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Health, education and shelter: an overview

19 May 2008

Education, health and shelter are three basic and essential services long enshrined as a fundamental human right in the Universal Declaration of 1948, but ever since contradicted by the grave reality of life for a large swathe of the world population.

Still more than one billion people lack access to basic health care services, another one billion people (the majority of them women) lack even a basic education, and almost two billion people live in overcrowded and poor quality housing - with at least another 100 million people living homeless worldwide.

The factors relating these colossal numbers is made clear in scores of reports released by non-governmental organisations and campaigners, namely poverty, disempowerment and a lack of government provision.  Although few governments would disagree with the ideal of universal provision in essential services, the road to achieving this noble goal - as well as the longer-term prospects for success - remains deeply contentious and unclear.

Primary Health Care

In 1978, 130 governments signed the Alma-Ata declaration which aimed for primary health care by the year 2000, involving the equal sharing of health services by all people irrespective of their ability to pay.  After three decades of neoliberal economic policies, the agreed target of ‘Health for All' has never appeared more elusive.  In Africa, a child dies needlessly of malaria every 30 seconds, a women dies of pregnancy-related causes every minute, and almost 6,000 people die of Aids each day - with a further 90 million new infections predicted for the next two decades.  Despite a renewed target by world leaders for universal HIV/Aids treatment by 2010, some estimates suggest that 14 million people will still be in need.

Read more - Healthcare: key facts and resources

Universal Basic Schooling

This mismatch between goals and reality is equally stark in the field of education.  In 1990, the notion of education as a human right was reaffirmed at the World Declaration on Education for All held in Thailand, aiming at universal basic schooling by the turn of the millennium.  The abortive target was again outlined in Millennium Development Goal (MDG) number two in 2000, aiming at a full course of primary schooling for all children by 2015.  Five years later, 90 countries failed to reach the MDG of gender parity in primary and secondary education, 80 million children remained out of school, and less than 10% of the requisite annual donations were provided for universal primary education.  Progress reports continue to reveal that the International Development Targets (IDTs) on education - as on health - will be missed by a wide margin if current trends continue.

Read more - Education: key facts and resources


The crisis of shelter is no less foreboding.  As the majority of humanity leaves its rural past behind to live in towns and cities from 2008, one out of three of these people - about one sixth of the world population - live in overcrowded, poorly sanitised and poverty-stricken slums, with over 90 percent of them in the developing world.  Despite the modest and vague MDG of achieving "a significant improvement in the lives of at least 100 million slum dwellers by 2020", UN-HABITAT predicts that an additional 400 million people will then be living in slums.  If no serious action is taken, the number of slum dwellers worldwide is projected to rise to about 2 billion over the next 30 years.  Regardless of the prospect of terrorist slum militias and informal urban warfare in the burgeoning slums of Third World megacities, the future implications spell previously unimagined inequalities and segregations both within and between densely overpopulated urban centres.

International pledges from wealthy nations to address these connected crises are further contradicted by development priorities over the past three decades.  Since Structural Adjustment Programmes (SAPs) were introduced by the World Bank to most developing countries from 1980 onwards, the enforced prioritising of loan repayments over public welfare expenditure resulted in a 50 percent reduction in healthcare spending for the 42 poorest countries in Africa during the 1980s.  Many developing countries, including former communist countries trying to undergo rapid economic reform after the Cold War, spent more on debt servicing than education, with some campaigners like Oxfam going as far as saying that IMF policies effectively denied children an education.  The neoliberal policies of agricultural deregulation and financial discipline enforced by the IMF and World Bank continue to impoverish rural communities as a result of competitive global markets, to deteriorate local safety nets as a consequence of privatisation, and to generate an exodus of surplus rural labour who are driven into mushrooming cities.

Read more - Shelter: key facts and resources

Human Costs and Human Rights

The human costs of neoliberal economic policies are by no means confined to the poorest countries.  North America, the wealthiest and most corporatized region of the world, now spawns informal settlements that are virtually identical to the peripheral slums in any Latin American city.  The number of homeless people across the USA meanwhile continues to rise, the education system is widely criticised as a hugely profitable business increasingly infiltrated by commercial interests, and the privatised healthcare system in America has become a subject of massive popular dissent, with an estimated 18,000 people who die each year because they lack health coverage.

The differences in health, education and housing provision between the richest and poorest countries, however, could not be sharper in contradistinction.  Today, the richest 15 percent of the world consumes over 90 percent of its pharmaceuticals, leaving 85% of world consumers underserved or without access to essential medicine.  Although equity in the access to education is hotly disputed in the richest nations, only 17 percent of girls in sub-Saharan Africa go to secondary school, and the overwhelming majority of world illiterates reside in developing countries. As for the idealised provision of adequate shelter, the million-strong shanty towns and mega-slums of cities like Dakar, Nairobi or Mumbai are incomparable in squalor to even the precedents of nineteenth- and early-twentieth-century Europe and North America.

A valuable policy framework in the provision of these basic human rights can be drawn from the impartial, often impassioned and critical voices employed as Special Rapporteurs by the United Nations. If the universal rights to education, health and an adequate standard of living "as a common standard of achievement for all peoples and all nations" are to be finally realised, an enormous shift in global priorities is clearly essential.  The first step on this long road of reform requires a foremost acknowledgement by the international community that the path of commercialisation, wholesale privatisation and an over-reliance on market forces has failed to provide these basic needs over the past 30 years, and remains an unsustainable barrier to their universal achievement.