Poverty kills children / by Jorge E. Hardoy

Poverty kills children The poor of the cities are not true citizens of their own countries, for they have no political, social or econ- omic rights. The poor age rapidly and they die young Wl ost Third World nations are becoming increasingly urban. Cities of half a million, one million or several million people now dot the landscape, even in regions that were sparsely settled until a few de- cades ago. But Third World cities tend to grow physically and demographi- cally without developing genuine resources to build indispensable infra- structure and services for their popula- tions. And most Third World nations have not been able to raise their depressed- and depressing -levels of under-development. Cities, then, bear witness to the consequences of un- equal global and national devel- opment, usually in the form of a multiplicity of degraded human environments. The population of most large Third World agglomerations inhabits an area and utilises Space and services that were planned and built for a much smaller population. The result is a growing deficit in the basic equipment of all cities and a rapid rise in unem- ployment. Unskilled, unemployed or under-employed low income house- holds are particularly affected by this situation. A recent report about living condi- tions among the 17 million people who dwell and try to work in the Mexico City Metropolitan Area showed that in this, the largest human concentra- tion in the world , 75 per cent of the scarce supply of potable water is used by nine per cent of the population. Only 65 per cent of the garbage gener- ated daily is collected, but it is then dumped untreated in various places. 12 by Jorge E. Hardoy And there are only 2.9 square metres of green space for every inhabitant. In addition, 2.2 million private cars use 10 times more road surface and consume 15 times more fuel per per- son than urban buses, while one of the most modern and extensive under- ground railways in any Third World city, used daily by 3.5 million travel- Or Jorge E. Hardoy is director of the Human Settlements Pro- gramme of the International In- stitute for Environment and Development, London-Buenos Aires, and Senior fellow of the Centre of Urban and Regional Studies, Buenos Aires. lers, already has an overload of 40 per cent. Some 3,500 irregular settle- ments, half of them using land unsuit- able for human life and most of them formed by squatters who self-build their shelters, can be seen in almost all districts of the Metropolitan Area but mostly on its periphery. At least seven million people live in some form of uncontrolled or unauthorised settle- ments, and the population of the Metropolitan Area grows at an annual rate of 600,000 people. Needless to say, no viable solution has been found even to satisfy the most pressing needs of an agglomeration with such characteristics. Mexico is a large country with big resources and eventually could pull out from its present crisis. But Nouak- chott, in Mauritania-a West African nation on the edge of the Sahara Desert and with few resources-has grown from a small town with 5,800 inhabitants in 1965 to more than 250,000 today; an estimated 64 per cent of the population live in self-built communities. Sao Paulo in Brazil will probably reach 22 million inhabitants by the year 2000-not the 26 million that many people have predicted. Just to keep the situation in services, infra- structure, employment generation and so forth, at the present low levels, an estimated US $50 thousand million would need to be invested; this sum is close to half of Brazil's foreign debt, the largest of any Third World nation. In situations such as these, the worst hit are obviously the poor and espe- cially their children. The habitats of the poor have always been bad, but somehow they are rapidly deteriorat- ing still further because of pressures like those described here. No govern- ment has yet been able to overcome the problems of a process of urbanisa- tion of such magnitude. Or perhaps it would be more appropriate to say that few governments are willing to face up to the special interest groups which support an urban expansion that is shaped by market trends and not by the interest of society as a whole. The most distinctive feature of cities in developing countries today are the large numbers of poor people and the ever worsening degrees of poverty. Poverty is forcing a spatial redistribu- tion of the population within cities and also within national territories. This is W ORLD HEALTH, July 1986 recurring in a context of low and possibly declining investments per capita in the social services and infra- structure , and a lack of concrete national and local strategies to im- prove the living conditions of the neediest groups. For hundreds of millions of people the entire lifetime will be spent in the most degraded promiscuity and in en- vironments subject to floods, land- slides or persistent dust or sand storms. The 'environments of poverty have no trees and no flowers. Den- sities can reach 1,300 persons per hectare. Every piece of land in the settlements and every square metre covered with a precarious roof is in- tensively used. Each daily task poses special difficulties ; queuing for hours to fill a bucket with water at a street tap , waiting for hours to use a public latrine, or standing at the door of a dispensary. Slum-dwellers urinate and defecate in the streets, or at the back of their tiny plots, or on any empty space near their settlement. Poverty means hunger, poor health , poor housing, inadequate social envi- ronments , illiteracy, lack of skills and very low incomes. But it also means living with little or no power to influ- ence political life. In most Third World countries, a poor person is no more than a number in a census. Often, not even that official recogni- tion is granted to them. They are not true citizens of their own countries for they have no political, social or economic rights . The poor age rapidly and they die young. Pulling a rickshaw in Calcutta for 12 hours every day, sleeping on its seat and eating a meagre diet will shorten the rickshaw puller's life. Carrying heavy loads in the broken streets of an Andean city or spending endless hours in a dusty, noisy work- shop in South-East Asia can lead to accidents and ill-health. Spending day after day on a garbage dump seeking the few valuable things that can be found, even the ingredients for the family's next meal, can lead to poison- ing and death. The poor work hard. Everybody in a squatter settlement is busy doing something, buying or selling, especial- ly travelling to and from the squatter settlement in the search for an income . W ORLD HEALTH, July 1986 Above : A cement pipe offered a temporary home to this refugee boy on the outskirts of Calcutta. Below: For two children in a Bogota slum, this lean-to hut built of scraps and rubble counts as "home " . Photos L. Sirman © People cannot wait for years before finding a stable income . Because of their meagre resources they buy tiny quantities of food. Weakened by their efforts , poor diets and the stress of living overcrowded in a small and precarious shelter , they are unable to build up the reserves they need to fight any disease. Children are ever-present in the urban and rural scenes of the Third World , especially in the streets , waste- lands and schools of poor districts and rural villages. One has no need for detailed studies to understand their problems. Many will spend their child- hood in an illegal squatter settlement , eating food that is not subject to official controls and drinking water from contaminated wells or streams. If they fall sick, they will be treated by 14 unlicensed pseudo-medical practition- ers. From early childhood , the chil- dren of poor households will have to perform many tasks that are meant for adults, so that their parents have time to earn badly needed additional mcomes. The household head has to travel a long distance to go to work , while the wife may take on jobs outside the neighbourhood , working as a maid or a street vendor perhaps. Again , many poor households are headed by women responsible for earning the income and rearing the children. In such circumstances, longer absences from home and children is the likely result. Life for poor households in an envi- ronment of poverty is an endless strug- gle for all household members in order to survive . The household energy con- sumption and energy waste will be enormous. Just to obtain fuel , wood and water will demand immense efforts. These tasks are frequently performed by children. They usually take care of their brothers and sisters , prepare meals, clean the shelter. From an early age children are subjected to the humiliation of begging or pros- . tituting themselves. Certainly they have little time to play, and lack the space and oppor- tunities to grow as children. Under- nourishment affect a great many, and the numbers with infectious diseases are also on the increase. Millions of children are abandoned and survive as they can , living in the streets or in empty buildings. Many are ill-treated by their parents as a result of tensions W ORLD HEALTH , July 1986 Poverty kills children Where a burgeoning population outstrips the growth of city services, the worst hit are obviously the poor and especially the chil- dren. Millions will spend a lifetime in the most degraded promiscuity. The common fate of two children in their tarpaulin-covered shack in Manila (left), and of the little boy in an insalubrious Mexico City slum is to have very little hope of ever escaping from such poverty. Photos L. Sirman © stemming from inadequate living en- vironments and the total uncertainty of their economic and employment situation. In these conditions children aged under 14 often have extensive urinary infections , possibly linked with nutri- tional problems, or intestinal para- sitosis and anaemia associated with deficits in their growth and develop- ment. Their weight and height is below average; orthopaedic problems and eye defects are frequent. Usually there is no overall increase in the child mortality rate , except in particularly adverse circumstances. But the num- bers of low-birth-weight children , of abandoned children , of households headed by women and of pregnancies among adolescents are in themselves alarming indicators of a critical situa- W ORLD HEALTH , July 1986 tion which could deteriorate still more as the impact of the present reces- sion on Third World nations makes itself felt. The differences between the city of the rich and the city of the poor will continue to grow wider. These differ- ences are not new. In the past , as now , they reflect the fact that the elimina- tion of poverty is seldom regarded as the collective responsibility of a na- tion , still less as the collective respon- sibility of the world. Minority groups discuss develop- ment programmes without under- standing the interests and aims of the poor , or the role that free people , democratic institutions and equal rights and opportunities can play in development. I doubt whether positive development , good health , potable water and a safe shelter for all will ever be achieved without the active involvement of the people. Govern- ments are losing credibility , particular- ly those which have not been elected by the people over whom they rule and which seldom pay attention to their minimal needs and aspirations. So many administrations fail to under- stand the ways in which Third World cities grow, the inadequacy of their institutions or the irrelevance of their legislation . Millions of children will continue to die unless governments and interna- tional agencies learn to start working directly with communities , both rural and urban , to improve their environ- ments. After all, the true builders of Third World cities are not the govern- ments but the people themselves . • 15