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Asia's uneven development
Monday, 07 May 2012 08:29

Asia has wowed the world with its massive reduction in the number of people living on less than $1.25 a day, the standard measure of extreme poverty.  The region has thus achieved the first Millennium Development Goal well ahead of the 2015 deadline.

But on many other scores like health, nutrition and education, the region is lagging behind...

Regarding issues like political freedom and respect for human rights that are not covered by the MDGs, the region is not doing so well at all.  And even on the poverty count, some parts of Asia are doing much very much better than others.

In the year 2000, world leaders came together at the United Nations in New York and agreed on a set of Millennium Development Goals covering issues like poverty, health, education, and the environment, as well as commitments by developed countries to be good development partners.  The concern at the time was that, while globalization was a very positive force, too many people in developing countries were being bypassed by globalization.

The headline MDG has been the goal of reducing the share of people living on less than $1.25 a day by half between 1990 and 2015.  Developing Asia has led the charge on this point, with this proportion living in extreme poverty falling from 50% in 1990 to 22% in 2009.  Thus, the region achieved the goal ahead of schedule -- even though the region had the world's highest poverty rate in 1990.  Scratching below the surface we find that China and its East Asian neighbors have been the main contributors to this goal.  Leading South Asian countries like Bangladesh, India and Nepal, while making progress in reducing poverty, will not make this MDG by 2015.

Asia has also achieved the goal of eliminating gender inequities in primary, secondary and tertiary education, although South Asia is again behind for tertiary education.  Asia is also ahead on reversing trends for TB incidence and prevalence, and HIV prevalence.

When it comes to the issue of underweight children, Asia is performing poorly.  There is a long list of countries which are not on track for meeting the goal of reducing the proportion of underweight children by half, countries like Indonesia, Laos, Myanmar, the Philippines, India, Nepal and Pakistan.  China, Mongolia and Thailand are among the rare countries to have achieved this goal already.

Moving on to education, the region is on track to realize the MDG for 100% primary enrollment, but is behind schedule for reaching the last grade and primary completion.  The poorest performers include the Philippines, Thailand, Bangladesh, Nepal, and Pakistan.

Now we turn to the dark side of Asian development.  MDG 4 aims to reduce infant and under-5 mortality rates down to one-third of their 1990 level.  No Asian sub-region is on track to achieve this goal.  The region loses a shocking number of children before their 5th birthday.  Only a handful of countries are doing well, countries such as Mongolia, Laos, Malaysia, Singapore, Bangladesh, and Nepal.  The region's big players like China, Korea, Indonesia, and India are all improving too slowly to achieve this MDG by 2015.

The MDGs are also ambitious in the areas of maternal mortality, skilled birth attendance and antenatal care.  But the region as a whole, as well as its major sub-regions, will not achieve these goals by 2015.  Thousands of mothers die unnecessarily as a consequence of the natural process of childbirth -- often because births take place without the presence of skilled attendants.  Only a few countries are doing well on this count, like China, Mongolia, Vietnam, and Sri Lanka.

Perhaps one of the most shameful aspects of Asia's development is the lack of basic sanitation facilities.  The region will not achieve its goal of reducing by half by 2015 the proportion of people without a toilet.  A number of smaller countries will achieve this goal, countries like Korea, Laos, Myanmar, Malaysia, Philippines, Singapore, Thailand, Vietnam, and Sri Lanka.  But the region's big countries will not, countries like China, Indonesia, Bangladesh, India, Nepal, and Pakistan.

Overall, 1.9 billion people in developing Asia do not have access to a toilet, double the number of people living on less than $1.25 a day.  It is widely quoted, almost with pride, that in India there are more mobile phones than toilets!  Something must be wrong in this country.  Sanitation facilities are not just a question of human dignity, but also result in improved health.

As a whole, the region is doing well in terms of improving access to safe drinking water.  There are however a number of countries where insufficient progress is being made, such as Indonesia, Laos, Bangladesh, India and Pakistan.

Lastly, a very important MDG is reducing the trend decline in forest cover.  While Asia as a whole has already met this goal, much of South East Asia is going backwards, notably Brunei, Cambodia, Indonesia, Laos, Malaysia, Myanmar, Thailand and Timor Leste, along with Nepal, Pakistan and Sri Lanka from South Asia.

The excellent report by the Asian Development Bank, UNESCAP and UNDP, on which this article is based, only serves to remind us that Asia has achieved a lot more economic growth than economic development. Economic growth, the production of goods and services, has put money in people's pockets and helped them consume and survive, but doesn't necessarily improve health and education outcomes.

Greater emphasis should now be placed on more equitable and inclusive growth which focuses on the needs of the poor and vulnerable.  Government needs to play a stronger and more effective role in the provision of basic services in the areas of health, education and sanitation.  This report also highlights how much must be done to improve development prospects in India, often perceived as an emerging power in the region.

What should be the key priorities for government action in the health area?  

(i)  addressing the social determinants of health such as gender, class, ethnicity, caste, language, and religion -- these can arise from ingrained social structures, norms and processes that accept and even encourage unfair distributions of wealth and social resources.

(ii) expand access to primary health care with supporting basic infrastructure such as connectivity to roads, electricity and access to clean water and improved sanitation.

(iii) integrate child and maternal health into a continuum of care.

(iv) act on the health needs of the urban poor who often live in slums and squalid conditions that expose them to disease and to high rates of morbidity and mortality.

(v)  devise sustainable financial strategies by mobilizing more taxes through tax reforms and improving tax administrations.  

(vi) improve the governance of health systems through better management, and tackling corruption, notably related to the spread of fake, counterfeit and substandard medicines particularly in South East Asia.  Those more likely to resort to counterfeit drugs in the informal market are the poor, while the rich are better able to afford guaranteed high-quality medicines.

(vii) enhance the affordability of medicines through generics.  

Despite Asia's uneven progress towards achieving the MDGs, overall the region has done pretty well.  At the same time, we must recognize that the MDGs are themselves a very modest endeavor relative to the ultimate goal of freeing Asia's citizens of all their deprivations that prevent them from leading a decent life.  We still have around 900 million people struggling on less than $1.25 a day.  And reflecting the fact that many who have escaped extreme poverty have only climbed one step on the development ladder, 1.9 billion people or about half the region's population live on less than $2 a day.


"Accelerating Equitable Achievement of the MDGs: Closing Gaps in Health and Nutrition Outcomes".  Asia-Pacific Regional MDG Report 2011/12.  UNESCAP, ADB, UNDP.


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