Living and Dying
Despite considerable improvement in the state of world health since the 1950s, unequal access to care is not diminishing, with women and children particularly affected. The goal of universal health care is far from being attained and the health consequences of environmental damage are only adding new threats.
Human health throughout the world has improved considerably since the 1950s. In the years 1990-2015, average life expectancy rose from 64 to 71 years, with an annual average rise of 4 months. These improvements in life expectancy have been particularly strong in countries where the situation was particularly disastrous (49 to 58 years in sub-Saharan Africa, 58 to 68 years in Central and Southern Asia, 65 to 71 years in Southeast Asia, 70 to 77 years in East Asia and 68 to 75 years in Latin America).
Comment: For selected countries, the graph enables a comparison to be made between the situation at the latest date (2015), with a 33-year gap between the lowest life expectancy (between 50 and 60 years for 8 African countries) and the highest (more than 80 years for 17 countries in Europe and Asia). It also shows some remarkable improvements with over 30 years of increased life expectancy for 30 countries. However, these national averages may conceal considerable differences within each country.
The reductions seen since the early 2000s in infant mortality (-32 %), maternal mortality (-25 %) and deaths related to AIDS (-50 %) and malaria (-49 %) are due to better education, falling birthrates, improved living conditions and major aid programs (vaccinations, antiretroviral drugs, insecticide-treated mosquito nets, drinking water, etc.) implemented by many global actors (United Nations agencies, NGOs, private foundations, global funds, bilateral aid and civil society).
However, within this overall picture great inequalities persist, both between and within societies, and in some cases they are growing, and this despite the fact that fairness in relation to heath has been on the agenda of international organizations and NGO s since the late 1970s (1978, Declaration of Alma-Ata ; 1994, International Conference on Population and Development. Cairo; 2000, Millennium Development Goals 4, 5 and 6; 2015, sustainable development goals 3 and 6). The persistence of disparities can be explained by unequal access to adequate, nutritionally balanced food, proper hygiene and regular health care, and by differences in schooling, working conditions, housing and, increasingly, environmental conditions. Poor populations in the countries of the South are those most at risk of health problems, but those in the societies of the North who cannot get proper health care are also at risk. In 2017 the also highlighted health issues among refugees and displaced persons (65.5 million 2016), who are exposed to all kinds of violence and health risks.
Comment: Although, on a worldwide scale, the deaths of children under 1 year old has seen a rapid decrease, this has slowed in Africa and Western Asia where mortality rates remain very high, sometimes reaching almost three times the world average. This marker of poverty and deficient public health services is still more pronounced in conflict zones.
While the Millennium Development Goals (MDGs) called for a 75 % reduction in maternal mortality in the years 1990–2015, the real reduction was only 44 % (216 deaths per 100,000 naissances). Maternal mortality remains the prime cause of female death in the countries of the South, where it primarily affects the poor, rural women and adolescent girls. The reduction itself can be explained by the retreat of Aids, programs encouraging women to give birth with specialist help, the monitoring of pregnancy and its outcomes and better information, all of which remain inaccessible to large numbers of women. In 2015, the lifetime risk of maternal death stood at 1 in 36 women in sub-Saharan Africa as opposed to one in 4,900 women in high-income countries, and in over half of cases its causes were avoidable (hemorrhage, infection, blood pressure). The family planning needs of 225 million women in the world are not met, with an annual 89 million unplanned pregnancies, 48 million abortions and 10 million miscarriages in developing countries. In addition to destabilizing family units, the mother’s death often results in the children leaving school, particularly girls, who are required to take on domestic duties. To break this cycle, the UN advocates the development of universal health care coverage, including sexual and reproductive health, prioritizing the poorest women who do not enjoy their fundamental right (recognized by 179 countries at the Cairo Conference in 1994) to the knowledge, capacity and means necessary to enable them to decide when and how often to have children.
Comment: The striking gap between the lowest and highest rates of public and private health spending per inhabitant in the different countries of the world (700 times more in Switzerland than in Madagascar) is evidence of the unequal access to health care: Insufficient public investment and the impossibility for families to pay for private health care both combine to create this situation for most of the inhabitants of Africa and Western and South East Asia.
Threats to World Public Health
In addition to insufficient progress on water (at least 1.8 billion people are drinking water contaminated by fecal matter) and sanitation (2.4 billion have no access to toilets or latrines), health risks linked to the environment are rising considerably and currently cause 12.6 million deaths a year. These include river basins with a deficient water balance (over 40 % of the global population do not have an adequate water supply), and pollution of the water (80 % of used water goes untreated into the rivers and seas), air (92 % of the planet’s inhabitants breathe air containing too many fine particles, responsible for 7 million deaths annually) and soil.
Although progress has been made, many are still threatened by lack of access to proper health care, although the right to social security has been recognized as a fundamental human right since 1948. In 2017, 400 million people did not have access to basic health services, while the extension of universal health coverage, which has been on the global agenda since 2000, has been slow in reaching many countries.
- aid > Official development assistance
- Gifts and loans granted by developed countries (bilateral aid) and international institutions (multilateral aid) to developing and less developed countries: food aid, technical assistance, military assistance, debt relief, and so on. Bilateral aid (2/3 of world aid) leads to dependency (obligation to buy goods and services from the donor’s companies). Introduced during the Cold War era and the time of decolonization, it was used by the United States and the USSR to create or maintain links with their respective blocs, as well as between former metropoles and their former empires. The target of spending 0.7% of developed countries’ GDP for ODA, which was set by the UN in 1970, has only rarely been reached. The European Union is the primary world provider of aid. Multilateral aid is conditional upon respecting economic and political “good governance” criteria.
- civil society > Civil Society
- At the national level, civil society refers to a social body that is separate from the state and greater than the individuals and groups of which it is formed (social classes, socio-professional categories, generations, etc.). The notion of a global civil society emerged in the 1970s (John Burton, World Society) and refers to social relations formed in the international arena and beyond the control of states, when citizens of all countries take concerted action to demand regulations that may be supranational or infranational. However, the term conceals a great diversity. The notion of world society emerged among geographers in the 1990s and refers to the more all-encompassing process of creating a social space at the planetary level.
- inequalities > Inequality
- Unequal distribution of goods, material and/or non-material, regarded as necessary or desirable. Beyond income inequality (national, international and global), cumulative inequalities can also be measured with respect to accessing public services (healthcare, education, employment, housing, justice, effective security, etc.) and accessing property and natural resources more generally, and also relative to political expression or the capacity to respond to ecological risks. When these inequalities are based on criteria prohibited by law, they constitute discrimination.
- NGO > Nongovernmental Organization
- Use of this expression became more widespread following its inclusion in Article 71 of the United Nations Charter. NGOs do not have an international legal status and the acronym is used in different contexts to refer to very different kinds of actors. It generally designates associations formed by individuals over the long term in relation to not-for-profit goals, often linked to values and beliefs (ideological, humanist, ecological, religious, etc.) rather than financial interests. Active on a wide range of issues at both the local and global levels, NGOs now number tens of thousands, but vary greatly in the scale of their budgets, staff and development.
- sustainable development goals > Millennium Development Goals
- In 2000, UN member states adopted eight MDGs for the eradication of extreme poverty and in response to other major humanitarian issues (hunger, access to education and health, sexual equality, etc.) in the countries of the South by 2015. These goals were very unevenly met and widely criticized on different grounds, including the lack of human rights goals, the lack of civil society involvement in negotiating the goals, and the fact that they related solely to the countries of the South. The SDGs that replaced the MDGs in 2015 have in part answered these criticisms. They comprise 17 goals and 169 targets to be met by all countries by 2030, and relate to a range of sectors, including poverty, hunger, health, education, sexual equality, social justice, infrastructure, environment, climate, etc.
- environmental > Environment
- In broad terms, the environment is understood as the biosphere in which living species cohabit, while ecology studies the relations between these organisms and their environment. The environment encompasses very diverse natural areas from undisturbed virgin forests to artificialized environments planned and exploited by humans. In a more limited definition of the term, “environmental” issues are those relating to natural resources (their management, use and degradation) and biological biodiversity (fauna and flora). As a cross-cutting public concern, the environment encompasses issues of societal organization (production models, transport, infrastructure, etc.) and their impacts on the health of humans and ecosystems.
- refugees > Refugee
- A status applying to persons living outside their country of origin, who have been recognized by their host country as refugees according to definition set out in the Geneva Convention of 1951. This convention grants the protection and assistance of the United Nations High Commission for Refugees (HCR) to anyone who, “owing to well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his nationality and is unable or, owing to such fear, is unwilling to avail himself of the protection of that country.” The term refugee should not be confused with that of asylum seeker, which applies to people who have fled their country and have submitted a request for asylum to their host country or to the HCR in order to benefit from refugee status. A refugee has been an asylum seeker, but not all asylum seekers have their request accepted (those who have been rejected must then leave the country).
- displaced > Displaced
- According to the International Organization for Migration (IOM), the term describes persons or groups who have been forced or obliged to flee or leave their homes or their habitual place of residence, in particular because of armed conflict, situations of generalized violence, violations of human rights or natural or human-made disasters, or to avoid the effects of these, but who have not crossed an internationally recognized state border. These are known as IDPs (internally displaced persons).
- risks > Risk
- Risk refers to the perception and recognition of dangers and threats to individuals and to the environment. Having first appeared in academic and political thinking in the late 19th century, with the emergence of a welfare state whose role was to protect against the new social risks, the notion of risk developed in recent decades in the light of the globalization of trade and scientific and technological innovation. In his book Risk Society (1992), German sociologist Ulrich Beck analyzes the transition from “modern” societies built on the dogma of economic growth and technological progress to “post-modern” societies based on the production, management and regulation of risk. This is reflected in the rise of the precautionary principle, which seeks to anticipate the possible or probable consequences of natural and industrial disasters, epidemics or technological innovation, in order to protect the affected populations.