Inequity Impedes Progress on Millennium Goals

A report launched recently at Pan American Health Organization (PAHO) headquarters takes stock of PAHO member countries' progress toward achieving the Millennium Development Goals (MDG). It concludes that the region has advanced toward several of the goals, but some goals are proving more difficult than others, and a few countries lag seriously behind. The main stumbling block is the region's enduring problem of inequity.

The Millennium Development Goals: A Latin American and Caribbean Perspective was prepared by 12 United Nations agencies led by the Economic Commission for Latin America and the Caribbean (ECLAC) and including PAHO. The report was presented at PAHO in July by ECLAC's executive secretary, José Luis Machinea, and by PAHO Director Mirta Roses.

The report assesses progress made since 1990 toward achieving the millennium goals and notes that Latin America and the Caribbean appear to be on track to achieve some goals and indicators, including:

• Reducing hunger and malnutrition.
• Cutting infant and child mortality.
• Expanding access to safe drinking water.
• Achieving gender equity in education.

But the region is not making sufficient progress in these areas:

• Reducing extreme poverty.
• Improving maternal mortality.
• Achieving universal primary education.
• Expanding access to sanitation.
• Ensuring environmental sustainability.

The rate of extreme poverty in the region declined from 22.5 percent in 1990 to 18.6 percent in 2004, according to the report. Even so, the absolute number of people living on less than $1 per day rose by 3 million during that period, to 96 million. Contributing to the lack of progress in some countries and toward some goals is the region's slow rate of job creation, which prevents many people from escaping poverty and makes it hard for them to provide adequate health care, education, and food for their families. Stronger economic growth would help, says the report, but the overarching problem is the region's extreme levels of inequality.

"Latin America and the Caribbean continue to be the most unequal region in the world," Machinea said in his presentation of the report. "We see persistently high levels of inequality in income distribution and inequities related to place of residence, ethnicity, and gender."

In this area, he noted, Latin America and the Caribbean compare poorly with Asian countries, where poverty has declined and the income gap has narrowed much more rapidly. As a result, Latin America and the Caribbean will have to attain much higher rates of economic growth to reach the millennium goals.

"At the same level of growth, poverty declines much more slowly in countries with high inequity. An improvement of just 10 percent in the Gini coefficient would mean significantly less growth would be necessary," said Machinea.

Real progress

One piece of good news in the report is that one country—Chile—has already achieved the number-one MDG, cutting extreme poverty by half. And if present trends continue, Brazil, Costa Rica, Mexico, Panama, and Uruguay could also meet this goal. In other countries, however, progress has been slow or there has been backsliding.

The countries of Latin America and the Caribbean have significantly improved rates of child mortality. But maternal mortality has stagnated in recent years, and countries will have to redouble their efforts if they are to meet the Millennium Development Goals in this area. Photo Julio Vizcarra/PAHO

Regarding hunger, the region is on its way to meeting the millennium goal of reducing by half the proportion of the population that consumes too few calories per day; 15 of 24 countries are also on track to reduce the proportion of children with low body weight. However, the report notes that the region's poorest countries, where progress is most needed, are lagging behind.

In primary education, the region has raised enrollment rates to more than 93 percent, with countries of intermediate development, such as Brazil and Mexico, registering the greatest progress. Nevertheless, if current dropout rates hold, 6 percent of the region's children will not have completed primary education in 2015, falling short of the millennium goal of universal primary education.

Regarding gender equality in education, Latin America and the Caribbean compare well with other developing regions. Only Bolivia, Guatemala, and Peru have failed to achieve gender parity in schools, and in some countries, more women than men are completing primary, secondary, and higher education. On the down side, women in the region earn 30–40 percent less than their male counterparts in the workforce. Moreover, women continue to suffer disproportionately from family violence and are underrepresented in legislative bodies throughout the region.

In the area of child health, under-5 mortality in the region fell from 56 per 1,000 live births in 1990 to 33 per 1,000 in 2003 (a 40 percent decline), and under-1 mortality fell from 43 to 25 per 1,000 (a 42 percent drop), indicating the region is well on its way to meeting the millennium goal of reducing child mortality by two-thirds by 2015.

However, the report warns that "averages mask wide disparities between and within countries."Ten countries in Latin America and the Caribbean still had more than 40 under-5 deaths per 1,000 live births in 2004, representing 270,000 infant and child deaths.

On the issue of maternal mortality, the report says the region is not on track to meet the MDGs.The ratio of maternal deaths to live births has stagnated in the past decade, and the absolute number of mothers who die each year is "troubling,"says the report. "Evidently, the countries will have to redouble their efforts in order to approach this target."

In the HIV/AIDS epidemic, Latin America and the Caribbean saw an increase of 200,000 cases between 2000 and 2004. Brazil, with the region's largest population, has 28 percent of the region's 2.4 million cases, but it has made significant progress in holding back the epidemic.

The July 1 presentation of The Millennium Development Goals: A Latin American and Caribbean Perspective followed a regional launch of the report at ECLAC headquarters in Chile in June. Commenting at the PAHO launch were Organization of American States Secretary General José Miguel Insulza, World Bank Vice President for Latin America and the Caribbean Pamela Cox, and Carlos Eduardo Vélez-Echavarria, head of the Inter-American Development Bank's Poverty and Inequality Unit.

PAHO helped design, plan, and write the 335-page report. The other U.N. agencies involved were FAO, UN-HABITAT, ILO, WFP, UNDP, UNEP, UNFPA, UNESCO, UNICEF, and UNIFEM. The report can be viewed or downloaded at www.eclac.cl.