by George Biro
How can underdeveloped countries around the globe get imported heat-sensitive vaccines to children in isolated villages, and keep the vaccines potent?
To keep up the vital ‘cold chain’, some countries use solar-powered refrigerators, but most rely on insulated boxes of ice or carbon dioxide. Heat-sensitive markers turn blue if the temperature rises above 10 degrees Celsius.
During the civil war in El Salvador, guerilla leaders agreed to a cease-fire; for ‘three days of tranquillity’, the only shots fired were of vaccines. When Turkey organised a national immunisation day, civil servants, including the military, helped to immunise children.
Is it worthwhile? Is it cost-effective? Can the world afford such intricate chains to continue the necessary mass campaigns?
To give one child one extra year of life by measles immunisation costs 40 cents; one extra year of life in the USA by treating high blood pressure costs $10,000.
Critics of immunisation and other public-health measures claim that saving the lives of young Third World children is futile if they simply die of other causes soon after. UNICEF accepts the need for other measures as well. To improve child health, UNICEF works towards seven priorities, the acronym of which is GOBIFFF:
• Growth monitoring (weight and height)
• Oral rehydration for diarrhoeal disease
• Breast-feeding
• Immunisation
• Food
• Female literacy
• Family planning
Every Third World problem interacts with the others: drought, floods, war, defence spending, poverty, corrupt governments, malnutrition, disposal of sewage and industrial waste, polluted drinking water, illiteracy, high death rates of mothers and children, high birth rates, overpopulation, and environmental damage.
One link is crucial: that between child deaths, birth rate and population growth in developing countries.
It may seem natural to believe that improvement in health care is futile, because it only causes a fall in death rates, and therefore a population explosion. This belief sounds plausible, and can too easily become a justification for us in the West to deny aid to the Third World.
But there is strong evidence to the contrary: as they become confident that most of their children will survive, parents gradually have fewer children.
As UNICEF says, there is no conflict between meeting the needs of people and controlling the growth of population.
In 1960, many developing countries had high mortality rates for children under five years (between 200 and 350 deaths per 1000 live births). When these death rates first started to fall, birth rates did not all respond at once. But once child mortality fell below about 150, births also fell.
By now, most Asian and Latin American countries have passed through this initial phase: they are approaching or entering the stage when further falls in child deaths will bring much steeper falls in births.
Maurice Strong, Secretary of the 1992 World Conference on Environment and Health in Rio de Janeiro, summed up: ‘The effort to reduce child illness and malnutrition … is crucial, not only for its own sake, but … to slow population growth and make possible sustainable development in the 21st century and beyond.’
Critics point out that the world population is still rising, and that falling mortality may be associated with (but not the cause of) falling birthrates. Even so, there is convincing evidence that aid and better health care need not cause a population explosion.
The case for wider use of family planning appears overwhelming. Each year, half a million women die from causes related to pregnancy and childbirth. There is also a ripple effect: many infants in developing countries do not survive the early death of their mother.
Four types of pregnancy are especially dangerous for both mother and child: too young, too old, too many, or too close. That is, when the mother is under 18 or over 35 years old, and has already had four children or has had her last child within two years.
UNICEF estimates that if all births could be spaced at least two years apart, this single change would reduce maternal deaths by about 30 per cent, and child deaths by 20 per cent.
The potential for greater use of family planning is enormous.
One simple contraceptive method is full breast-feeding for four to six months, which also protects infants from many infectious diseases.
But there are many obstacles to the spread of effective contraception. For example, to promote their infant formulas, multinational companies are exploiting the fear of AIDS being transmitted by breast-feeding.
Reportedly it was pressure from the Vatican that removed birth control from the agenda at the Earth Summit in Rio.
Just as problems of children in the Third World are varied, but closely linked, so must be our efforts to relieve them. Priorities should include immunisation, family planning, female literacy, raising the status of women, and the relief of poverty.
(GB)
Bibliography
Chapter 1: Kings and Queens
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Chapter 2: Eccentrics, Reformers and Pioneers
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Chapter 3: Quacks, Pseudologists and Other Phonies
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Chapter 4: Famous Patients
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Chapter 5: Warfare and Medicine
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Chapter 7: Disasters
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Chapter 8: Addictions and Obsessions
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Chapter 9: Longevity
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A Final Word
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