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MORTALITY IN LESS DEVELOPED COUNTRIES 231

may be at the core of why being poor predicts In Latin American countries, the situation was
poor health.… The disease consequences of reversed, where poorer people were in an
feeling poor are often rooted in the psycho- advantageous position as far as the share of
logical consequences of being made to feel public health expenditure was concerned.
poor by one’s surroundings’ (Sapolsky, However, several studies do not find public
2005b: 652). In sum, the greater the inequal- spending on health to be an important predic-
ity in a society, the greater is the likelihood tor of mortality. The oft-cited study by Filmer
for the poor to be psychosocially stressed and and Prichett (1999) found public spending on
consequently in poorer health. health to be a poor predictor of child mortal-
ity, once variables such as per capita income,
female education, and access to safe water
were held constant. This is a contentious issue
Public spending on health
that needs further research.
Another variable that has often been linked to
economic development and inequality as
a determinant of high mortality in less- Maternal education
developed countries is the low per capita public
health expenditure (Anand and Ravallion, 1993; Mother’s education is known to be an impor-
Houweling et al., 2005; World Bank, 2003: tant determinant of infant mortality. In a
35–42). Poor and unequal societies not only number of studies, Caldwell (1986b) showed
spend less on health on a per capita basis, but that in less-developed countries educated
also poor people in those societies do not have mothers were more likely than illiterate
equal access to knowledge and health facili- mothers to be sensitive about the risks of
ties. There exists an intense conflict and com- health problems among infants and children,
petition between various groups for the access and more knowledgeable about the available
to scarce resources for improving their well- health care facilities. Also, they were more
being, including health conditions. Moreover, likely to bring sick children to hospitals and
the less privileged are not able to make better health practitioners, and to follow the sug-
use of the available resources, due largely to gested treatment. Thus, for every country
lower education, remote residential locations, where data are available, the infant mortality
and poorer social and political networks. In rate for children born to illiterate women is
most developing countries the poorest fifth of higher than for those born to women with a
the population receives less than a fifth of the secondary school or higher level of education
health expenditures, while the richest fifth (World Bank, 2005a: Table A3). In general,
receives much more (World Bank, 2003, the effect of education on mortality does not
Table 3). Even in a country such as India vary with the level of economic development.
which is one of the fastest growing economies
and among the largest beneficiaries of global-
ization in recent years, the poorest fifth of the
population received about 10% of public CONCLUDING REMARKS
health expenditures during 1991–2001,
whereas the richest fifth received 32%. The Over the past fifty years, the progress in
situation was much worse in countries such as morbidity and mortality declines in the
Ecuador, Armenia, and Guinea, although less-developed world has been highly
other poor countries such as Kenya, uneven. While mortality in developed coun-
Bangladesh, Indonesia, or Vietnam have done tries, particularly that which occurs during
better. In countries such as South Africa, infancy and childhood, has been reduced to
Nicaragua, and Sri Lanka, there was no such extremely low levels (for example, an infant
imbalance between the rich and the poor. mortality rate of 3 per 1000 live births in