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Introduction
Sweeping changes in public health have transformed life over the past century. On average, people live longer, healthier lives than ever before. Even so, this past century’s revolution in human health and well-being is incomplete. For people living on less than US$1 per day—and there are more than 1 billion of them—health services and modern medicines are still out of reach.
Moreover, many initiatives to improve the health of people in extreme poverty have been unsuccessful.
Governments and international organizations have widely recognized the need to improve the health of the poor. In the 1970s, for instance, the World Health Organization led a global effort to achieve “Health for All” by the year 2000. Representatives from more than 130 governments met in 1978 in Alma-Ata (now Almaty, Kazakhstan) and signed a declaration stating that “Inequality in the health status of people, particularly between developed and developing countries as well as within countries, is politically, socially, and economically unacceptable.”
More than 25 years after the Alma-Ata Declaration, however, Health for All remains an elusive goal. On average, those living in the world’s poorest countries will not live to age 50. In Africa, the leading causes of death still include diseases such as diarrhea, measles, and malaria. Large disparities in health persist both within and between countries. And the health disparities between poor and rich countries are growing.
The human, economic, and societal costs of ill health are immense. Millions of people die prematurely from diseases that are
preventable or curable (see Box 1, page 2). At relatively little expense, many of these people could lead longer, healthier, and more productive lives. Mounting evidence also shows that the links between health, poverty reduction, and economic growth are powerful, confirming the popular notion that “health is wealth.”
This Bulletin examines facets of the poor-rich health divide, factors that play a role in health disparities, and approaches for
improving the health of the poor. In recent years, a great deal of new research has become available on health
inequalities within low-income countries. These studies shed light on how the world’s poorest people are faring, demonstrating for
the most part the persistence and pervasiveness of inequalities in health.
About the Author:
Dara Carr is a technical director for health communication at the Population Reference Bureau. She is the author of a wide range of publications on reproductive and child health and has more than 10 years of experience in managing communication projects in Africa and Asia. Ms. Carr previously worked at the World Bank and the Demographic and Health Surveys Program. At PRB, she oversees efforts to increase the quantity and quality of population and health information available to decisionmakers
in less developed countries.
The author gratefully acknowledges the reviewers Mushtaque Chowdhury, Gordon Perkin, Shea Rutstein, and Barbara Starfield
for their invaluable comments and suggestions. Special thanks to Davidson Gwatkin, who provided early guidance; to William Newbrander, who answered queries while in Afghanistan; and to Gopi Gopalakrishnan, James Phillips, Laura Raney, and Abu Sayeed, who provided information on different program activities. The author thanks PRB’s Allison Tarmann for her editorial guidance; Lori Ashford, Mary Kent, and Nancy Yinger for their suggestions; Zuali Malsawma for her library research; and Carl Haub for his advice on data.
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