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Poverty and Human Development in the Third World*

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Poverty and Human Development in the Third World* Arch Dis Child: first published as 10.1136/adc.60.9.880 on 1 September 1985. Downloaded from Archives of Disease in Childhood, 1985, 60, 880-886 Current topic Poverty and human development in the Third World* K CONNOLLY Department of Psychology, University of Sheffield A nation's policies with regard to children and The underdeveloped countries of the world are families give a fairly direct reflection of its econ- very heterogeneous. The problems with which they omic, social, and political structure. Economic, must cope are economic, political, demographic, social, and political beliefs are translated into climatic, and structural. Some are rich in natural assumptions about the ideal relation of society to the resources, other have almost none. Some are in family and the individual. The industrial, developed effect preliterate societies with a high degree of countries with their relatively high standard of living social organisation, whereas others are largely sunk face an entirely different set of circumstances from into the 'culture of poverty'. There are some those confronting underdeveloped countries where accounts of an anthropological kind of the circum- resources are often grossly unevenly distributed; tances of children in the Third World. Among the where malnutrition is often endemic; childhood best known is the work of Oscar Lewis' who made disease rife; and where survival is the first goal. important observations among Mexicans and Puerto copyright. The bulk of the world's children are in the Ricans. One feature of the 'culture of poverty', as he developing countries, and the largest number are in called it, is that it tends to perpetuate itself, for the the low income countries. In the past 35 years the most part people are unable to take advantage of world's population has almost doubled, and that opportunities that may occur. In these circum- growth has been largely concentrated in the de- stances, the family does not cherish childhood as a veloping countries where it is now about 2% per prolonged and especially protected stage in the life year. In a substantial proportion of the world's low cycle. The young have all too soon to do battle with income countries the number of children in the year their environment in order to maintain even a 2000 will be double what it was in 1975, and this marginal position. It is hardly surprising that a child http://adc.bmj.com/ despite an expected fall in the birth rate. Conse- growing up in such a culture has strong feelings of quently, the age distribution of the population fatalism, helplessness, dependency, and inferiority. differs between the developed and underdeveloped A central feature of science is developing methods countries (Table 1). On average just under 40% of of describing and measuring the variables that are of the population of underdeveloped countries is below concern to us, and this is equally true of the life the age of 15 years. sciences, the social sciences, and the physical sciences. How do we measure the condition of children? Our principal means is by the use of social on October 2, 2021 by guest. Protected Table 1 Age structures in developed and developing indicators. Social indicators are an attempt to countries'9 develop tools for monitoring patterns of change in populations.2 They provide us with information on Country group Percentage age distribution (years) Total fertility the conditions of children's lives and on the health, 0-4 5-14 15-64 65+ All rate education, and well being of children themselves. Developed Some basic social indicators are shown in Table 2 in countries 7-6 15-5 65-6 11-3 100 1-9 relation to the infant mortality rate. The construc- Developing success countries 13-4 25-6 57-0 4-0 100 4-2 tion of social indicators followed the economists had with measures such as gross national *This paper is based on the sixth Greenwood Lecture given to the University of Exeter on February 14, 1985. The full text of the lecture is available from the Publications Office, University of Exeter. 880 Arch Dis Child: first published as 10.1136/adc.60.9.880 on 1 September 1985. Downloaded from Poverty and human development in the Third World 881 Table 2 Some basic indicators in relation to the infant mortality rate'2 Very high infant High infant Middle infant Low infant mortality mortality mortality mortality countries countries countries countries Infant mortality rate (0-1 years) 140 90 40 11 Child death rate (1-4 years) 26 11 2 (.) Life expectancy at birth 47 57 69 74 Percentage immunised at 1 year Tuberculosis 32 51 70 90 Diphtheria/pertussis/tetanus 17 35 56 85 Polio 10 37 67 92 Measles 17 34 52 70 Percentage infants of low birthweight 16 14 10 6-4 Crude birth rate 46 44 29 14 Gross national produce (US$) 320 870 1770 9110 Percentage with access to drinking water Urban 69 85 91 Rural 20 21 50 Percentage adults literate Men 42 68 90 96 Women 19 55 85 94 Percentage population urbanised 21 41 51 76 product, but at the same time they are also a protest standards have played a supporting role rather than against the dominance of economic values in official acting as a prime mover. statistics and political/social decision making. In general terms, the determinants of health are There are clear signs of improvement over the known. Income gives access to goods and services; past 30 years. Infant mortality rates have decreased, climate is often an important factor as is the life expectancy has increased, primary school enrol- availability of public sanitation. Given that the copyright. ment has gone up (especially among girls), and adult socioeconomic correlates of childhood mortality in literacy rates have improved. But although improve- developing countries are known, the problem is one ments are clearly discernible, there remain great of moving from correlations to an understanding of problems-life and death problems-facing an enor- the causal matrix. For example, maternal education mous number of children around the world. The correlates with reduced infant mortality but it is also manifestations of poverty vary between countries associated with other socioeconomic variables such and even different regions within - country, but four as income. From an examination of factors associ- principal concerns emerge from the statistical in- ated with infant mortality in rural Peru, Young et al3 formation that has been collected. These relate to identified three classes of factors; the physical http://adc.bmj.com/ poor health, inadequate nutrition, high fertility, and ecology, intervention programmes, and the social little or no education. structure. All of them correlated with infant mortal- ity, but when all the other relevant variables were Health controlled for only the educational level of women significantly predicted reduced infant and child In Birmingham in 1906, the infant mortality rate was mortality. The observation does not mean that other 200 per 1000, higher than in all but about three factors, such as intervention programmes, may be on October 2, 2021 by guest. Protected countries of the world today. In 1906 the main safely ignored or that they are unimportant, but causes of infant death in Birmingham were much the what it does do is focus our attention on the same as in the Third World today-malnutrition, immediate context of the child. Many factors diarrhoeal diseases, whooping cough, and respira- contribute to the causes of ill heath and they can be tory infections. By 1946 the rate in Birmingham was attacked in various ways. 46. The precipitate decline from 200 to 46 per 1000 Let me take a specific example. Water is an was achieved very largely by rising living standards essential commodity we take for granted in Britain, (food, housing, sanitation, clean water, education, but it is well to remember that without water there and increased income) supported by maternal and can be no life. Large numbers of people living in child care services and by medical advances. In most rural areas, and some city slums, in the developing developing countries the changes have followed a countries do not have access to a regular supply of different pattern. The major impact has been made clean water. Women and children devote a good by medical and biological technology-by insecti- deal of time and energy to fetching water; water cides, antibiotics and immunisation. Rising living which is often contaminated. Not all disease is life Arch Dis Child: first published as 10.1136/adc.60.9.880 on 1 September 1985. Downloaded from 882 Connolly threatening, some debilitates but rarely kills. One of deficits also have effects. For example, iodine de- the widespread diseases of the Third World trans- ficiency, which is common in many of the under- mitted by water is schistosomiasis. The World developed countries, especially those in mountain- Health Organisation estimated in 1965 that between ous regions of the world, is known to have con- 180 and 200 million people were infected, and the sequences on the behavioural development of number has probably increased as irrigation pro- children.7 8 grammes have been implemented. Infection rates Any investigation of behavioural mediation on are usually highest in children because of the pattern the dynamics of nutritional deficit requires careful of water contact that they have. Infection is known attention to the pattern of caretaking because we to affect their activity level and their involvement in need to understand the contextual mechanisms of play-they are debilitated by the disease.4 It seems early development. Super et al,9 in a carefully likely that mental function may also be affected but designed intervention experiment among poor fam- no satisfactory investigation has so far been made, ilies in the barrios of Bogota, have shown that and the evidence relating to this important question nutritional supplements and a maternal training is equivocal.
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