in extending health care to the poor has been made in all regions of the Third
World. Government spending on social services tends to be diverted away
from those whose needs are greatest – the poor.
Many problems remain. Absolute mortality levels in developing countries
are high, and child mortality is ten times greater than in developed countries.
Malnutrition is a major contributory factor. Maternal mortality ratios are thirty
times higher. It is estimated that decades of improvement in mortality rates
will be wiped out by the AIDS epidemic, currently causing 1.8 million deaths
annually. Malaria is proving resistant to treatment and tobacco-related deaths
are likely to double in the first decade of this century and grow to more than
12 million a year by 2025 (World Bank, 1993, pp. 1–3). To achieve significant
improvements in health and education in the Third World requires higher lev-
els of expenditure on the social sectors than have been achieved in the 1980s.
It is difficult to see how these can be provided by governments that are under
pressure to reduce public expenditure as part of economic restructuring.
Inequalities in social well-being, as indicated by health and education, are also
found between urban and rural areas and between men and women. There is
generally greater poverty in rural areas and more severe problems of malnutri-
tion, lack of education, life expectancy and substandard housing. This applies
to countries with high levels of urbanization, such as those in Latin America.
Women in all regions of the Third World do worse than men in terms of
human development. For example, in 1980 the literacy rate for women was
only 61 per cent of that for men in Africa, 52 per cent in South Asia, 57 per
cent in the Middle East, 82 per cent in South East Asia and 94 per cent in Latin
America. Women can also be expected to work longer hours for lower wages
than men. They face more cultural, legal, economic and social discrimination
than men – even poor men (World Bank, 1990, p. 31). When a country’s
Human Development Index is adjusted for gender disparity, every country’s
value declines. Rankings change too, showing that some countries do better
than others. The most significant disparities for women lie in employment
opportunities, earnings (also the main factors in industrialized countries),
health care, nutrition and education. It has been estimated that in South and
East Asia there are some 100 million women fewer than there would be were
it not for maternal mortality rates, infanticide and the nutritional neglect of
young girls (UNDP, 1993, p. 17).
East Asia has made most progress in expanding education and improving
survival rates generally, while South Asia and Sub-Saharan Africa still lag
behind, with adult literacy rates well below the average for developing
countries. Life expectancy, infant mortality and adult literacy have all
improved in the Arab states.
The Idea of a ‘Third World’ 7