By Karl Miller
Last year the World Health Organisation (WHO) released its eighth report on world health. The document, which evaluates WHO's global strategy, "Health For All by the Year 2000", in place since 1981, measures its success by a series of global indicators including life expectancy, infant mortality, adult literacy, access to various types of primary health care and per capita gross national product.
According to the report, infectious and parasitic diseases are the biggest annual cause of death. In 1990, up to 22.5 million people died from such diseases, 17 million in poor countries. WHO admits that only some 2.5 to 3 million of these deaths are preventable by immunisation. The top three killers in the category were parasitic diseases, diarrhoeal infection (including cholera) and acute respiratory disease.
Between 1985 and 1990, tropical diseases spread out of control. One hundred million cases of malaria were reported in sub-Saharan Africa. The seventh new cholera pandemic in 30 years spread to the Americas through Peru, where, in six months, there were 250,000 new cases.
In 1990, there were some 9 million HIV-infected people and some 1.5 million people with AIDS. This year WHO estimates that 17 million people have the HIV virus and 4 million AIDS. There are about 10,000 new HIV infections each day. Over two-thirds of all HIV infections will occur in poor countries.
While these figures show otherwise, the only category of ill health that WHO acknowledges to be the result of social conditions is mental/neurological conditions, which, the report estimates, affected 300 million people in 1990.
Some of WHO's global strategies have brought change. There were slight improvements in life expectancy and infant mortality rates from 1985 to 1990, which WHO estimated were due to the expanded immunisation program of the 1980s. Global life expectancy at birth improved from 64 to 65 years — ranging from 50 years in the 22 poorest countries to 76 years in the rich countries.
Infant mortality rates improved from 76 to 68 per 1000 — ranging from 15 in rich countries to 120 in the poorest. Some improvements were also made in the percentage of people with access (to safe water and excreta-disposal facilities and child birth attendance.
Transition?
The underlying proposition of the report is that health is improving. This argument is not confined to WHO but is part of the establishment's justification for Third World poverty. Poor countries are simply "developing".
The health industry refers to this process as the "epidemiological transition" — a transition the rich countries have already been through.
The leading cause of death in the rich countries 150-200 years ago was infectious/parasitic diseases. Today it is degenerative diseases — cardiovascular disease (48%) and cancer (22%). It is argued that as the infectious/parasitic diseases are "cured", resulting in longer lifetimes, the degenerative diseases have taken over as the main cause of death.
The slight improvements in life expectancy and infant mortality rates, and increases in cancer and cardiovascular disease in the poor countries, are cited as evidence in favour of the theory that the poor countries are entering the "epidemiological transition".
No account is taken of the political and historical reasons that propelled First World development and now restrict such development in the Third World.
The main reason for the decline in prevalence of the infectious/parasitic diseases in the rich countries was the rise in living standards that accompanied capitalist development in the imperialist era.
The development of vaccines helped combat disease but was much less significant than is generally realised. Malnutrition is the leading cause of ill health and susceptibility to infection. The central cause of malnutrition is poverty. Expanded immunisation programs have definite limits, and population increases are already beginning to threaten the stability, let alone the extension, of these programs.
A further problem with the "epidemiological transition" analysis is its assumption that degenerative diseases are merely the natural result of longer lives. Extensive pollution and highly stressful living are ignored as causes of degenerative diseases.
For example, a United States study carried out during the 1970s showed that the leading indicator for longevity was "work satisfaction", followed by "life happiness". Factors such as diet and exercise accounted for only 25% of cardiovascular disease.
Politics
WHO's strategy does acknowledge the need for some broader measures, such as access to safe water and trained health care workers. Hidden away in the report is a recognition of the political problems involved in improving global health: "A surge in the tempo of development will be impossible if the flow of external resources continues to be from the poorer to the richer countries rather than vice versa". But WHO's main thrust stops short of any preventive measures.
Underlying the expectation of an "epidemiological transition" in the Third World is a technocratic view of health. The development of medicine and the health industry can only make small and temporary gains in world health while the monopolisation of the world economy continues to spread poverty and restrict control over and access to preventive care.
The increasing divide between rich and poor nations and within nations will result in new health problems. Already infectious/parasitic diseases are on the rise in the rich countries, particularly among the urban poor.
In the short term, it is likely that diseases such as measles will be adequately acted on. However, it is also likely that the current strategy will lose out against tuberculosis, malaria and cholera.
In the medium term, the possibilities are mixed; gains such as improving access to safe water will be set against losses such as the HIV pandemics. In the long term, if present trends continue, health will be a major casualty of the "new world order".