lymphatic filariasis, neonatal tetanus, iodine deficiency disorders and blinding
trachoma).
The development of new treatments for diseases prevalent in developing
countries is important but the main problem is not a lack of suitable treatments.
Diarrhoeal disease and respiratory infections are the first and fourth leading
causes of deaths worldwide but are rapidly and easily treatable with oral rehy-
dration therapy (a mixture of salt and sugar to prevent dehydration) and antibi-
otics respectively. Infectious diseases such as whooping cough, tetanus, polio,
diphtheria and measles kill more than a million children each year worldwide
and have all been nearly eliminated in developed countries by existing cheap
vaccine treatments. By the late 1990s avoidable mortality still accounted for
about 87 per cent of total deaths among children up to the age of five in low-
and middle-income countries (CMH, 2001). The National Family Health
Survey in India for 1998–99 found that almost 20 per cent of children aged
three years and under had suffered a bout of diarrhoea during the two-week
period prior to the survey. While most women are aware of the importance of
providing sick children with extra fluids and oral rehydration therapy, only
about half suffering children had actually been treated. Measles remains a
substantial cause of morbidity and mortality in India but only about half of
children between 12 and 23 months were reported to have been immunized in
the mid-2000s (Visaria,2005).
Successful health programmes in poor countries such as the eradication of
smallpox and the near-eradication of polio have been top-down campaigns run
from outside the country by international organizations such as the WHO or
UNICEF (Cutler et al., 2006:109). The problem here is that such campaigns
are very different from what is needed to improve general health care on a
sustainable basis. With most developing countries spending less than US$10
per capita,per year on health care, how can they accomplish anything worth-
while? Case studies from Brazil (Box 6.2) and China (Box 6.3) offer good
examples of successful and low-cost health interventions relying on incen-
tives, motivation and information rather than large investments.
Hospital care
Sustaining mortality reduction in developed countries is more closely associ-
ated with expensive hospital care. In the US, mortality from cardiovascular
disease due to medical advance has declined by over 50 per cent since 1960,
and such reductions account for 70 per cent of the seven-year increase in life
expectancy between 1960 and 2000. Around 20 per cent of this increase is a
result of reduced infant mortality through improved neonatal medical care for
low birth-weight infants (Cutler, 2004).
In many developing countries the public budget for health care is princi-
pally absorbed by public hospitals staffed by doctors expensively trained and
using costly medical technologies. However, even when treating urban elites
there is widespread evidence of poor-quality medical care. One study directly
observed doctors (some medical school graduates and others untrained) in
138 Sources of Growth in the Modern World Economy since 1950