From: rich@pencil.cs.missouri.edu (Rich Winkel)
Subject: UNICEF: State of the World's Children (1/5)
Followup-To: alt.activism.d
Originator: rich@pencil.cs.missouri.edu
Organization: PACH
Date: Mon, 25 Jan 1993 07:08:46 GMT

** Topic: State of World's Children -- 1993 **
** Written  8:07 pm  Jan 20, 1993 by jnr in cdp:hr.child **
The first response to this topic is the full text of UNICEF's

State of the World's Children -- 1993

editted from the oringinal into e-mail format.  prox. 132kB
** End of text from cdp:hr.child **


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Response   1  of   1

** Written  8:11 pm  Jan 20, 1993 by jnr in cdp:hr.child **
The State
of the World's
Children
1993



UNICEF




Ed's note:  This version edited for e-mail from the MSWORD
document, obtained directly from UNICEF.  Footnotes have been
placed at the end of the document.  As figures and panels were
not reproducible in this form, all references to figures and
panels have been removed.  These are the only changes from the
UNICEF authored text.



I

The age of neglect
and the age of concern 

Amid all the problems of a world bleeding from continuing wars
and environmental wounds, it is nonetheless becoming clear that
one of the greatest of all human aspirations is now within reach.

Within a decade, it should be possible to bring to an end the
age-old evils of child malnutrition, preventable disease, and
widespread illiteracy. 

As an indication of how close that goal might be, the financial
cost can be put at about $25 billion a year*.  That is UNICEF's
estimate of the extra resources required to put into practice
today's low-cost strategies for protecting the world's children. 
Specifically, it is an estimate of the cost of controlling the
major childhood diseases, halving the rate of child malnutrition,
bringing clean water and safe sanitation to all communities,
making family planning services universally available, and
providing almost every child with at least a basic
education.(fn#1)   

*    In 1990, UNICEF estimated at $20 billion a year the extra
     financial resources needed to meet the health, nutrition,
     education, and water and sanitation goals agreed at the
     World Summit for Children.  Estimates for the additional
     resources required to also meet family planning goals have
     since become available (fn#2) and this has increased the
     overall estimate to approximately $25 billion a year.

In practice, financial resources are a necessary but not
sufficient prerequisite for meeting these basic needs.  Sustained
political commitment and a great deal of managerial competence
are even more important.  Yet it is necessary to reduce this
challenge to the denominator of dollars in order to dislodge the
idea that abolishing the worst aspects of poverty is a task too
vast to be attempted or too expensive to be afforded.

To put the figure of $25 billion in perspective, it is
considerably less than the amount the Japanese Government has
allocated to the building of a new highway from Tokyo to Kobe; it
is two to three times as much as the cost of the tunnel soon to
be opened between the United Kingdom and France; it is less than
the cost of the Ataturk Dam complex now being constructed in
eastern Turkey; it is a little more than Hong Kong proposes to
spend on a new airport; it is about the same as the support
package that the Group of Seven has agreed on in 1992 for Russia
alone; and it is significantly less than Europeans will spend
this year on wine or Americans on beer (fn#3).  

Whatever the other difficulties may be, the time has therefore
come to banish in shame the notion that the world cannot afford
to meet the basic needs of almost every man, woman, and child for
adequate food, safe water, primary health care, family planning,
and a basic education.  

A 10% effort

If so much could be achieved for so many at so little cost, then
the public in both industrialized and developing countries might
legitimately ask why it is not being done.  

In part, the answer is the predictable one: meeting the needs of
the poorest and the least politically influential has rarely been
a priority of governments.  Yet the extent of present neglect in
the face of present opportunity is a scandal of which the public
is largely unaware.  On average, the governments of the
developing world are today devoting little more than 10% of their
budgets to directly meeting the basic needs of their
people.(fn#4)  More is still being spent on military capacity and
on debt servicing than on health and education.(fn#5)  

Perhaps more surprising still, less than 10% of all international
aid for development is devoted to directly meeting these most
obvious of human needs. (fn#6)    According to one study, for
example, as little as 1.5% of all bilateral aid goes to primary
health care, 1.3% to family planning, 3.2% to 'other health
care', and only 0.5% to primary education.(fn#7)  Because
national aid programmes are not broken down into common or
comparable categories, such figures can only be approximate; but
10% is probably a generous overall estimate of the proportion of
bi-lateral aid allocated to such purposes.(fn#8)  And as total
bi-lateral aid from the Western industrialized nations is
approximately $40 billion a year,(fn#9) this means the amount
given for nutrition, primary health care, water and sanitation,
primary education, and family planning comes to about $4 billion
a year.  This is less than half as much as the aid-giving nations
spend each year on sports shoes(fn#10).  

It could therefore fairly be said that the problem today is not
that overcoming the worst aspects of world poverty is too vast or
too expensive a task; it is that it has not seriously been tried.

A watershed

With the beginning of the 1990s has come new hope that the age of
neglect may be giving way to the age of concern.

The evidence for this new hope, amid all the seismic shifts in
the political and economic landscape of recent years, is a series
of quieter changes which have not made the nightly news but which
have affected the daily lives of millions of people.  

The first of these changes is the entirely new priority that has
been given to the task of immunizing the world's children.  For a
decade, national health services, UNICEF, the World Health
Organization (WHO) and many thousands of individuals and
organizations have struggled towards the goal of 80% immunization
coverage in the developing world.  In 1990, that goal was
reached.  The result is the saving of over 3 million children's
lives each year, and the protection of many millions more from
disease, malnutrition, blindness, deafness, and polio.  Second,
the number of child deaths from diarrhoeal disease has been
reduced by over 1 million a year through empowering one third of
the developing world's families to use the technique of oral
rehydration therapy.

The significance of these achievements goes beyond even the
extraordinary numbers of lives saved and illnesses prevented. 
Eighty per cent immunization means that approximately 100 million
children are being reached by a modern medical technique on four
or five separate occasions during their first year of life.  As a
logistical achievement, it is unprecedented; and it shows beyond
any doubt that the outreach capacity now exists to put the most
basic benefits of scientific progress at the disposal of the vast
majority of the world's poor.  Secondly, it demonstrates that,
with sustained political commitment, progress can now be made
towards basic social goals even by the poorest of developing
countries; over the last five years, immunization coverage has
been lifted dramatically in many nations with per capita incomes
of less than $500 a year, including Bangladesh, the Central
African Republic, Equatorial Guinea, Myanmar, Nepal, the Sudan,
Uganda, Viet Nam, and Zambia.(fn#11)  

Other advances in knowledge and technique are now lining up
outside the door that immunization has unlocked.  And the
potential remains enormous.  Thirty-five thousand children under
five die in the developing world every day.  Almost 60% of those
deaths, and much of the world's illness and malnutrition, are
caused by just three diseases - pneumonia, diarrhoea and measles
- all of which can now be prevented or treated by means which are
tried and tested, available and affordable.  Similarly, the
vitamin A deficiency which threatens up to 10 million of the
world's children with death, serious illness, and loss of
eyesight, could now be brought under control at a cost which is
almost negligible in relation to the benefits it would bring.
(fn#12)  Or to take another example, the iodine deficiencies that
lower the mental and physical abilities of up to a billion people
and are the world's single biggest cause of mental retardation
could also now be eliminated at a total cost of approximately
$100 million - less than the cost of two modern fighter
planes.(fn#13)  

Even those aspects of poverty which have traditionally been
considered the most expensive and the most logistically stubborn
- the lack of adequate nutrition, safe water supply, and basic
education - are also now becoming susceptible to a combination of
new technologies, falling costs, and community-based strategies. 
The cost of providing clean water in Africa, for example, has
been halved since the mid-1980s and now stands at an average
figure of about $20 per person per year.(fn#14)  Similarly,
countries such as Bangladesh and Colombia have demonstrated that
a basic, relevant education can be provided at a cost of
approximately $20 per child per year.(fn#15)  

Equally large- scale trials in Africa and in India have shown
that the incidence of child malnutrition can also now be halved
at a cost of less than $10 per child per year.(fn#16)  "A direct
attack on malnutrition is needed..."  says a World Bank report,
"and governments willing to make that effort now have effective
and affordable measures to make it happen."    

New goals

These advances in technology and strategy, and the extraordinary
potential they have revealed, were the principal concern of the
World Summit for Children held at the United Nations in September
1990 - at about the same time as the immunization goal was being
reached.  The Summit was attended by approximately half the
world's Presidents and Prime Ministers and resulted in a set of
specific commitments which, if implemented, would indeed mark the
beginning of a new era of concern.

Those commitments, designed to reflect the potential of the new
knowledge and the new technologies now available, were expressed
as a series of specific goals to be achieved by the end of the
present century.  These goals include: control of the major
childhood diseases; a halving of child malnutrition; a one-third
reduction in under-five death rates; a halving of maternal
mortality rates; safe water and sanitation for all communities;
universally available family planning services; and basic
education for all children. 

To give these commitments a more permanent purchase on political
priority, all the countries represented at the Summit, and many
more who have subsequently signed the Declaration and Plan of
Action, also agreed to draw up detailed national programmes for
reaching the agreed goals.  As of September 1992, such plans have
been completed in 50 countries and are nearing completion in more
than 80 others.  In June of 1992, the United Nations
Secretary-General reported to the General Assembly that 31
countries have so far indicated they will restructure budgets to
increase the proportion of government spending devoted to basic
education, primary health care, nutrition, water, and
sanitation(fn#17).  

The drawing up and financing of such plans is inevitably a
bureaucratic process, and too much should not be expected too
soon.  But most nations have made a start towards keeping the
promises that have been made to the world's children. 
Immunization levels have been sustained and in some cases,
notably in China, lifted above the new goal of 90% (at which
point very significant decreases in the incidence of disease can
be expected).  Polio has almost certainly been eradicated from
Latin America and the Caribbean, where a year has now passed
since the last confirmed case of the virus.  

Reported cases of the main vaccine-preventable diseases are
declining and WHO believes there is a reasonable chance that the
1995 goal of eliminating neonatal tetanus will be met.  Countries
such as Bangladesh, Bolivia, Ecuador, Malawi, Namibia, Sri Lanka,
Tanzania, and possibly Brazil have already begun serious efforts
to halve the rate of malnutrition.  Similarly, several countries
are moving determinedly towards the goal of water and sanitation
for all - including Bangladesh, Burundi, China, Ghana, India,
Nigeria, Paraguay, the Sudan, Togo, Viet Nam, and virtually all
the countries of Central America. (fn#18)

And to achieve the Summit goal of empowering all families with
today's knowledge about the importance of breastfeeding, hundreds
of hospitals and maternity units have begun to change
institutional policies and to use their enormous influence to
reverse the trend towards the bottle-feeding of infants.  

Not least, the promise of the Summit is being kept by the rapid
spread of acceptance for the Convention on the Rights of the
Child, which seeks to lay down minimum standards for the
survival, protection, and development of all children.  The
Convention was adopted by the General Assembly of the United
Nations towards the end of 1989 and came into force, with the
necessary 20 ratifications, on the eve of the 1990 World Summit
for Children.  Usually, such conventions require many decades to
achieve the stage of widespread international recognition; but in
this case, the Summit urged all national governments to ratify as
quickly as possible and more than 120 have so far done so.      

In some nations, the process of translating the Convention into
national law has begun.  In many nations, it is becoming the
accepted standard for what is and is not acceptable in the
treatment of the young.  In all nations, its mere existence gives
citizens, journalists, and non-governmental organizations (NGOs)
an agreed platform from which to remind political leaders of
their promises and to campaign against the neglect and abuse of
children in all its forms.

Finally, it is clear that these promises made to the world's
children have now established themselves on the international
political agenda.  Over the last two years virtually every major
summit meeting of the world's leaders - the Ibero-American, the
Islamic States, the francophone countries, the non-aligned
movement, the Commonwealth, the Organization of African Unity,
The South Asian Association for Regional Cooperation, the League
of Arab States, and finally the  United Nations Conference on
Environment and Development - has formally confirmed the
commitment to achieving the basic social goals that were agreed
at the World Summit for Children.

Promises on paper

The importance of the Convention, the Summit goals, and the
national programmes of action that have been drawn up should
neither be overestimated nor underestimated.  At the moment they
remain, for the most part, promises on paper.  But when, in the
mid-1980s, over 100 of the world's political leaders formally
accepted the goal of 80% immunization by 1990, that, too, was
just a promise on paper.  Today, it is a reality in the lives of
tens of millions of families around the world.

One lesson to be learned from that achievement is that formal
political commitments at the highest levels are necessary if
available solutions are to be put into action on a national
scale.  But a second lesson is that such commitments will only be
translated into action by the dedication of the professional
services; by the mobilization of today's communications
capacities; by the widespread support of politicians, press, and
public; and by the reliable and sustained support of the
international community.  Most of the countries that succeeded in
reaching the immunization goal, including many that were among
the poorest and the hardest hit by problems of debt and economic
adjustment(fn#19), succeeded primarily because large numbers of
people and organizations at all levels of national life became
seized with the idea that the goal could and should be achieved. 
Many developing countries could provide examples, but it will be
sufficient to cite the case of Bangladesh: against formidable
internal and external difficulties, one of Asia's poorest and
most populous countries succeeded in lifting its level of
immunization coverage from only 2% in 1985 to 62% in 1990. 
"Never in the country's history," wrote a UNICEF officer in
Dhaka, "had so many groups come together for a single social
programme: the President, eight social sector ministries,
parliamentarians, senior civil servants, journalists, TV and
radio, hundreds of non-governmental organizations, social and
youth clubs, religious leaders, film and sports stars and local
business leaders all worked successfully towards a common
goal."(fn#20)

The question for the years immediately ahead is whether people
and organizations in all countries and at all levels are prepared
to breathe similar life into new goals that have been agreed on,
and into the national programmes of action that have been drawn
up for achieving them.  Only by this degree of popular
participation, by the practical and political energies of
literally millions of people and thousands of organizations, will
the new commitments and the promises of the 1990s be given a
priority in national life.  And only by such means will a new age
of concern be born.    

Wider changes

All of these developments, and the hopes to which they have given
rise, come at a time of extraordinary change in world affairs. 
And it is possible to hope that the cause of overcoming the worst
aspects of poverty will also draw sustenance, for the long haul
ahead, from the changed political and economic environment of the
1990s.

At the moment, that environment remains extremely difficult for
most nations of the developing world.  There is as yet no sign
that the ending of the cold war is leading to any increase in the
resources available for development.  Indeed, much of the
developing world is today facing its worst financial famine of
the modern era, starved of resources by its own high levels of
military spending, by the continuing debt crisis, by the further
falls in commodity prices, by the restrictive trade policies of
the industrialized nations, by the lingering recession in large
parts of the world, by the costs of post-war reconstruction in
the Persian Gulf, and by the channelling of new aid, credit, and
investment to the nations of Eastern Europe and the former Soviet
Union.

But despite all of these problems, the prospects for progress
have been profoundly improved by the enormous political and
economic upheavals of recent years: the advance of democracy
throughout Latin America; the liberation of Eastern Europe; the
collapse of the Soviet Union; the ending of the cold war; the
spread of democratic political reform through most of Africa
(including the erosion of apartheid); the almost world wide
retreat from the ideology of highly centralized government
control over all aspects of economic life; and the growing
acceptance of the necessity of joint international action in
response to both humanitarian and environmental problems.

These changes amount to one of the most sudden and fundamental
transformations in history.  And for all the suffering that is
surfacing in the turbulent wake of these changes, from Somalia to
the former Yugoslavia, it can still be said that this is a
transformation which holds out new hope for world development. 
If the various forms of free-market economic policies now being
adopted are not crushed under the weight of military spending,
debt repayment, and trade protectionism, then there is real hope
of achieving sustained economic growth.  And if the steps now
being taken towards democracy do not falter under the assault of
continued poverty and social unrest, then there is also real hope
that the poor will eventually begin to share more equitably in
the benefits of that growth.

These developments are changing the overall environment in which
the developing world must earn its living and within which its
people must struggle to meet their own needs.  Whether those
needs are met or not depends, first of all, on whether families
have jobs and incomes.  Second, it depends on whether governments
fulfil their responsibilities for providing the essential
services and safety nets to support families so that even the
most disadvantaged do not suffer from preventable malnutrition,
from disease borne by unsafe water and sanitation, or from the
lack of even basic health care and education.  The great changes
of the last five years by no means make such progress inevitable
or automatic; but they do make it more possible and more likely.

This coming together of both general and specific developments
means that a new threshold in the struggle to overcome the worst
aspects of poverty has been reached in the early years of the
1990s.  Broad-scale political and economic change is creating an
environment more conducive to a renewal of progress against
poverty; and advances in technology, in strategy, and in
political commitment to meeting basic social goals have given
that challenge both a specific focus and a new impetus.        

Symptom and cause

If there is one area of the development process that is more
widely misunderstood than any other it is the relationship
between these two factors - between the long-term processes of
overall development and the specific, deliberate, targeted
interventions such as are represented by the basic social goals
that have been agreed.  And it is the nature of this relationship
which should also give a new urgency to meeting essential human
needs.

With sufficient public and political support, it is clearly now
possible to control those aspects of poverty that bring the
greatest suffering to the greatest number.  In particular, it is
possible to close some of the most obvious, the most shameful,
and the most damaging gaps between today's knowledge and today's
needs.

Closing these gaps will not solve the problems of economic
development; it will not remove the burden of debt or restructure
inequitable economic relationships; it will not bring an end to
oppression and exploitation or eradicate the many causes of
unemployment and low incomes; nor will it meet the legitimate
aspirations of hundreds of millions of people in the developing
world who are not living in absolute poverty but who do not enjoy
the amenities of life that are taken for granted in the
industrialized nations.  It has therefore sometimes been argued
that such specific, targeted interventions address only the
symptoms of poverty and leave the causes undisturbed.

This is an argument which is no longer deserving of the
politeness extended to it in the past.

It is an unacceptable argument on two counts.  First, it is an
inhuman argument.  How much longer must the poorest families wait
before it is decided that the world has reached the level of
socio-economic development at which a few dollars per capita can
be afforded to help them prevent millions of their children from
becoming malnourished, blinded, crippled, mentally retarded?  

Second, it fails to recognize that frequent illness,
malnutrition, poor growth and illiteracy are some of the most
fundamental causes as well as some of the most severe symptoms of
poverty.  It fails to take into account that the pulse of
economic development is weakened when millions of children suffer
from poor mental and physical growth; that the march toward
equality of opportunity is slowed when the children of the very
poor drop out of school and into a lifetime of illiteracy; that
the productivity of communities is enervated by hours spent
carrying water from unsafe sources and by the time, energy, and
health that is lost to the diseases it brings; that the prospects
of finding a job and earning an income are crushed by preventable
disabilities such as polio or nutritional blindness; that a
family's capacity to save and invest in the future is the less
when a child is born mentally retarded by iodine deficiency; and
that the contribution of women to economic development cannot be
liberated if women remain chained to long years of child-bearing,
long days of attendance on illness, and long hours devoted to the
fetching and carrying of water and fuel.

In these and many other ways, the worst symptoms of poverty help
to crush the potential of the poor, to reduce their control over
circumstance, to narrow the choices available to them, and to
undermine the long-term process of development.

The struggle for social justice and economic development, both
within and between nations, must continue - just as the poor
themselves will continue to struggle, as they have always done,
to meet most of their own needs by their own efforts.  But it is
a tragic mistake not to recognize that those efforts can be
enhanced by reductions in disease, disability, malnutrition,
illiteracy, and drudgery.  Today's advances in knowledge and
technology could therefore augment future prospects as surely as
they could diminish present suffering.  And the argument that
making today's advances widely available is dealing only with
symptoms is an argument as destructive to the future as it is
insensitive to the present.