Investing in health is a crucial and indispensibe part of human resources development. However, many people in the ESCAP region suffer from poor health as a result of social conditions, including customary attitudes, harmful traditional practices and in some cases by their own actions. Poor health is often caused by the lack of a healthy environment, the absence of information, awareness and support systems which promote healthy behaviour patterns in everyday life, and inadequate health services.

In a poor health environment, the risk of infectious, parasitic and water-borne diseases, as well as diarrhoea, is often high because of the use of unpotable water and very low standards of hygiene and awareness. In South Asia, an estimated 280 million people lack access to safe water, while more than 800 million people have no access to basic sanitation. Even more important than the overall status of adequate provision of safe water and a sanitary environment, is the acuteness of the rural-urban gap in that regard. In South-East Asia and the Pacific, access to safe water and basic sanitation in rural areas is 47 per cent and 38 per cent respectively, which is only two-thirds of urban access. While 84 per cent of the people in urban areas of Papua New Guinea and China have access to safe water, only 17 per cent and 56 per cent respectively of their rural counterparts have access to similar services. Statistics on access to adequate sanitation in China and Papua New Guinea indicate an even sharper contrast, with 74 per cent and 82 per cent respectively of the urban population having such facilities, compared with only 11 per cent and 7 per cent respectively of the rural population (see table).

The gender implication of a healthy environment is also important. Malnourishment is still an issue in some countries of the region. In South Asia, some 300 million people do not have enough to eat. In South-East Asia and the Pacific, more than a third of the children under five are malnourished, creating a situation which has a serious impact on the health status of youth. Girl children tend to be underfed more than boys in some countries, which leads to severe effects on the health of young women in their reproductive period. Poor maternal health and inappropriate birth-spacing have implications, both for mothers and children. In South Asia, about 80 per cent of pregnant women suffer from anaemia, the highest rate in the world.

Also, about a third of all newborn babies in that subregion are underweight. One of the main reasons for the high incidence of difficult births and anaemia in women is poor nutrition and the excessive workload women and girls are made to bear from early childhood. In fact, South Asia is the only subregion of the world where, in such countries as Bangladesh, Maldives and Nepal, the female life expectancy rate is shorter than that for males, and where there are noticeably fewer women per 100 men, defying the natural sex ratio. It should be noted, however, that the health issues of women are not limited to the South Asian subregion.

The maternal mortality rate in South-East Asia and the Pacific, at 295 per 100,000 live births, is more than three times higher than that in East Asia, at 92 per 100,000 live births. Early marriages and teenage pregnancies, which have continued to flourish despite legislation to the contrary in some countries, have contributed to this problem.

Poor health is often caused by lack of information. The growing consumption of tobacco, alcohol and drugs, unwarranted risk-taking and destructive activity, resulting in unintentional injuries, are often the result of a lack of awareness.

Further, in many countries of the ESCAP region, the reproductive health needs of adolescents have been largely ignored despite the fact that many women marry during the early stage of their adolescence. Countries in which the average age of first marriage for women is below 20 years include Bangladesh (16.7 years), Afghanistan (17.8 years), Nepal (17.9 years), India (18.7 years), the Islamic Republic of Iran (19.7 years) and Pakistan (19.8 years). In fact, 44 per cent of the young women in the South Asian subregion will be married before reaching the age of 19. Yet, at present, there is a lack of information and services for helping adolescents to understand their sexuality, including sexual and reproductive health, and for protecting them from unwanted pregnancies, sexually transmitted diseases including the human immunodeficiency virus/acquired immunity deficiency syndrome (HIV/AIDS).

Again, the gender implication of reproductive needs must receive due attention, because the fact that women have little say in defining the terms of sexual relationships in most Asian and Pacific societies largely determines the victims in that regard. According to UNDP, more than two million people have been infected with HIV in the East and South-East Asian subregions. According to the World Health Organization (WHO), the HIV epidemic is spreading at a rate of over 6,000 new infections per day in the world; in many countries, 60 per cent of the new infections are found among young people aged between 15 and 24. Young women are twice as likely to be on this list as compared with men. The group that is most vulnerable in terms of absolute numbers comprises single-partner married women who are exposed to infection by sexually promiscuous husbands. Also among the most affected by the HIV/AIDS crisis, and at the receiving end of many sexually transmitted diseases, are prostitutes who often lack adequate health protection. In addition, the incidence of unwanted pregnancies is still very high in the region, suggesting among other factors, the inadequate access of women to education about reproductive choices and to family planning services, or the lack of control over their reproductive roles in an unequal sexual partnership.

While many countries of the region have made significant advances in the provision of health care services, marked inadequacies remain. Many countries continue to suffer from inadequate medical services, with distribution heavily skewed in favour of urban areas. In Pakistan, 99 per cent of the urban population has access to health services, compared with 35 per cent of the rural population. In Myanmar, the ratio is 100 per cent and 47 per cent for the urban and rural population, respectively (see table).

Finally, it should be noted that access to health services is generally skewed in favour of men; consequently, poor rural women are the most neglected of all groups. General and maternal health care and the treatment of complications resulting from pregnancy and childbirth-related problems are still highly inadequate in many countries. Facilities for the treatment of infections, toxaemia and haemorrhage, which are the major causes of maternal mortality, are generally inadequate in many countries.

1997-2001 United Nations ESCAP.