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2003 in Finland, Norway, Sweden, Japan, such as water purification and delivering
and Singapore), in many less-developed treated water to rural homes (Mosk and
countries it has remained at extraordinarily Johansson, 1986; Sachs et al., 2001). It is
high levels (for example, an infant mortality true that the availability of medical and
rate of over 150 in Angola, Niger, and Sierra health facilities is an important proximate
Leone). Even in less-developed regions enor- determinant of mortality decline and interna-
mous heterogeneity exists, with infant mor- tional bodies and donor agencies can cooper-
tality varying between a rate as low as 8 in ate in providing guidance and assistance to
Costa Rica and 13 in Sri Lanka to the high national governments (Croghan et al., 2006).
levels mentioned above. Not only have health However, outcomes depend heavily on
and mortality levels in less-developed coun- whether the assistance reaches the needy seg-
tries been slow to converge, but also the dif- ments of the population.
ferences between the various subgroups Apparently, there is inherent conflict and
within countries do not show significant competition between nations and groups for
signs of diminution. Ironically, much of this the access to scarce resources that are
divergence has become apparent during required to improve health conditions and
times when the world has become more reduce mortality. During the course of glob-
interconnected and interdependent and when alization and economic development over the
medical technologies have become more past 30 years or so, this conflict has intensi-
readily available. fied in many countries, including China and
People in every society want to live longer India and people with the fewest needs have
and save their children from death, and will succeeded in getting better access to maxi-
do whatever is necessary to reduce mortality. mum resources. Considerable evidence has
Then why should there be such slow progress accumulated to suggest that the gap between
in the convergence in health, illness, and various segments of the populations within
mortality patterns between and within coun- some countries has widened in recent years,
tries? This chapter focused on four major with those in greater need falling behind. The
factors to address this question: economic less privileged and more disadvantaged indi-
development, income inequality, public viduals and groups who are more likely than
spending on health, and maternal education. the privileged to be exposed to higher risks of
By far, economic development is the most illness and early death are finding it difficult
important and robust predictor of mortality to get easy access to health care services and
decline in the less-developed world. It brings to make adequate use of the available
reductions in mortality among the rich and resources. In good economic times, the poor
the poor, and the well educated and the illit- and the disadvantaged simply cannot com-
erate via high expenditures on health and pete with the rich and resourceful, and in bad
widespread availability of medical and health economic times, they are the ones who are hit
care facilities. However, many countries hardest. Widening social and economic
(e.g., Bangladesh, Ecuador, and Egypt) have inequality has encouraged conflict and com-
reduced their mortality levels without signif- petition between various segments of the
icant economic progress (Croghan et al., population and has intensified the maldistrib-
2006), while others (e.g., China and India) ution of health care facilities.
have experienced increased divergence in mor- Economic development is certainly the
tality patterns despite rapid economic develop- real answer to reducing morbidity and mor-
ment (Braveman and Tarimo, 2002; Zhao, tality and to improving health conditions in
2006). Moreover, some others are so poor less-developed countries. However, it is well
that they cannot afford to buy enough food known that inducing economic prosperity is
and medicine in the world markets or spend not only complicated, but it is a long-term proj-
enough on the improvement of technologies ect. Despite great strides in industrialization,