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Reducing global inequalities in child health
  1. A Costelloa,
  2. H Whiteb
  1. aCentre for International Child Health, Institute of Child Health, University College London, 30 Guilford St, London WC1N 1EH UK, bInstitute for Development Studies, Sussex, UK
  1. Dr Costelloa.costello{at}

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Since 1950, global poverty and child mortality rates have declined more rapidly than during any other period in history. Progress has been uneven, however, so that inequalities have widened; since the 1970s, an increasing number of countries have experienced periods of prolonged economic decline. Eighty countries now have per capita incomes lower than in 1990. Partly in consequence, indicators of maternal and child health and nutrition have remained static or deteriorated.1

Poverty and health trends

Poverty is multidimensional. While poverty has traditionally been seen as a lack of income, and poor health and education as correlates of low income, it is now recognised that illiteracy, child death, and lack of human rights indicate poverty in their own right. These different dimensions of poverty are correlated with one another, although imperfectly so. These correlations are not merely statistical; the various dimensions reinforce one another to create poverty traps. For example, a person or family on low income is more likely to suffer permanent disability or to be forced into destitution by illness.


Data on global trends in income poverty are published by the World Bank, using poverty lines of $1 and $2 a day. Data are adjusted for “purchasing power parity” (PPP), which reflects the fact that a dollar will buy more (when converted at the official exchange rate) in, say, Dar-es-Salaam than New York (see table 1). The proportion of the developing world population living in poverty has fallen slightly in the mid 1990s to reach just under one quarter. But there are large regional variations—a sustained fall in east Asia, and the largest relative rise in the former communist countries. In absolute terms, the numbers of the poor have risen in all regions other than east Asia and the Middle East/North Africa, the largest absolute rise being in sub-Saharan Africa, where nearly …

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