reducing poverty. The international development goals for 2015 will not be met if inter-sectoral complementarities are not better exploited. This point is illustrated through the ‘education vaccine’ against HIV. KEYWORDS basic social services; education vaccine; HIV/AIDS; integrated delivery; international development goals
The association of poverty with progress is the great enigma of our times. (George, 1882)
Introduction Poverty reduction must begin with children, not only because they are hardest hit when poverty strikes, but because child poverty causes life-long damage to minds and bodies so that they are likely to pass poverty on to their children – sowing the seeds of a perpetual cycle of poverty. Child development is a succession of events for which there is seldom a second chance. In the few cases where ‘second chances’ exist, they are invariably less effective and more costly than timely investment in children. This paper argues that the provision of an integrated package of basic social services of good quality to all children is one of the most direct and least expensive ways of reducing poverty. Their integration remains an unmet challenge. Broken promises At the World Summit for Children in 1990, the promise was made that all children would be enrolled in primary school by the year 2000. It is estimated, however, that at least 110 million children remain out of school. Their numbers continue to rise. The under-five mortality rate (U5MR) in developing countries
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Vandemoortele: Investment in Health was to be reduced by an average of about 50 percent by 2000. Preliminary data show that on average U5MR declined by a mere 5 percent over the 1990s. In other words, only a tenth of the promise was kept. Similarly, it was promised to halve child malnutrition between 1990 and 2000, but preliminary estimates indicate that only onethird of the promise was kept. The promise was made to ensure universal access to safe water and sanitation by 2000, but only a fifth of the gap was closed. Thus, progress has not kept pace with promises. Key social indicators even suggest that the pace of progress has fallen off in the 1990s in most regions. Why are the promises not being kept? Why are two in every five children in developing countries struggling to survive on less than US$1 per day when the global economy is experiencing unprecedented prosperity? The answer is both simple and complex. Under-investment in basic social services It is simple because most countries under-invest in childre
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