World Bank Health Article

WORLD BANK

Ensuring adequate levels of basic health and nutrition lies at the heart of poverty reduction and economic development, which are the cornerstones of the World Bank's mission. While much of the world has experienced notable health gains, the health, nutrition, and population challenges for most developing countries remain great in the twenty-first century:

• Six communicable diseases—HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome), malaria, tuberculosis, measles, diarrheal disease, and acute respiratory infection—account for more than half of the global communicable disease burden.
• HIV/AIDS threatens the future progress of many countries, particularly in Africa where health care systems are stretched beyond their limits.
• Two million children die each year from vaccine-preventable diseases, and over half of the child mortality in low-income countries is linked to malnutrition.
• Cancer, heart disease, and injuries represent a growing proportion of the disease burden in many countries, and tobacco-related illness and death threaten more people, particularly women and young people.
• More than 500,000 maternal deaths occur each year, and more than one-third of all pregnancies are believed to be unwanted or mistimed.
• Environmental degradation poses a serious threat to health in much of the world, and the ability of populations to fight poverty and improve well-being.

Addressing these challenges requires approaches which transcend regional or organizational boundaries and embrace the active participation of communities. Together with sustained improvements in education (particularly for girls), the environment, and the availability of roads and safe water supplies, better health care can be achieved.

The World Bank's objectives for its work in health, nutrition, and population (HNP) are to assist countries in improving the HNP outcomes of poor people and protecting the population from the impoverishing effects of illness, malnutrition, and high fertility; enhancing the performance of health care systems; and securing sustainable health care financing.

The bank works together with countries in achieving these objectives in several complementary ways. First, the World Bank is the single largest source of HNP financing for developing countries. From 1970 through 2000, the bank has offered $16 billion in loans to more than one hundred countries. Second, the World Bank provides technical and policy advice on a wide range of topics in HNP, from health-system reform to maternal and child health and nutrition. The bank also supports governments in the formulation of poverty-reduction strategies that stress the role of human capital in general, and health status in particular, in fighting poverty. Third, the bank mobilizes and maintains partnerships with countries, nongovernmental organizations (NGOs), private enterprises, bilateral donors, foundations, and other agencies. Fourth, knowledge management and sharing, including dissemination of the bank's analytical work, are also critical.

The bank's work in health emphasizes the interconnectedness between ill health and poverty. Recent work has supported improvements in the equity and efficiency of health systems through changing how health care providers are paid, how resources are allocated, and engaging private providers in publicly funded service provisions. Support is also directed towards upgrading infrastructure and equipment, training health personnel, and strengthening policymaking and capacity building.

In public health, the bank focuses on five priority areas: HIV/AIDS, malaria, tuberculosis, maternal/child health and nutrition, and tobacco control. Recent work in the economics of tobacco control is helping to demonstrate to governments that taxation, together with other measures such as advertising bans, can significantly reduce smoking and save lives without permanent negative effects on the economy. Support for immunization programs continues to expand through the bank's partnership with the Global Alliance for Vaccines and Immunization.

Recognizing that malnutrition takes an enormous toll on health and well-being, the bank committed about $2 billion to support nutrition activities from 1976 through 2000. The multisectoral approach adopted in these activities encompasses community-and school-based programs, with an emphasis on communication for behavior change, food fortification programs, and food policy reforms.

From 1970 through 2000, the bank supported more than 239 population and reproductive health projects in 87 countries. These activities help to address the impoverishing effects of unplanned pregnancy and maternal mortality, and to ensure that the vital needs of women, children, and adolescents are met. The bank's work links population policy with poverty reduction and human development through an approach which integrates family planning, maternal health, and the prevention and treatment of sexually transmitted infections, including HIV/AIDS.

SABRINA HUFFMAN

(SEE ALSO: Family Planning Behavior; HIV/AIDS; International Development of Public Health; International Nongovernmental Organizations; Maternal and Child Health; Poverty; Reproduction)

BIBLIOGRAPHY

World Bank (2001). World Development Report 2000–2001: Attacking Poverty. New York: Oxford University Press.

—— (2001). The World Bank Annual Report 2000. Washington, DC: Author

World Bank Group (1997). Health, Nutrition, and Population Sector Strategy Paper. Washington, DC: Author.