Poverty threatens medical advances

This child's health is threatened by the surrounding poverty

World poverty is threatening to wipe out medical advances made over the last 30 years, according to an international group of doctors.

Doctors say much more must be done to help this child

In a letter to the British Medical Journal they warn: "The world is facing a health crisis that endangers the immense achievements of the past three decades."

The doctors, from the World Health Organisation, universities, public health agencies and non-governmental organisations, say that health is the responsibility of society as a whole and not merely the medical establishment.

They all have first-hand experience of working in Africa, Asia and Latin America and the inner cities of developed countries in Europe and North America.

"The number one health problem is poverty," they say. "For the poorest countries, the health sector alone cannot ensure better health even if it were able to function at maximum effectiveness.

"We have to accept that we can no longer deal with health while ignoring poverty.

Clean water is essential

"The World Health Organisation's annual report on the state of the world's health asserted in 1995 that poverty is the main reason why babies are not vaccinated, why clean water and adequate sanitation are not available to hundreds of millions of people, why curative drugs and treatments are not accessible, and why more than 500,000 mothers die every year - unnecessarily - during childbirth.

"It is also the underlying cause of reduced life expectancy."

The doctors say there are now 1.3 billion people living in absolute poverty in the world, more than double the number in 1975, and the problem is not confined to the third world.

"One need not point only to a developing country in the south to quantify the effects of poverty on people's health.

"Take Scotland in the north. The inhabitants of the huge housing development in suburban Drumchapel live close to Glasgow's richest suburb of Bearsden, but they die on average 10 years earlier than their wealthy neighbours."

Health problems of the slums are returning

The group says they are seeing the return of problems experienced in large industrial cities in Britain and the United States a century ago.

They say people's health improved dramatically with the introduction of clean drinking water, better sanitation and hygiene, female education, access to food, higher wages and labour legislation.

"Doctors and health professionals could not, and did not, do it alone."

They add: "Basic health care and basic education for all are vital, and investment for development must ensure that the poorest and most vulnerable groups of the population have access to them.

"Development from the bottom upwards with the active participation of poor people has proved to be the best and most sustainable approach."