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BMJ No 7093 Volume 314 Letters Saturday 24 May 1997
Cancellation of debt of poorest people would be worthy memorial to millenniumEditor,Andrew Haines and Richard Smith rightly argue that the increasing disparity in wealth, between and within countries, is having such a profound effect on health that doctors must cooperate with others to analyse the 'pathology' of poverty and lobby for change.(1) Medical Action for Global Security, the British affiliate of International Physicians for the Prevention of Nuclear War, is doing just that. By linking with health professionals globally and by working with economists, we are examining why health gains are being eroded in parts of the world. Of the many obstacles to reducing poverty, debt repayment is among the most formidable. By the end of the decade more than half of sub-Saharan Africa's population-300 million people-will be living in poverty; sub-Saharan Africa is the only region of the world where malnutrition is rising. Nevertheless, the region struggles to service a debt that has reached two and a half times its annual export earnings.(2) Four times more is spent on servicing debt than on health. Far from being the caricatured 'basket cases,' many African countries had successful primary health care in the 1970s and impressive achievements in literacy, child mortality, and life expectancy.(3) But throughout the 1980s these achievements were eroded as money was diverted from social spending to debt servicing. By 1990 many African countries were spending less per capita on health than they had done in 1980. It is ironic that the World Bank, which is the main source of funding for health (total annual health lending roughly $3bn(4)), is also the organisation responsible for some of this deterioration. With the shift in emphasis from state provision to privatisation and 'cost recovery' poor people have been asked to pay for health and education, which they cannot afford. The bank's policies are so driven by monetarist ideology that the living standards of millions take second place to chasing some economic nirvana. Is it right that a bank should dictate global health strategy to such an extent? I suggest that health professionals could adopt the idea of a jubilee for 2000: a one off cancellation of the unpayable debt of the poorest people, in countries where health as a basic right has been revoked. Surely it would be a worthier memorial to the millennium than the construction of a Ferris wheel in London. Dorothy Logie
Medical Action for Global Security, References 1 Haines A, Smith R. Working together to reduce poverty's damage. BMJ 1997;314:529-30. (22 February.) 2 Pettifor A. A fresh start for Africa. London: Christian Aid, 1996. (Debt Crisis Network working paper.) 3 United Nations Development Programme. The human development report 1991. New York: Oxford University Press, 1991. 4 The World Bank, listening and learning [editorial]. Lancet 1996;347:411.
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