Underweight prevalences in South America are the lowest in the developing world. Malnutrition could be largely eliminated in the foreseeable future, but rates of improvement will nonetheless have to increase to achieve this - progress has been slower than elsewhere, except for Sub Saharan Africa, in the last ten years. Examples of trends in Bolivia and Colombia are shown in Figure 7 and others in Table 3 at the end of the paper. Estimates of poverty levels indicate a small increase in the period 1987-90-93 (from 22.0% to 23.5%), which is in line with the underweight trends. Further, as seen in the Middle America and the Caribbean, GNP growth in middle income countries seems to have only a minor effect on underweight prevalences. On the other hand, infant mortality rates have come down steadily in the last ten years.
Estimates of per capita GNP growth point to significant increases on average in the last ten years (see Panel 7D), although the poverty data indicate a worsening income distribution. In fact some of the most unequal income distributions anywhere are recorded in South America - for example in Brazil where the lowest 40% of households have only 7% share of the income - and regional disparities, like for North Eastern Brazil, are extreme. Structural adjustment programmes, responding to severe economic problems marked by hyperinflation in some countries, succeeded in reducing the debt burden, but often with a cost to nutrition and health. Nonetheless, over the course at least of the '80s nutrition improved in countries such as Brazil, in line with major investments in health infrastructure (like sanitation) and education, and (it is argued) as a result of the mobilization of civil society at the local level, often despite a lack of official support.
The food availability in South America has been at a reasonably high level throughout this period, and even during periods of hyperinflation the nutritionally important ratio of food price to consumer price indices did not generally rise greatly, and in fact actually fell in Brazil in 1986-93.
Access to health services and environmental health have improved and tended to remain at a high level, and immunization rates have been maintained with a reasonable coverage. Girls secondary education has grown, enrollment now estimated at about 60%. Total fertility rates continue downward, now passing a value of 3 births per woman.
Depending on developments, South America is set to largely eliminate malnutrition in the population during the early part of next century - although large pockets of poverty, regional and in the massive and rapidly expanding slum populations, will require sustained efforts.
PANEL 7. SOUTH AMERICA
A. Million, log scale
CHILD GROWTH AND SURVIVAL
B. Underweight preschool children (Percent below -2 s.d. weight for age)
C. Infant Mortality Rate (Per 1,000 live births)
ECONOMICS AND FOOD
D. GNP per capita (Atlas US dollars)
E. Dietary energy supply (Kcals per caput per day)
F. Immunization coverage (Percent)
G. Access to health services and potable water (Percent)
WOMEN'S STATUS AND CARING CAPACITY
H. School-age females in secondary school (Percent)
I. Total fertility rate (Births per woman)