Structural adjustment and health

BMJ 1995; 311 doi: http://dx.doi.org/10.1136/bmj.311.6997.71 (Published 08 July 1995) Cite this as: BMJ 1995;311:71
  1. Angela M Wakhweya
  1. Associate editor Medicine and Global Survival, 10 Brookline Place West, Brookline, MA 02146, USA

    Consider the consequences for the least empowered

    Copenhagen's world summit for social development has come and gone,1 but women and children continue to bear the brunt of socioeconomic adjustment and consequent ill health. Their burden is particularly poignant in sub-Saharan Africa, where indicators such as female literacy, maternal mortality, infant mortality, mortality among under 5s, and immunisation rates continue to stagnate or deteriorate.2 In Copenhagen some of the world's most powerful leaders discussed the social problems that afflict every country, “especially poverty, unemployment and social exclusion.”3 4 Their declaration to target the causes of poverty, however, are unlikely to focus on the structural and institutional causes of poverty.5 6 7

    How can one impress on Africa's policymakers and the Western powers that encourage them that the money spent on arms would be better spent on educating women and providing basic health care? How can one impress on Africa's policymakers that it is their responsibility to encourage the preservation of family structures and to take measures to avoid conflict in the home and the community, thereby making life for our children, who are tomorrow's adults, more stable?

    Throughout history, African women have stoically dealt with socioeconomic adjustment, struggling to ensure that as many of their offspring as possible survive their early years. But the cumulative impact of their struggle will probably result only in beleaguered survivors who, before the age of 5, are already in debt to the World Bank. Each year of their lives they unknowingly accumulate a larger debt, without hope of ever paying it off.8

    Socioeconomic adjustment at the microlevel …

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