In cities, access to quality health care varies greatly between the rich and poor, from Lagos to Washington, D.C. The poorest urban children in some developing countries are twice as likely to die as their wealthy counterparts. Steps must be taken immediately to eliminate health inequality, says charity group Save the Children.
Its annual State of the World’s Mothers report finds that the world is making major gains in reducing the number of child and maternal deaths, but the poor are not receiving all of the benefits. An analysis of 36 developing countries revealed that all but one have “significant gaps between rich and poor urban children.” And the problems are not isolated to the poorest places in the world. The accompanying index shows just how far behind the United States is compared with other countries.
Top and bottom countries in the 2015 Mothers’ Index
Closing the gap is vital to achieving the global targets that are soon to be established for 2030.
“We can’t achieve the goal of eliminating preventable maternal, newborn, and child deaths by 2030 if we fail to focus more attention on the urban poor,” said David Oot, Save the Children’s senior adviser for health and nutrition, in an interview with Humanosphere.
The news is not all bad. Countries are seeing significant reductions in child mortality rates. In Rwanda, the under-5 mortality rate for the poorest 20 percent of children living in cities fell by 41 percent between 2000 and 2010. However, the mortality rate for the top 20 percent of children in Rwandan cities fell by 65 percent over the same period. The mortality rate gap between the rich and poor roughly doubled in 10 years. It is the exact same story seen in Kenya.
“For many years people assumed if you lived in an urban area you will be better off,” said Oot. “What the data show is that the poor in urban areas are not faring very well compared to those who are wealthy. They are as bad or worse off than those living in rural areas.”
The case of Malawi is equally striking. The health gap between rich and poor children was virtually eliminated between 1992 and 2000. But that progress reverted over the next 10 years. Outcomes for the richest improved slightly and got worse for the poor. It shows that equity is achievable, but does not automatically stick once reached.
For the urban poor, it is a combination of factors that make for bad health outcomes. On one hand, living conditions, such as lack of toilets and clean water, increase risk for diarrhea and other child killers. On the other hand, access to care when sick or in need of a facility is problematic in slums. Poor women give birth without attendants at higher rates. Quality health facilities to treat sick children are not often available or are too expensive.
The river that runs through the Kroo Bay slum community in Freetown, Sierra Leone, carries with it waste from houses further up the hills in the city. (Credit: Save the Children)
“Many people end up going to unqualified private practitioners, which in some cases it may be worse than no care at all,” said Oot. “We need to be giving more attention to both quality and availability of infrastructure and services that can have the greatest impact.”
He also argued further for ensuring that health equity be an central part of improving outcomes. And it comes at a moment when governments are working to establish the next set of global development goals. As the Millennium Development Goals expire at the end of the year, their replacement will help set the tone for determining progress against poverty in all parts of the world.
The Save the Children report shows that the problem of health inequity is not just a concern for developing countries. Washington, D.C., is home to the infant mortality rate among the capital cities of the world’s 25 wealthiest countries. Again, the outcomes between the rich and poor in the city are not the same. A child born in poorest section (Ward 8) had a mortality rate 10 times higher than the richest section (Ward 3) in 2012. It is even worse in other American cities. Cleveland recorded a child mortality rate of 14.1 child deaths per 1,000 births. That is more than double the national average of 6.1 and much worse than Oslo, Norway, where the rate is below 2.
It is reflected in the overall performance of the United States against other countries. Included in the report is an index ranking countries based on health outcomes for mothers and children. The Scandinavian countries come out on top: Norway, Finland, Iceland, Denmark and Sweden. All the way down at No. 33 sits the United States, just ahead of Slovakia, Serbia and Argentina. The bottom countries are from Africa, with the exception of Haiti and Yemen. Performing worst on the index are the places where insecurity makes life more difficult: Somalia, Democratic Republic of the Congo, Central African Republic and Mali.
