Chapter 3
Poverty in Underdeveloped Countries—The Poorest of the Poor

Underdeveloped countries are at the very bottom of the global economy, with widespread extreme poverty and dire living conditions. They usually have little or no infrastructure or reliable health care and other social services. Many have experienced long-term political unrest in the form of civil war or armed conflict with other nations, or have been subject to unstable governments, dictatorships, and/or corruption. In addition, they may frequently suffer environmental events and natural disasters that cause famine, destruction, and displacement of large segments of their populations.

THE UNITED NATIONS' LIST OF LEAST DEVELOPED COUNTRIES

Many scholars and researchers refer to nations whose economies are almost completely lacking in industry and technology as "least developed countries" (LDCs). That term has a specific meaning according to the Economic and Social Council of the United Nations (UN), which maintains a list of countries it considers to be "least developed" according to whether they meet certain criteria:

• A low-income criterion, based on a three-year average per capita estimate of the gross national income (under $750 for inclusion on the list, above $900 to be removed from the list)
• A human resource weakness criterion, involving a composite Human Assets Index (HAI) based on indicators of nutrition, health, education, and adult literacy
• An economic vulnerability criterion, involving a composite Economic Vulnerability Index (EVI) based on indicators of the instability of agricultural production; the instability of exports of goods and services; the economic importance of nontraditional activities (the share of manufacturing and modern services in gross domestic product); merchandise export concentration and the handicap of economic smallness (as measured through the population in logarithm); and the percentage of population displaced by natural disasters

Of the UN's list of least developed countries (LDCs) in 2006, thirty-four are in Africa, fourteen are in Asia and the Pacific, one is in the Caribbean/Latin America, and one is in the Arab states of the Middle East (http://www.un.org/special-rep/ohrlls/ldc/list.htm). Because the list automatically excludes very large economies—which necessarily have certain advantages over smaller econo-mies—not all countries where large percentages of the population are extremely poor are represented on the list. (Africa is notable as a continent with many large economies that is nonetheless almost uniformly underdeveloped and impoverished.) The list is maintained and reviewed every three years by the Economic and Social Council. To be removed from the list a country must meet at least two of the criteria for two three-year reviews in a row. As of January 2006, Cape Verde, the Maldives, and Samoa were all under consideration for removal from the list.

AFRICA: THE POOREST CONTINENT

Africa is the second-largest continent on the planet (after Asia) in both land area and population—with more than 800 million people living in fifty-four countries. With a total land area of more than eleven million square miles, Africa accounts for 20% of the land on the planet; its population accounts for one-seventh of the population of earth.

Africa is typically discussed as two distinct regions: northern Africa—the area north of the Sahara Desert that is inhabited mostly by Arabic-speaking people whose ancestors come from the Middle East—and sub-Saharan Africa, the area south of the desert, in which many different tribes and nationalities live. These designations are not, however, absolutely definitive because political regional definitions differ from geographical regional definitions. For example, while the United Nations lists just seven territories as North African (Algeria, Egypt, Libya, Morocco, Sudan, Tunisia, and the Moroccan-occupied Western Sahara), geographically the Azores, Mauritania, Mali, Niger, Chad, Ethiopia, Eritrea, and Djibouti also are sometimes considered part of the North. Some commentators prefer the term "tropical Africa" to "sub-Saharan Africa," but others note that this excludes the country of South Africa, which falls outside the tropical zone. Regardless of political or geographic designation, however, Africa suffers from the overall highest rate of poverty in the world. Of the continent's fifty-four countries, thirty-four—all typically considered to be part of sub-Saharan Africa—are on the UN's list of least developed countries.

Colonialism and Slavery

Africa is unique in that, between the fifteenth and twentieth centuries, a great number of its native inhabitants were enslaved and shipped to other countries and almost the entire continent was colonized by outsiders. In simple terms, colonialism is when representatives of a wealthy country move to an underdeveloped country and set up a branch of their homeland government to rule over the indigenous people, usually profiting from the natural resources and local labor. Often the indigenous people are enslaved; almost always they are exploited and discriminated against. Even when a colonial government is successfully overthrown or voted out of power, poverty and injustice are often so deeply ingrained that liberated countries do not recover from their years as colonies. In the case of Africa—a continent with abundant natural resources such as gold, oil, and diamonds—the worldwide slave trade that relied on labor from the continent lasted for centuries, dispersing millions of native Africans all over the world, and even after the abolishment of slavery and the dismantling of the colonial system, the continent continued to be plagued by war and chronic poverty.

In the late fifteenth century, European slave traders, led by the Spanish and the Portuguese, began importing slaves from Africa. With the colonization of North and South America beginning in the 1500s and 1600s, the African slave trade increased dramatically, and within a century, many countries in Europe as well as North and South America were importing African slaves. The United States in particular relied on slave labor to fuel its southern farming economy. Native Africans were also forced into labor in Africa itself, to work in the burgeoning industries that exploited Africa's natural resources. Estimates vary, but it is believed that at least twenty-eight million Africans were kidnapped and enslaved.

At the same time, the European nations were colonizing African lands, and by the time World War I began in 1914, virtually all of Africa was occupied. The colonizers sought to make native Africans easier to rule by turning native groups against each other, deliberately inflaming old conflicts and creating inter-tribal strife, which later exploded into war and genocide.

By the turn of the twentieth century, public opinion abroad had begun to turn against colonialism, and a move toward independence gained strength in the 1920s and 1930s as descendants of slaves helped raise awareness of the injustices of foreign occupation in Africa. Anticolonialism increased within Africa as well, with frequent strikes and public protests that often ended in violence. In some countries the battle for independence was led by guerilla fighters, while protesters in other countries were inspired by the nonviolent resistance methods of Indian leader Mohandas Gandhi, who had led his country to independence from British rule in 1947. Most African nations had gained their independence by either peaceful or violent means by the late 1960s.

Cold War Politics

Sadly, the overthrow of the colonial governments did not guarantee a just society for native Africans. The rise of the United States and the Soviet Union as world powers resulted in a state of "neocolonialism," in which the two nations vied to secure allies during the cold war. Agents of both governments—including the Central Intelligence Agency (CIA) of the United States and the Komitet Gosudarstvennoy Bezopasnosti (KGB; "State Security Committee") of the Soviet Union—colluded with African political factions that had little interest in creating just and prosperous societies. The U.S. operatives were more successful than the Soviets in creating allies: helping to overthrow fledgling African governments that were based on Communist principles, the CIA supported the ascent of harsh dictators who would serve U.S. interests. Many of these leaders managed to amass great personal wealth while driving their own countries into economic ruin and further encouraging ethnic violence.

Ongoing Violence

Even after the end of the cold war, the continent was plagued by violence among ethnic groups. Especially noteworthy is the Rwandan genocide of 1994. During that conflict, ethnic tensions between the majority Hutus and minority Tutsis led to civil war and mass killings in which an estimated 800,000 people were slaughtered in just 100 days ("Rwanda: How the Genocide Happened," BBC News Online, April 1, 2004).

Violence in the vast Democratic Republic of Congo (DRC; formerly called Zaire) dates back to the country's independence in 1960. In the late 1990s Rwanda invaded the DRC in search of Hutu extremists in hiding; this ignited a rebellion that eventually involved Uganda, Angola, Namibia, and Zimbabwe, as well as Rwanda and the DRC. In 2003 the war ended in a tentative peace agreement, but not before three million Congolese had died either in the conflict or from the disease and malnutrition that followed its wake.

The East African country of Sudan has been in a near-constant state of civil war since about 1955. In 2003 tensions erupted in country's Darfur region between rebel fighters and the military government. Hostilities between black Arabs and non-Arabs, as well as between cattle herders and farmers fighting for scarce land and resources, turned into attacks on civilians that have been compared to the genocide in Rwanda. Hundreds of thousands of people have been murdered and about two million driven into exile. Hundreds of thousands more are expected to die of starvation because of the conflict.

Many other examples of conflict in Africa exist, such as the anarchy in Somalia, the tensions between Eritrea and Ethiopia, and rebel movements in scores of other countries. What all of these conflicts have in common is that they drain the nations involved of precious human, financial, and natural resources, weakening their societies and deepening their poverty.

THE POOR IN AFRICA

The United Nations tracks trends in poverty worldwide using its Human Development Index (HDI; see Chapter 1), which measures overall well-being in underdeveloped and developing countries. In its Human Development Report 2005, the UN indicated that the HDI has risen since the 1990s in almost all developing and underdeveloped areas of the world but two: the Russian Federation and sub-Saharan Africa. (See Figure 3.1 and Table 3.1.) As Table 3.1 shows, thirteen of the eighteen countries that have experienced significant reversals in their HDIs since 1990 are in sub-Saharan Africa. According to the UN, the African countries that experienced the sharpest declines in their HDI rankings between 1990 and 2003 are South Africa, with a drop of thirty-five places; Zimbabwe, with a drop of twenty-three places; and Botswana, with a drop of twenty-one places. The main indicators on the human development index include life expectancy and health, literacy and educational attainment, and income.

LIFE EXPECTANCY AND HEALTH

According to the UN's Human Development Report 2005, life expectancy has fallen dramatically in the countries of sub-Saharan Africa since 1990, when it saw a brief increase. This is due largely to the spread of the human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) on the continent. The UN's Human Development Report 2005 estimates that, of the three million people worldwide who died of AIDS in 2004, 70% were in Africa. Of the thirty-eight million total people infected with HIV, 25.8 million live in sub-Saharan Africa. In a press release at the XV International Conference on AIDS (July 14, 2004), the UN reported that in Zambia, a country in southern Africa with a total population of 10.4 million people, 16.5% of adults ages fifteen to forty-nine were infected with HIV or AIDS, and life expectancy had dropped from 47.4 years in 1990 to 32.7 years in 2004. In Zimbabwe 25% of adults among the country's million people were HIV-positive, and life expectancy dropped from 56.6 years in 1990 to 33.9 years in 2002. Life expectancy in Swaziland, a small country bordering South Africa, dropped from 55.3 years in 1990 to 35.7 years in 2002; 38.8% of adults in Swaziland—with a total population of 1.1 million people—were HIV-positive in 2004. Human Development Report 2005 noted that chances of survival for a person born in sub-Saharan Africa between 2000 and 2005 are not much better than those of individuals living in England and Wales during the 1840s.

According to the AIDS Epidemic Update, December 2005, published jointly by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO), AIDS in Africa cannot properly be called a single epidemic. Rather, each region and country has experienced its own trends in HIV/AIDS infection. Countries in southern Africa, for example, are considered the "epicenter" of the global epidemic. The report notes, however, that the epidemics in Zimbabwe, Kenya, and Uganda have, for the first time, shown signs of slowing down. Surveys have shown that the prevalence of HIV infection among pregnant women in Zimbabwe has fallen from 26% in 2002 to 21% in 2004. In the late 1990s HIV rates among adults in Kenya were as high as 10%; by 2003 the rate had dropped to 7%. In Uganda, which has experienced the most success among African countries in lowering rates of HIV/AIDS infection, 15% of the adult population was infected in the early 1990s; 2004 surveys found that the rate had dropped to 7%, although in some regions of the country surveys suggested that rates were rising among fifteen- to twenty-four-year-olds. In all three countries that have seen a decreasing rate of infection, there is strong evidence to suggest that changes in sexual behavior are the cause of the drops in rates—most notably, an increase in condom use.

While AIDS is certainly the most notable factor contributing to Africa's low life expectancy, it is not the only disease that takes millions of African lives a year and threatens the continent's economic stability. Preventable disease is both a cause and a result of poverty. Unable to afford simple prevention, families often lose their primary breadwinner to these diseases, leaving them even deeper in poverty. Additionally, violent conflict has made Africa one of the most dangerous places on earth. Warfare that has become a routine part of life for Africans in many countries leads to malnutrition and outbreaks of disease, which sometimes kill more people than the violence itself. (See Figure 3.2.)

Malaria, a highly infectious but preventable disease that is spread through tropical regions by mosquitoes, is perhaps the most prominent example of this. According the World Health Organization (WHO), malaria costs Africa about $12 billion each year in lost gross domestic product and accounts for 40% of public health expenditures. Countries with high rates of malarial infection are known to have significantly lower GDP, slower rates of economic growth, and higher rates of poverty than those without. In the case of sub-Saharan Africa, the disease has had a significant impact on labor force participation and school attendance; children who suffer from repeat infections often develop permanent neurological damage that cuts short their education and hampers their ability to participate fully in the labor force as adults.

In the early twenty-first century poverty researchers began to recognize malaria's role in increasing impoverishment at the micro (family and community) level and diminishing economic advancement at the macro (national and global) level in countries prone to epidemics of the disease. Aside from the obvious difficulties facing poor families who cannot afford treatment or prevention, the wider effects of frequent epidemics include impeded market activity and tourism industries as traders and potential tourists avoid areas with heavy infection rates. Even agricultural trends can shift with malaria rates; farmers dependent on the availability of workers during harvest seasons will be less likely to plant labor-intensive cash crops, instead relying on subsistence crops.

According to the World Malaria Report 2005, published by the Roll Back Malaria (RBM) campaign—a global partnership of the World Health Organization, UNICEF (United Nations Children's Fund), the World Bank, and the United Nations Development Program—66% of the total population of Africa is at risk of developing malaria. There are as many as twelve million cases of malaria reported every year in Africa, more than a million of them fatal in 2002; about 90% of all deaths from malaria worldwide occur in Africa. Children are particularly vulnerable to the disease. In those under age five, nearly 20% of all deaths in sub-Saharan Africa are directly attributable to malaria. Considerably more are believed to be indirectly related to the disease because repeated malarial infections can lead to severe anemia, which in turn makes children more susceptible to other illnesses. Additionally, infection of pregnant women raises the rate of infant mortality because it can cause low birth weight and other complications.

The WHO reports that malaria is particularly common in sub-Saharan Africa because of the prevalence of plasmodium falciparum (http://www.rbm.who.int/cmc_upload/0/000/015/370/RBMInfosheet_3.htm)—the most deadly strain of the disease—and of the species of mosquito most likely to spread the disease. In addition, the infection's resistance to the most effective and affordable antimalarial drug, chloroquine, is high in African countries, and resistance to the second most commonly used drug, sulfadoxine-pyrimethamine, is growing. More effective drugs are available, but they are prohibitively expensive.

Prevention of malaria is relatively simple. The most effective way to prevent its spread is the use of insecticide-treated mosquito nets (ITNs) draped over beds at night, when most disease-carrying mosquitoes bite. Early trials of the nets in the 1980s and 1990s showed that they could help reduce malaria-related deaths in children by 20%. Unfortunately, the RBM campaign has found that there are two ongoing problems with the use of ITNs. First, the nets and the materials used to make them have been subject to high taxes and import tariffs that make them too expensive for most African families to afford. As of 2005, negotiations were underway throughout Africa to reduce or eliminate taxes and tariffs on the nets and the materials used to make them; twenty countries had already done so. Second, WHO studies have shown that, even when ITNs are used routinely, fewer than 5% are regularly retreated with insecticide to continue their effectiveness. The WHO has been working with ITN manufacturers to develop nets that would require less frequent or no re-treating and is encouraging families to participate in community "dipping" events to re-treat their nets at least once a year. Additionally, African governments are instituting public health education campaigns to promote the use of ITNs.

In June 2005 U.S. President George W. Bush announced plans for a $1.7 billion aid package for Africa, $1.2 billion of which was to go to combating malaria infection (Peter Baker, "Bush Pledges $1.2 Billion for Africa to Fight Malaria," Washington Post, July 1, 2005). Scheduled to be distributed over five years, the money would be used for insecticide spraying, stronger combination drug therapies, and longer-lasting ITNs. In June 2006 R. Timothy Ziemer was named U.S. Malaria Coordinator for the President's Malaria Initiative to oversee all malaria programs and policy at USAID, the U.S. government foreign aid agency.

In October 2005 the Bill and Melinda Gates Foundation announced it would donate $258.3 million to fund research on malaria—$107.6 million toward developing a vaccine, $100 million for new treatment drugs, and $50.7 million for ITNs and other forms of mosquito control (http://www.gatesfoundation.org/globalhealth/pri_diseases/malaria/announcements/announce-051030.htm). In November 2005 the Gates Foundation, which was founded by Microsoft pioneer Bill Gates and his wife, Melinda, helped organize a project to combat the disease in Zambia, donating another $35 million. Zambia, where 30,000 people die annually of the disease, had already begun waging a somewhat successful campaign to cut malaria-related deaths. Money from the Gates Foundation will be used to step up the campaign, in the hopes of providing effective protection for 80% of Zambia's population ("A Model Fight against Malaria," New York Times, November 22, 2005).

Literacy and Education

According to the Millennium Development Goals Report 2005 (United Nations, http://unstats.un.org/unsd/mi/pdf/MDG%20Book.pdf), 42% of children in sub-Saharan Africa did not attend school in 2001. The United Nations Educational, Scientific, and Cultural Organization (UNESCO) reported in EFA Global Monitoring Report 2006: Literacy for Life. Regional Overview: Sub-Saharan Africa that in more than half of the countries in the region only about 6% of children were enrolled in preprimary education during 2002; on average, 63% of children were enrolled in primary school; an average of 28% of children were enrolled in secondary school. Children in sub-Saharan Africa spend an average of 7.8 years in school (versus an average of twelve years in developed countries); of those who enroll in school, fewer than 60% complete their education.

The prevalence of disease—particularly HIV/AIDS—takes an especially heavy toll on school-age children in sub-Saharan Africa. Along with the many children who must leave school because they suffer from such diseases as HIV and malaria, many others are indirectly affected; the UN reports that in 1999 almost one million children in the sub-Saharan region lost teachers to AIDS. The likelihood of qualified teachers becoming available quickly to take the place of the millions who have died of AIDS is small. Carole Palma, acting director of USAID, projected in October 2004 that 15% to 20% of teachers in the sub-Saharan region would have died of AIDS by 2005. Moreover, children whose parents or other family members become ill with or die from diseases such as AIDS usually must leave school, either to care for the sick relative or to go to work to support the family. At the broader level, the African educational system overall suffers from a lack of funding because of the drain of AIDS on public monies and human resources.

The persistent military conflicts in many African countries also make it nearly impossible for many children, particularly those living in rural areas, to attend school, even if schools still exist. Decades of political, economic, and social turmoil have decimated the educational sector on the continent. Schools have been destroyed; students and teachers have been killed; teaching materials and supplies are virtually nonexistent. For many children merely walking to school can be deadly; as of 2001 there were an estimated nine to fifteen million land mines in Angola and more than two million in Mozambique, as well as an unknown number newly laid along the border of Eritrea and Ethiopia ("Reconstruction from War in Africa: Communities, Entrepreneurs, and States," CSAE Conference 2001: Development Policy in Africa—Public and Private Perspectives, Center for the Study of African Economies, University of Oxford, March 29-31, 2001).

The EFA Global Monitoring Report 2006: Literacy for Life. Regional Overview: Sub-Saharan Africa reports that rates of adult literacy in Africa range from below 40% in Benin, Burkina Faso, Chad, Mali, Niger, Senegal, and Sierra Leone to more than 90% in Seychelles and Zimbabwe. Only South and West Asia have a lower literacy rate than sub-Saharan Africa. (See Table 3.2.) According to UNESCO, 140.5 million adults in sub-Saharan Africa are illiterate. Countries with the highest rates of poverty have correspondingly high rates of illiteracy; similarly, the larger a country's rural population is, the higher its rate of illiteracy will be.

Not all of the news about Africa's educational sector is bad, however. In the early twenty-first century some countries have seen marked improvements in access to education and literacy among children. In Zambia, for example, a Primary Reading Program was instituted in 1998 to increase literacy at all grade levels by focusing on reading and writing activities in grades one through seven. Within a year, the literacy rate of children in primary schools—87% of which are located in rural areas—rose 64% (Francis K. Sampa, "Zambia's Primary Reading Program [PRP]: Improving Access and Quality Education in Basic Schools," Association for the Development of Education in Africa, 2005). One of the main goals of the program, and of Zambia's Ministry of Education overall, has been to provide free education for all, including girls, rural and poor children, special needs children, and orphans. The Primary Reading Program also includes texts about HIV/AIDS and other social issues in its materials for school children.

In Nigeria there are an estimated 9.3 million nomads, 3.1 million of them children. Only about 0.2% to 2% of Nigerian nomads—most of whom earn their living herding sheep and fishing—are literate (Gidado Tahir et al., "Improving the Quality of Nomadic Education in Nigeria: Going beyond Access and Equity," Association for the Development of Education in Africa, 2005). Nomadic people have a difficult time sending their children to school consistently for several reasons: they relocate frequently to find grazing and water for their livestock and to find more available fish; children are an essential source of labor, which makes adults reluctant to send them to school; the rigid time schedules of traditional schools do not account for the nomadic lifestyle; nomads often live in inaccessible areas where terrain is difficult to navigate; and, in Nigeria, a land tenure system often prohibits nomadic people from acquiring permanent settlement land. In response to these problems, the Federal Ministry of Education of Nigeria developed the Nomadic Education Program (NEP), under the direction of the National Commission for Nomadic Education (NCNE), established in 1989. Key components of the NEP include developing a curriculum that is relevant to the experience of nomadic children, who are generally regarded as living outside the mainstream in almost every way; educating nomadic parents and adults about the importance of schooling for their children; and creating flexible, "moveable" schools that take into account the nomads' seasonal relocations. The case study "Access to Basic Education: A Focus on Nomadic Populations of Nigeria" presented at the 1999 biennial meeting of the Association for the Development of Education in Africa found that, in the ten years since the creation of the NCNE, total school enrollment among nomadic children rose from 18,831 in 1990 to 155,786 in 1998. The number of nomadic schools rose from 329 in 1990 to 1,098 in 1997. Gender parity in schools (the ratio of girls to boys attending school) rose from 54% in 1990 to 85% in 1998. In addition, the number of nomadic children completing school rose from 2,077 in 1994 to 7,632 in 1998. According to the NCNE, by 2002, 229,944 nomadic children were enrolled in school.

Economic Well-being in Africa

In its World Development Report 2006: Equity and Development, the World Bank notes:

An individual's consumption, his or her income, or his or her wealth have all been used as indicators of the command of an individual over goods and services that can be purchased in the market and that contribute directly to well-being. It is clear too, that individuals' economic status can determine and shape in many ways the opportunities they face to improve their situations. Economic well-being can also contribute to improved education outcomes and better health care. In turn, good health and good education are typically important determinants of economic status.

The interconnectedness of health, education, and economic status is true in countries around the world. As was discussed above, however, certain circumstances in Africa—the colonial presence, government corruption, the AIDS epidemic—have led to a long and well-documented history of extreme poverty. In the large West African country Mali, for example, the average monthly income in 1994 was $54 a month (less than two dollars a day), whereas the average monthly income for Americans in 1994 was $1,185 a month (World Bank, World Development Report 2006). Poverty researchers agree that it is not merely a coincidence that the people of Mali spend an average of less than two years in school.

According to the World Bank, poverty rates worldwide have declined since the 1980s in almost every region of the world but sub-Saharan Africa, where, in 1981, there were about 160 million people living on less than one dollar a day; by 2001 the number had doubled, to 313 million. In 2003 the region's total unemployment rate for people ages fifteen to twenty-four was 21.1%-18.6% among women and 23% among men. Unemployment in this age group represented 62.8% of sub-Saharan Africa's total jobless rate.

According to the United Nations Development Program's Human Development Index, average annual income for women in sub-Saharan African countries in 2003 ranged from a low of $325 in Sierra Leone to a high of $10,771 in Equatorial Guinea. For men, average annual income in 2003 ranged from $717 in Malawi to $27,053 in Equatorial Guinea. By comparison, men in the United States earned an average of $46,456 in 2003, while U.S. women averaged annual incomes of $29,017 (http://hdr.undp.org/statistics/data/pdf/hdr05_table_25.pdf).

ASIA: THE LARGEST AND MOST POPULOUS CONTINENT

In terms of both land mass and number of people, Asia is the largest continent on earth, with four billion people in approximately fifty countries covering about 17.2 million square miles, including parts of Siberia (North Asia); China, Japan, Taiwan, and the Korean Peninsula (East Asia, or the Far East); the Middle East, including the Arabian Peninsula, the Persian Gulf countries, Armenia, Georgia, Azerbaijan, the Near East countries of Israel, Jordan, Syria, Lebanon, and Iraq, and parts of North Africa (West Asia); India, Pakistan, Nepal, Bhutan, Bangladesh, Sri Lanka, and the Maldives (South Asia, or the Indian Subcontinent); Indonesia, Malaysia, the Philippines, Vietnam, Thailand, Laos, and Cambodia (Southeast Asia); Afghanistan and the Central Asian republics of Kazakhstan, Kyrgyz Republic, Tajikistan, Turkmenistan, and Uzbekistan (Central Asia). Because the borders around Asia have never been permanently defined, experts disagree on the total number of countries on the continent, and even the distinctions outlined here are in dispute. Sometimes, for example, East and Southeast Asia are discussed together as "East Asia and the Pacific."

The continent of Asia is home to two-thirds of the world's people—and almost two-thirds of the world's poor. There are approximately 2,269 distinct living (currently used) languages spoken in Asia—415 of them in India alone—and no fewer than nine major religions were founded and continue to be practiced on the continent. With such geographic, ethnic, and cultural diversity, Asia is a region of immense economic differences, housing at the same time some of the wealthiest people in the world and some of the most startlingly poor, many of whom reside in the fourteen least developed Asian countries.

LEAST DEVELOPED COUNTRIES OF ASIA AND THE PACIFIC

In Voices of the Least Developed Countries of Asia and the Pacific: Achieving the Millennium Development Goals through a Global Partnership (Elsevier, 2005), the United Nations Development Program (UNDP) reported that the least developed Asia/Pacific countries—Afghanistan, Bangladesh, Bhutan, Cambodia, Kiribati, Lao People's Democratic Republic, Maldives, Myanmar, Nepal, Samoa, Solomon Islands, Timor-Leste, Tuvalu, and Vanuatu—together account for 37% of the total population of all LDCs. These countries range in size from Bangladesh, which has 130 million people, to Tuvalu with 11,000. Between 1990 and 2000 Asia/Pacific LDCs saw overall improvement in some areas: average per capita gross domestic product increased, the total adult literacy rate increased from 60% to 71%, life expectancy went from fifty-eight years to sixty-two years, and the infant mortality rate dropped from seventy-seven to fifty-five deaths per 1,000 live births.

While Asia as a whole has experienced much growth and the very large Asian economies of China and India have expanded in the early twenty-first century and reduced their rates of overall poverty, the least developed countries of the Asia/Pacific region are in general not on track to meet the Millennium Development Goals—in particular the first goal of halving extreme poverty by 2015. (See Table 3.3.) According to the UNDP, 22% of the population of developing countries in Asia live on less then one dollar a day, but 38% of the population of Asia/Pacific LDCs live on less than a dollar a day. So although Asia/Pacific least developed countries account for 7% of the total population of the region, they account for 12% of the region's extremely poor. Furthermore, 46.8% of the Asia/Pacific LDC population live below the region's individual country poverty lines. In individual least developed countries in the region, according to UNDP estimates, the national poverty rates range from 34% in Cambodia to 56% in Afghanistan.

As in Asia/Pacific countries such as China and India that are experiencing unprecedented economic growth but a wider poverty gap, least developed countries in the region have seen increasing disparities in income, wealth, and consumption: Cambodia's consumption rose by 18% among the country's wealthiest segment but only 1% among the poorest. However, even among a single economic category of countries in a region, such as the LDCs of Asia/Pacific, great differences exist in levels of poverty and human development indicators.

Afghanistan

About a year after signing the 1978 Treaty of Friendship, Cooperation, and Good Neighborliness with Afghanistan, the Soviet Union invaded the country and deposed the Afghan president, sparking a bloody civil war between Soviet supporters and anticommunist rebels. By the time the Soviets withdrew in 1989, more than five million Afghans had fled to refugee camps in Pakistan and Iran. The civil war, however, continued after the Soviet withdrawal, creating a state of chaos between competing warlords and eventually giving rise in 1996 to the Taliban, an extreme Islamic nationalist movement that stabilized the country to a degree but also controlled nearly every aspect of Afghan citizens' lives. The Taliban were responsible for massive human rights abuses, including torturing and killing thousands of Afghan civilians. Devastating earthquakes hit the country in 1998 and 1999, further displacing tens of thousands of Afghans. When terrorists associated with the Islamic fundamentalist group al-Qaeda struck the United States on September 11, 2001, the U.S. retaliated militarily against the Taliban—and therefore against Afghanistan—for sheltering al-Qaeda leader Osama bin Laden. Afghanistan was again torn by war.

Afghanistan is considered the least developed country in the world. According to the United Nations Development Program's Afghanistan National Human Development Report 2004, more than two decades of near-constant war and natural disasters have left Afghanistan with one of the worst human development indexes (HDI) in the world, at 0.346, ranking 171 out of 177 countries. As a comparison, Norway had the world's highest human development ranking in 2003 at 0.963; the United States ranked tenth at 0.944. Niger, with the lowest HDI in the world, had a score

of 0.281. Afghanistan's gender-related development index (GDI) was 0.300. The gender development index examines basic quality of life but is adjusted for inequalities between men and women. Norway again ranked first in the world, with a GDI rating of 0.960; the United States was eighth at 0.942. Of the 140 countries ranked using the GDI, Niger was again last at 0.271.

Individual poverty indicators are equally low, especially compared with those of Afghanistan's neighboring countries. Per capita gross domestic product in 2002 was $190—the lowest in the region—and only 23% of Afghans have access to safe drinking water. All of the country's poverty indicator numbers were the worst in the region: As indicated in Table 3.4, Afghanistan's per capita GDP was lower, its life expectancy at birth was lower, its infant mortality rate was higher, and its population without access to an improved water source was higher than other countries in the region, than the average of countries with low human development, and than the average of low-income countries.

Because of the constant wartime conditions in Afghanistan, the idea of poverty encompasses more than income and human deprivation as they are discussed in Chapter 1. Overall "human security" includes not only security in the physical sense of safety from armed violence but also security that allows for economic development and even access to safe water, sanitation services, and farmable land. In Human Security and Livelihoods of Rural Afghans, 2002–2003 (June 2004), the Feinstein International Famine Center at Tufts University used data collected by the United Nations Food Program and the Ministry of Rural Rehabilitation and Development's Nationwide Risk and Vulnerability Assessment (NRVA) of 2003, which found that Afghans living in rural provinces who were asked about their physical and economic conditions overwhelmingly reported a lack of access to safe water sources, health care, education, and economic opportunities and said that this lack of essential services posed as much of a threat to their security as the ongoing armed conflict. As in most developing and underdeveloped countries, women and children are the most vulnerable members of Afghan society.

The Tufts study revealed that Afghan people by and large have a very different idea of their country's biggest challenges than do those in the international community:

Rural people throughout Badghis, Herat, Kabul, Kandahar, and Nangarhar provinces defined security as having access to health care, education, employment, clean drinking water, reproductive choices, political participation, good governance, and housing. This conception of security illustrates a marked difference from the understanding of security on the part of the international community (i.e., a lack of armed attacks and fighting). It also more accurately reflects the reality of "security issues" in the lives of rural Afghans.

Regarding the differing perceptions of men and women, the report notes: "In contrast to men's overwhelming concerns regarding physical security, women consistently ranked poverty as their top concern."

Eighty-five percent of Afghans live in rural areas. The UNDP identifies seven critical factors that influence the country's high poverty level in addition to chronic violent conflict:

• Lack of income
• Lack of access to basic necessities
• Social, political, and economic exclusion and isolation
• Lack of marketable skills and exposure to technologies; lack of assets such as tools, livestock, and machinery
• Lack of property ownership rights and access to credit
• Vulnerability to environmental risks, natural disasters, and other poverty risk factors
• Erosion of indigenous cultures, values, and social support networks

HEALTH AND MORTALITY IN AFGHANISTAN

According to the UNDP report, life expectancy in Afghanistan is 44.5 years; healthy life expectancy (the number of years a newborn can expect to live in full health) is just 33.4 years. Afghans live about twenty fewer years than those in their neighboring countries and about 18.7 fewer than the average of South Asia overall. Mortality rates of infants, children, and mothers are some of the highest in the world: UNICEF's State of the World's Children 2006 reports that 257 out every 1,000 children—one out of every five and the fourth worst rate in the world—die before reaching the age of five (85,000 children annually die from diarrhea); and a woman dies of pregnancy-related causes every thirty minutes. An estimated 50% of the population suffers from chronic malnutrition, as do 50% of children under five. Fewer than 15% of pregnant women receive medical attention during labor and delivery; only eleven of the country's thirty-one provinces have obstetric care available, and Afghan women report that the care they do receive is inadequate.

The Afghan population suffers from high rates of malaria infection—an estimated two to three million per year. Afghanistan also has a high number of tuberculosis cases, with 72,000 new cases annually and about 15,000 deaths (at least 12,000 to 13,000 of which are women). Because fewer than 40% of Afghan children receive preventative vaccinations, diseases such as measles and polio—which have been largely eradicated in developed countries—continue to afflict Afghans; there are approximately 35,000 cases of measles every year, and in 2001 the country had eleven cases of polio. (Afghanistan is one of only six countries where polio still exists.) State of the World's Children 2006 reports that 54% of Afghan children under age five suffer from stunted growth, and 39% are moderately or severely underweight. The main causes of death for children under five are diarrhea disease (accounting for 25% of under-five deaths), respiratory tract infections (19%), and measles (16%).

Additionally, the UNDP reports that most Afghans suffer from some degree of mental illness or stress disorder due to the country's almost chronic state of war since 1978. The World Health Organization estimates that as many as one in five Afghans have some form of mental disorder related to stress, including severe anxiety, depression, insomnia, and post-traumatic stress disorder. A large percentage of Afghans is also believed to have serious health problems related to drug use, although exact figures are unavailable. Health officials fear that, as heroin injection increases among drug users, rates of HIV/AIDS and hepatitis infection will also increase, although, again, numbers are not available.

EDUCATION AND LITERACY

As a result of the country's longstanding military engagements, about 80% of its schools have been seriously damaged or destroyed, according to the UNDP. So although Afghanistan's constitution of 1964 guaranteed free and compulsory (required) education for all citizens, by 1999 almost 70% of Afghans (85% of women) were illiterate and its education system was considered one of the worst in the world. In the Tufts study fewer than 10% of women in rural areas reported having attended any school at all. After the American invasion in late 2001 and the subsequent fall of the Taliban, which had outlawed education for girls, pressure from the international community led to the enrollment of nearly four million children in grades one through twelve in 2002—a higher enrollment than the country had ever experienced.

Nonetheless, access to education is limited and schools remain substandard. Most classes are held in tents or the open air, with few materials available. Disparities exist between urban and rural areas as well, with only about one-third of schools located in rural provinces (2,233 out of 6,870 total). In more remote areas schools often are located inside mosques, where girls and women are not allowed. In areas where gender segregation is enforced, schools must either hold separate sessions for girls and boys, or there must be separate schools altogether. With teachers earning only about $30 a month, there is little incentive to work double the hours to educate both boys and girls equally. Many parents continue to resist sending their daughters to school as well because of cultural beliefs. In a country where most girls have no options for higher education or careers, educating them seems like a waste of time and money that could be better spent elsewhere. Additionally, traditional beliefs hold that girls have lesser capabilities and will never have to support their families financially. In 2002 more than twice as many Afghan boys attended school as girls (2,533,272 boys versus 1,171,963 girls).

ACCESS TO NATURAL RESOURCES

The ongoing military conflict in Afghanistan is another example of a cyclical situation that is both a cause and a consequence of poverty. On the one hand, it has caused environmental destruction that prevents many Afghans from earning a good living. On the other hand, because they cannot earn a living wage, Afghans continue to join militias and fight, thus causing more damage to natural resources and preventing other Afghans from getting out of poverty. In addition to the environmental affects of war, Afghanistan has suffered from natural soil erosion and drought, which make agricultural work extremely difficult. A rapidly diminishing water table due to drought and infrastructure mismanagement has made safe water and sanitation rare in Afghanistan.

In fact, water scarcity is considered one of the greatest threats to human development in Afghanistan, according to the UNDP. Wetlands in the country have disappeared, along with the wildlife they housed and the agriculture they supported. Overall, a lack of reliable water supplies has caused widespread loss of income. The UNDP reports that many families reduce their food intake, take out loans, and sell possessions to cope with the inadequate water supply. The quality of water in Afghanistan is also a danger to the poor, causing water-borne illnesses such as cholera outbreaks. Only 8.5% of Afghans had access to indoor piped water in 2003—23.8% of urban residents and 2% of those living in rural areas. The rest of population relied on surface water and wells for drinking, bathing, and cleaning. Sanitation causes equally serious problems for the poor. In six provinces less than 20% of households had access to a flush or pit toilet. Only one province had near 100% toilet access. Open sewers spread communicable diseases that can cause severe illness or death, especially in children.

Access to farmable land also threatens the health and livelihoods of impoverished Afghans. Just 12% of Afghanistan's land can be used as farmland, but about 80% of Afghans rely on farming for food; 85% of the population lives in rural areas. Competition among rural farmers over land and water often leads to outbreaks of violence, and families can become displaced—forced to move to urban areas to survive—when they lose valuable land on which to farm or let their livestock graze, leaving them even more vulnerable to malnutrition and disease. One survey cited by the UNDP found that 37% of Afghan households have become displaced due to the shrinking supply of arable land. Such competition increases both the rate and the depth of poverty by pitting the relatively well off against those who are already poor.

Timor-Leste

While Afghanistan is the world's least developed country in terms of social and human development indicators, Timor-Leste (formerly known as East Timor) is commonly cited as the world's poorest in terms of income poverty. As with many extremely poor countries, Timor-Leste has experienced violent conflict that has in many respects truncated its potential for economic development and kept much of the population in poverty.

A TURBULENT HISTORY

Timor-Leste makes up half of the island of Timor in Oceania, surrounded by the Banda Sea to the north and the Timor Sea to the south. Portugal colonized the island in the mid-sixteenth century, but a treaty in 1859 ceded the western half of the island to the Dutch. During World War II Imperial Japan occupied Timor-Leste, but Japan's defeat in the war in 1945 returned colonial rule to Portugal. A military coup in Portugal in 1974 led to a decolonization process in all of Portugal's territories, including Timor-Leste. In August 1975 the Timorese Democratic Union Party launched a coup, which was followed by a short civil war with the Revolutionary Front for an Independent Timor-Leste. The Democratic Union Party was forced into West Timor (the other half of the island), which was under Indonesian rule. Indonesian forces began entering Timor-Leste in September 1975. In November 1975 the Revolutionary Front declared Timor-Leste an independent state; in December Indonesia launched a full-scale military attack.

Although Indonesia's takeover of Timor-Leste was never recognized by the United Nations, its insistence that the Revolutionary Front was a communist organization incited fear—many Western countries, including the United States, supported Indonesia's brutal regime in Timor-Leste to prevent the spread of communism, even though an estimated 100,000 to 250,000 Timorese died because of the violence and starvation caused by the Indonesian occupation. Finally, in January 1999 the Indonesian government allowed the Timorese to vote to choose between remaining under the rule of Indonesia and establishing an independent state. In August 1999, 75% percent of Timorese voters chose independence, but in September an anti-independence front of militias rampaged through the country, burning three-quarters of the houses and destroying most of the infrastructure, schools, and utility systems. More than a thousand Timorese were killed, a thousand Timorese women raped, and another 250,000 to 300,000 people were forced into West Timor to live as refugees. Late in September peacekeeping forces from Australia entered Timor-Leste to end the violence. In August 2001 the United Nations supervised elections, and in May 2002 Timor-Leste officially became an independent republic recognized by the global community. In April 2005 Indonesia and Timor-Leste signed an agreement to demarcate their borders.

Timor-Leste has continued to experience phases of violence and unrest. According to the Office of the United Nations High Commissioner for Refugees (UNHCR) 2006 "Country Operations Plan" for Timor-Leste (September 1, 2005), further violence is expected during the scheduled 2006 elections.

ECONOMIC CONDITIONS SINCE INDEPENDENCE

Timor-Leste has valuable natural resources, particularly petroleum reserves. However, the political unrest over the second half of the twentieth century caused such disruption in essential services, food production, and livelihoods in general that extreme poverty became the norm. The joint publication by the World Bank, Asian Development Bank, Japanese International Cooperation Agency, United Nations Development Program, UNICEF, United Nations Mission of Support in Timor-Leste, and the Government of Timor-Leste, titled Timor-Leste. Poverty in a New Nation: Analysis for Action (May 2003), reports that in 1999—the year Timorese citizens voted in favor of independence, followed by the violent militia crackdown—Timor-Leste's gross domestic product fell 38.5% and its agricultural output fell 48.4%. In 2000 and 2001 recovery began in earnest, with GDP increasing 15% in 2000 and 18% in 2001, and food production increased 15% in 2000. Reconstruction of roads and residential and commercial buildings also began shortly after the UN-supervised elections—almost 70% of damaged or destroyed houses have been or are being rebuilt. Utilities, however, have not been fully restored: electricity in particular remains unavailable in much of the country, especially rural areas.

As of the publication of the World Bank's joint report in 2003, the poverty line in Timor-Leste was US$15.44 per capita a month, or about fifty cents per day. Just less than 40% of the population lives below this poverty line. About 75% of Timorese live in rural areas; six out of seven poor people in the country are rural dwellers.

HEALTH

According to the International Monetary Fund's July 2005 Country Report on Timor-Leste, Timor-Leste's rate of maternal mortality is one of the highest in the region, at about 800 per 100,000 live births. The rate of infant mortality is also high, at seventy to ninety-five per 1,000 live births. The mortality rate of children under age five is 126 per 1,000 live births. The World Health Organization (WHO) reports that life expectancy was fifty-five years for males and sixty-one years for females in 2003; healthy life expectancy was 47.9 years for males and 51.8 years for females. In 2002, 23.6% of births were attended by skilled practitioners.

The WHO reports in Health Profile: Democratic Republic of Timor-Leste (October 2002) that 80% of Timorese had access to health care as of 2002, but distance is a problem: on average, people must walk about seventy minutes to reach one of the country's four hospitals, sixty-five community health centers, or eighty-two health posts. Timor-Leste has had a serious shortage of doctors since the violence of 1999, when many health care professionals fled to Indonesia. The lack of technical services, clean water, reliable electricity, and communications systems adds to the inadequacy of the medical system.

Common childhood diseases include acute respiratory and diarrheal diseases, malaria, and dengue fever. Additionally, as many as 80% of Timorese children suffer from intestinal parasites, which can lead to severe malnutrition. In fact, hunger and its consequences are major health problems in Timor-Leste. In March 2000 the WHO estimated that 45% of children ages six months to five years were underweight, and 41% had stunted growth. About 35% of mothers were also found to be underweight. According to the WHO, several deadly and/or communicable diseases are prevalent in Timor-Leste, including malaria, leprosy, lymphatic filariasis (an infection of the lymph system by parasitic worms), Japanese encephalitis, yaws (a bacterial infection of the skin), and tuberculosis. In 2002 communicable diseases were responsible for about 60% of deaths in Timor-Leste. Although the immunization program was revived in 2000, in 2002 fewer than 50% of children five years and younger had received basic immunizations.

ACCESS TO ESSENTIAL SERVICES

As in Afghanistan, access to essential services such as water and sanitation is a strong indicator of poverty in Timor-Leste, especially among those living in rural areas. Only 4% of the rural population has access to safe water, sanitation, and electricity, versus almost 50% of urban dwellers. According to the Health Profile of Timor Leste prepared by the World Health Organization, of the country's 850,000 citizens, 620,000 have no electricity and 560,000 have no radios, making daily conveniences and communication across even short distances almost nonexistent.

EDUCATION

Before the 1999 vote for independence, 80% of sixteen- to eighteen-year-olds in Timor-Leste had completed grades one, two, and three of primary school, compared with nearly 100% of Indonesians in the same age group. During the violence that followed the independence referendum, 95% of schools were destroyed, and 20% of primary school teachers and 80% of secondary school teachers fled the country. By 2001, however, about 86% of schools had been rebuilt at least to the point of being usable, with overall enrollment in primary school increased from 65% in 1998–99 to 75% in 2000–01—girls made up 45% of those enrolled. Among adults, however, literacy and educational attainment are very low, with 57% reporting little or no formal schooling. Less than 40% of Timor-Leste's wealthiest adults age thirty and older are literate; in the poorest group only about 15% are literate. This poses a problem for the development of the country's education system because it means the pool of potential teachers is extremely small.