Caring For Those Left Behind

Although significant progress has been made positive change has limited reach. Millions of people continue to be left behind from mainstream progress  – especially the young, the poor and those who are disadvantaged.

Progress has always been a pretty bumpy journey; the next ten years looks as if little will be done to improve the ride. Although for some, access to better medicine, education and employment will be transformational; for others, life will just get worse. It may also feel worse as the chasm between the haves and the have-nots is widening, and some expect that it will become progressively difficult for anyone to hear the voices of those left behind.

Consider the plight of the children who stay in the countryside while their parents head to the city. In China, where over 270 million people have left their villages to look for work, they are named liushou ertong, or left-behind children. According to the All-China Women’s Federation, there are around 61m of them, only 10 million less that the total child population of the US. China is not the only country whose children suffer as a result of urbanisation; but given the one child policy, and its enormously distorted sex ratio, this mass abandonment may fundamentally alter an entire generation.

Not that there is a significant “urban advantage” for the poor living in informal townships; UN Habitat estimates that one in six people in the world live in deprivation in urban slums and squatter settlements. Given the demographics of poor countries and communities, with their relatively high numbers of children, we can estimate that one out of every four children in the world currently lives in urban poverty. As more people migrate, the chances are this number will grow. Slum children’s lives are frequently challenged from the get-go. Their parents are often unable to register their birth, limiting their access to basic services, like education and health. Reliant on the informal economy, many poor urban households are also obliged to push their children into labour.

On the surface, things look a bit better in the countryside, but not by much. In many cases farming productivity is pretty woeful; in India, roughly half the population, 600 million people, depend upon growing crops or rearing animals to survive. Volatile prices, poor access to markets, out-dated regulation, limited access to finance and stringent land ownership rules – all combine to make it almost impossible for many to earn a reasonable wage. Low productivity is a bigger long-term problem. One cause of this is the shrinking size of cultivated plots; as India’s population expands, the average plot size has fallen from nearly 2.3 hectares (5.7 acres) in 1970 to under 1.2 hectares today. Oxfam states that 216 million people – a quarter of rural India’s population – live below the poverty line.

A search for a better way of life for a population of this magnitude is never going to be possible only by relying on migration to the cities so, looking ahead, many see that much could be done to improve the lot of farmers. A high rate of suicides amongst Indian farmers has already drawn widespread media attention; an overhaul of regulation would help. Current restrictions on the storage of commodities such as onions and wheat actively discourage farmers from investing in cold storage and warehouses; leasing land is famously hard, since strong tenancy rights discourage owners from renting out fields; state marketing boards restrict trade in fruit and vegetables often making it easier for traders to import from abroad.

In addition to advocating a regulatory review, some pointed out that little changes could make fundamental differences. In Bangalore, for example, only those who have no other choice become truck drivers – which explains why there are so many road accidents. The International Road Assessment Programme estimates that, in India, there are 76,000 deaths and serious injuries every year, with most casualties being male and under 30. Often the breadwinner, their deaths take a huge emotional and financial toll, plunging families into generations of poverty and costing the government around USD 2.8 billion. Licencing and improving the working conditions of drivers would it is argued, make a difference. In towns, giving pedestrians a safe place to walk would help too.

You don’t have to be poor, living in an emerging economy, to slip through the system. Rich countries face challenges too, not least in the care of the mentally ill. This accounts for more suffering and premature deaths than heart disease and strokes, or than cancer; in many nations it costs around 3-4% of GDP in treatment and lost productivity. Some argue that the US in particular is ill-prepared to cope, leaving prisons and police officers to deal with the effects of untreated mental illness, but across Europe, 40-70% of prison inmates are also mentally ill. In the developed world, the WHO estimates that only about half of all people with depression are diagnosed and treated.

There are indications that change is on its way, because of the heightened attention now being given to the impacts of urbanisation, rural need and mental illnesses. The United Nations has already declared 2011-2020 the Decade of Action for Road Safety and the new Sustainable Development Goals has an ambitious target to halve road deaths by 2020. Governments are becoming more proactively involved, while small donors make a sizeable difference; indeed their contributions vastly outweigh those of billionaire philanthropists and their foundations, although the Gates Foundation has done a lot to reduce child mortality and improve agricultural activity. Around 200 countries have approved the WHO’s Mental Health Action Plan, calling for better treatment by 2020. In the UK, the NHS has pledged to invest more than a billion pounds a year by 2020 to help more than a million extra people. Within the corporate world, companies are adding mental illness into their diversity initiative; Accenture has recently launching its Mental Health Allies programme.

And yet, the most telling moment in any workshop is often the casual comment just before a coffee break. On one such occasion a well-meaning participant observed that nothing would change over the next decade because mostly bad things happen to poor people or to those on the peripheries. Too comfortable and too distant from the reality of others, many of the rich are unprepared to sacrifice their high quality of life to change the status quo. No one disagreed. Let’s hope they’re wrong.


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216 Million

A quarter of rural India’s population live below the poverty line.

61 Million

Number of left-behind children in China





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