Bitter Pills:Medicines & The Third World Poor | Page 17

modernisation and consumerism have made an impact even in remote rural areas.
They have created new aspirations that can often only be satisfied at the expense
of buying food. <3I)
The food intake of families dependent on subsistence farming can, however, be
dangerously low because of their inability to produce enough food. Marginal
farmers are particularly vulnerable to drought and floods. Very few can get advice
on how to improve poor, overworked soil or legal aid if forced off their land.
They may have no access to credit to buy seeds or water supplies to irrigate their
land. (321
The availability of water can be critical for food production and conseqently for
nutrition. Lack of water is also a major factor in the spread of infectious disease.
Skin infections and communicable disease are rapidly transmitted, when families
have no easy access to water for washing.<331 Moreover, the poor are particularly
vulnerable to water-borne diseases, because many have to rely on unsafe water
for drinking. In North Yemen, for example, only 4% of households had clean
piped water in 1978.(341 In India, although 80% of the urban population has been
provided with a protected water supply, out in the rural areas, only one village
in ten has safe drinking water. One village in five lacks even basic water facilities. m
In most developing countries there is a chronic shortage of sanitation facilities
and sewerage, particularly in the rural areas, where even simple latrines are virtually
unknown. In Bangladesh, for example, no more than 6% of households
throughout the country had sanitation facilities in 1977. (36) The Third World
poor almost invariably live in overcrowded housing. In North Yemen the
Government has estimated that nearly half the population live in one- room
housing. (37) Living conditions in the Third World's sprawling urban slums are
particuarly unhealthy, as people are forced to live alongside open drains and refuse
tip s.
The problems of lack of food and unhealthy living conditions are compounded
by ignorance, apathy and fatalism, generated by a lifetime of powerlessness and
deprivation. The oppression of millions of poor women is an important factor
in perpetuating ill-health. In some societies girls have even less access than boys
to elementary education with the result that over 90% of women are illiterate.'•""
Their low status can mean that adult males come first in sharing out a family's
meagre diet, to the disadvantage of women and children. Mothers may have little
understanding of hygiene or the nutritional needs of their children. Commercial
pressures have compounded the problems in recent years as a growing number
of women in poor communities have abandoned breast- feeding, unaware of the
hazards to their babies' health from contaminated feeds in unsterilised feedingbottles. (39)

THE REMEDIES
From the broad range of social, political and economic factors underlying illhealth in poor countries, it must be readily apparent that medicines alone cannot
solve the problems. Disease that is rooted in poverty can only be prevented by
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