About 40 children die every hour in Brazil, a nation where the youths bear much of the brunt of the economic crisis, doctors and economists say.
In an effort to cut public spending and service its massive $121 billion external debt, Brazil is investing less in health care today than it did in the 1970s.At a recent Sao Paulo conference on the impact of the economic crisis on child welfare, doctors, sociologists and economists issued a ringing warning to the government: Unless child health care is quickly improved, Brazil will pay a very heavy price indeed.
Navantino Alves Filho, a consultant with the Brazilian Pediatric Society, told the conference that about 40 children die every hour in Brazil and about 2 million were expected to die over the next five years, mainly from malnutrition.
John Donohue, director of the United Nations Children's Fund (UNICEF), told Reuters, "Half of Brazil's 320,000 children up to the age of 5 who die each year could be saved if basic sanitation and education programs were implemented."
Child deaths are usually caused by diarrhea, infectious disease and malnutrition.
In Brazil's northeast, acute malnutrition is producing a generation of stunted dwarfs little bigger than African pygmies.
It is a startling reality for the world's eighth largest economy and the biggest by far in the southern hemisphere.
Official statistics show that infant mortality rates vary considerably from year to year, apparently reflecting the ups and downs in the economy.
The rate decreased steadily during the 1970s, but in 1984, a year of serious recession, the rate jumped to 68.2 deaths per 1,000 births compared to 62.7 in 1982.
In 1986, government-imposed price controls led to a rise in real income and brought the mortality rate down to 53 deaths per 1,000 births, the lowest ever.
But with controls lifted and inflation skyrocketing at 20 percent a month, experts say more deaths will result.
"Given past experience it is clear that the social cost of this economic crisis in terms of infant mortality will mirror those of the 1984 recession," Malaquias Batista Filho, a nutrition lecturer from Recife University, told Reuters.
Batista and other experts accused the government of concentrating on balance of payment problems and of ignoring the needy, particularly in the countryside.
They mocked President Jose Sarney's slogan which boasts "Everything for Social Welfare" and argued that the few 1987 statistics available showed government neglect of the poor.
Welfare expenditure fell about 13 percent in 1987 compared with 1986, while money going specifically to medical care dropped 10 percent, according to official figures.
In public hospitals across the country, basic care is precarious.
One patient who recently arrived with appendicitis in a hospital in Bahia state was stretched out on a counter top as a doctor went on a 15-minute search for a thermometer.
Many experts said that the money which was available was not used well.
A confidential World Bank report leaked this April in the Brazilian press concluded that resources had not been effectively targeted to the underprivileged majority.
"In fact, a large share of social expenditure actually subsidizes higher-income groups," the report said.
One peculiarity of Brazil is the high number of Caesarean births, a world record of 31 out of 100. This costs the government money, since according to the report 72 percent of the operations - many for middle and upper class women - are subsidized by the government.
Unnecessary Caesarean births are encouraged by underpaid doctors who wish to double their profits and save time.
According to Roberto Macedo, a leading Brazilian economist and a contributor to the World Bank report, Brazil has traditionally sponsored programs for urban workers while widely ignoring the rural and underemployed classes.
"The programs miss their target," he said.