Urban Poor Face Health Problems

DEJANIRA CAVALCANTI DA SILVA is pregnant, has six children, and lives in a wooden shack infested with rats, cockroaches, and fleas. Every weekday, she and some of the children take a train, a bus, and the subway to a downtown pedestrian area where street vendors sell everything from barrettes to batteries. The Silvas sell phone tokens in order to pay their water and light bills. Weekends, Ms. Silva washes clothes and cleans houses to buy food. ``My water bill is 5,000 cruzeiros a month,'' she says.

The water money would buy more than 25 kilos (55 pounds) of beans, a Brazilian mainstay.

High utility bills are new in much of Latin America, where for decades governments subsidized food, water, electricity, and transportation.

But today, cities are caught between growing populations and declining ability to pay for services - and poor infrastructure is beginning to cause serious health problems, according to a new study in progress. The higher bills may be the necessary if water-quality is to be improved.

``Cities like Lima and La Paz have become, in essence, giant peasant markets. The formal economy is receding,'' says Norman Gall, executive director of the Sao Paulo-based Fernand Braudel Institute of World Economics, which is doing the study.

This trend's impact is already visible in Peru, where a cholera epidemic that began in January is said to have infected 34,000 people and killed 166. Officials fear its spread to other countries on the continent where water supplies are contaminated and health programs underfinanced.

The breakdown in the urban structure, says Mr. Gall, has also caused the return in the region of other diseases, such as tuberculosis, leprosy, meningitis, dengue fever, and malaria.

Foreign aid is flowing into Peru to help with the cholera epidemic, but won't be enough to stem tragedy in the region as a whole, Gall predicts. ``People are writing off the third world, and these countries have to help themselves to gain credibility. Only then may, I repeat, may they get some outside help.''

Poverty is not new in Latin America, but the study indicates it is getting worse. Over decades, inflation has undermined public investment in infrastructure. At the same time, periodic economic crises have squeezed living standards. The results are acute poverty, endemic power and water shortages, and crumbling schools and hospitals.

UTILITY subsidies accompanied and abetted Latin America's postwar waves of migration from the countryside to the cities, and helped to keep the burgeoning slums from becoming a political problem. But inflation soared.

The study says that governments must stop printing money: ``Market-oriented pricing, after decades of subsidized resource transfers, entails substantial initial costs which, however, will be less than those expected from collapse of institutions and infrastructure in coming decades. Prospects for growth will shrink unless economic policy moves firmly and clearly toward creation of surplus for investment,'' the institute advises.

Easier said than done. In late January, Argentina raised the prices of cooking gas, electricity, train tickets, postal rates, water, and sanitation rates by 20 to 30 percent. In response, train workers began a strike that has lasted more than two weeks, paralyzing much of the urban transport system. Other countries have seen similar reactions.

But economists and officials say resistance to a new pattern of sharing the costs of social and economic development will drop off as society perceives that there is no easy solution to the inflation problem. ``There is no other way out,'' says Sao Paulo state planning secretary Paul Singer.

What happens to Ms. Silva's family in the process? ``People who can't afford to live in the city will fall by the wayside,'' Gall says. This may have already begun to happen, partly in the form of urban exodus, although in Brazil no statistics are available because last year's census was canceled for lack of funds.

``Just as soon as I can get my documents and a job to earn the fare, I'm leaving,'' says Almir Soares. He lives under a highway bridge and works as a painter when he can get a job. ``I can earn more money as a butcher at home than I do here. It's OK here when the job comes with housing and food. But if you don't have a place to live, it's no good.''