Bolivia is one of the most successful countries in reducing child mortality. Health care for children under five and for pregnant women is now free. Children are vaccinated against measles, polio, tetanus and whooping-cough. However, this health programme is not easily accessible to the Indian population living in rural areas. Thanks partly to the help of international organizations like Unicef, child mortality in Latin America and Asia has been reduced by over fifty percent since 1990. According to the millennium objectives, child mortality should be reduced worldwide by two-thirds in 2015. A country like Bolivia will probably achieve this aim, but figures in many African countries are less favourable, even though progress is being made there.

Worldwide, over nine million children per year still die before they are five; a large proportion of them from diseases that are relatively easy to treat such as diarrhoea, pneumonia and malaria. Malnutrition, and consequently weakened resistance to disease, is a major factor. In addition, in many developing countries’ basic health care and vaccination programmes do not reach the entire population. It is significant that in the Netherlands there is one doctor available for every 385 inhabitants as opposed to a ratio of 1 to 100,000 in a country like Ethiopia. In Indonesia, a child from the richest twenty percent of the population has four times as much chance of reaching its fifth birthday as a child from the poorest twenty percent. This shows that access to health care forms part of the distribution issue, just like access to food and housing.

An interesting Dutch initiative from the medical circle, supported by a number of Dutch multinationals, is the Health Insurance Fund for inhabitants of a number of African countries. Employees of these companies and their families can join a collective health insurance. Thanks to a premium subsidy they can access a standard package that also covers HIV inhibitors. Despite these and similar efforts, the sixth millennium goal, which is to halt the spread of AIDS, malaria and other fatal diseases, will probably not be achieved in 2015; at least, that is the expectation of medical experts. The worldwide struggle against infectious diseases and other epidemics – certainly in the case of diseases for which there is still no effective vaccine – is so immense that it will take a long time.