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Holding governments accountable for the right to health

Otto Kolbl (follow on facebook, twitter), created: 2010-08-19, last modified: 2015-07-21

The principle that the governments are accountable to the international community as regards the situation of human rights in their country is part of the basic concepts of human rights. NGOs like Amnesty International and Human Rights Watch make it the basis of their whole work, which is largely relayed by our media. However, it is disappointing or even shocking to see that the latter will never accuse a country of "violations of human rights" in relation to the economic, social and cultural rights (ESC rights), although they are an integral part of the human rights as they were defined at the UN (see our article Europe and human rights – the history of a silent amputation). In this article I wish to propose the necessary tools to hold governments accountable for their policy relating to health care.

Babies in a hospital in Beijing, China, at the beginning of the 20th century. Photo: Sidney D. Gamble.

Babies in a hospital in Beijing, China, at the beginning of the 20th century. Photo: Sidney D. Gamble.

The right to the access to health care is a fundamental right, which decides over life and death of millions of human beings in the world. In the Universal Declaration of Human Rights (Declaration), this right is expressed only indirectly:

Article 25.

(1) Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services […].

 The International Covenant on Economic, Social and Cultural Rights (Covenant ESC) on the other hand transforms it into a direct and very detailed right:

Article 12

1. The States Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.

2. The steps to be taken by the States Parties to the present Covenant to achieve the full realization of this right shall include those necessary for:

(a) The provision for the reduction of the stillbirth-rate and of infant mortality and for the healthy development of the child;

(b) The improvement of all aspects of environmental and industrial hygiene;

(c) The prevention, treatment and control of epidemic, endemic, occupational and other diseases;

(d) The creation of conditions which would assure to all medical service and medical attention in the event of sickness. [emphasis mine]

This covenant has been signed and ratified by all the European countries, upholding this concept of human rights is therefore part of our international obligations. The first problem we must solve is to know how we can evaluate the efforts made by the governments in order to grant this right to their people. There are many organizations which evaluate the infant mortality rate (IMR) across the world, which is expressed as the number of babies which die during their first year for one thousand babies born alive.

According to many experts, this figure is a good indicator for the access which the population has got to health care, better than for example the life expectancy, which depends on many other factors. Moreover, we have got quite solid data about the IMR for most countries since 1950. But can we really use this figure to hold a government accountable? Can we require from poor countries that they offer to their population the same access to health care than industrialized countries?

Article 2, paragraph 1 of the Covenant ESC stipulates that the efforts we can expect from a government depend on its resources:

Each State Party to the present Covenant undertakes to take steps, individually and through international assistance and co-operation, especially economic and technical, to the maximum of its available resources, with a view to achieving progressively the full realization of the rights recognized in the present Covenant by all appropriate means, including particularly the adoption of legislative measures. [emphasis mine]

The data presented in this article is just an attempt to evaluate as precisely as possible to what extent each government makes the efforts which it is required to do by the Covenant. The survival of the babies born in this world must not depend on the arbitrary will of the powerful in this world; that's precisely why this right has been included into the fundamental human rights texts.

The best available way of measuring "available resources" in a country is certainly the per capita purchase power parity gross national income (GNI PC PPP). It is calculated using the gross national product (GDP), which measures the value of all the goods produced in a country. Using this figure as a departing point, the gross national income (RNI) is calculated by integrating the benefits realized by national enterprises in foreign countries. This figure is then divided by the number of inhabitants and compensated for the cost of the different products necessary for daily life. Like this, we get a good indicator of the standard of living in each country. The World Bank , present in virtually every country in the world, is without any doubt the most reliable source for this indicator. This data is available online , select the indicator "GNI per capita, PPP (current international $)".

The organization Child Mortality Estimate, born from collaboration between the World Health Organization WHO, the UNICEF and the World Bank, provides the most reliable figures for the infant mortality rate IMR.

If we look at this data, we realize immediately that the standard of living has got a huge influence on the infant mortality rate. However, there are mathematical methods which allow us to calculate the relation between the IMR and the GNI, and then to exclude the influence of the latter. Like this, we get a figure which evaluates the effort each country makes to save its babies. A separate article {} explains the mathematical methods used here in detail.

The table below represents the ranking 2009 of all the countries for which the necessary data was available. The data is published generally a little more than one year after the end of the year. The top of the list corresponds to the countries which make an effort above average to decrease the IMR, the bottom of the list contains those who could easily do much better. On the right side of the name, further data can put the rank of the country into perspective:

Column Caption
1 Ranking 2009
2 Name of the country
3

Infant mortality rate (IMR) 2009 (out of 1000 babies born alive, how many died in their first year)

4

GNI (gross national income) per capita purchase power parity, in 2009 US dollars, an indicator of its standard of living

5

Percentage of the measured IMR in relation to the average one calculated based on the GNI. For example, the value of 30% for Cuba indicates that the infant mortality rate is the quarter of the average value expected for a GNI of 9700.- USD

6

Percentage of the measured IMR in relation to the one which a country can reach with a consistent and sustained effort according to its GNI

7

Number of babies which the county saved as compared to an average IMR corresponding to its standard of living

8

Number of babies which the county saved as compared to a consistent and sustained effort

9-14

Ranking for the years 2005 to 1980

Rank 2 3 4 5 6 7 8 Rank          
2009 Country Mort. GNI/cap.     Saved 1 Saved 2 '05 '00 '95 '90 '85 '80
1 Cuba 4.4 9'700 30% 53% 1'197 456            
2 Eritrea 39.1 640 39% 69% 11'428 3'291 4 14 39      
3 Moldova 14.6 3'060 40% 70% 991 282 1 1 4 43    
4 Slovenia 2.3 26'340 43% 76% 59 14 16 12 9      
5 Czech Republic 2.8 23'610 46% 82% 359 69 5 3 21      
6 Sri Lanka 12.7 4'720 48% 84% 5'167 894 2 4 2 1 3 3
7 Portugal 3.0 22'870 48% 85% 342 57 7 24 29 41 25 37
8 Serbia 6.2 11'420 49% 87% 541 80 6 5        
9 Vietnam 19.5 2'850 50% 88% 29'460 4'009 3 2 3 2    
10 Nicaragua 21.8 2'450 50% 88% 3'089 412 17 27 32 35 61 68
11 Syria 14.2 4'620 53% 93% 7'618 663 8 9 23 12 42 43
12 Malaysia 5.7 13'530 53% 93% 2'859 247 9 11 18 10 8 7
13 Madagascar 40.5 1'050 53% 94% 25'005 1'756 15 46 60 84 65 62
14 Nepal 38.6 1'180 55% 97% 23'955 1'051 20 43 56 50 52 45
15 Solomon Islands 29.6 1'860 56% 99% 371 4 23 23 8 6    
16 Fiji 15.4 4'570 56% 99% 213 1 10 8 5 4 5 10
17 Liberia 79.9 290 57% 101% 9'174 -65 14 52     103 94
18 Estonia 4.4 18'890 57% 101% 52 -1 21 16 19 19    
19 Lithuania 5.0 16'740 57% 101% 118 -2 27 7 15 25    
20 Greece 2.8 28'440 58% 102% 222 -6 25 44 46 40 53 69
21 Croatia 4.5 19'170 59% 105% 131 -9 13 10 6 24    
22 Japan 2.4 33'280 61% 89% 1'613 309 29 31 40 13 7 8
23 Ukraine 13.3 6'190 62% 110% 3'666 -545 24 6 7 31    
24 Chile 7.0 13'430 65% 114% 969 -220 19 20 33 15 9 19
25 Hungary 5.1 18'570 65% 115% 270 -65 33 34 25 48 46 30
26 Israel 3.4 27'040 66% 117% 259 -72 37 61 42 39 27 32
27 Finland 2.5 34'430 66% 93% 75 12 34 41 12 26 13 6
28 Thailand 12.0 7'640 67% 118% 5'853 -1'819 31 28 41 16 15 14
29 Kyrgyzstan 32.1 2'200 68% 121% 1'763 -654 30 33 36 91    
30 Cyprus 3.4 28'050 69% 122% 15 -6 22 38 66 30 18 21
31 Paraguay 19.4 4'430 70% 123% 1'340 -563 39 48 64 49 40 40
32 El Salvador 14.6 6'360 70% 123% 798 -339 63 92 110 89 86 90
33 Mongolia 24.3 3'330 70% 123% 532 -231 55 72 87 93 91  
34 Bangladesh 41.2 1'580 70% 124% 60'954 -27'895 36 49 54 52 48 55
35 Bulgaria 8.3 12'290 71% 124% 251 -119 40 26 24 9 6 4
36 Montenegro 7.8 13'130 71% 124% 24 -12 11 21        
37 Poland 5.6 18'440 71% 125% 854 -421 18 18 28 11    
38 Sweden 2.3 38'560 72% 85% 98 43 46 45 37 37 21 20
39 Macedonia 9.8 10'550 73% 128% 82 -48 32 50 63 106    
40 Costa Rica 9.6 10'940 73% 129% 268 -162 26 15 11 7 10 16
41 Togo 64.3 850 75% 133% 4'640 -3'457 48 54 52 47 37 44
42 Malawi 68.8 760 76% 133% 13'658 -10'637 52 73 84 78 75 75
43 Ghana 46.7 1'480 76% 134% 11'249 -9'247 54 59 47 28 32 39
44 Niger 75.7 660 77% 136% 18'329 -16'685 59 68 86 97 81 81
45 Guyana 28.9 3'030 78% 137% 115 -106 50 53 45 8 16 17
46 Singapore 2.3 49'850 78% 85% 27 16 12 25 34 38 17 11
47 Bosnia and Herzegovina 12.5 8'740 78% 138% 120 -119 28 13 1      
48 Honduras 25.0 3'730 78% 138% 1'434 -1'419 53 51 43 32 55 58
49 Philippines 26.2 3'540 79% 139% 16'064 -16'942 41 39 35 27 30 25
50 Latvia 7.0 16'510 79% 140% 42 -45 43 32 30 18 14 5
51 Egypt 18.2 5'690 79% 140% 9'719 -10'666 68 102 114 115 99 91
52 Italy 3.4 31'330 80% 126% 488 -395 47 77 85 80 58 56
53 Albania 13.5 8'170 80% 140% 159 -180 56 58 53 75 78  
54 Burundi 101.3 390 81% 143% 6'803 -8'717 35 29 27 36 24 26
55 Armenia 19.6 5'420 82% 145% 199 -284 62 35 31 68    
56 Uzbekistan 31.8 2'890 82% 145% 3'869 -5'582 57 63 55      
57 Ethiopia 67.1 930 83% 146% 45'165 -67'134 45 47 44 65 43  
58 Spain 3.5 31'630 83% 130% 363 -407 49 30 22 20 11 15
59 France 3.2 33'980 84% 119% 483 -386 65 64 57 62 31 34
60 China 16.6 6'770 84% 147% 58'138 -96'176 44 36 20 3 2 1
61 Slovakia 5.8 21'600 87% 154% 47 -112 38 19 14 17 19  
62 Ireland 3.5 33'280 89% 130% 31 -56 93 108 26 14 4 9
63 Korea South 4.5 27'310 89% 158% 249 -768 58 40 17 5 1 2
64 New Zealand 4.8 26'430 91% 160% 29 -107 67 57 49 44 56 36
65 Congo DR 125.8 300 91% 160% 37'215 -140'818 42 17 16 71 66 65
66 Haiti 63.7 1'200 91% 161% 1'702 -6'749            
67 Belarus 10.9 12'380 93% 164% 79 -409 51 22 10 23    
68 Kenya 54.8 1'570 93% 164% 6'347 -33'177 72 71 76 42 23 24
69 Rwanda 70.4 1'060 94% 165% 1'993 -11'346 74 88 83 54 45 54
70 Senegal 50.7 1'790 94% 165% 1'601 -9'752 77 75 74 61 54 48
71 Norway 2.8 56'050 95% 104% 9 -6 61 56 48 64 38 13
72 Jordan 21.5 5'840 96% 169% 136 -1'364 60 42 38 21 47 41
73 Georgia 26.0 4'700 97% 171% 37 -558 66 37 13 108    
74 Laos 45.8 2'210 98% 173% 164 -3'362 70 69 81 85 74  
75 Colombia 16.2 8'500 99% 174% 155 -6'501 75 70 89 53 35 31
76 Romania 10.0 14'460 99% 175% 14 -921 82 55 70 60    
77 Indonesia 29.8 4'060 100% 176% 307 -55'593 73 62 82 55 36 35
78 Denmark 3.3 37'720 100% 122% 0 -38 101 81 62 79 44 18
79 Uruguay 11.3 12'910 101% 177% -4 -249 64 65 69 29 20 47
80 Lebanon 11.1 13'230 101% 179% -10 -326 78 99 126 98    
81 Tajikistan 51.8 1'950 102% 179% -165 -4'469 80 66 88 131 104  
82 Tunisia 17.9 7'820 102% 179% -54 -1'330 71 60 59 72 76 73
83 Germany 3.5 36'960 103% 130% -64 -534 76 67 71 69 50 61
84 Austria 3.3 38'550 103% 122% -8 -46 89 76 80 81 82 76
85 Guinea-Bissau 115.2 520 105% 184% -340 -3'514 81 96 97 88    
86 Tanzania 68.4 1'350 105% 186% -6'394 -57'442 85 80 75 70    
87 Belgium 3.8 36'520 110% 141% -41 -135 84 86 96 94 59 59
88 Guinea 87.8 970 111% 195% -3'421 -17'194 97 118 113 105    
89 Comoros 74.8 1'300 113% 198% -180 -799 90 95 92 82 77 67
90 Yemen 50.8 2'340 113% 199% -5'147 -22'131 108 123 118 111    
91 Uganda 79.4 1'190 113% 199% -13'957 -59'915 83 82 73 45 28  
92 Papua New Guinea 52.0 2'270 113% 200% -1'307 -5'540 79 93 95 67 62 50
93 Peru 19.4 8'140 114% 201% -1'475 -6'038 99 122 132 122 107 98
94 Mozambique 95.9 880 114% 202% -10'912 -43'692 88 74 50 66 33 71
95 Suriname 23.6 6'690 118% 207% -35 -121 110 112 119 110 89 78
96 Ecuador 20.4 8'040 119% 209% -925 -3'049 94 87 100 96 93 87
97 Morocco 33.2 4'450 119% 210% -3'509 -11'407 100 98 98 109 88 83
98 Gambia 78.4 1'330 120% 211% -814 -2'601 92 105 108 90 84 82
99 Lesotho 61.0 1'950 120% 211% -604 -1'929 119 124 104 77 69 53
100 Guatemala 32.6 4'590 120% 211% -2'529 -8'019 106 104 111 103 97 92
101 Central African Republic 112.0 750 122% 216% -3'221 -9'452 98 114 99 83 70 66
102 Benin 74.8 1'510 124% 218% -5'084 -14'324 109 121 112 104 90 77
103 Netherlands 3.7 40'510 125% 137% -137 -188 107 97 78 51 26 23
104 Brazil 17.3 10'260 125% 220% -10'926 -29'968 114 127 130 126 105 96
105 Argentina 13.0 14'120 127% 223% -1'922 -5'042 91 103 109 63 68 80
106 Burkina Faso 90.8 1'170 128% 226% -14'977 -38'071 112 109 90 73 60 52
107 Zambia 86.3 1'280 129% 227% -10'734 -26'944 111 110 102 99 72 60
108 Cambodia 68.0 1'850 129% 227% -5'618 -14'035 102 79 58      
109 Venezuela 15.3 12'370 131% 231% -2'204 -5'271 103 106 116 101 85 86
110 Australia 4.3 38'210 133% 160% -294 -446 96 94 61 57 41 29
111 Switzerland 4.0 41'830 136% 148% -79 -98 95 86 68 59 39 38
112 United Kingdom 4.6 37'360 137% 171% -943 -1'437 120 107 65 56 29 27
113 Bolivia 39.7 4'260 138% 243% -2'932 -6'287 133 137 136 123 102 95
114 Panama 15.9 12'530 138% 243% -313 -672 87 83 72 34 49 28
115 Sierra Leone 122.8 790 138% 243% -7'766 -16'623 115 91 103 112 96 88
116 Sudan 69.3 2'000 138% 244% -25'620 -54'545 105 89 67 33 34 33
117 Jamaica 25.9 7'320 139% 245% -385 -808 116 100 93 46 22 22
118 Russia 11.1 18'390 141% 248% -4'910 -10'147 104 90 77 102    
119 Mauritius 15.4 13'270 141% 248% -80 -165 69 84 51 22 12 12
120 India 50.3 3'260 142% 251% -397'660 -803'353 113 111 94 76 57 42
121 Mexico 14.7 14'110 143% 251% -9'016 -18'160 124 126 123 119 98 89
122 Mali 100.5 1'190 143% 252% -16'881 -33'779 121 120 106 95 73 84
123 Mauritania 74.3 1'960 146% 258% -2'613 -5'054 122 119 107 92 63 64
124 Dominican Republic 26.7 8'100 156% 276% -2'205 -3'895 117 116 91 86 80 70
125 Oman 9.1 24'370 157% 276% -207 -365 125 139 144 134 115 104
126 Canada 5.3 37'590 160% 197% -708 -932 123 101 79 59 51 51
127 Namibia 33.6 6'410 162% 285% -774 -1'316 129 138 125 100 71 63
128 Nigeria 85.8 1'980 170% 300% -219'661 -354'940 128 135 134 120 95 85
129 Algeria 29.0 8'130 171% 301% -8'730 -14'067 131 133 128 124 106 101
130 Djibouti 75.0 2'480 174% 307% -791 -1'253 127 129 131      
131 Pakistan 70.5 2'710 174% 307% -153'878 -243'483 130 132 129 118 94 74
132 Turkey 18.5 13'730 175% 307% -10'852 -17'150 140 143 138 133 112 99
133 Timor-Leste 48.1 4'700 180% 317% -974 -1'500 86 78        
134 Chad 124.0 1'230 180% 318% -28'356 -43'617 132 115 101 87 83 57
135 Afghanistan 133.7 1'110 183% 322% -84'011 -127'975 126          
136 Kazakhstan 25.6 10'270 185% 326% -3'708 -5'591 135 125 124 130    
137 Libya 16.8 16'430 190% 334%     138          
138 Azerbaijan 29.6 9'030 191% 336% -2'350 -3'470 118 117 115      
139 Swaziland 52.0 4'580 191% 336% -880 -1'299 145 142 135 121    
140 Cameroon 94.6 2'200 202% 355% -34'556 -49'239 141 136 122 116 101 72
141 Iran 25.9 11'490 207% 365% -18'466 -25'916 143 140 137 128 110 102
142 Congo 80.5 2'940 211% 372% -5'414 -7'520 136 131 105 113 92 46
143 Turkmenistan 41.5 6'990 215% 378% -2'492 -3'432 134 113 117      
144 Bhutan 52.4 5'300 216% 381% -423 -580 137 134 127 114 64  
145 United Arab Emirates 6.8 40'000 224% 252% -242 -263   141 142 132 113 105
146 United States of America 6.8 46'730 231% 252% -16'784 -17'896 139 130 121 107 87 79
147 Bahrain 9.5 33'480 243% 353% -81 -98 142 128 120 74 67 97
148 Kuwait 8.2 51'200 278% 304% -263 -275 144 144 141   111 103
149 South Africa 43.1 10'060 306% 538% -31'601 -38'249 148 148 140 129 109 100
150 Saudi Arabia 18.2 24'000 308% 542% -7'362 -8'895 146 146 146 136 117 107
151 Qatar 9.7 121'000 330% 361% -117 -121            
152 Botswana 42.6 12'860 378% 667% -1'509 -1'744 149 149 145 125 79 49
153 Angola 98.1 4'970 384% 677% -57'616 -66'376 147 147 143 135 114  
154 Gabon 51.5 12'460 444% 782% -1'618 -1'821 151 150 147 137 116 106
155 Trinidad and Tobago 31.1 25'100 554% 976% -505 -553 150 145 133 117 100 93
156 Equatorial Guinea 88.1 19'350 1176% 2071% -2'071 -2'155 152 151 139 127 108  

Table 1: Ranking of the countries according to their effort to reduce infant mortality

When we look at the results, a first conclusion comes to mind: as we could expect from the fact that we compensated the effect of the standard of living, all the regions of the list contain as well rich as poor countries. This is probably one of the reasons why this kind of calculations has never been done before: the rich countries want always to be well ranked.

Among the first ten ranks, we find countries like Cuba, Eritrea, Moldavia and Vietnam,, which are considered to be countries with a "poor human rights record". It becomes quite obvious that this label is given by our media only according to the respect of the civil and political rights, which is in stark contradiction to the fundamental texts. In general, we find many communist or former communist countries in the upper part of the list. However, we find there also countries like Sri Lanka, Portugal and on rank 12 Malaysia, which all have a long democratic tradition and have not the reputation of sacrificing economic growth to an exaggerated welfare state.

On the other hand, the ranking seems not to be influenced by the region of the world or the culture. Among the ten first countries, we find two from Latin America, one from Africa, five from Europe (four from Eastern Europe and one from Southern Europe) and two from Asia.

The big industrialized countries don't do very well, apart from one exception: Japan ranks 22nd. Then follow Italia rank 52, Spain rank 58, France 59, Germany 83, United Kingdom 112, and finally USA on rank 146 out of 156, behind countries like Bhutan, Turkmenistan, Congo, Iran and Cameroon… Switzerland on rank 111 is not especially brilliant either.

Of course we can wonder why rich countries which put cleanliness on top of their agenda and which have got a well organized welfare state like Germany (IMR 3.5) and Switzerland (4.0) are below average, far behind countries like Portugal (3.0) and Greece (2.8) which, despite a lower standard of living, have got a lower infant mortality. These countries are maybe not very good at managing their public finances, but at least they take care of their babies!

Only a detailed study could explain the bad ranking of Germany and Switzerland, but we can venture a few hypotheses: is this due to the fact that the people in the south of Europe are used to rush to the doctor for every small problem, as the tough Germanic people in the north love to point out? Could it be that this habit saves  the lives of many babies?

Another hypothesis is probably based on more evidence: it is obvious that countries which advocate a liberal economic policy are quite systematically at the bottom of the list. Some countries in Northern Europe (Sweden 2.3, Norway 2.8, Finland 2.8) are known for having an extremely efficient welfare state, and they are doing well even though their inhabitants are know to be rather "tough guys". We have to ask ourselves whether the economic growth which can be achieved through a liberal economic policy is worth sacrificing the lives of 15'000 babies each year, as is the case in the USA according to the figures.

If we look at the bottom of the list, we see a group of countries which got rich from oil or other mineral wealth. On the last rank, far behind the next-to-last, we find Equatorial Guinea. The figures seem quite shocking. This country has got an IMR 12 times greater than the average corresponding to its standard of living, and even 21 times greater than what they could achieve with a consistent and sustained effort. As a consequence, even "human rights" organizations like Human Rights Watch and Amnesty International, which normally don't care too much about the general access to health care by the population, harshly criticize this country in their 2010 reports (see the World Report 2010 of Human Rights Watch and the International Report 2010 of Amnesty International). However, we can ask ourselves whether this criticism is justified. In 12 years (between 1996 and 2008), the country has experienced a growth from a GNI PC PPP of 1,609.- to 14,523.- (in 1990 international dollars, calculated according to the figures of the World Bank), due to the discovery of oil on its territory.

If a country has got suddenly lots of wealth at its disposal, it is not easy to decrease the IMR accordingly. It is simply not enough to spend millions of dollars on medicine: hospitals and dispensaries are needed, doctors, nurses and sage-femmes must be trained, the population must be educated and the infrastructure must be built which allows the population to reach the medical facilities; this can not be done in one day. Importing the medical staff from a foreign country is not a solution. Apart from the language problems (especially in the countryside, it is essential to speak the local language), this would only move the problem to another location. Many African countries have got huge problems because the Western countries attract their medical staff with much higher salaries.

The scathing criticism of the "human rights" organizations against Equatorial Guinea only masks their inability (or unwillingness) to develop efficient tools to measure the efforts made by the different countries. In particular, in the 2010 report of HRW, this country is the only one to be singled out for having neglected the access to healthcare for the population in general. Like this, the organization tries to show that they care about this problem by mentioning the most spectacular case, but they will ignore all the other cases where there are not the lives of 2000 babies which are at stake like in Equatorial Guinea, but the lives of hundreds of thousands of babies every year.

However, the table above shows only a part of reality: it shows only a snapshot of the situation in 2009, completed by some information about the previous years. We must ask ourselves to what extent a government can change the situation on its territory if it decides to take the necessary measures. The evolution of the ranking over the years offers only some very indirect information about its development: the difference necessary to get from one rank to another varies according to the region of the table where you are.

Therefore we have to develop the necessary tools to describe the short term evolution of the situation in every country. In the same way in which we can calculate the "growth rate" of the GDP or GNI, we can calculate the "reduction rate" of the IMR in order to evaluate the progress from one year to another. This rate can then be compared to the growth rate of the economy. In order to reduce the quantity of data, the table below shows the average over five years and the average for the years 1990-2009.

Rank Rank   Decrease infant mortality     GNI growth per capita PPP     
2009 2009 Years from... '05 '00 '95 '90 '85 '80 '90 '90 '05 '00 '95 '90 '85 '80
  rel. GNI to ... (averave) '09 '05 '00 '95 '90 '85 '09 '09 '09 '05 '00 '95 '90 '85
    9th decile 6.4 6.2 6.2 5.7 5.7 6.1 5.5 3.8 5.5 7.9 5.2 4.7 4.9 4.0
    median 3.4 3.1 3.1 2.7 2.8 3.1 3.2 1.7 2.2 2.4 2.2 0.8 1.0 0.4
1 4 Slovenia 10.6 3.9 5.7 7.5 6.5   6.8 2.2 1.4 3.6 4.4 -0.6    
2 76 Romania 10.4 3.8 3.3 2.0 0.6 1.6 4.6 1.7 3.6 6.5 -1.1 -1.7 -2.2 2.8
3 51 Egypt 7.8 7.7 5.5 5.3 5.6 6.2 6.5 2.6 4.5 1.6 3.2 1.4 1.5 4.0
4 19 Lithuania 7.7 2.7 9.5 -2.1 2.4 4.4 4.4 1.0 1.4 8.3 5.2 -10.0    
5 33 Mongolia 7.6 7.3 4.4 3.5 4.0 2.5 5.6 1.9 5.2 5.1 1.7 -3.3 0.8 3.9
6 125 Oman 7.4 7.5 7.5 6.0 6.4 7.9 7.1 2.5 4.8 1.8 1.3 2.5 -0.7 9.5
7 20 Greece 7.4 7.5 5.4 4.3 6.4 6.1 6.1 2.2 1.8 3.7 2.9 0.3 0.8 -0.5
8 132 Turkey 7.3 7.2 7.1 5.2 4.1 4.2 6.7 1.9 0.5 3.1 2.3 1.4 3.7 2.7
9 35 Bulgaria 7.2 4.9 1.6 -1.8 1.9 4.5 2.8 1.9 3.9 6.2 0.0 -1.9 2.0 3.2
10 138 Azerbaijan 7.2 7.1 5.1 0.8 0.8 0.8 5.0 3.3 18.1 12.5 6.1 -17.2    
11 32 El Salvador 7.1 6.8 6.5 4.1 4.4 6.8 6.1 2.7 1.7 1.9 2.3 4.7 0.8 -4.1
12 78 Denmark 6.9 0.4 2.1 8.3 0.8 -0.3 4.4 1.3 -0.7 1.0 2.4 2.0 1.3 2.8
13 118 Russia 6.9 6.2 2.2 0.0 1.8 1.9 3.7 0.4 3.4 6.6 1.9 -9.1    
14 139 Swaziland 6.9 0.6 -1.6 0.4 2.3 3.1 1.3 1.3 1.0 1.5 2.5 0.4 6.8 2.0
15 93 Peru 6.7 6.1 7.3 3.7 4.0 2.7 5.9 3.0 5.5 2.8 0.8 3.5 -4.0 -2.0
16 80 Lebanon 6.5 6.6 6.5 2.6 1.4 0.9 5.6 3.9 5.4 2.2 -0.1 8.7 -11.2 6.2
17 60 China 6.3 6.3 3.9 0.2 -0.1 4.5 4.1 9.5 10.8 9.1 7.6 10.9 6.2 9.2
18 18 Estonia 6.3 7.5 8.5 0.5 2.2 3.1 5.7 2.5 -0.6 8.6 7.1 -5.1 0.1 2.1
19 26 Israel 6.2 4.4 5.2 5.4 4.7 5.2 5.3 1.8 1.9 0.2 2.4 2.9 2.3 1.2
20 21 Croatia 6.1 4.5 3.0 5.2 6.8   4.6 1.0 1.6 4.5 4.3 -5.8    
21 39 Macedonia 6.0 6.0 6.0 5.9 5.9   6.0 0.2 3.4 1.2 2.5 -5.2    
22 99 Lesotho 6.0 1.9 -2.0 -0.9 2.8 2.6 1.0 2.3 3.9 1.6 1.1 3.1 2.5 0.4
23 133 Timor-Leste 5.9 6.1 5.9 3.7 2.4 2.4 5.4   0.6 -4.0        
24 8 Serbia 5.9 5.9 8.8 7.1 6.5   7.0 -0.8 4.0 5.4 2.8 -13.4    
25 53 Albania 5.7 5.9 5.6 5.3 3.9 2.2 5.6 3.4 4.5 5.1 5.9 -1.6 -1.6 0.0
26 38 Sweden 5.6 3.1 3.7 6.7 2.3 1.8 4.8 1.4 -0.4 2.2 3.3 0.0 2.0 1.7
27 62 Ireland 5.6 6.3 -1.0 5.5 2.6 5.9 4.1 3.9 -1.2 3.7 8.4 4.0 4.9 1.7
28 17 Liberia 5.5 5.6 4.6 -0.5 -0.5 -0.5 3.7 -1.6 2.7 -7.7 26.1 -20.8 -18.9 -4.7
29 25 Hungary 5.5 5.3 5.4 6.0 4.1 3.6 5.6 1.7 -0.1 4.5 4.4 -2.3 0.9 2.0
30 56 Uzbekistan 5.5 5.5 1.6 1.4 3.2 3.3 3.4 1.4 6.9 4.2 2.2 -6.1    
31 5 Czech Republic 5.4 4.0 9.5 7.4 3.1   6.7 1.6 2.1 3.8 1.6 -0.9    
32 55 Armenia 5.3 5.2 5.2 2.8 2.3 2.3 4.6 2.6 4.0 12.3 6.1 -10.3    
33 14 Nepal 5.3 5.2 5.5 3.4 3.3 2.1 4.8 2.1 2.3 1.1 2.3 2.6 2.1 2.4
34 104 Brazil 5.3 5.3 4.8 4.7 5.3 3.5 5.0 1.5 2.7 1.4 0.5 1.5 0.1 -1.2
35 84 Austria 5.3 1.4 5.0 6.1 6.3 4.4 4.4 1.6 1.0 1.0 2.8 1.4 2.5 1.4
36 7 Portugal 5.1 7.6 6.0 8.2 7.0 6.3 6.8 1.4 -0.1 0.2 3.7 1.4 5.9 0.4
37 12 Malaysia 5.1 5.3 5.2 5.2 5.1 4.7 5.2 3.5 1.9 2.7 2.3 6.7 3.8 2.4
38 34 Bangladesh 5.0 5.0 4.9 3.8 2.0 3.7 4.7 3.4 4.8 3.7 3.2 2.3 1.4 1.0
39 13 Madagascar 5.0 5.2 5.1 3.6 0.3 0.3 4.7 -0.4 1.9 -0.6 0.7 -3.3 -0.1 -4.1
40 113 Bolivia 4.9 4.9 3.7 2.2 3.0 2.5 3.9 1.7 1.7 2.0 1.3 1.7 0.0 -4.0
41 10 Nicaragua 4.9 4.9 4.7 3.3 3.7 5.0 4.4 1.3 1.0 1.8 3.1 -0.6 -5.4 -2.0
42 103 Netherlands 4.8 2.5 1.9 3.8 3.2 1.7 3.2 1.7 0.9 0.8 3.4 1.6 2.8 0.7
43 149 South Africa 4.8 0.7 -2.4 -0.2 3.4 3.6 0.5 0.8 2.1 2.4 0.4 -1.2 -0.7 -1.2
44 69 Rwanda 4.7 4.6 2.4 -3.5 -0.8 3.9 2.0 1.7 5.1 3.8 2.1 -3.5 -1.7 -0.7
45 36 Montenegro 4.6 5.7 0.8 2.4 6.0   3.3   4.6 4.0        
46 127 Namibia 4.5 4.1 -1.0 0.8 2.1 1.3 2.0 2.1 2.1 2.9 1.1 2.1 -1.5 -2.7
47 27 Finland 4.5 3.0 3.6 6.3 1.0 3.0 4.3 1.5 0.1 2.3 4.5 -1.2 3.0 2.2
47 50 Latvia 4.5 6.3 6.8 -5.9 1.2 3.5 3.0 1.3 -0.4 8.9 6.9 -9.5 1.5 2.8
49 121 Mexico 4.4 4.5 6.3 3.4 3.4 4.7 4.7 1.1 -0.3 0.8 3.9 -0.3 -0.3 -0.3
50 136 Kazakhstan 4.4 4.4 4.3 1.3 1.8 1.7 3.6 2.1 4.7 10.0 3.7 -8.7    
51 141 Iran 4.2 4.2 4.1 3.1 3.2 6.3 3.9 2.8 3.0 4.0 2.4 1.7 -2.6 0.1
52 2 Eritrea 4.2 4.4 4.5 4.5 2.1 1.7 4.4   -1.7 -1.5 -1.8      
53 81 Tajikistan 4.2 4.0 3.3 0.5 0.7 0.8 2.9 -2.8 4.9 8.1 -1.3 -19.0 -1.4  
54 59 France 4.2 2.4 4.8 5.5 3.2 3.4 4.2 1.1 -0.2 1.0 2.4 0.8 2.7 1.1
55 43 Ghana 4.2 4.0 0.7 1.6 3.1 0.7 2.5 2.3 3.5 2.6 1.8 1.4 1.9 -3.7
56 42 Malawi 4.1 3.7 3.2 2.1 1.5 1.5 3.3 1.2 5.6 -1.9 0.8 1.5 -2.9 -1.0
57 1 Cuba 4.1 4.7 4.2 4.6 5.8 5.8 4.4       4.3      
58 145 United Arab Emirates 4.0 4.2 4.1 3.9 4.1 6.3 4.1 0.2 1.7 1.9 -0.7 -1.9 -3.2 -8.9
59 105 Argentina 4.0 4.0 3.6 2.0 3.8 4.2 3.4 3.0 5.1 1.0 1.3 5.1 -1.9 -3.9
60 61 Slovakia 3.9 2.7 5.2 4.0 4.6   4.0 2.3 4.4 4.9 3.8 -3.2 1.0  
61 28 Thailand 3.9 4.0 3.9 4.4 5.7 5.2 4.1 3.2 1.8 3.9 -0.3 7.3 8.7 3.2
62 143 Turkmenistan 3.8 3.9 3.4 2.7 2.7 2.7 3.4 3.0 8.9 15.0 2.6 -11.4    
63 90 Yemen 3.8 3.9 3.0 0.8 3.0 4.3 2.9 1.2 0.5 1.2 2.2 0.8    
64 3 Moldova 3.8 3.8 3.7 3.8 3.7 2.1 3.8 -2.2 3.2 8.9 -1.2 -16.6 1.9 1.5
65 67 Belarus 3.8 3.7 3.7 1.8 0.8 0.8 3.2 3.1 7.5 8.0 6.7 -8.2    
66 22 Japan 3.8 2.6 5.3 1.4 3.6 6.1 3.3 0.7 -0.5 1.2 0.8 1.2 4.3 2.4
67 44 Niger 3.8 3.8 3.7 2.1 0.3 0.0 3.3 -0.5 0.9 0.7 -0.6 -2.5 -0.4 -5.4
68 95 Suriname 3.8 3.8 3.8 1.6 1.5 1.5 3.2 1.4 3.4 4.0 0.1 -1.5 -1.6 -2.6
69 97 Morocco 3.7 3.6 3.5 4.2 3.4 3.7 3.8 2.3 4.0 3.8 2.4 -0.7 2.2 0.6
70 37 Poland 3.7 4.1 8.8 3.3 3.6 3.0 5.1 3.8 4.9 3.2 5.5 1.9 0.6 -2.2
71 74 Laos 3.5 3.6 4.9 5.5 2.2 1.0 4.4 4.2 5.5 4.5 3.7 3.4 1.4 4.3
72 29 Kyrgyzstan 3.5 3.4 3.5 3.5 3.5 3.5 3.5 -1.0 4.7 2.8 4.2 -13.3    
73 96 Ecuador 3.5 3.4 3.4 4.2 5.3 4.8 3.6 1.7 2.7 4.2 -0.6 0.6 0.3 -1.3
74 79 Uruguay 3.4 3.3 3.4 2.2 4.1 6.9 3.1 2.6 5.5 0.9 1.6 3.2 3.2 -4.4
75 6 Sri Lanka 3.4 3.3 3.4 2.1 3.0 4.8 3.1 4.1 5.1 2.9 4.3 4.2 2.1 3.5
76 129 Algeria 3.4 3.4 3.0 1.7 4.4 7.7 2.9 0.9 0.8 3.3 1.6 -2.0 -1.9 1.5
77 75 Colombia 3.4 3.3 3.4 1.4 2.9 2.8 2.9 1.5 2.8 2.3 -0.8 2.2 2.8 0.0
78 57 Ethiopia 3.4 3.4 3.4 2.7 0.2 0.2 3.2 2.4 7.6 3.7 1.7 -2.3 1.8  
79 137 Libya 3.3 3.5 3.3 3.1 4.7 6.1 3.3 0.0 2.4 2.0 -0.9 -2.8 -4.4 -10.7
80 64 New Zealand 3.3 1.4 3.1 5.4 5.1 1.1 3.3 1.6 0.0 2.6 1.7 1.8 -0.5 2.2
81 71 Norway 3.3 3.4 3.3 9.2 2.1 0.2 4.9 2.1 0.2 1.6 3.1 3.2 1.3 3.0
82 63 Korea South 3.3 2.6 2.9 2.8 3.7 10.9 2.9 4.3 2.8 4.0 3.5 6.7 8.6 6.4
83 45 Guyana 3.2 3.2 2.5 1.5 1.1 1.1 2.6 3.5 4.3 0.5 2.8 6.8 -1.8 -4.3
84 120 India 3.2 3.3 2.6 1.7 2.4 1.8 2.7 4.7 6.5 5.4 4.0 3.1 3.8 2.9
85 94 Mozambique 3.2 2.4 2.3 2.2 1.2 0.9 2.5 3.7 4.7 5.7 4.6 0.1 5.1 -6.6
86 128 Nigeria 3.1 3.1 1.9 0.1 0.1 0.1 2.0 1.7 2.9 3.6 0.6 -0.1 2.6 -5.6
87 77 Indonesia 3.0 3.2 2.8 4.2 2.9 3.5 3.3 3.2 4.3 3.4 -0.7 6.2 5.2 3.5
88 11 Syria 2.9 3.0 3.9 5.4 6.9 5.0 3.9 2.0 2.1 1.2 -0.2 5.0 -1.8 -0.9
89 48 Honduras 2.9 2.9 2.2 3.4 5.4 4.7 2.8 1.5 1.6 2.6 0.8 0.9 0.2 -1.3
90 151 Qatar 2.9 2.7 2.8 2.7 6.0 6.7 2.8 2.3 0.3 0.5 8.5 -0.3 -5.3 -11.7
91 31 Paraguay 2.9 2.9 2.9 2.9 3.0 3.2 2.9 0.1 1.3 0.6 -2.3 1.3 1.1 -1.3
92 109 Venezuela 2.9 2.9 2.9 2.8 2.8 3.6 2.9 0.8 3.0 0.7 -1.2 1.2 0.1 -3.8
93 86 Tanzania 2.9 2.2 1.9 0.9 0.5 0.8 1.9 1.7 3.7 3.8 1.4 -1.5 2.5 -2.1
94 144 Bhutan 2.8 2.9 2.9 2.9 2.9 2.9 2.9 5.4 7.5 4.8 4.2 5.5 8.7 5.4
95 30 Cyprus 2.7 6.8 8.5 1.4 6.2 8.1 5.0 2.2 1.5 2.0 2.3 3.0 5.9 4.3
96 82 Tunisia 2.7 2.8 4.9 5.7 5.8 5.7 4.1 3.3 3.9 3.4 4.2 1.9 0.6 1.5
97 153 Angola 2.7 2.7 3.0 0.8 0.3 0.3 2.3 2.7 9.8 7.0 3.7 -7.6 0.5 -1.7
98 24 Chile 2.7 3.7 6.7 6.2 4.1 6.4 4.9 3.7 1.8 3.1 2.8 6.8 4.9 -0.7
98 83 Germany 2.7 2.4 3.3 5.8 5.1 6.7 3.6 1.2 0.6 0.5 1.9 1.6 2.8 1.5
98 58 Spain 2.7 1.9 5.1 5.7 3.6 7.1 3.9 1.7 -0.3 1.7 3.6 1.2 4.3 0.8
101 88 Guinea 2.6 2.6 2.2 1.9 2.0 1.7 2.3 0.9 -0.1 1.5 1.9 -0.1 1.0 -0.6
102 66 Haiti 2.6 2.6 2.6 2.6 2.4 2.2 2.6 -1.5 0.7 -2.2 0.6 -4.5 -2.4 -2.7
103 148 Kuwait 2.6 2.8 2.8 2.7 4.9 6.1 2.7   0.8 5.1 -2.0   -4.6 -8.7
104 112 United Kingdom 2.5 1.9 1.4 5.6 3.4 4.9 2.9 1.6 -0.4 2.0 3.1 1.4 3.1 2.0
105 23 Ukraine 2.5 2.4 1.4 0.6 2.1 2.0 1.7 -1.8 0.7 8.6 -1.1 -13.5    
106 114 Panama 2.2 2.3 2.3 2.3 3.0 3.6 2.3 3.6 6.6 2.4 2.6 3.4 -2.7 1.2
107 152 Botswana 2.2 6.7 -3.1 -4.1 1.6 3.7 0.4 2.7 0.2 3.9 5.2 1.2 8.4 6.4
108 115 Sierra Leone 2.2 2.2 1.4 0.6 1.0 1.1 1.6 0.3 3.0 9.4 -4.8 -4.9 -1.4 -1.4
109 110 Australia 2.2 1.6 2.2 5.6 4.0 3.1 3.0 1.9 1.2 1.9 3.1 1.3 2.3 1.4
110 9 Vietnam 2.2 2.0 6.3 3.6 0.7 1.8 3.6 5.9 5.8 6.1 5.6 6.1 2.4 4.7
111 40 Costa Rica 2.1 2.0 2.0 4.2 5.5 5.4 2.6 2.6 2.9 2.1 2.4 3.0 2.4 -2.7
112 154 Gabon 2.1 1.6 1.0 1.1 1.7 2.3 1.4 -0.7 0.1 -0.4 -2.3 -0.1 -2.0 -0.6
113 52 Italy 2.1 4.7 6.0 5.1 5.0 5.4 4.6 0.6 -1.4 0.3 1.9 1.2 3.1 1.6
114 41 Togo 2.1 2.1 2.1 0.6 0.6 1.7 1.7 -0.5 0.0 -0.5 0.9 -2.3 -0.8 -3.9
115 124 Dominican Republic 2.1 2.1 2.4 5.4 3.8 3.3 3.1 3.8 5.4 2.0 5.1 3.2 0.7 -0.4
116 107 Zambia 2.1 1.2 1.1 0.5 -1.3 -0.7 1.1 -0.2 3.6 2.4 0.0 -5.8 -1.5 -2.8
117 70 Senegal 2.1 2.1 2.1 1.4 1.1 3.4 1.9 0.8 0.4 2.0 1.3 -0.7 -0.6 -0.1
118 131 Pakistan 2.0 2.1 2.1 1.3 1.3 1.6 1.9 1.9 2.2 2.5 0.8 2.0 3.1 3.9
119 102 Benin 2.0 1.9 2.0 2.3 1.4 1.1 2.1 1.1 1.1 0.5 2.2 0.6 -2.2 1.5
120 68 Kenya 2.0 2.0 1.5 -2.0 0.0 1.9 0.8 0.0 1.6 1.0 -0.6 -1.6 2.0 -1.3
121 122 Mali 1.9 1.9 1.9 1.0 1.4 1.5 1.7 2.6 2.2 3.9 3.2 0.9 1.7 -4.2
122 91 Uganda 1.9 1.8 1.9 1.5 0.2 -0.1 1.8 3.6 5.2 2.8 3.3 3.5 1.3 -0.4
123 100 Guatemala 1.9 1.8 3.6 4.0 5.6 4.4 2.9 1.4 1.5 0.5 1.6 1.9 0.6 -3.5
124 98 Gambia 1.9 1.9 1.8 0.3 1.8 3.1 1.5 0.6 3.0 1.0 0.8 -1.7 0.1 -0.4
125 73 Georgia 1.8 1.8 2.6 2.9 2.9 2.9 2.3 -1.0 6.0 8.6 7.2 -21.2 -5.5 3.5
126 111 Switzerland 1.8 1.3 2.0 5.6 0.9 3.1 2.8 0.5 0.9 0.6 1.6 -0.9 2.2 1.0
127 108 Cambodia 1.8 1.7 1.6 -0.2 1.5 2.4 1.2 5.1 4.5 7.5 4.9 3.5    
128 47 Bosnia and Herzegovina 1.7 1.0 5.5 2.0 1.7 6.0 2.6   3.8 4.5 25.1      
129 156 Equatorial Guinea 1.6 1.6 1.6 1.6 1.6   1.6 15.2 3.9 23.7 29.9 3.2 -2.4 -1.9
130 72 Jordan 1.6 1.6 2.1 3.0 3.7 4.6 2.1 2.4 4.4 3.8 0.5 1.3 -4.7 1.2
131 106 Burkina Faso 1.3 1.3 1.3 0.1 1.5 1.7 1.0 2.1 0.9 2.7 3.7 1.1 0.2 1.7
132 87 Belgium 1.3 2.8 6.7 5.2 2.6 4.2 4.1 1.3 0.2 1.2 2.5 1.3 2.9 0.9
133 85 Guinea-Bissau 1.2 1.3 1.3 0.6     1.1 -1.2 0.1 -2.8 -2.4 0.5 1.6 4.2
134 130 Djibouti 1.2 1.3 1.3 1.3 1.3 1.3 1.3 -1.4 3.3 1.0 -3.5 -5.2    
135 49 Philippines 1.2 1.2 2.7 4.1 4.5 0.5 2.4 1.6 2.4 2.5 1.8 -0.1 2.1 -3.9
136 135 Afghanistan 1.1 1.2 1.2 1.2 1.2 1.2 1.2   9.8          
137 92 Papua New Guinea 1.1 1.1 1.1 1.9 2.0 1.8 1.3 1.0 2.7 -0.9 -2.9 5.8 -1.4 -1.2
138 147 Bahrain 1.0 1.2 1.5 3.8 3.5 7.3 1.9 3.2 3.8 3.7 1.9 3.5 1.0 -4.8
139 150 Saudi Arabia 0.9 0.9 5.0 6.1 6.1 6.1 3.4 0.5 0.0 1.5 0.1 0.5 -1.3 -10.0
140 89 Comoros 0.9 0.9 0.9 1.1 1.9 1.9 1.0 -0.1 1.2 0.6 -0.7 -1.5 -1.0 1.6
141 101 Central African Republic 0.7 0.6 0.1 -0.8 -0.1 0.8 0.1 -0.9 1.1 -2.7 0.0 -1.6 -2.2 -0.8
142 54 Burundi 0.6 0.6 0.6 0.5 -0.1 0.3 0.6 -1.6 1.1 -0.5 -2.4 -4.1 0.6 1.7
143 116 Sudan 0.6 0.6 0.6 0.7 2.4 -0.6 0.6 3.8 5.7 3.9 3.8 2.4 1.9 -2.5
144 16 Fiji 0.5 0.5 0.5 2.8 5.7 5.0 1.1 0.9 -0.9 1.8 1.2 1.4 2.5 -2.4
145 123 Mauritania 0.4 0.4 0.5 0.5 0.5 2.5 0.5 0.7 1.4 1.2 -0.2 0.5 -0.2 -1.8
146 146 United States of America 0.4 0.6 2.1 3.2 2.8 3.1 1.6 1.4 -0.3 1.4 2.9 1.2 2.3 2.3
147 15 Solomon Islands 0.3 0.3 0.3 0.3 0.3 5.3 0.3 0.0 3.0 -1.6 -5.4 4.9 0.2 -3.9
148 117 Jamaica 0.3 0.4 0.3 0.3 2.7 2.8 0.3 0.8 -0.4 1.5 -1.2 3.2 4.3 -1.2
149 140 Cameroon 0.2 0.1 -0.3 -0.6 0.7 1.5 -0.2 -0.1 0.8 1.3 2.2 -4.6 -5.3 6.2
150 126 Canada 0.0 0.0 1.4 3.5 3.2 4.9 1.3 1.4 -0.3 2.0 3.2 0.6 1.5 1.7
150 134 Chad 0.0 -0.3 -0.3 0.0 1.1 1.3 -0.2 2.2 -2.3 12.8 -0.7 -1.2 -1.5 6.2
150 65 Congo DR 0.0 0.0 0.0 0.0 0.3 0.3 0.0 -3.9 2.2 0.9 -6.3 -10.8 -3.3 -1.1
150 155 Trinidad and Tobago 0.0 -0.5 -0.3 0.4 0.4 2.7 -0.1 4.1 3.9 7.5 4.5 0.6 -2.9 -3.9
154 142 Congo -1.0 -1.0 -1.0 -1.0 -1.0 1.0 -1.0 0.5 2.4 1.6 0.6 -2.1 -3.2 6.9
155 46 Singapore -1.1 6.0 5.1 8.9 6.8 5.2 5.1 3.6 0.3 4.3 3.5 5.7 6.2 3.7
156 119 Mauritius -4.7 5.7 1.7 2.3 2.6 5.7 1.6 3.5 3.5 2.1 4.6 3.6 6.6 3.6

Table 2: Average reduction rate of the infant mortality rate and growth rate of the economy

The first line indicates the ninth decile, i.e. the value reached or exceeded by the ten percent of the countries in the world with the fastest IMR decrease. We can estimate that this is a value (6.4% per year for 2005-2009) which all the countries can achieve if they put infant mortality high on their agenda. The second line shows the median, i.e. the value which separates the countries in two equal groups (3.4% per year for 2005-2009). These reduction rates are a combination of the technological progress which allows us nowadays to achieve a lower IMR with the same means, and economic growth which means that most countries have got more means at their disposal than previously.

If we look at the figures for the different countries, it is quite obvious that there is only a weak relation between the evolution of the IMR and the evolution of their standard of living. If we consider the eight countries with the highest reduction rate ((Slovenia 10.6%, Romania 10.4%, Egypt 7.8%, Lithuania 7.7%, Mongolia 7.6%, Oman 7.4%, Greece 7.4%, Turkey 7.3%), we realize that there is not necessary a direct link with their present rank as indicated in the previous table (between Slovenia 4 and Turkey 132).

The fact that some countries at the top of the table are also among the best ranked in the first table shows that even countries which already have a very low infant mortality rate can still make fast progress.

The example of Turkey, on the other hand, shows that a country which has totally neglected its health care system can make significant progress, but it will take a lot of time before it can catch up with the other countries. For instance, despite the third highest reduction rate over 19 years (from 1990 to 2009), it could only move from rank 133/137 in 1990 to rank 132/156 in 2009. If a country wishes to offer it's population the "highest attainable standard of physical and mental health" mentioned in the fundamental texts, even if only "to the maximum of its available resources", decades of consistent and sustained efforts are necessary.

Fast economic growth is not necessary in order to reduce the IMR, as is shown by the example of Slovenia which had a relatively low growth rate (1.4% per year between 2005 and 2009, 2.2% between 1990 and 2009).

1990 has been chosen as a starting point because the GDP/GNI figures for the USSR successor states are not available before this year, and because it is also the reference point for the Millennium Development Goal (MDG) program of the UN, which tries to push the governments to work towards concrete social progress. One of the objectives of the program is to reduce the IMR by two thirds between 1990 and 2015.

We can now compare the reduction rates of the table above with those necessary to reach this objective. In order to achieve a reduction of 66.66% over 25 years, an average annual reduction rate of 4.3% is necessary. Only 43 countries out of 156 exceed this value, which is quite disappointing.

However, there are only seven countries out of 156 where the IMR stagnated or increased during the last four years: Mauritius, Singapore, Congo, Trinidad and Tobago, Democratic Republic of Congo, Chad and Canada. Chad, Congo and the Democratic Republic of Congo went through difficult times. Singapore has got a low IMR relatively to its standard of living (rank 46) and has seen a fast decrease over the long term (5.1% between 1990 and 2009).

On the other hand, other countries have got a terrible score on all three indicators (IMR relative to the standard of living, decrease rate 2005-2009, decrease rate 1990-2009). It is quite surprising that almost all of them are in the sphere of influence of the USA. You might be interested in knowing that several times in the past, high ranking American government officials publicly declared that in their opinion, the economic and social rights are not part of the human rights. Therefore it is not surprising that this country ranks 146/156 as well in the IMR relative to the standard of living as in the decrease 2005-2009.

Only Trinidad and Tobago does even worse with ranks 155/156 resp. 153/156, zero decrease between 2005 and 2009 and even an increase between 1990 and 2009, even though this country has achieved fast economic growth in the last decades and is the richest country in the Caribbean. Jamaica and Canada do a little bit better, but show a similar pattern. Fortunately, Cameroon is there to diversify the picture and divert attention from the US region…

Let us have a look now at some of the few countries where the IMR has increased. The case of South Africa and some neighbouring countries is especially interesting. From 1990 to 1995, IMR increased by an average of 0.2% per year, from 1995 and 1999 by 2.4% per year. This corresponds to the presidency of Nelson Mandela (see the article Nelson Mandela – responsible for the death of 95,000 babies?). Swaziland, Lesotho and Botswana present a similar pattern. Like in the case of the United States, We have got a regional power which launched a deadly fashion: neglecting the health care system. Most of the other cases of an increase of the IMR are countries which were shaken by internal trouble (Rwanda, Cambodia, Uganda, Liberia) or which have experienced a breakdown of their communist regime.

The cases of China and Ireland are also interesting. Both did quite well overall, but there is a period where their IMR increased, in the case of China between 1985 and 1990, in Ireland between 1995 and 2000. Both correspond to a period of economic liberalization which brought sudden economic growth. This economic success has been widely commented in the media, but generally not with the number of babies who paid it with their lives. It is quite reassuring to see that both countries readjusted their health care policy without any pressure from our media: in the decrease of IMR 2005 to 2009, China ranks 17th, Ireland 27th.

However, there are still many countries which neglect their health care system in a criminal way, especially the US and some neighbouring countries. It is time that we hold the governments accountable, which implies explaining the human rights to them and confronting them with figures which show the efforts they make or on the contrary their gross negligence. However, our media do nothing like it. Maybe we should ask ourselves whether they care even a little bit about the survival of the babies born in this world and about the human rights in general.

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