After studying this section you should be able to:

• identify and evaluate theories that explain health inequalities in developing nations
• outline how the causes of health inequalities in the developing world can be linked to the developed world

Explanations for morbidity and mortality rates in the developing world
LDCs experience low life-expectancy and high infant-mortality rates compared with the West. Many diseases such as measles are major killers of children.

Modernisation theory and health-care
Modernisation theory argues that the traditional practices and medical remedies found in many LDCs are actually dangerous for health. Modernisation theorists would argue that only modern medicines can provide the cure for many LDC health problems and that LDCs require European-style health-care systems.

Moreover, health education is also required – especially in the field of family planning. It is suggested that this would improve female mortality and morbidity rates (which are worsened by constant childbearing) and reduce population. It is envisaged that these health improvements could be funded from official aid packages, the income generated by world trade and, in the long term, improvements in the standard of living as the country progresses up the development ladder.

Dependency theory and health-care
Dependency theory does not question the need for universal health-care but points out that many of the LDC’s health problems are linked to global inequalities, i.e. which stem from the First World’s exploitation of LDC peoples and resources.

A number of points can be made to support this idea.

• Colonialism introduced European diseases to LDC populations who were unable to resist them. The effects of such diseases were, and still are, devastating.
• Colonialism also entailed the replacement of crops for food with cash crops. In some cases, this resulted in famine and mass starvation. Cash crops have meant that people’s diets in the LDCs have become less balanced over time, resulting in less resistance to disease.
• Poverty is the major killer in the LDCs. This is partly a result of a world trading system that prevents the LDCs getting a fair price for their goods.
• Aid and the debt it generates also means that less money is available to spend on health-care. There is evidence that as countries pay more in interest repayments so infant mortality increases. Organisations such as the World Bank and IMF will only lend money if countries cut public spending – health-care is one of the main types of public spending in the LDCs.
• Existing health-care systems and medical aid from the West tends to focus on cure rather than prevention. It is argued that much disease could be prevented by focusing aid and health-care on clean water (80% of all LDC disease is water-related) and sanitation.
• There is evidence that multinationals have had a negative effect on LDC health. Their failure to provide workers with health and safety equipment, their poor record on pollution (e.g. the Bhopal disaster in India), the selling of products banned in the West for health reasons (e.g. high-tar cigarettes) and the promotion and advertising of false needs (e.g. Nestlé and baby-milk powder) have all contributed to poor health in the developing world.

Some socialist countries (e.g. Cuba) have adopted socialist development strategies which strongly emphasise preventative medicine and a system of universal medical care. They have also acknowledged the need to raise general living standards in order to raise resistance to disease. Such strategies have generally proved successful despite, in the case of Cuba, attempts by the USA to prevent medical supplies entering the country.