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Peru HEALTH AND WELL-BEING
In the early 1990s, Peru was hit by a cholera epidemic,
which
highlighted longstanding health care problems. Review of
health
statistics amply illustrates Peru's vulnerability to
disease and
the uneven distribution of resources to combat it. The
most and
the best of the health facilities were concentrated in
metropolitan Lima, followed by the principal older coastal
cities, including Arequipa, and the rest of the country.
The
differences among these regions were not trivial. Whereas
Lima
had a doctor for every 400 persons on average, and other
coastal
areas had a ratio of one doctor for every 2,000, the
highland
departments had one doctor for every 12,000 persons (see
table 9,
Appendix). The same levels of difference applied with
respect to
hospital beds, nurses, and all the medical specialties.
In the early 1990s, over 25 percent of urban residences
and
over 90 percent of rural residences lacked basic potable
water
and sewerage. Thus, the population has been inevitably
exposed to
a wide variety of waterborne diseases. The incidence of
disease
not surprisingly reflected the inequities evidenced in the
health
system: the leading causes of death by infectious diseases
have
varied from year to year, but invariably the principal
ones have
been respiratory infections, gastroenteritis, common
colds,
malaria, tuberculosis, influenza, measles, chicken pox,
and
whooping cough. The cholera epidemic, which began in 1990
and
claimed international headlines, ranked well down the list
of
causes for death behind these others, which have been
endemic and
basically taken for granted. In a typical case, during one
year
in Huaylas District, which had a small clinic and often
was
fortunate enough to have a doctor in residence, 40 percent
of all
deaths registered were children below four years of age,
who died
because of a regional influenza epidemic.
Although Peru's infant mortality rate per 1,000 live
births
dropped from 130 to 80 over a 26-year period (1965-91),
the rate
in 1991 was still over twice the rate of Colombia and four
times
the rate of Chile. The mortality rate for children under 5
was
also brought down greatly, from 233 per 1,000 in 1960 to
107 per
1,000 in 1991. Both measures for 1991 still exceeded all
the
other Latin American countries except Bolivia and Haiti.
The only
direct measure of social welfare that deteriorated was
nutrition:
calorie consumption per capita fell 5 percent from the
average
for 1964-66 to 1984-86. In 1988 calorie consumption was
2,269, as
compared with 2,328 in 1987. Because calorie consumption
levels
generally parallel income levels, the decrease must have
been
concentrated at the level of the extremely poor (see
table 10,
Appendix).
Peru's lack of general well-being was further suggested
by
the nation's high and growing dependence on foreign food
since
1975 through direct imports, which had increased 300
percent, and
food assistance programs, which showed a tenfold
increment. The
United States has been by far the largest provider of food
assistance to Peru through its multiple programs
administered
under the Food for Peace (Public Law 480) projects of the
United
States Agency for International Development (AID). During
the
1980s, food aid amounted to over 50 percent of all United
States
economic assistance. The aid was delivered as maternal and
child
health assistance and food-for-work programs administered
by CARE
(Cooperative for American Relief), church-related private
voluntary organizations, or by direct sale to the Peruvian
government for urban market resale.
Peru's totally inadequate social security system,
operated by
the Peruvian Institute of Social Security (Instituto
Peruano de
Seguridad Social--IPSS), did not remain exempt from the
Fujimori
government's privatization policy. As a result of two
legislative
decrees passed in November 1991, Peru's system for
providing
social security retirement and health benefits underwent
significant modification. The changes were similar to
those made
by the military government of Chile in the early 1980s,
when
employees were given a choice of either remaining with the
existing system or joining private systems set up on an
individual capitalization basis. The Fujimori government
decided
to adopt the Chilean social security model almost
completely. The
stated objectives were to permit open market competition,
alleviate the government's financial burden by having it
shared
by the private sector, improve coverage and the quality of
benefits, and provide wider access to other social
sectors.
Private Pension Funds Administrators (Administradoras de
Fondos
de Pensiones--AFPs) were expected to begin operating in
June
1993. A presidential decree in December 1992 ended the
IPSS's
monopoly on pensions. This provided a boost to Peru's
small and
underdeveloped capital market by allowing the AFPs to
invest in
bonds issued by the government or Central Reserve Bank
(Banco
Central de Reservas--BCR, also known as Central Bank) as
well as
in companies.
The cholera and other health and social issues in Peru
were
interrelated closely with the country's steadily worsening
environmental conditions. The high levels of pollution in
large
sectors of Lima, Chimbote, and other coastal centers had
resulted
from uncontrolled dumping of industrial, automotive, and
domestic
wastes that had created a gaseous atmosphere. The loss of
irrigated coastal farmland to urban sprawl, erosion of
highland
farms, and the clear-cutting of Amazonian forest all have
conspired to impoverish the nation's most valuable natural
resources and further exacerbate social dilemmas. Although
Peru
is endowed with perhaps the widest range of resources in
South
America, somehow they have never been coherently or
effectively
utilized to construct a balanced and progressive society.
The
irony of Peru's condition was captured long ago in the
characterization of the nation as being a "pauper sitting
on a
throne of gold." How to put the gold in the pauper's
pockets
without destroying the chair on which to sit is a puzzle
that
Peruvians and their international supporters have yet to
solve.
* * *
The literature on Peru is extensive. Particularly
important
have been the many monographs, books, and series issued
under the
aegis of research institutes, such as the Institute of
Peruvian
Studies (Instituto de Estudios Peruanos--IEP) and the
Center for
Development Studies and Promotion (Centro de Estudios y
Promoción
del Desarrollo--DESCO), and publishers such as Mosca Azul
and the
Pontificia Universidad Católica del Perú, to name but a
few.
Readers can find a lucid review of Incan and pre-Incan
societies
in Richard L. Burger's review essay, "An Overview of
Peruvian
Archaeology." Henry F. Dobyns and Paul L. Doughty give an
overview of national society in Peru: A Cultural
History.
Women's roles are thoroughly explored in B. Ximena Bunster
and
Elsa Chaney's study of market women, Sellers and
Servants,
and in Susan C. Bourque and Kay B. Warren's Women of
the
Andes. Stephen B. Brush's description of peasant life,
Mountain, Field, and Family, gives a clear
explanation of
Andean farming. There are many excellent studies of the
central
highlands and Mantaro Valley, including Norman Long and
Bryan R.
Roberts's edited volume, Miners, Peasants, and
Entrepreneurs. Susan Lobo discusses the social
organization
of Lima's squatter settlements in her monograph, A
House of My
Own. Peter Lloyd's comparative study of Lima's
squatter
settlements, The `Young Towns' of Lima, gives a
strong
overview of the results of migration. Teófilo Altamirano's
studies of migration are especially good in showing the
impacts
of change, as is David Collier's Squatters and
Oligarchs
for dealing with the politics of settlement.
By far the most important analysis of demography and
policy
is Alberto Varillas Montenegro and Patricia Mostajo de
Muente's
La situación poblacional peruana. Successful early
grassroots development work is described in Henry F.
Dobyns, Paul
L. Doughty, and Harold D. Lasswell's account of the
Cornell Peru
Project at Vicos in Peasants, Power, and Applied Social
Change. The religious experiences of Peruvians are
reviewed
in Jeffrey L. Klaiber's Religion and Revolution in
Peru, 1824-
1976; and Manuel Marzal's Los caminos religiosos de
los
inmigrantes en la gran Lima, an excellent account of
neighborhood-level Catholicism and Protestantism. The
literature
on Peasant Communities is large, but note should be made
of
Cynthia McClintock's Peasant Cooperatives and Political
Change
in Peru, which recounts the changes during the Velasco
era.
The special problems of coca and cocaine are
well-presented in
Deborah Pacini and Christine Franquemont's Coca and
Cocaine and in Edmundo Morales's Cocaine: White
Gold Rush
in Peru. (For further information and complete
citations,
see
Bibliography.)
Data as of September 1992
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