With many countries having made impressive—or at least measurable—progress toward the human development goals relating to education, health and nutrition, the glass is at least half full at the midpoint to 2015.
However, there is largely unequal access to high-quality education and healthcare, with poor and marginalized people bearing most of the consequences of low-quality services. The benefits of progress are not being shared widely by all.
Malnutrition—the forgotten Millennium Development Goal (MDG)—continues to be a major concern, especially in South Asia and Sub-Saharan Africa, where severe to moderate stunting affects as much as 35 percent of under-5 children. There is strong potential for quick progress on reducing child hunger and mortality, and recent high food prices only underline the need for quick action.
Environmental hazards such as air pollution and the spread (due to climate change) of diseases such as malaria pose grave health risks starting in infancy.
Raising the quality of health and education services
Better quality healthcare can reduce child mortality and malnutrition, improve maternal health, and check the spread of disease—in short, help attain the MDGs.
Access to healthcare is rising, but access and quality are both highly variable.
Absenteeism of doctors in developing countries remains a major issue. In larger clinics in Bangladesh, for instance, absenteeism was 40 percent, while in small single-doctor subcenters, it was 74 percent.
Higher per capita income is linked to better quality healthcare, but higher public health spending is not. Governance issues include provider incompetence, weak performance incentives and accountability, and a lack of focus on data and results.
Likewise, more education spending will not necessarily raise quality. For long-run positive effects on per capita GDP growth, education spending must be more efficient, backed by institutions that promote competition, autonomy, and accountability.
Equity in health and education results
Sri Lanka and Kerala, India are known for low disparities in education and income, and equal healthcare access and outcomes. But nearly everywhere else in the developing world, rich people are far healthier than the poorest and more likely to complete school.
In Latin America & the Caribbean (LAC), a child in the poorest quintile is three times more likely to die before age five as a child in the richest quintile. Globally, the worst health inequalities are seen in upper middle-income countries.
With the exception of Eastern Europe and Central Asia, school participation and completion rates are much higher for the richest population quintile.
Gender equity in primary education has made great strides. The challenge is to reach marginalized groups, with a focus on girls. The Education for All Fast-Track Initiative bundles donor funds to support local efforts to reach these groups.
Tackling child malnutrition and mortality
Malnutrition has fallen substantially in recent years. While data are being revised to account for new child growth standards, trend calculations based on older US growth standards (not likely to be radically affected) show that malnutrition declined from 34 to 23% between 1990 and 2006 in developing countries.
Calculations of nutrition outcomes based on current standards indicate that significant progress has been made in most regions. Now, 36 countries account for 90 percent of all stunted children worldwide.
This steady progress can be derailed by worldwide commodity price increases. Rising food and fuel prices lower the real incomes of households that do not produce these products, possibly resulting in less food or less nutritious diets.
The best help includes oral rehydration therapy, vitamin and other supplements for pregnant women and infants, and promoting exclusive breastfeeding.
Child malnutrition affects other Millennium Development Goals
Malnutrition increases the risk of contracting diseases such as diarrhea or measles, and of dying from them. It is one of the most important determinants of child mortality.
Malnutrition reduces school achievement and results in inferior cognitive abilities that can persist throughout life. In rural Zimbabwe, childhood nutritional deficits due to civil war in the late 1970s and drought in 1982-84 led to late school entry and an estimated 14 percent reduction in lifetime earning.
A study of supplementary child feeding programs in northwestern Tanzania shows that such programs would let the income poverty goal be reached at a lower annual growth rate than otherwise.
Addressing environmental health risks
A lack of clean water and basic sanitation accounts for 90 percent of global diarrhea cases. Reaching the water and sanitation targets will require an annual investment of $30 billion (double the current investment level).
An estimated 1.5 million deaths occur annually because of respiratory infections linked to outdoor or indoor (cooking fuel-related) pollution.
The health effects of climate change
Climate change is directly linked to heat waves, floods, and storms, and affects the spread of tropical vector-borne diseases like malaria.
Better environmental management can prevent over 40 % of global malaria cases.
The largest risks to health from climate change are likely to be felt in Sub-Saharan Africa, Asia, and the Eastern Mediterranean, where vulnerability is greatest.
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In Latin America & the Caribbean (LAC), a child in the poorest quintile is three times more likely to die before age five as a child in the richest quintile. Globally, the worst health inequalities are seen in upper middle-income countries.
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