Micro-Macro Connection

The Global Health Divide

People around the world are living longer and healthier lives than ever before because of changes in public health policies over the past century—disease control, safe drinking water, effective medical treatment, and the like. Infant mortality rates worldwide are at an all-time low, less than half of what they were in 1970 (Population Reference Bureau, 2014c). But these improvements have not been shared equally by all the planet’s inhabitants. For the more than 1 billion people worldwide living in extreme poverty, basic health services remain virtually nonexistent (World Hunger Education Service, 2015). They lack safe drinking water, decent housing, adequate sanitation, effective birth control, sufficient food, health education, professional health care, transportation, and secure employment. Ninety-eight percent of people worldwide who go hungry live in the less developed world (World Hunger Education Service, 2015).

Not surprisingly, poor countries lag behind wealthier countries on most important measures of health: infant and child mortality, stunted growth, malnutrition, childhood vaccinations, prenatal and postnatal care, and life expectancy (Population Reference Bureau, 2014c; UNICEF, 2009). The developing countries of South Asia and sub–Saharan Africa account for 82% of all the world’s children who die before they turn five (UNICEF, 2012). The risk of a woman dying from childbirth complications is 14 times higher in less developed countries than it is in developed countries (Population Reference Bureau, 2014c). Over half of all women who die during pregnancy and childbirth are African; and for every African woman who dies, another 20 suffer from debilitating complications (cited in Grady, 2009).

HIV/AIDS presents one of the most troubling global health imbalances. Although significant progress has been made in the past few years with rates of new infections on the decline worldwide (UNAIDS, 2014), the vast majority of HIV-infected people around the world remain those who are poor and lack access to the effective but extremely expensive drug treatments. Seventy percent of people living with HIV/AIDS worldwide live in sub-Saharan Africa and three-quarters of people who die from AIDS-related causes come from this region (UNAIDS, 2014).

The effect HIV/AIDS has had on overall life expectancy is staggering. In the developed regions of North America and Europe, people born today can expect to live until they are close to 80. In those African countries with high rates of HIV infection (Botswana, Lesotho, and Swaziland), life expectancy is under 50 (Population Reference Bureau, 2014c). Such startling figures will have severe long-term consequences as millions of the world’s poorest children become orphaned and face a lifetime of despair.

Even susceptibility to natural disasters is stratified. Globally, the poorest regions are at the greatest risk for life-threatening drought, tropical storms, earthquakes, tsunamis, and floods (Marsh, 2005). Four out of five poor people in Latin America and over half of the poor people in Asia and Africa live on land that is highly vulnerable to natural degradation and disaster. These people often have no choice but to occupy the least valuable and most disaster-prone areas, such as riverbanks, unstable hills, and deforested lands. Developing countries contain 90% of the victims of natural disasters and bear 75% of the economic damage they cause (DeSouza, 2004).

Politics may sometimes get in the way of improving the health of people in developing countries. Wealthy countries could easily afford to provide regular vaccines, mosquito nets, soil nutrients, sufficient food, and clean water supplies to poor countries to address treatable problems like malaria and malnutrition. In fact, in 2005, the United Nations declared that ending world hunger and disease was “utterly affordable” and would only require that wealthy countries commit one half of 1% of their total incomes to aid poor countries. However, many of these nations have been reluctant to provide such assistance. The United States, for example, provides less than two tenths of 1% of its total income, the smallest percentage among major donor countries (Shah, 2009). As long as expenditures for health care in poor countries remain a politically unpopular budget item in wealthy countries, the global health divide will persist.