Dear Dr. Kim,
The World Bank classification of Middle Income (MI) countries is sending the wrong message to the world. The concept is being misused by development agencies and funding institutions and it gives the false impression that populations living in these countries are middle class societies. It is accurate that, for political reasons, governments of these countries like to be classified by the WB from low to middle and from middle to upper middle income as a reflection of their political success; however, the immediate and midterm effects that these classifications bring to people is not a positive one in terms of public health.
In fact, when the MIC classification is given to a specific country, immediately development agencies and international/multilateral financing mechanisms reconsider providing funding to that country. In addition, other private multinationals often increase their prices of goods and services offered to those countries, including and particularly lifesaving medicines. Lowering or stopping the flow of funding coupled with price increases, adversely affects the lives and wellbeing of communities, especially the most vulnerable and key affected populations. This gravely impacts the continuum of care by minimizing access to prevention, care, treatment and support services.
The middle-income classification is in fact a distortion of reality and does not accurately reflect the income level of the majority of people in these countries.
Withdrawal in funding due to a perceived upgrade in income classification, creates the idea that people get used to living in poverty and ill-health, and therefore do not need international aid because of their governments’ ability to pay. This is simply not true. This is theory and not real life. Currently, most of the world’s poor live in MI countries. Most of the people living with HIV, live in MI countries. Most of the people affected by TB live in MI countries.
Under a global economy concept the following paradoxes should not exist: Someone living with $9,000 dollars a year in the US and EU is considered living below poverty line and therefore subject to government aid, but if that same person lives in Mexico, Brazil, Jamaica, Serbia, or Macedonia, he/she is classified as upper middle income and therefore subject to zero aid. Same thing happens if a person earns $3,500 a year he/she is close to extreme poverty in the US and the EU, but labeled as middle income if he/she lives in Ukraine or Guatemala. Even more alarming, a person earning less than $1,900 a year will be in extreme poverty in the US and EU, but be middle income if he/she lives in Nicaragua or Kyrgyzstan.
Even under a theoretical and perfect equal distribution of wealth, all MI countries of the world have a lower per capita income than Greece; however, all the rich countries, especially the OECD ones, are deeply concerned of Greece’s financial crisis and giving that country billions of dollars/euros in aid to solve its crisis at the same time, they are pressuring multilaterals and their own development agencies, to stop funding communicable diseases like HIV, TB and Malaria programs in MI countries
In conclusion, the below signatories, mainly from Latin America & The Caribbean and Eastern Europe & Central Asia want to request the World Bank to:
- Acknowledge that the income classification of countries has severe limitations
- Acknowledge that this income classification uses information from the past and is used by development agencies to predict ability to pay for health services in the future
- Until there is a change in the method of classification, immediately explain the development agencies and multilateral organizations, that the WB income classification of countries is not an indicator of a country’s ability to pay for its population’s needs on health, HIV, TB and malaria;
- Change the method of classifying per capita income of countries to reflect the reality of people in a globalized economy;
- Recognize that if a financial crisis, like the one in Greece, is transmittable and of global concern to deliver aid to jointly solve it; communicable diseases like HIV, TB and Malaria are also transmittable and aid should not be stopped just because of the MI classification given to countries by the WB.
Sign the petition here: