Behind all the numbers for poverty and inequality presented in the preceding pages are the lives of nearly one billion desperately poor people across the world who live in some of the worst conditions possible. AIDS, malaria, malnutrition, and other deadly diseases are common. Many children die before reaching adolescence, and many adults die before reaching what in the richest nations would be considered middle age. Many people in the poorest nations are illiterate, and a college education remains unattainable. Millions of people on our planet die every year because they do not have enough to eat, because they lack access to clean water or adequate sanitation, or because they lack access to medicine and/or medical care.

As noted earlier, the United Nations Development Programme, the World Bank, and other international agencies issue annual reports on human development indicators that show the impact of living in a low-income nation. This section begins with a look at some of the most important of these indicators.

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Human Development

The status of a nation’s health is commonly considered perhaps the most important indicator of human development. When we look around the world, we see that global poverty is literally a matter of life and death. The clearest evidence of this fact comes from data on life expectancy, the average number of years that a nation’s citizens can be expected to live. Life expectancy certainly differs within each nation, but poverty and related conditions affect a nation’s overall life expectancy to a startling degree.

Figure 8.4 Average Life Expectancy Across the Globe (Years)

Fnweirkmnwperojvnu – CC BY-SA 4.0 – Wikimedia Commons

A map of global life expectancy appears above in Figure 8.4 “Average Life Expectancy Across the Globe (Years)”. Life expectancy is highest in Western Europe, North America and certain other regions of the world and lowest in Africa and a few countries of South Asia. The gap in life expectancy when comparing high-income and low-income nations can be some 30 years shorter.

Child Mortality

A key contributor to life expectancy and also a significant indicator of human development in its own right is child mortality, the number of children who die before age 5 per 1,000 children born. As Table 8.2 “Human Development Index and Child Mortality, 2020” shows, the average rate of child mortality in the six nations with the lowest human development is 92, meaning that 9.2% of all children who are born in these nations will die before age 5. In contrast, the average child mortality rate in six nations with the highest HDI values is only 4. Children in these low-income nations are 23 times more likely to die before age 5 than children in the high-income nations.

Table 8.2 Human Development Index and Child Mortality, 2020

Source: data from “Human Development Reports.” | Human Development Reports, http://hdr.undp.org/en/2020-report. Retrieved from http://hdr.undp.org/en/content/latest-human-development-index-ranking. Data from UN Inter-Agency Group for Child Mortality Estimation. Retrieved from https://childmortality.org/.

Two other important indicators of a nation’s health are access to adequate sanitation (disposal of human waste) and access to clean water. When people lack adequate sanitation and clean water, they are at much greater risk from life-threatening diarrhea, from serious infectious diseases such as cholera and typhoid and from parasitic diseases such as schistosomiasis (World Health Organization, Sanitation, 2019). About 2 billion people around the world, almost all of them in low- and middle-income nations, do not have adequate sanitation, and more than 432,000, most of them children, die annually from diarrhea. Additionally, approximately 237 million people each year, almost all of them again in low- and middle-income nations, require treatment for parasitic infection caused by flatworms (World Health Organization, Schistosomiasis, 2022).

Access to adequate sanitation and clean water is strongly related to national wealth. Adequate sanitation is virtually universal in wealthy nations but is available to only 45% of people in low-income nations. Similarly, clean water is also nearly universal in wealthy nations but is available to only 71% of people in poor nations (World Health Organization, 2017).

Malnutrition

Another health indicator is malnutrition. This problem is caused by a lack of good food combined with infections and diseases such as diarrhea that sap the body of essential nutrients. About 650 million adults and children are underweight, stunted (too short for their age), or wasted (too thin for their height), due to being undernourished. Half of children who are undernourished live in only three nations: Bangladesh, India and Pakistan; over one-third of children in these and other South Asian and African nations are underweight.

About one-fifth of the population of poor nations are malnourished. Fifaliana Joy – Pixabay

Children who are malnourished are at a much greater risk for fat and muscle loss, brain damage, blindness and death. Not surprisingly, child malnutrition contributes heavily to the high rates of child mortality that we just examined. Around 45% of deaths of children under the age of 5 are attributed to undernourishment, totaling 2.3 million deaths annually (World Health Organization, Malnutrition, 2021; UNICEF, Malnutrition, 2021). On a positive note, in part due to programs and projects associated with the Millennium Development Goals and Sustainable Development Goals, rates of undernourishment and the associated conditions of stunting and wasting have declined, as has child mortality. In the year 2000, a full 33% of children under the age of 5 experienced stunted growth due to undernutrition, while by 2020, the prevalence of stunting had fallen to 22%, a decline of more than 50 million children suffering from this condition (UNICEF, Malnutrition, 2021). Correlating with this change has been the global reduction in child mortality. In 1990, 1 out of every 11 children died before the age of 5, whereas by 2019, this figure dropped to 1 in 27 children, a significant improvement (UNICEF, Under-Five Mortality, 2021)

Literacy

Moving from the area of health, a final indicator of human development is adult literacy, the percentage of people 15 and older who can read and write a simple sentence. The global rate of adult literacy is 86%, with higher rates of literacy for young people compared to the elderly, as indicated in Table 8.3 “Global Rates of Literacy.” This difference reflects increased access to schooling among the youth population in comparison to the access had by their parents and grandparents. The United Nations Educational, Scientific and Cultural Organization (UNESCO) reports that 750 million adults worldwide are illiterate, 2/3 of whom are women (2017).

Table 8.3 Global Rates of Literacy

Source: data from Literacy Rates Continue to Rise from One Generation to the Next. UNESCO Institute for Statistics, Sept. 2017. Retrieved from http://uis.unesco.org/sites/default/files/documents/fs45-literacy-rates-continue-rise-generation-to-next-en-2017_0.pdf

Global Illiteracy is concentrated in low- and middle-income nations, specifically in the regions of South Asia, where 49% of the global illiterate population live, and sub-Saharan Africa, which houses 27% of the world’s illiterate population (UNESCO, 2017). There are 20 countries where rates of literacy fall below 50%. Two of these are countries in South Asia (Afghanistan and Iraq), while the remainder are all low-income nations found in sub-Saharan Africa (UNESCO, 2017). The high rate of illiteracy in poor nations not only reflects their poverty but also contributes to it, as people who cannot read and write are obviously at a huge disadvantage in the labor market.

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Gender Disparities

In discussing illiteracy above, it was noted that women are disproportionately likely to be illiterate. This reflects the status of females in general, where it is estimated that females make up 70% of the world’s poor. Because females tend to be poorer than males worldwide, they are more likely than males to experience all the problems that poverty causes, including malnutrition and disease. But they also suffer additional problems. Some of these problems derive from women’s physiological role of childbearing, and some arise from how they are treated simply because they are female.

Let’s first look at childbearing. One of the most disturbing examples of how global poverty affects women is maternal mortality, or the number of women who die during childbirth for every 100,000 live births. The World Health Organization estimates that 810 women die every day, or roughly 300,000 per year, due to preventable causes related to pregnancy and childbirth (Maternal Mortality, 2019). Maternal mortality usually results from one or more of the following: inadequate prenatal nutrition, blood loss or infection associated with the birth process, high blood pressure or unsafe abortion, all of which are much more common in low-income nations than in high-income nations.

In high-income nations, the rate of maternal mortality is a minuscule 11 per 100,000 births, but in low-income nations the rate is a distressingly high 462 per 100,000 births, equivalent to almost 1 death for every 217 births (World Health Organization, Maternal Mortality, 2019). Women in low-income nations are thus 42 times more likely than those in high-income nations to die from complications during pregnancy or childbirth. Figure 8.5 “Global Stratification and Medically Assisted Births, 2018” suggests a reason for this difference, as it shows that births in poor nations are far less likely to be attended by skilled medical staff than those in wealthy nations. This is especially true for women in remote rural areas and/or regions with fewer skilled health workers, as is found in South Asia and sub-Saharan Africa (World Health Organization, Maternal Mortality, 2019)

Figure 8.5 Global Stratification and Medically Assisted Births, 2018

Source: Data from World Bank. (2018). Development Data. Retrieved from https://databank.worldbank.org/home.aspx

In addition to these issues, women in poor nations fare worse than men in other ways because of how they are treated as women. One manifestation of this fact is the violence they experience. About one-third of women worldwide have been raped or beaten, and Amnesty International (2004) calls violence against women “the greatest human rights scandal of our times.” Although violence against women certainly occurs in wealthy nations, it is more common and extreme in low- and middle-income nations.

Beyond violence, women in low-income nations are less likely than their male counterparts to get a higher education, and girls are less likely than boys to attend primary school. Women are also less likely than men to work in jobs that pay a decent wage and to hold political office. In many low-income nations, girls are less likely than boys to receive adequate medical care when they become ill and are more likely than boys to die before age 5. In all these ways, women and girls in low-income nations especially suffer.

Two sets of international statistics cited by writers Nicholas D. Kristof and Sheryl WuDunn (2009) are especially troubling. Because women outlive men, ordinarily there should be more females than males in a country. For instance, in the U.S., in the overall population, there are 97 males per every 100 females. Yet China, with 106 males per 100 females, and India with 108 males per 100 females, shows the opposite. The data is even further skewed when looking at the sex ratio at birth and for younger age groups. In both China and India, there are 111 boys born per every 100 girls. This phenomenon largely results from sex-selective abortions of female fetuses. Similarly, for the 0-14 age group, there are 116 Chinese and 113 Indian males per every 100 females and for those aged 15 – 24 years, there are 117 males in China and 114 males in India per every 100 females (CIA World Factbook, n.d.). This shows that in addition to sex-selective abortions skewing the sex composition of these countries, there are other factors such as female infanticide (the killing of female infants), abuse, neglect and lack of health care access causing female infants and children to die at higher rates.

A second set of statistics concerns sexual slavery. Kristof and WuDunn (2009, p. MM28) summarize this problem,

In the developing world, …millions of women and girls are actually enslaved. While a precise number is hard to pin down, the International Labor Organization, a U.N. agency, estimates that at any one time there are 12.3 million people engaged in forced labor of all kinds, including sexual servitude. In Asia alone about one million children working in the sex trade are held in conditions indistinguishable from slavery, according to a U.N. report. Girls and women are locked in brothels and beaten if they resist, fed just enough to be kept alive and often sedated with drugs—to pacify them and often to cultivate addiction.

This situation is so horrid that Kristof and WuDunn (2009, p. MM28) call for a moral crusade to save women’s lives. “In the 19th century,” they write, “the paramount moral challenge was slavery. In the 20th century, it was totalitarianism. In this century, it is the brutality inflicted on so many women and girls around the globe: sex trafficking, acid attacks, bride burnings and mass rape.” They add that an important reason for global poverty is that women in poor nations are uneducated, victimized by violence, and generally oppressed. For this reason, they say, international organizations are increasingly recognizing that “focusing on women and girls is the most effective way to fight global poverty.”

Status of Children

Because of their size, immaturity, and lack of resources, children are considered the most vulnerable members of any society. We have already seen evidence of this vulnerability in this chapter’s earlier discussion of childhood disease, malnutrition, and mortality. International agencies estimate that 5.2 million children under age 5 died in 2019 across the world. This equates to more than 14,000 children dying each day. Of these child deaths, more than 80% occur in just two world regions, with sub-Saharan Africa accounting for 53% and South Asia for 27% of child deaths. Sub-Saharan Africa is the region with the highest rate of child mortality with 76 deaths per every 1,000 live births. This means that in this region, 1 in 13 children die prior to their fifth birthday (UNICEF, Under-Five Mortality, 2021). Typically, conflict-ridden nations see the most extreme rates of child mortality, Somalia being a good example, with a rate of 117 children dying by the age of 5 per every 1000 children born. This equates to 1 in every 9 children dying before their 5^th birthday.

As disturbing as these statistics might be, there is also good news, as discussed earlier in this section. Much progress has been made during the past few decades in helping the world’s children, thanks to the focus placed on women and children by agencies of the United Nations. Child mortality worldwide declined by 59% from 142 to 38 deaths per 1,000 live births from 1970 to 2019. International efforts have saved millions of children’s lives during the past four decades. Similarly, literacy rates have improved.

These child soldiers from the Democratic Republic of Congo in central Africa are among the estimated 300,000 child soldiers found globally. L. Rose – Public domain – Wikimedia Commons

Before we leave the issue of children’s welfare, it is worth noting one additional problem they face in certain parts of the world. In some low- and middle-income countries, children are taken by force to join the armed forces or armed groups, or they join out of economic necessity or to escape abuse. These “child soldiers” may bear arms and engage in combat, serve as cooks and messengers, or be sexual slaves. Approximately 300,000 children (under age 18) worldwide are thought to be child soldiers. Beyond the dangers of being involved in armed conflict, these children are not in school and are often sexually abused.

Test Yourself

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Section 8.2 References

Amnesty International. (2004). It’s in our hands: Stop violence against women. Summary. London, England: Author.

Central Intelligence Agency. (n.d.). World Factbook. Central Intelligence Agency. Retrieved from https://www.cia.gov/the-world-factbook/.

Dollar street – photos as data to kill country stereotypes. (n.d.).  Gapminder. Retrieved from https://www.gapminder.org/dollar-street.

Duflo, E. (n.d.). Social experiments to fight poverty. TED. Retrieved from https://www.ted.com/talks/esther_duflo_social_experiments_to_fight_poverty?utm_campaign=tedspread&utm_medium=referral&utm_source=tedcomshare.

Human Development Reports. New York, NY: United Nations Development Programme. Retrieved from https://hdr.undp.org/en/composite/HDI.

Kristof, N. D. and S. WuDunn.  (2009, August 23). The women’s crusade. The New York Times, p. MM28.

UNESCO. (2017). Literacy Rates Continue to Rise from One Generation to the Next. UNESCO Institute for Statistics. Retrieved from https://uis.unesco.org/sites/default/files/documents/fs45-literacy-rates-continue-rise-generation-to-next-en-2017_0.pdf. FS/2017/LIT/45.

UNICEF.  (2021, April).  Malnutrition.  UNICEF DATA.  Retrieved from https://data.unicef.org/topic/nutrition/malnutrition/

UNICEF.  (2021, December).  Under-Five Mortality.  UNICEF DATA. Retrieved from https://data.unicef.org/topic/child-survival/under-five-mortality/.

World Health Organization.  (2017, July 12).  Progress on Drinking Water, Sanitation and Hygiene.  World Health Organization and the United Nations Children’s Fund (UNICEF).    Retrieved from https://www.who.int/mediacentre/news/releases/2017/launch-version-report-jmp-water-sanitation-hygiene.pdf

World Health Organization. (2019, June 14). Sanitation. World Health Organization. Retrieved from https://www.who.int/news-room/fact-sheets/detail/sanitation.

World Health Organization.  (2019, September 19).  Maternal Mortality.  World Health Organization. Retrieved from https://www.who.int/news-room/fact-sheets/detail/maternal-mortality.

World Health Organization. (2021, June 9). Fact sheets – malnutrition. World Health Organization. Retrieved from https://www.who.int/news-room/fact-sheets/detail/malnutrition.

World Health Organization. (2022, January 8). Schistosomiasis. World Health Organization. Retrieved from https://www.who.int/news-room/fact-sheets/detail/schistosomiasis.

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