Public Health 4Everywhere in the developing world, death, disease, and disability is associated with poverty. The absence of an effective public health infrastructure reinforces global disparities in health and economic status between North (the developed world) and South (the developing world). The result is a whirlpool of instability and suffering, with the South forced relentlessly downward.

We must face our own role in this predicament. One very real reason that developing nations’ attempts to invest effectively in public health have been hampered is that the South is saddled with debt. Third World debt has often been incurred by unelected, oppressive regimes, without their peoples consent. Forgiving these debts would enable countries that are increasingly becoming democratic to put more resources toward public health and economic development.

A second reason is our reliance on curative medicine and the for-profit pharmaceutical industry. In the new millennium, HIV/AIDS, left unchecked, will decimate entire economies. Initially, Africa will be worst hit. In the year 2000, HIV will kill nearly two and a half million Africans. At the start of 2001, there will be more than 40 million people living with AIDS worldwide, three quarters of them in Africa. Fifteen percent of the adult population in eight African countries are infected; a third of their 15-year-olds will die from the disease.

The toll of HIV-related death and disability will continue to devastate Africa’s economies. As the trend toward illness and death among people of prime working age intensifies, so will the decline of business productivity and the rise of health costs. By 2010, the nation of South Africa alone will have lost $22 billion dollars and will have seen its GDP fall by 17% because of AIDS. The current debate about pharmaceuticals, about how big a price reduction private nonprofit companies can be expected to extend to poor nations, is almost irrelevant. Countries whose entire per capita expenditures for health care are a fraction of the cost of even reduced-price HIV treatments cannot be expected to carry this burden of care. Even palliative measures are beyond African countries’ economic capabilities. Without massive assistance from the US and other developed nations, it will be increasingly impossible for African countries to make the kind of public health investments necessary to curb HIV, much less to attend to their other serious issues of health, disease, and malnutrition, or to pull themselves out of poverty.

Impact of Trade

We import and consume goods from developing countries, which provides them with much-needed foreign capital, but means that our prosperity and health are linked to their poverty and illness. Global inequalities have created a trade situation in which we depend on the countries of the South to supply us with low-wage, labor-intensive goods, while we export high-wage, high-cost, capital-intensive goods to them. If we had to produce their goods ourselves, doing so would impede our own economic growth and lower our standard of living. The prosperity we enjoy, then, is in part made possible by trade with developing countries, whose workers fail to earn even a subsistence-level wage.
Child labor in the developing world may be the most heinous example of the human toll of this relationship. The International Labor Organization estimates that 200 million to 300 million children in developing countries ages 5 to 14 are laborers. About half of them work full-time, foregoing any chance of developing skills that would improve their life circumstances. Millions of them work under abusive and dangerous conditions for starvation-level wages or in indentured servitude.

In 1996, the plight of working children suddenly captured national attention when the media reported that the soccer balls used in the multimillion-dollar soccer indus try, the same soccer balls that healthy, well-fed, well-educated US kids kick around on well-maintained suburban playing fields, are made by Pakistani children, some no older than 5, whose circumstances have forced them to forfeit their futures to labor for a pittance under horrific conditions. As the concept of comparative advantage suggests, soccer balls are heavily labor-intensive products exported exclusively from poor countries. Pakistan, where one-third of the population live in absolute poverty, produces 75% of the world’s soccer balls (71% of US soccer balls come from there); the rest are made in China, India, and Indonesia. No soccer balls are produced in the US.

Despite the media attention, follow-up reports suggest that the soccer ball industry still employs child labor, with little indication that this is going to change. The conditions that these children endure mirror the conditions of a quarter of a billion children in the developing world. We are major consumers of their output.