The "African Institute for Scientific Research and Development" has
written:

"In rural Africa agriculture, health and the environment are like three
sides of a triangle. As the sides define and determine the triangle, so do
agriculture, health and the environment both define and determine rural
development. For socio-economic development to occur attention must be
paid to all the three aspects...

"Despite national and international efforts to improve health for all,
many communities in East Africa are still plagued with communicable and
other preventable diseases such as tuberculosis, immunisable childhood
diseases, nutritional disorders, maternal deaths, eye infections,
injuries, and problems related to alcohol and narcotic drug abuse.

"Common infections such as acute respiratory tract infections, diarrhoea,
malaria and sexually transmitted diseases (including HIV/AIDS) are
responsible for most of the morbidity and mortality in rural communities.
The incidence of many of these diseases can be drastically reduced through
community based health education, immunization, improved mother and child
health care and enhanced nutrition."

The University of Glasgow Department of General Practice, International
primary health care, has published the following article:

"Health in Zambia and the UN AIDS Conference in Lusaka"

Dr DOROTHY LOGIE, GP Adviser to Borders Health Board (Report on a meeting
held on 09/02/00) in which she writes:

"At a recent conference in Lusaka the staggering proportions of the AIDS
epidemic in Sub-Saharan Africa was thrown into relief. With 10% of the
world's population and two thirds of the world's cases of HIV, the burden
of what is arguably the worst epidemic to hit mankind since the 'black
death' has fallen primarily on the world's poorest nations.

"With Zambia as an example, Dr Logie set the HIV epidemic in its context.
The fall in life expectancy to 43 years has not only followed on from an
ever increasing incidence of HIV but has been in the context of a 30% cut
in spending on education and a 50% cut in spending on health. In a country
which 20 years ago had a well developed schooling and health care service,
diseases of poverty such as TB, waterborne diseases and malaria are on the
increase, as are maternal and infant mortality indicators. One quarter of
children are undernourished and one half of the country has no access to
safe water. Three quarters of girls and a half of all children do not now
complete primary education. Four fifths of the population live on less
than 60p a day.

"Zambia owes the rest of the world, primarily the World Bank and the IMF,
$6.5 Billion, more than twice the country's gross national product. The
debt must be serviced at $200 million per annum, regardless of the cost to
health, education or nutrition. This amounts to one half of all export
earnings. Seven times as much is spent on servicing its debt as it can
afford to spend on health care. The cuts in education and health care
spending have been driven by structural re-adjustments demanded by the
World Bank. These have included introducing user fees for health and
education and placing a limit on state responsibilities. (see Table 1)...

"There is urgent need for action to challenge the selective blindness of a
global economic system incapable of taking the radical steps necessary to
provide stability and hope in an entire continent facing a bleak future.
The positive first steps of the British government to cancel the debts of
the world's 25 poorest countries, albeit with heavy pre-conditions, are to
be supported and more drastic steps urged. As health professionals we have
a duty to research and highlight the damaging impact on health of imposed
Western economic re-adjustments and to unequivocally condemn the
intolerable burden of unsustainable debt."

For its part, the "African Journal of Food and Nutritional Sciences",
Volume 1 No. 1 August 2001, Abstracts, published the article:

CO-EXISTENCE OF OVER- AND UNDERNUTRITION RELATED DISEASES IN LOW INCOME,
HIGH-BURDEN COUNTRIES: A contribution towards the 17th IUNS congress of
nutrition, Vienna, Austria 2001

Rutengwe R., Oldewage-Theron W, Oniang'o R & Vorster H.H.

Abstract

"About one third of the world's population suffer from micronutrient
deficiencies and hundreds of millions suffer from chronic diseases of
lifestyle. Prevalence rates, particularly low birth weight, stunting and
underweight, remain high particularly in Eastern Africa and South Central
Asia. More than a third of all children in developing countries remain
constrained in their physical growth and cognitive development. The 1990
ambitious goal of halving childhood underweight prevalence by the year
2000 has not been achieved by most countries. Global progress in fighting
malnutrition is slow and crippled by rapid increase of both communicable
and non-communicable diseases, the so-called "double burden of disease".
About 115 million people suffered from obesity related diseases in the
year 2000. Overweight and obesity (globesity) prevalence is advancing
rapidly in developing countries.

"Cardiovascular diseases (CVD), myocardial infarction, angina pectoris and
stroke as one of the most important causes of mortality and morbidity
globally, will continue to be first and second leading causes of death in
the world. Most developing countries, including South Africa, currently
are in the process of transition and experiencing the double burden of
both communicable and non-communicable diseases in which chronic diseases
of lifestyle such as CVD have emerged while the battle against infectious
diseases has not been won. In the last few years the HIV/AIDS epidemic has
spread extremely rapidly and is likely to double overall mortality rates,
undermine child survival and halve the life expectancy over the next five
years." (Our emphases).

The US Environmental Research Foundation published an article on February
5, 1998, entitled:

"Poverty Makes You Sick"

"Numerous studies in England and the U.S. have shown consistently that a
person's place in the social order strongly affects health and longevity.
It now seems well-established that poverty and social rank are the most
important factors determining health – more important even than smoking...

"George Kaplan and his colleagues at the University of California at
Berkeley measured inequality in the 50 (US) states as the percentage of
total household income received by the less well of 50% of households.
(British Medical Journal, Vol 312, April 20, 1996: 999-1003.) It ranged
from 17% in Louisiana and Mississippi to 23% in Utah and New Hampshire. In
other words, by this measure, Utah and New Hampshire have the most EQUAL
distribution of income, while Louisiana and Mississippi have the most
UNEQUAL distribution of income.

"This measure of income inequality was then compared to the age-adjusted
death rate for all causes of death, and a pattern emerged: the more
unequal the distribution of income, the greater the death rate. For
example in Louisiana and Mississippi the age-adjusted death rate is about
960 per 100,000 people, while in New Hampshire it is about 780 per 100,000
and in Utah it is about 710 per 100,000 people. Adjusting these results
for average income in each state did not change the picture: in other
words, it is the gap between rich and poor within each state, and not the
average income of each state, that best predicts the death rate...

"Isn't it time that the public health community – physicians, public
health specialists, and environmentalists – recognised that poverty,
inequality and racism cause sickness and death? Given what science now
tells us, medical policy – including medical training – should aim to
combat and eliminate poverty, inequality, and racism just as it now aims
to combat and eliminate infectious diseases and cancer. With U.S. health
care costs now exceeding $1 trillion each year, anti-poverty and
anti-racism initiatives would be economically efficient as well as
humane." (Our emphasis).

A British medical journal aimed at medical students, Student BMJ Vol 9,
June 2001, published:

"Poverty and Health" by Mike Rowson in which he says:

" Poverty is the number one killer in the world today, outranking smoking
as the leading cause of death... (Our emphasis).