Latin America and the Caribbean still face major challenges in reaching Millennium Development Goals

Washington, July 1, 2005 (PAHO/ECLAC) —In the past five years, Latin America and the Caribbean have continued to advance in the fight against hunger, improving gender equity in education and access to drinking water, and reducing infant mortality, but the region still lags behind in meeting key Millennium Development Goals, such as halving extreme poverty, reducing maternal mortality, and the spread of HIV/AIDS, making primary education universal, and turning around the decline in the environment.

These are among the conclusions of a study on “Millennium Development Goals: a Latin American and Caribbean Perspective,” presented today by Dr. José Luis Machinea, Executive Secretary of the Economic Commission for Latin America and the Caribbean and Dr. Mirta Roses, Director of the Pan American Health Organization (PAHO), The presentations highlighted several aspects of the report, followed by comments from a panel of representatives from international organizations, including OAS Secretary General José Miguel Insulza, World Bank Vice President Pamela Cox, and the Inter-American Development Bank Chief of the Poverty Reduction Unit Carlos Eduardo Vélez.

The report provides an overview of the region’s progress and challenges in achieving the millennium development goals (MDGs). Its analysis and recommendations also seek to foster innovation and contribute information to the UN General Assembly this September to review progress in meeting MDGs. Coordinated by ECLAC, the document was prepared by United Nations bodies including ECLAC, FAO, UN-HABITAT, ILO, PAHO/WHO, WFP, UNDP, UNEP, UNFPA, UNESCO, UNICEF, and UNIFEM.

The governments of 189 countries adopted the Millennium Declaration in 2000, committing themselves to take concrete steps toward eradicating extreme poverty and hunger, making primary education universal, promoting equality between the sexes, improving infant health care, reversing environmental damage, and fostering worldwide cooperation for development.

Extreme poverty remains very high: 222 million Latin American and Caribbean people are poor, of these 96 million (18.6 percent of the population) are indigents. Only Chile has halved extreme poverty and measures indicate that provided progress to date continues, Brazil, Costa Rica, Mexico, Panama and Uruguay could meet this goal. In the other countries, however, progress was poor or there was some slipping backward.

The region is on its way to meeting the goal regarding hunger, with 15 of 24 countries having reduced sub-nutrition. Countries are also expected to reduce infant malnutrition (children with lower than normal body weight) by half by 2015. But it is worrisome that the poorest countries, where the population has the most trouble gaining access to food, are the ones making the least progress.

Unlike other developing areas, the region posts no significant gender inequality in education. Except for Bolivia, Guatemala and Peru, countries have met the goal and in some cases more women than men are completing primary and going on to secondary and university education. But women’s income from work is 30 percent to 40 percent lower than men’s, difficulties such as family violence persist, and there is still insufficient representation of women among parliamentarians.

The theme underlying the report is inequality, since Latin America and the Caribbean is the least equitable region in the world. Limited by low growth during lengthy periods, it has been unable to improve income distribution and access to productive assets, a situation aggravated by the lack of jobs that would allow workers to escape from poverty and their children to achieve adequate health care, education and food.

Three of the eight goals and seven of the 18 targets refer explicitly to health issues, and identify common denominators in terms of coverage, access to basic services and social protection. The publication describes how the right to health and investment in this sector have been placed at the heart of social development strategies, recognizing the need to increase public and private spending and improve the allocation of national resources to broaden coverage of health services, improve access to medications and expand infrastructure for drinking water and sanitation services, since these strongly influence each community’s primary health status.

Although there have been advances in reducing infant and child mortality, the report notes, the “averages mask wide disparities between and within countries”. Ten countries in Latin America and the Caribbean still had levels in excess of 40 deaths per 1,000 live births in 2004, accounting for about 270,000 deaths of children under 5 years old, or 61 percent of all deaths in this age group in the region.

In maternal mortality, the report says that “The relative stagnation of the ratio and of the absolute number of maternal deaths in Latin America and the Caribbean in the past decade is troubling, as it indicates that the region is not nearly on track to meet the target of reducing maternal mortality by three quarters by 2015. Evidently, the countries will have to redouble their efforts in order to approach this target.”

On HIV/AIDS, the report notes, “It is estimated that in 2004, 2.4 million people in Latin America and the Caribbean were
living with HIV/AIDS. Between 2002 and 2004, this number increased by 200,000. The prevalence of HIV/AIDS in the adult population is higher in the Caribbean than in any other region in the world except sub-Saharan Africa.” In several countries, “HIV/AIDS has already had an impact on life expectancy in these countries and has caused them to lose ground with respect to the gains they had made prior to the outbreak of the epidemic.”

The MDG report cites several challenges for the health sector, including major progress needed in health-care coverage under social protection schemes, increased public-sector current and investment spending, reorienting health-care services to primary health care, and sustained improvements in public health infrastructure. It says, “Progress is urgently needed in
formulating and implementing cross-sectoral policies and actions that have a real impact on the political, economic and sociocultural determinants of the health targets laid down in the Millennium Development Goals. All this is necessary to increase social cohesion and strengthen citizens’ right to health. Accordingly, these aims should be integrated into the health policies, plans and programs of the region’s countries so that, in conjunction with the actions taken in other sectors, they can enable the countries to meet the commitments undertaken for 2015.”

Primary education has seen progress and registration rates are over 93 percent. Progress occurred mainly in countries of intermediate development, such as Brazil and Mexico, with rates of 95 percent. But if early drop-out rates hold, 6 percent of children will not have completed primary education in 2015, and countries will fail to meet the goal of universal access.
In Latin America and the Caribbean, 2.4 million people had HIV/AIDS last year, up 200,000 between 2000 and 2004. Brazil, with its large population, has 28 percent of cases, but is also the only country that has been able to hold back the epidemic.

Indicators reveal significant environmental damage in the region and few possibilities of meeting goals. Loss of forests and biodiversity is particularly alarming, along with air pollution and the increase in city slums. However, most of the region’s countries should meet the Millennium goal for urban drinking water in most countries, although sewage treatment looks less promising. The goal of urban sewage treatment has been met in the Caribbean, but Bolivia, Brazil, El Salvador, Guatemala, Haiti and Peru lag behind with coverage at less than 60 percent.

Another objective that has not shown progress has been aid promised by industrialized countries to developing countries: they committed to providing amounts worth 0.7 percent of their GDP but to date these have reached just 0.25 percent. Similarly, a complex web of barriers also hampers the region’s exports to more developed countries.

The UN argues that to halve extreme poverty and hunger by 2015, the region will require sustained economic growth at different rates for each country, but averaging 2.9 percent per capita in the next decade. However, the poorest countries and those progressing less in the past 14 years require an annual average growth rate of 4.4 percent per capita.

The report argues that economic growth that does not change income distribution will not improve the poor’s standards of living enough. A change in distribution to boost the poorest strata’s income more rapidly would make it possible to meet the goal more quickly. This growth with equity strategy requires, moreover, institutional changes that place social policies at the centre of development strategies.

Along with the urgent need to reduce poverty and hunger in the short term, investment in infrastructure and human capital through social programmes is also necessary. These should involve monetary transfers conditional on ensuring school aid at the primary and secondary level, along with health care, school meals, nutrition and preventive medical care programmes, especially for pregnant women and newborns.

To meet the Millennium Goals in the countries of Latin America and the Caribbean requires an enormous effort within each country, including a fiscal pact to ensure the efficient use of State resources, transparency, accountability, clear rules and greater availability of resources so the government can meet development priorities. Even so, official aid to development in the poorest countries must be increased, particularly in Bolivia, Guatemala, Guyana, Haiti, Honduras, Nicaragua, Paraguay and Suriname. The UN is planning a world meeting at its New York headquarters next September to present a global report on progress toward meeting the Millennium goals. This interagency report, coordinated by ECLAC, will contribute to those debates.

PAHO, which serves as the Regional Office for the Americas of the World Health Organization, works with all the countries of the Americas to improve the health and quality of life of their people. PAHO Member States today include all 35 countries in the Americas. France, the Kingdom of the Netherlands, and the United Kingdom of Great Britain and Northern Ireland are Participating States. Portugal and Spain are Observer States, and Puerto Rico is an Associate Member.