WTimes: Asian crisis harming health

[Robert Weissman <rob@essential.org>]

>  Asians in unhealthy crisis Financial woes produce ill effects on
depressed    
>                           region's poverty-stricken
     
>                          (Washington Times; 09/25/98)
     
>
>   A generation of Asian families has begun to slip backward into disease,  
>hunger, malnutrition, illiteracy and poverty as a result of the Asian
economic  
>crisis that began in the summer of 1997.
>
>   Millions of workers have already lost their jobs and are slipping back
from  
>the middle or working class into poverty in Indonesia, Thailand, South
Korea,  
>the Philippines and Malaysia.
>
>   Ripples from the crisis are also swamping poor families beyond the
reach of  
>aid programs on the fringe of the now-bankrupt East Asian economic
miracles:  
>Cambodia, Vietnam, Laos and Burma.
>
>   A sharp impact on the health of the newly poor was predicted when the
crisis 
> began. But families still had some savings, some possessions to sell, some  
>relatives and friends to lend them enough to get by.
>
>   Now, many have reached the end of their rope.
>
>   Officials at the World Bank, U.N. Children's Fund, U.S. Agency for  
>International Development and private relief agencies say they are
beginning to 
> see massive privation and malnutrition and the collapse of health care 
>systems.
>
>   Among the most dangerous long-term health problems, said Nils Daulaire,
a  
>former AID senior adviser on international health, are a rise of AIDS in
girls  
>who turn to prostitution, a reduction in vaccination for measles and other  
>diseases, and more infant deaths because of malnutrition. Another major
threat  
>is the new type of drug-**resistant** diseases that are spreading worldwide.
>
>   "It's pretty clear where things are heading," said Dr. Daulaire, the
current 
> president of the Global Health Council, an alliance of U.S. medical  
>professionals, drug firms and relief groups.
>
>   He said the health of Asians is harmed because 100 million people have  
>fallen below the poverty line since last year. They are no longer able to
buy  
>medicine or pay a private doctor so they turn to the public clinics.
>
>   But governments are bankrupt and can't afford to maintain their
pre-crisis  
>health programs, let alone care for tens of millions more people.
>
>   Without preventive measures, there will be increases in malaria,  
>tuberculosis, AIDS, measles and many other diseases, said Dr. Daulaire and  
>other experts.
>
>   "Statistical systems were not designed for a crisis," said Katherine  
>Marshall, World Bank director for East Asia. "But a number of rapid
studies are 
> beginning to get information."
>
>   The World Bank and other agencies say the weight at birth of babies is
the  
>best single indicator of a health crisis. But that evidence is still in the  
>womb and just beginning to reflect the huge jump in food prices, the loss
of  
>jobs and the resulting malnutrition spreading to hundreds of millions of
people 
> in Asia.
>
>   Early studies by Helen Keller International, Worldvision and other
relief  
>agencies in Indonesia and elsewhere in Asia paint a bleak picture.
>
>   Millions no longer eat more than one or two meals a day. Clinics are
closing 
> because the sick no longer can afford fees or medicines. Governments are 
>unable  to pay doctors' salaries. Women no longer get prenatal care or 
>sanitary,  medically attended deliveries.
>
>   In addition, millions of children are being pulled out of school and
will  
>fail to get an education, and millions of infants are suffering
irreversible  
>brain impairment from malnutrition - leaving a legacy of intellectual
damage  
>that will make recovery from the crisis more difficult, said Dr. Daulaire
and  
>senior UNICEF officials.
>
>   "Kids who do not get adequate food while their mother is pregnant and
during 
> the first years of their lives are at high risk of inadequate intellectual  
>development," said Dr. Daulaire. "This could have long-term consequences.
>
>   "A generation of young people in 20 years will pay the price of the
economic 
> downturn," he said.
>
>   An unpublished University of Indonesia nutritional survey obtained by
The  
>Washington Times reports a 28 percent increase in urban poverty since the  
>crisis hit.
>
>   In East Jakarta, among children under 5 years of age, approximately 18  
>percent are wasting, 16 percent stunting and 29 percent underweight, the
March  
>study reported.
>
>   Worldvision, the U.S.-based relief agency, said that 8 million children  
>dropped out of school in Indonesia due to poverty. The number of 12- to
15-year 
> olds in school dropped by 25 percent and is expected to decline further.
>
>   Before the crisis, poor families paid 43 percent of their income to keep  
>their children in school: fees, books, clothing, lunches, transportation.
Now  
>"low-income families pay 85 percent of their income on food alone," said  
>Worldvision in a study.
>
>   In the short term, poor families can use the saved school costs to
provide  
>food. Children who work instead of study add a few cents a day to the
family  
>budget.
>
>   But in the long run, education would have improved family health and  
>increased income.
>
>   "The impact of the economic crisis has been felt at the human level much  
>more quickly and with more severity than we expected," said the World
Bank's  
>Mrs. Marshall.
>
>   "When the crisis first struck, it was in banking and high finance.
There was 
> a hope and expectation it would last a relatively short time. The
thinking was 
> you needed to bridge it for a short time - to ensure food supply and
price, to 
> focus on public works to create jobs.
>
>   "Now you've got a fundamental change in the social picture that calls
for  
>rethinking social policy agenda," Mrs. Marshall said. "You need to protect  
>people who have no safety net."
>
>   More than half the children under 2 years old on Indonesia's heavily  
>populated island of Java are malnourished, according to UNICEF.
>
>   The Helen Keller relief agency reports that severe malnutrition in
Indonesia 
> nearly doubled since last year when the value of the currency fell by more 
>than  two-thirds and average income dropped from $1,000 per year to about
$350.
>
>   Anemia, a key sign of malnutrition and a cause of permanent mental  
>impairment, now affects 60 percent of Java's children. Diarrhea rates
doubled  
>in women and children, the Keller study said.
>
>   Dr. Daulaire said, "It's likely we'll see a reduction in the proportion
of  
>women receiving prenatal and obstetrical care. We expect to see increases
in  
>both maternal deaths and bad outcomes from pregnancies; that is, child
deaths.
>
>   "I'm also concerned people will take shortcuts on treating infections.  
>Instead of taking a two-week course, they'll take a three-day course of  
>**antibiotics**. It's a classic setup to increase the **resistance** {of
germs} 
>to  **antibiotics**, which could have an effect around the world as they
spread 
>so  rapidly."
>
>   Prostitution is another effect worrying Dr. Daulaire and others.
>
>   In the Philippines, the Tambayan Center for Abused Street Girls reports
more 
> than 1,000 teen-age girls have turned to prostitution in Davao City,
charging  
>as little as from 50 cents to $2.50.
>
>   This rise in prostitution increases the spread of AIDS, especially as  
>contraceptive costs have gone up with the currency collapse and bankrupt  
>governments cut back on distribution programs.
>
>   There is also fear that "as people become desperate and forlorn, they
will  
>turn to drug use, whose direct consequences are addiction and AIDS," said
Dr.  
>Daulaire.
>
>   Right now, the crisis that began with high-rise banks collapsing from
poorly-
> planned borrowing and lending has come down to lack of food.
>
>   Worldvision, which has 40 years' experience working in Indonesia, said
in a  
>new report released to The Washington Times that due to the El Nino
drought,  
>rice production has crashed, leaving a shortfall of 4.4 million tons.
That's  
>equal to 40 percent of the rice sold on international markets and it would
cost 
> $5 billion to cover the rice shortage, assuming that much rice can be found.
>
>   The World Bank and other foreign agencies are moving to supply some  
>emergency food, some of it in exchange for work cleaning drains in
preparation  
>of an expected period of heavy rains because of La Nina, and some in the
form  
>of subsidized rice to be sold to the poor.
>
>   But beyond the food problem, the health crisis is expected to grow as  
>medicines become increasingly expensive and unavailable.
>
>   Medicines produced in Indonesia contained up to 90 percent foreign  
>materials, according to one expert. Because of this, the cost of medicines
has  
>tripled as the Indonesian currency collapsed.
>
>   Studies are being launched to examine how people will pay for malaria  
>medication and other essentials.
>
>   There is a growing fear that many people will turn back to herbal and
other  
>traditional medicines, which may work for minor illnesses, but won't help  
>serious ones. Already, health experts fear people will delay seeking  
>professional help due to poverty and that delay will cost lives.
>
>   Worldvision, CARE and the Baltimore-based Catholic Relief Services are
also  
>looking at how the crisis is affecting women and microcredit, which had
enabled 
> many families to run small businesses before the crisis.
>
>   Spinoff effects on health and society include increasing violence
within the 
> family, rising crime, anti-immigrant hostility and hatred of ethnic
minorities 
>-  especially the ethnic Chinese in Indonesia, targets of several riots.
>
>   Malaysia and Thailand have already moved to deport immigrant workers.
>
>   Thailand relented when it found few Thais willing to haul 200- pound
rice  
>sacks at rice mills and allowed Burmese, Laotian and Cambodian workers to  
>remain and do those jobs.
>
>   But hundreds of thousands of Thais and other Asian urban workers laid
off in 
> the crisis have migrated back to their home villages to find few jobs,
their  
>family land had been sold off, and housing in short supply.
>
>   This has spawned rivalries and family tension, despite traditional
family  
>unity, which has gone a long way in easing the early pain of the economic  
>crisis.
>
>(Copyright 1998)