Health

   Burma, like neighboring Asian countries, has a sophisticated tradition of indigenous medicine, and many long-established customs, such as frequent bathing and a diet rich in fruits and vegetables, are healthful. But the history of modern public health services began during the British colonial period. After independence, the governments of U Nu and Ne Win invested significant resources in health facilities in accordance with the socialist principle that they should be available to all. From 1962 to 1988, when the Burma Socialist Programme Party (BSPP) was in power, the number of trained physicians, nurses, and midwives increased 300 to 500 percent, and the number of hospitals almost doubled. Medical care was free in principle, although of a rather low standard.

   Since the State Law and Order Restoration Council (SLORC) seized power in September 1988, both the quality and availability of health care for the great majority of Burmese people has declined dramatically. This is because smaller percentages of government budgets are allocated to health compared to the BSPP years (while military-related spending has grown dramatically), and because the old system of public hospitals and clinics has been allowed to deteriorate. Since 1988, people with money have patronized expensive, private sector hospitals, and Tatmadaw personnel have their own relatively well-equipped system of hospitals and clinics.

   Three other factors have also had a negative impact on health standards: the growing expense of food, including rice, which has led to widespread malnutrition among poor people, especially children; the Tatmadaw's stepped-up pacification of ethnic minority areas, where people are often subjected to forced relocation and forced labor; and growth in the sex industry and the use of heroin, which have created an epidemic of AIDS. According to a 2000 report by the World Health Organization (WHO), Burma ranked 139 out of 191 countries listed in terms of the population's overall health. Life expectancy at birth for both sexes, 55.8 years, is low by regional standards (Thailand's is 71.2 years), while rates of infant, child, and childbirth death are high. There are grave shortages of physicians, nurses, and equipment at most hospitals, and patients often have to buy their own medicines on the black market.

   At present, malaria surpasses even AIDS as a serious public health threat, not only because of inadequate facilities, but because treatmentresistant strains of the mosquito-borne parasite have emerged, especially in the mountainous region along the Thai-Burma border. Refugees and forcibly relocated persons in the border areas, including many Karens (Kayins), Karennis, and Shans, are especially vulnerable. In Burma, most cases of malaria (according to one source, 85 percent) are of the potentially lethal P. falciparum variety. Tuberculosis is also widespread, according to WHO statistics reported in 2002, causing 85,000 new cases and 20,000 deaths a year. Other widespread diseases include dengue fever, dysentery, and hepatitis. Since 1991, a number of international nongovernmental organizations have worked in Burma's health sector, though under restrictive conditions imposed by the military regime. Because of the country's many health emergencies, the issue of humanitarian aid has become controversial. Some groups, such as the National Coalition Government of the Union of Burma and ALTSEAN-Burma, argue that humanitarian aid should not be given unless it is in consultation with the National League for Democracy and without State Peace and Development Council (SPDC) involvement; aid given in border areas should be strictly monitored by independent observers. Critics of this position, such as the International Crisis Group, say that the health crisis is too serious for aid to be subject to "political" conditions, and that it should be given even through SPDC-controlled channels.

   See also Education; Population.