Bitter Pills:Medicines & The Third World Poor | Page 21

the poor to go on buying drugs without doing anything to stop diseases from
recurring makes as much sense as continuously wallpapering a damp wall and
failing to do anything to treat the damp. It is expensive, wasteful and ultimately
doomed to failure.
So to improve health in poor countries disease has to be attacked simultaneously
on a number of fronts. Amongst them clean water, sanitation and other public
health measures are vital. The difficulty is that these require a great deal of capital
investment. For example, it has been calculated that the basic cost of providing
clean water supplies for the rural population of India by the year 2000 would require
an investment of at least £277 million a year. This estimate excludes all the timeconsuming and expensive business of coping with the technological and
maintenance problems that would have to be overcome. (5J| This sum is roughly
equivalent to the £250 million calculated to have been invested in the Indian drug
industry in 1977. (54) But whereas there are immediate returns to be made on
medicine sales, there are clearly few attractions for private investors in providing
poor communities with clean water.
However, lack of money to carry out preventive health projects need not be an
insurmountable obstacle to better health. This is illustrated by the experience of
Kerala, one of the most economically underdeveloped States in Indir Kerala
spends less on health per person that all but one of the 14 remaining states, but
it has by far the best health statistics, even by comparison with the most affluent
Indian States such as the Punjab. The death rate in Kerala is 7.2 per thousand,
compared to 19.2 per thousand in the State of Uttar Pradesh. The significantly
better health status of people in Kerala has been linked to its greater social and
educational development. Women have relatively better status. The society is less
rigidly segregated on caste lines. Literacy rates are high and women, in particular,
are now benefiting from widespread adult literacy campaigns and elementary
education. <55)
The experience of Kerala, that greater awareness can generate better health, is
confirmed by OXFAM's experience of community development projects
throughout the Third World. The poor only take an active interest in preventive
health measures, such as devising basic sanitation, if they participate in making
decisions. For this to happen, poor communities need to go through a process
of social education, to gain the will and the confidence to organise to improve
things. I5M
We have seen that the main health problems of the poor are rooted in their poverty
and powerlessness, and that no single prescription for better health is likely to
succeed. Improved living standards, more equal distribution of land, job
opportunities, clean water, control of disease vectors and other public health
measures are all essential elements, as are education and preventive and curative
health care. All depend on the political will of governments to give priority to
the needs of the poor. Consequently lack of political will and of money to
implement c hanges remain the major stumbling blocks to meeting these needs.
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