2. health
Transcript
2. health
2 FEMISE RESEARCH PROGRAMME 2002-2004 The Mediterranean Limes. The Social Variables of Development: Health, Poverty and Crime The Impact of the Euro-Med Partnership and Globalization on Social Imbalances between The North and the South of the Basin Volume 2 Research n°FEM21-30 Directed By Carla Collicelli, CENSIS, Italie In collaboration with Faculty of Economics and Political Science - Cairo University, Egypt Royal Scientific Society, Jordan KEPE, Greece Bogazici University, Turkey November 2003 Ce rapport a été réalisé avec le soutien financier de la Commission des Communautés Européennes. Les opinions exprimées dans ce texte n’engagent que les auteurs et ne reflètent pas l’opinion officielle de la Commission. This report has been drafted with financial assistance from the Commission of the European Communities. The views expressed herein are those of the authors and therefore in no way reflect the official opinions of the Commission. Femise Coordinators Economic Research Forum Institut de la Méditerranée For the Arab Countries, Iran and Turkey C AISSE D EPARGN E PROVENCE -ALPES - CORSE Research in the FEMISE network STUDY D2: POVERTY, INFORMAL SECTOR, HEALTH AND LABOUR THE MEDITERRANEAN LIMES. THE SOCIAL VARIABLES OF DEVELOPMENT: HEALTH, POVERTY AND CRIME THE IMPACT OF THE EURO-MED PARTNERSHIP AND GLOBALIZATION ON SOCIAL IMBALANCES BETWEEN THE NORTH AND THE SOUTH OF THE BASIN Volume II The case-studies in the 5 countries Rome, november 2003 The study was carried out by a working party of the Censis Foundation with the collaboration of Abaton-Ricerca, Progetti e Studi. Working party: Carla Collicelli (Leader); Rosario Sapienza, Massimiliano Valerii (Coordinator); Matteo Scaramella, Marta Piccarozzi, Andrea Baglioni, Gloria Pizzichemi, Giuseppe Lubrano, Elena Mariniello, Vittoria Coletta; Maria Antonella Di Candia, Roberta Bernardi, Sabrina Pusceddu (Secretariat). INDICE VOLUME I Foreword Statement of Research Issue and Literature Review Research Methodology Pag. “ “ 1 5 8 Part One - Comparative study of Poverty, Health and Crime in the Mediterranean Countries “ 10 1. Poverty 1.1. Human development 1.2. Economic deprivation 1.3. Social exclusion 1.4. Millennium Goals directly linked to poverty “ “ “ “ “ 11 11 16 23 31 2. Health 2.1. General trends and figures 2.2. Healthy life expectancy 2.3. Access to health 2.4. Spending on health 2.5. Millennium Goals for health “ “ “ “ “ “ 37 37 45 48 54 72 3. Crime 3.1. A problem of approaches and definitions 3.2. Comparative analysis of crime statistics 3.3. Governance as the habitat of security “ “ “ “ 80 80 81 84 Part Two - Analysis of main factors, creation of new indicators and study of correlations “ 100 1. Premises for analysis “ 101 “ “ 102 103 “ 104 2. Methodological approach to Principal Component Analysis (PCA) 2.1. Defining the concepts 2.2. Definition of macro-phenomena and identification of evaluation criteria 2.3. Aggregation of indicators: Principal Component Analysis (PCA) 2.4. Rating Pag. “ 105 107 3. Creation of Poverty and Access Index (PAI) “ 108 4. Construction of the Health System Index (HSI) “ 115 5. Construction of the Governance Security Index (GSI) “ 125 “ 128 “ 128 “ 133 “ 136 “ 152 Egypt “ 1 Jordan “ 74 Greece “ 123 Italy “ 189 Turkey “ 291 6. Incidence of Poverty, Health and Governance in human development in the Mediterranean region 6.1. The three indicators in relation to the Human Development Index (HDI) 6.2. Crossing the three indicators Health, Poverty and Governance with one another 6.3. Crossing the three indicators (PAI, HSI and GSI) with a number of active variables present in each of them Research Synopsis VOLUME II - THE COUNTRY-STUDIES EGYPT Alia El-Mahdi - Professor of Economics Faculty of Economics and Political Science - Cairo University Magued Osman Suzanna Sobhy Marwa Salem Anwar Abdel Aal 11873_02 1. Study D2: Poverty, Informal Sector, Health and Labour COUNTRY PROFILE: ESSENTIAL FIGURES Official Name: Republic of Egypt Arab Background: Egypt is reputed worldwide for its distinct 7,000-years-old record of history and civilization. This has made Egypt a master and pioneer of science, arts, culture, architecture as well as almost all fields of human knowledge (SIS, Year Book, 2002). 1.1. Population - Population: In January 2002, the population of Egypt was estimated at 65.986 million (32.220 mill males and 33.766 mill females) excluding Egyptians living abroad (CAPMAS, 2002). - Age structure (CAPMAS): - Populations below 14 years represent 34.5 % of population in 2000 compared to 39.5% in 1986. - Population age category between 15 and 64 represents the majority of population (62%) in 2000. - Old age category, 65 years and over represent 3.6% of total population in 2000 - Birth rate: Birth rate dropped from 40 per thousand in 1986 to 26.7 per thousand in 2001 (CSD, 2002). 2 FONDAZIONE CENSIS 11873_02 Study D2: Poverty, Informal Sector, Health and Labour - Mortality rate: Mortality rate in 2001/02 is 6.2 per thousand compared to 6.3 per thousand in 2000/01 (SIS, 2002). - Natural growth rate: Normal Population Growth in 2001 was estimated at about 1.334 million i.e. one citizen / 23.6 seconds with a monthly growth of about 111,186 child and a daily increase of about 3655 child (SIS, 2002). Thus, natural growth rate fell from 30.5 per thousand in 1996 to 20.4 per thousand in 2001 (CAPMAS, 2002). - Population Growth Rate: 2.13 % in 2001 (CAPMAS, 2002) - Net migration rate: -0.24 migrant(s)/1,000 population (2001 est.) - Sex Ratio: 0.95 male(s)/female (MOHP, 2002) - Infant mortality rate: 60.46 deaths/1,000 live births (CAPMAS, 2002). - Life expectancy at birth: total population: 63.69 years, male: 67.1 years, female: 71.5 years (CAPMAS, 2002). - Total fertility rate: 3.5 children born/woman (1997-2000) (DHS, 2000). - Education rate: (HDR, various issues) - Primary enrolment ratio (gross) %: 91.7 (2002/2001). - Preparatory enrolment ratio (gross) %: 92.3 (2002/2001). - Secondary enrolment ratio (gross) %: 71.1 (2002/2001). - Tertiary enrolment ratio (gross) %: 30.2 (2002/2001). - Population Density: Average population density mounted to 1096/km2 in inhabited areas and only 61/km2 if the state’s total area is utilized (SIS, 2002). - Labor Force : Labor force amounted to about 19.73 million in 2001/02 and about 20.26 million in 2002/03 (SIS, 2002). 3 FONDAZIONE CENSIS 11873_02 Study D2: Poverty, Informal Sector, Health and Labour 1.2. Economy and Labor Economic performance tops the government’s priorities, especially under the current global conditions affecting world economy. The state’s economic policy focuses on activating and affecting the role of the private sector in development efforts, boosting domestic and foreign investments, implementing national mega projects, promoting human development to overcome the challenges of the new era, preparing youth to assume their responsibilities in different fields of national action and bolstering women’s role in community development. - GDP growth rate: After several years of strong growth in the second half of1990s, Egypt’s economic growth has slowed markedly over the last three years. Real growth rate in the country’s gross domestic product (GDP) was only 3.2% in 2002, compared to 3.4% in 2001, and to 6.0% as recently as 2000. - GDP per capita: GDP per capita has increased from US$ 1015 in 1995 to US$ 1276 in 2002 (Ministry of Planning). - GDP per Sector (2002) : 1. Commodity Sector: contributed by 49.8 percent of GDP) (HDR, 2002/2003). - Agriculture: 16.5 percent of GDP. - Industry: 33.3 percent of GDP. 2. Services sector: 50.2 percent of GDP. - Unemployment Rate: There are different estimates of the UER that range from 9.9% in 2002 (official estimate) to 17.5% (unpublished estimates) during 1998- 2002. - Inflation Rate: has declined sharply over the last 7 years. It was 2.4% in 2002 compared with 9.4% in 1996. However, the inflation rate rose again to exceed 8% during the months of March to September 2003, due to the new exchange rate policy, which moved towards a more liberalized exchange rate. As a consequence, the value of the Egyptian Pound (LE) 4 FONDAZIONE CENSIS 11873_02 Study D2: Poverty, Informal Sector, Health and Labour versus the US$ fell from LE 4.62/ US$ to LE 6.2/US$ in September 2003. A 35% drop in the value of the LE resulted in an increase in the CPI, which started to rise from 2% in April 2002 to 4.7% in April 20031. - Investment: The government has taken various steps to ensure that the investment climate is as favorable as possible. The most important step to date is the Investment Law of 1997, which codifies and clarifies all provisions pertaining to investment in the country. The investment law of 1997 allows foreign companies to have 100% ownership of Egyptian companies and provides for the repatriation of dividends. Another important feature of this law is the fact that it identifies 16 fields that benefit from investment incentives outlined in the law. - Trade: Historically, despite the volatility of the region in which Egypt is situated, trade has continued successfully. Egypt’s main trading partners are the US, Italy, France, Greece, Germany, Britain and Japan. Major categories of goods imported are wheat, meat, flour, machinery and automobiles. Major categories of goods exported are petroleum, oil, gas, cotton and cotton textiles, metal products, chemicals (CBE, 2002). The share of exports of goods & services to GDP in current prices has declined from 29.5% in 1995 to 17.5% in 2001 (CBE, 2002). However, exports represented 45 percent of imports in 2002 compared to 32.7 percent in 1996. Egypt is a member of several trade blocs (see Appendix). - Currency: Egyptian Pound (£E) consists of 100 piasters2. 1.3. Geography and territorial characteristics - Location: Egypt, a country in northeastern Africa, is located at the heart of the world, standing as a major trade and crossroads destination between Europe, the Middle East, Africa and west and south Asia. It occupies the north Eastern corner of Africa, bordered by Libya to the west, Sudan to the south, Palestine and Israel to the northeast. Its north 1 2 CAPMAS, Monthly Bulletin for CPI, May 2003. 1US$ = £E6.2 in 2003 (CBE). 5 FONDAZIONE CENSIS 11873_02 Study D2: Poverty, Informal Sector, Health and Labour coast is on the Mediterranean Sea, while the eastern coast is bounded by the Red Sea. The Suez canal links the Red Sea to the Mediterranean. - Geographical Borders: Egypt is bounded as follows: - To the north, by the Mediterranean with a 955-km-long coast. - To the east by the Red Sea with a 1941-km-long coast. - To the northeast, by 265-km-long borders with Palestine and Israel. - To the west, by 1115-km-long borders with Libya. - To the south, by 1280-km-long borders with Sudan. - Area: Egypt has a total area of about 1,002,000 km2, 55367 km2 (5.5%) are populated. - Capital: Cairo - Topography: The Arab Republic of Egypt is divided into four major parts: - Nile Valley and Delta: It has an area of about 33,000 km2, i.e. less than 4% of the total area of the country, while the remaining area, i.e. 96% is desert. - Western Desert: The Western Desert occupies an area of about 680,000 km2, i.e. 68% of Egypt’s total area. - Eastern Desert: Its area is about 225,000 km2, i.e. 28% of Egypt’s total area. - Sinai Peninsula: With an area of about 6100 km2, i.e. 6.1% of Egypt’s total area. - Climate: Egypt lies within the dry tropical region, except for the northern parts that lie within the warm moderate region, with a semi Mediterranean climate characterized by hot dry summers and moderate winters with little rain falls, potentially heavier along coastal areas. - Religions: Muslim (mostly Sunni) 94%, Coptic Christian and other 6% 6 FONDAZIONE CENSIS 11873_02 Study D2: Poverty, Informal Sector, Health and Labour - Languages: Arabic (official), English and French widely understood by educated classes - Natural Resources: Egypt possesses a wealth of major minerals, including oil, phosphate, iron, and manganese. The major products of stone quarries represented in granite, basalt, marble, limestone, sand, and glass. - Environmental Issues in Egypt: Some environmental issues represent a priority to policy makers as well as the concerned civil society organizations and they include: - Industrial Pollution (industrial liquid Wastes and industrial solid Waste). - Non- Industrial Pollution (Solid Wastes, Hospital Wastes, Sanitary Drainage and Air Pollution Generated from Vehicles Exhausts). - Archeological Environment Pollution. - Energy Consumption - Carbon and Energy-Related Emissions. - Energy and Carbon Intensity - Hydroelectric Power and the Nile River 1.4. Key Issues - Economic constraints 1. Economic recession, particularly since 1997. 2. Exchange rate volatility 3. Modest Export performance 7 FONDAZIONE CENSIS 11873_02 Study D2: Poverty, Informal Sector, Health and Labour 4. Low productivity 5. Inflationary pressures - Social constraints 1. Unemployment, low standards of living and levels of income 2. Low social and medical insurance coverage 3. High natural population growth rates - Political constraints 1. Limited political participation 2. Modest role of the civil society organizations 8 FONDAZIONE CENSIS 11873_02 2. Study D2: Poverty, Informal Sector, Health and Labour HEALTH 2.1. Definitions The government of Egypt is adopting the World Health Organization definition of health “a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity”. A recent survey3 indicates measured the perception of Egyptians about their own health. The results indicated that 49% of the Egyptians feel that their health is same as people in the same age, 40% feel that their health is better or much better, 11% feel that their health is worse or much worse. 2.2. Policy and Legislation The Egyptian constitution states that free health care should be available for every individual. Egypt started building health facilities in urban and rural areas to deliver primary health (PHC) services early in the nineteen twenties. In urban areas, it took the form of maternal and child health centers (MCH). In rural areas, it took the form of an old type of rural health facilities, which was followed by two types of wooden transferable health units, one to treat ophthalmic diseases, and the other to treat schistosomiasis and intestinal parasites. The national program for the rural health services started in 1942 by establishing the rural health centers, each centre was to serve about 30,000 inhabitants in one or more villages. Each centre was staffed by a health team headed by a physician and consisting of nursing staff, assistant laboratory technician, sanitarian, and other workers. The rural health centers were to offer all PHC programs to the served community including: maternal and child health 3 Ministry of Health and Population 2002, Egypt Household and Health Care Utilization and Expenditure Survey. 9 FONDAZIONE CENSIS 11873_02 Study D2: Poverty, Informal Sector, Health and Labour services, communicable diseases control, environmental sanitation, health education, parasitic and endemic diseases control, school health services, curative and emergency care (general practitioner level), family planning and dental care. Health care is delivered throughout public facilities, non-governmental organizations and the private sector. Public health facilities include: - Ministry of Health and Population (MOHP) owned facilities, which are mostly rural facilities, urban facilities, and secondary and tertiary hospitals for curative care. - Health insurance organization owned facilities, which provide services to employees, students, widows, pensioners and new born (about 45% of the Egypt population). - Curative care organization which runs some big hospitals and offers care for fixed fee. - Teaching hospitals and Technical Institutes Organization. - University Medical Teaching Hospitals, which have two systems, either completely free of charge curative services or fixed fee for service for those who can pay. Many NGO’s have health clinics and hospitals which offer services for reasonable prices to the public. The private sector plays an important role. It includes both formal and informal sectors. It manages private clinics or well-established specialized hospitals where people pay relative high fees for what they consider better services. This network also includes general practitioners, specialists, dentists, laboratories, pharmacists etc. During the nineties, the government was committed to the objective “health for all by the year 2000”. The government placed priority on meeting children’s health needs focusing on national programs to control diarrhea and acute respiratory infections and expanded childhood immunization program. Achievements were attained in the areas of high vaccination coverage, better health indices, especially infant mortality and life expectancy, and lower prevalence of intestinal parasites and schistosomiasis. 10 FONDAZIONE CENSIS 11873_02 Study D2: Poverty, Informal Sector, Health and Labour A policy reform agenda was developed to expand health insurance to a larger portion of the population. Several attempts was made recently to improve the quality of health care throughout changing the compensation scheme of health workers and providing on job training for the health team. Several initiatives are under consideration including improving health planning on the district level to strengthen decentralization, cost recovery, better referral system, support for deprived areas, and efficiency in using available resources. 2.3. Sources The Central Agency for Public Mobilization and Statistics (CAPMAS) is the main provider of data in Egypt. Periodical data include a census every decade and birth and death yearly report. In addition, seven rounds of a national representative sample survey were conducted during the last fifteen years under the umbrella of the Demographic and Health Surveys with support from USAID. The surveys provided detailed information on fertility, family planning, infant and child mortality and maternal and child health and nutrition. A national survey was recently conducted on health expenditure. The Ministry of Health and Population4 publishes regular reports on morbidity status. More data are provided through the Information Centre of the Ministry and through local authorities. 4 www.mohp.gov.eg 11 FONDAZIONE CENSIS 11873_02 Study D2: Poverty, Informal Sector, Health and Labour 2.4. Data [in addition to standard health indicators that can be accessed throughout the Human Development Report the following data are provided] Adult morbidity More than one third of individuals reported episodes of illness during the last two weeks5. Twenty percent of the individuals reported chronic illness/disability. Twenty two percent of adults Egyptians are at risk from chronic diseases that can be attributed to smoking. Seventeen percent of individuals reported chest sound wheezy/whistling and half of them experienced short of breath. Child morbidity The 2000 Egyptian Demographic and Health Survey provided data on the prevalence and treatment of two common childhood illnesses, diarrhea and acute respiratory illness. Seven percent of children under five were reported to have had diarrhea in the two weeks preceding the survey . Medical advice was sought in treating about around half of these cases. Use of ORS packets ( 34 percent ) or a homemade solution of sugar, salt and water (5%) to combat the dehydration was common. Altogether some form of ORT or increased fluids was used in treating around one in two of the children suffering from diarrhea. During the two weeks preceding the survey, 10% of children had a cough accompanied by symptoms of acute respiratory illness. In the case of twothirds of the cases a health provider was consulted and three fourth of the children were given antibiotics. Child nutrition Anthropometric data collected for children in the 2000 EDHS indicate that 19 percent of Egyptian children show evidence of chronic malnutrition or stunting, and 3 percent are acutely malnourished . The trend in 5 Ministry of Health and Population 2002, Egypt Household and Health Care Utilization and Expenditure Survey. 12 FONDAZIONE CENSIS 11873_02 Study D2: Poverty, Informal Sector, Health and Labour anthropometric indicators from EDHS surveys between 1992 and 2000 shows that the nutritional status of children under age five has improved from the situation prevailing during the first half of the 1990s, when 25 – 30 percent of children were found to be stunted. Large differentials in children’s nutritional status continue to be observed, however, particularly by residence. For example, the percentage stunted among children in rural Upper Egypt is 27 percent, three times the level found in the Urban Governorates . Macronutrient. Recent figures indicate that the coverage of the program for vitamin A supplementation for new mothers and for children is still limited. Around one ninth of mothers and one fifth of children reported receiving a vitamin A capsule. With respect to iodine, 44% of households were found not using salt containing some iodine despite the program adopted by the government to prevent iodine deficiency. Maternal health Maternal health indicators are still low. During pregnancy, only 37% saw a health provider for the recommended minimum four antenatal care visits. The pregnancy care that Egyptian mothers receive often does not include routine screening or advice that is important in detecting and preventing complications. For example, women reported that they had been weighed and their blood pressure monitored in the case of only about 60 percent of the births in which a medical provider was seen for pregnancy care. Urine and blood samples were taken in two in five births, the mother’s height was measured in about a third of births, and iron tablets/ syrup were received or bought in around a quarter of the births. Mother were given advice about potential pregnancy complications in 18 percent of the births and told by the provider where to seek assistance if they experienced problems in the case of 14 percent of the births. Health care during delivery can usually prevent maternal mortality and morbidity. In only 60% of the cases trained medical personnel assisted during delivery. Traditional birth attendants assisted with most of the remaining cases. Nearly one half of the deliveries took place in a health facility. In rural Upper Egypt, less than two-fifths of deliveries are 13 FONDAZIONE CENSIS 11873_02 Study D2: Poverty, Informal Sector, Health and Labour medically assisted and only one fourth of deliveries took place in a health facility. Disparity in health indicators Despite the improvement that has been achieved in most health indicators, one of the main concern in maternal and child health is the geographical disparity that continue to prevail especially between urban and rural areas and between Lower (northern) and Upper (southern) Egypt. Child mortality rate in rural Upper Egypt is twice the rate observed in Urban governorates. Prevalence of child malnutrition in rural Upper Egypt is tree folds its level in Urban governorates. With respect to maternal care during delivery, the percent of pregnant women seen by a health provider during pregnancy at least 4 times was 26% in rural area and 54% in urban areas. Health expenditure Annual per capita expenditure on health care is L.E. 205. This amount is divided to L.E. 121 on outpatient services, L.E. 15 on inpatient services and L.E. 69 on drugs6. 2.5. Phenomenology Currently, there is a large gap between the very comprehensive set of services that the actual primary care program intends to provide and the resources available to do it. The imbalance results in low salaries, lack of supplies and substandard facilities. Dissatisfaction is widespread. Already scarce resources are spread too thin to have an impact. The poor suffer to pay private doctors and make out of pocket payments to buy medicine. Services are fragmented and referral mechanisms loose people through the cracks in the system. The existing primary care system cannot provide a family and community focus, which is necessary to achieve primary health care goals. 6 Ministry of Health and Population 2002, Egypt Household and Health Care Utilization and Expenditure Survey. 14 FONDAZIONE CENSIS 11873_02 Study D2: Poverty, Informal Sector, Health and Labour The outcome of the large infrastructure of rural and urban health facilities has been far less than expected. Due to: - Lack of adequate training for the staff - Low utilization of services - Low investment in PHC, and in health in general - Bad physical status of the health facilities - Low salaries - Weak managerial skills, including lack of supervision, follow up and monitoring - Lack of effective community participation and involvement in health planning, monitoring, evaluation and utilization There is a clear need for policy reform, advances in quality assurance, human resource and systems development, decentralization, improved resource allocation, and increased private sector and community participation. Several health challenges are facing Egypt including lack of accessibility to adequate health care for poor and low insurance coverage among agriculture workers and unemployed. Another challenge that is due to external factor is the increasing cost for health care due to deteriorating exchange rate. If the current population growth rate continues and the economy does not recover, in the near future health problems will aggravate in the future. 15 FONDAZIONE CENSIS 11873_02 3. Study D2: Poverty, Informal Sector, Health and Labour POVERTY 3.1. Definition Although poverty has many manifestations and causes, but its main driving force is the process of exclusion from access to certain basic physical, human and social assets. To define poverty it needs selection of a welfare criterion in order to put a line that divides population into poor and nonpoor, this criterion could be income-based approach or non income-based approach: - Income-based approach is the commonly used measurement to define the poor, by determining a level of income7 if not attained by a person or a family, the later is classified poor. This critical level of income that separates the poor from non poor is named poverty line which could be in form of any of the following: - Absolute poverty line. - Relative poverty line. - Subjective poverty line. Most measurements in Egypt are based on some variant of the absolute consumption-based poverty line8. According to this approach of definition, three main features, which, characterize the poor people: low standard of living; low income and high propensity to borrow. In fact, this approach of defining poverty has two main limitations, as it does not account for access to essential public goods and services for instance clean water or environment, education and health, which affect 7 8 Owing to a number of well-known difficulties of collecting accurate data on income, consumption expenditure is employed instead of income levels. Although EHRD 1996 introduced estimation of subjective poverty based on people perceptions and their neighbor's situation. 16 FONDAZIONE CENSIS 11873_02 Study D2: Poverty, Informal Sector, Health and Labour the standard of living, also this approach does not measure the quality of life. - Non income-based approach is a broader definition of poverty that provides additional information, which reflects the actual experience of the poor; their perceptions of poverty and their own self-determined concepts and measures of poverty. This definition accounts also for human development in terms of education; health and nutritional status as well as other aspects like security and safety nets. - The Capability Poverty Measurement (CPM)9 is an application of non income-based definition of poverty, and it is used to complement rather than to substitute the income-based definition of poverty. Although this definition is used only by a minority of respondents, Egypt has introduced, in its published EHDR 1996, the capability measurement of poverty in order to complement the income-based measurement. - The Deprivation Index is another composite index which consists of nine indicators reflecting the standard of living and welfare, this Index was constructed by (IEC 1996) based on the result of Priority Survey conducted by CAPMAS for the Social Fund for Development (SFD), and it was published in EHRD 1997/98. - A Standard of Living Index was newly constructed as a broader measure of living conditions, and it is ranged from 0 to 100. It is comprised of five dimensions in order to capture different emphases in the definition of poverty by various analysts: per-capita income, per-capita expenditures, an index of economic security/vulnerability, an index of housing conditions, and an index of affordability of basic needs. 9 This was recently introduced by UNDP in the HDR 1996. 17 FONDAZIONE CENSIS 11873_02 Study D2: Poverty, Informal Sector, Health and Labour 3.2. Policies As it was realized, ERSAP might have negative effects on low-income groups; many recent policies have been designed and implemented to assist the poor. Both the government and NGO’s are considered the major players in poverty alleviation in Egypt. Major Government Policies: Poverty Alleviation policies are conducted through the following ministries and agencies: i. Social Fund for Development (SFD) SFD was established in 1992 as a result of the Structural Adjustment Program that was signed between the Egyptian Government and the World Bank. The SFD has five major programs: - The Enterprise Development Program, which aims on creating longterm employment opportunities through technical or credit assistance, concentrating on new projects and newly unemployed graduates. - The Public Works Program, supports labor-intensive public works projects in the poor and high unemployment governorates - The Community Development Program, aims to improve social services and productive activities in low income areas. - The Employment and Retraining Program, provides assistance to public sector workers who are displaced, and offers training for new graduates. - The Institutional Development Program, which aims to enforce the administrative and technical capacities of the SFD. Both of the second and the third programs achieved good records in reducing poverty. 18 FONDAZIONE CENSIS 11873_02 Study D2: Poverty, Informal Sector, Health and Labour ii. Ministry of Social Affairs (MOSA) MOSA works on alleviating poverty directly through social security and welfare aid system. This system is divided into two types of assistance: a) The Islamic system of zakat , which is compulsory religious duty whereby each Muslim pay a percentage of his wealth to help the poor, this system is organized by zakat committees registered in the Nasser Social Bank under the supervision of MOSA. The zakat committees use the funds to give grants or interest-free loans to the needy people. b) Financial support to the poor through social insurance and social security schemes, whereby the first scheme covers the permanent workers in the public and government and private sectors, as well as temporary workers in industry, commerce and services. The Social Security Scheme includes temporary and casual workers who are not covered by social insurance. Sadat Pension Scheme is a direct contributory transfer of payment system introduced by MOSA, it covers those who are eligible for a regular pension and not temporary assistance, and no additional beneficiaries were added since 1980. This pension is awarded to whoever reaches the age of 65 years or who is completely handicapped, and it has a value that ranges between LE 50 and LE 60 per month. Finally, there s a special program for the destitute named by ma`ash eldaman, targets the poorest of the poor and those who are not covered by any social insurance or security program, the amount of this pension varies between LE 11 and LE 37 monthly according to the size of the family. iii. The Ministry of Local Development Shuruk Program: The National Program for Integrated Rural Development The main objective of this program is to close the gap between rural and urban areas in Egypt. The plan is to achieve this target during the period 1994-2017. 19 FONDAZIONE CENSIS 11873_02 Study D2: Poverty, Informal Sector, Health and Labour The sum total of investment required for the program until 2017 is estimated at LE 267 billion; one third of this amount will be financed through the national budget. According to Shuruk projected investment, about one third of total investment will be directed to infrastructure projects and one quarter to human resources and institutional development projects, while the rest will be devoted to economic activity projects. iv. The Ministry of Trade and Supply Government programs for food subsidies It is the most expensive and widespread governmental assistance program in Egypt, administered by the Ministry of Trade and Supply. Currently subsidies are limited to bread, wheat, flour, sugar and edible oils. Non-Governmental Intermediaries: Organizations (NGO’s) and Development There are several poverty alleviation programs offered by these actors; the following are the most important: - UNICEF Supported Family Development Fund (FDF), which funds small and micro enterprise development, in order to provide socioeconomic support to the poorest of the poor living in remote rural areas in Upper Egypt. The Fund also aims to improve the standard of living for low-income women and their families. - CEOSS has an integrated program for literacy and general education, addressed to women and focused in Minia governorate and few poor communities in Cairo. Through this program, CEOSS tries to empower women and increase female leadership, as well as reinforces family ties. - The Upper Egypt Association (UEA), views the provision of affordable, but high-quality basic education, with an integrated development approach in poor villages. Despite being a Christian organization, UEA serves Christians and Muslims equally. 20 FONDAZIONE CENSIS 11873_02 Study D2: Poverty, Informal Sector, Health and Labour - The Association for the Protection of the Environment (APE), which began its work with young women in the garbage collectors community in Muqattam (Cairo), by organizing literacy classes. At a subsequent stage the APE added health awareness, leadership training, sex education and early childhood education to its services. - The Center for Egyptian Women’s Legal Assistance (CEWLA), is one of the few organizations in Egypt aims at enhancing poor women’s access to the legal system. CEWLA is located in Bulak El-Dakrur (Cairo), and offers help in issuing the identity card, obtaining of a birth or divorce certificates, as well as easing access to state social assistance for destitute women. The organization concerns with other legal issues includes representation in courts, it also organizes literacy classes to raise women’s awareness of their legal rights. - The Association of the Lawful Religious for those who behave according to the book and Muhammadan Sunna10, was established 12 years ago and it’s the largest network of Islamic Organizations that are currently working in Egypt. The association owns hospitals, health clinics and libraries; it adopts strict discipline and a clear division of labor. The Orphan Sponsorship Program is the association’s most important program, whose main objective is to care for the orphaned Muslim child from birth until adulthood in order to direct him to the right Islamic path and values. - CARITAS, El-Saeed Association and the Childhood and Development Association (CDA). The first two associations have the same objectives and follows similar procedures as well, as they aim at eradicating women illiteracy, increasing health awareness and alleviating poverty through provision of micro-loans to households. The CDA has wider activities than the previous two NGO’s, as it is involved in implementing a MultiPurpose Development Program with SFD targeting poor rural women aims at upgrading their status and enhancing their participation in economic activities. - Ford Project for Small Firms’ Loans, Ford has given two grants for two Egyptian banks in order to offer bank loans for existing small firms in urban areas, with concentration on women. 10 Al Jam`iyyah al-shar`iyyah lil`amilin bil-kitab wal-sunnah ai-Mohamadiyyah. 21 FONDAZIONE CENSIS 11873_02 Study D2: Poverty, Informal Sector, Health and Labour - The project of American Agency for Small Firms International Development, it offers loans for existing firms at market interest rates with no guarantees. - The project of the Association of Developing and Enhancing Women (ADEW), which offers loans to families sponsored by women 3.3. Sources The main source of data for measuring poverty in Egypt are the Household Income, Expenditure and Consumption Survey (HIECS) which were carried out in 1990/91 and 1995/96 and 1999/2000 by CAPMAS, these data were used to calculate poverty indicators in the following publications: - Institute of National Planning (INP), Egypt Human Development Report 1996. - Institute of National Planning (INP), Egypt Human Development Report 1997/1998. - Institute of National Planning (INP), Egypt Human Development Report 2003. - The World Bank, ARE, Poverty Reduction in Egypt 2002. - Subjective Poverty and Social Capital Survey (SPSC)11. 11 This Survey is designed specially for SPSC Report, its data were collected during December 2002, the sample include 4000 households (1720 in urban and 2280 in rural areas). 22 FONDAZIONE CENSIS 11873_02 Study D2: Poverty, Informal Sector, Health and Labour 3.4. Phenomenology According to poverty measures of El-Laithy presented in Table-1, poverty12 has increased on both national and regional level between 1981/82 and 1990/91, then stabilized in 1995/96 and then started to decline in 1999/00. However, it is noticed also that the Gini coefficient increased during 1999/00 compared to 1995/96. How could this contradiction of decline in poverty and increase in the Gini coefficient be explained? At the national level the growth was not pro-poor, thus the non-poor benefited more than the poor did from the growth. Correspondingly, the Gini coefficient increased from 34.5 to 37.813. Table 1 - Regional Poverty Measures (1981/82-1999/00) Region Year All Egypt 1981/82 1990/91 1995/96 1999/00 1981/82 1990/91 1995/96 1981/82 1990/91 1995/96 All Urban All Rural Lower Poverty Line P0 P1 P2 16.42 30.37 29.25 16.74 16.75 26.06 29.03 16.60 34.12 29.00 3.77 8.62 5.79 2.97 4.25 6.59 6.48 3.20 10.97 5.59 1.23 3.36 1.58 0.8 1.52 2.28 1.95 0.87 4.90 1.52 Upper Poverty Line P0 P1 P2 23.65 39.09 42.46 6.04 11.99 10.13 2.23 5.03 3.32 25.99 36.82 42.87 22.95 41.25 41.87 7.26 10.58 11.67 4.89 13.88 9.28 2.88 4.15 4.24 1.49 6.45 2.89 Gini Index 34.5 37.8 34.8 34.8 33.7 25.8 36.6 24.9 Source: El-Laithy (1999, 2002) 12 13 Named P0. WB, Op.cit., p.19 2 FONDAZIONE CENSIS 11873_02 Study D2: Poverty, Informal Sector, Health and Labour The Period 1981/82-1995/96 Urban poverty has increased more rapidly than rural poverty, although the rural poverty rate is still higher than urban rate. The observed increases in national and urban poverty are mainly due to the decrease in average percapita expenditure (growth component), as the decline in average per-capita expenditure neutralized improvements in distribution. However, the observed change in rural poverty is fully accounted for the improvements in expenditure distribution, at least for the poorest of the poor and this is consistent with the declining Gini coefficient and stagnant increase in rural areas. As a matter of fact, there is no lack of poverty estimates in Egypt, but debates about methods of poverty measurement are common because poverty is an elusive concept and no single measure can properly or adequately reflect its magnitude and features. Most of poverty studies in Egypt used household surveys conducted by CAPMAS, in 1974/75, 1981/82, 1990/91, 1995/96 and 1999/2000 and used the same food energy requirement, these studies adopted also the same indicator of welfare expenditure. Table 2 Poverty Incidence in Various Studies in Egypt 1981/82 Urban The World Bank (1991) Korayem (1994) El-Laithy & Osman(1997) Cardiff (1997) El-Laithy et al (1999): Lower 30.40 33.50 Rural The World Bank (1991) Korayem (1994) El-Laithy & Osman(1997) Cardiff (1997) El-Laithy et al (1999): Lower 29.70 26.90 16.80 16.60 1990/91 1995/96 21.00 35.90 39.00 12.60 26.10 45.00 30.80 29.00 25.00 56.40 39.20 32.20 34.10 50.9 55.2 29.00 Source: Subjective Poverty & Social Capital (2003) 2 FONDAZIONE CENSIS 11873_02 Study D2: Poverty, Informal Sector, Health and Labour However, Table-2 shows clearly that estimates of poverty may be different even when the same data are used. Korayem (1994) stated that poverty in 1990/91 reached 35.8% in urban areas, while it was 56.4% in rural areas, more than 50% higher than urban areas. El-Laithy et al (1997) showed that poverty levels in 1990/91 differed, between urban and rural areas, by not more than 0.2%. Although Cardiff (1997) used the same poverty lines as Korayem (1994), he estimated much lower poverty in 1990/91, he argued that national poverty has increased dramatically from 20.69% in 1990/91 to 44.29% in 1995/96. A study by El-Laithy and Osman (1997) indicated a decline in the incidence of poverty in rural areas from 28% to 23%, during the period 1990/911995/96, using lower poverty lines. However, they noticed that both regions (urban and rural) experienced increases in their poverty when using upper poverty lines. These discrepancies reflect a number of limitations concerning units for welfare measurement and estimation of poverty lines14. The Period 1995/96-1999/2000 The World Bank Report on Poverty (2002) uses a methodology that accounts for these limitations, and concludes that: Table 3 Share of the Poor Population in 1995/96 and 1999/2000 1995/96 All Egypt Upper Rural Upper Urban Lower Rural Lower Urban Metropolitan 19.4 29.3 10.8 21.5 8.3 13.1 1999/2000 16.7 34.2 19.3 11.8 6.2 5.1 Source: World Bank, ARE, Poverty Reduction in Egypt, 2002, Report No. 24234 EGT, p.vi. 14 For more details about these limitations refer to Subjective Poverty and Social Capital (2003). 2 FONDAZIONE CENSIS 11873_02 Study D2: Poverty, Informal Sector, Health and Labour 1. In 1999/2000 the poor in Egypt was 16.7% of the population, and this poverty is shallow which is reflected by the low values of distributionsensitive measures P1 and P2. 2. The incidence of poverty is highest in Upper Egypt. 3. During the periods 1995/96 and 1999/2000 overall poverty declined by 2.7%, however, patterns of change were not homogenous across regions, as Metropolitan and Lower Egypt has improved their poverty status, while poverty levels increased in Upper Egypt. 4. Decomposing poverty changes into growth and redistribution components, in the Metropolitan region the growth and redistribution components work in opposite directions; as the reduction in poverty resulting from increased real per-capita expenditure was lowered by deterioration in inequality. On the other hand, in both Upper and Lower Egypt the two components worked in the same direction. In Lower Egypt there was a reduction in poverty levels resulted from improvements in inequality and per-capita expenditure, while in Upper Egypt both per-capita expenditure and inequality worsened resulting in poverty increase. 2002: - The latest statistics (2003) show that the largest concentration of poor and ultra-poor individuals is found in Upper Egypt in both urban and rural areas. 3 FONDAZIONE CENSIS 11873_02 Study D2: Poverty, Informal Sector, Health and Labour Table 4: Regional Poverty Measures 2002 using different poverty lines Region Metropolitan Lower Urban Lower Rural Upper Urban Upper Rural All Egypt Lower Objective Poverty Line P0 P1 P2 Lower Relative Poverty Line P0 P1 P2 Subjective Poverty Line P0 P1 P2 % of individuals with insufficient income15 5.72 9.81 1.36 2.57 0.46 0.98 4.62 9.81 0.96 3.08 0.33 1.29 42.53 33.69 12.48 10.42 5.65 4.62 22.47 26.87 16.57 19.19 3.00 4.77 0.88 1.82 22.13 15.87 3.87 4.61 1.15 1.85 30.69 36.13 7.54 10.32 2.94 4.65 29.07 36.40 34.87 20.40 8.22 4.62 2.77 1.55 39.02 22.58 10.29 5.46 3.64 1.91 23.32 31.82 5.67 8.54 2.14 3.59 17.75 24.27 Source: Subjective Poverty & Social Capital (2003). Rural areas in each governorate are more deprived than urban areas especially when the objective poverty is used. Metropolitan Region16 has the highest subjective poverty, which could be explained by the fact that urban citizens are influenced by their surroundings and by “the demonstration effect”. They feel their neediness more than the rural citizens do. That is sometimes the reason why most of the government programs are biased towards Urban in developing countries17. - According to the newly measured (CPM)18, there is considerable chronic under-nutrition among Egyptian children with higher proportion in rural areas, and underweight children are common in rural Upper Egypt, on the other hand, medically assisted delivery is more common for urban births and to highly educated mothers. 15 16 17 18 This percentage reflects the perception of the individuals, whether they consider themselves poor or not. Which perceive higher basic needs requirements. As they rely on subjective poverty. Capability Poverty Measurement. 4 FONDAZIONE CENSIS 11873_02 Study D2: Poverty, Informal Sector, Health and Labour - The education status plays a major role in determining poverty in Egypt19, as poverty is inversely correlated with educational attained, it is noticed that the great majority of the poor have attained only primary level education or no education at all, and the lowest headcounts achieved by those with university education. However, poverty measures in urban areas are about 1.3 times those in rural areas in categories with low levels of education, which means that education in urban areas plays a more important role in determining poverty status. - According to statistics, real per-capita expenditure on education has increased by almost 75% for the poor, and 33% for the non-poor, this is because most of the poor household heads see education as the main escape gate out of poverty on one hand, and the reliance on “private lessons” raises the poor Household’s spending on education. Still, the distribution of the households` expenditure on education is severely skewed towards rich families and this is a reflection of low university enrolment ratios among poor households. On the other side, the Egyptian government has increased its public education expenditure in order to reduce the capability poverty, but the benefits are biased in favor of the rich especially in the higher education. - It is also evident that within each region, whether urban or rural, all objective poverty measures are highest for the private sector workers compared to other sectors of employment, the same thing is true if subjective poverty notion is applied, with narrower gaps between the poor and non poor, specially in rural areas. - It was noticed that families with children are worse off than families without children, and families with more children are worse off than families with few children. Combining gender of the household head with marital status and number of children shows that poverty is highest in household headed by females that are widows and have more than three children; this criterion may be a good characteristic for targeting the poor. 19 According to the World Bank Report on Poverty (2002), education was considered the strongest correlate of poverty, whit more than 45% of the poor are illiterate. 5 FONDAZIONE CENSIS 11873_02 Study D2: Poverty, Informal Sector, Health and Labour - Data show positive relationships between the housing conditions and percapita income levels, that’s why there is a correlation between the housing conditions index and poverty status, however the housing index for the non-poor represents 1.3 times that of the poor for objective poverty and only 1.02 times for subjective poverty. - The overall average Living Standard Index in 2002 has reached 28.55. As with most social indicators, there are urban/rural biases in favor of urban areas. - Male headed households have higher living standards than female headed households, and households with a head of lower education levels have lower living standards, and the same applies if the household head is unemployed or out of labor force. - Poor households, whether objectively or subjectively, have lower living standards than the non-poor do. However, households with unmet needs or those who are unsatisfied with their lives have a lower index, indicating that people rightly rank themselves as satisfied or not according to their living conditions and not only on their income. - Although both the non-traditional government programs and nongovernment sector’s role are expanding their poverty alleviation role in Egypt, certain government policies continue to impede such efforts and underpin the perpetuation of poverty across generations, such as centralization, lack of coordination, spread of corruption and weak institutional capacities. 6 FONDAZIONE CENSIS 11873_02 4. Study D2: Poverty, Informal Sector, Health and Labour CRIME 4.1. Definitions In general, “crime” refers to committing an act that is prohibited by law. The Egyptian penal code comprises many crimes, too many to be exhaustively covered in this section and hence only the main crimes20 will be presented. 1. Intentional homicide: is death deliberately inflicted on a person by another person. 2. Non-intentional homicide is death not deliberately inflicted on a person by another person and is the result of the latter person’s negligence, recklessness or indifference towards rules and regulations. It could have been avoided if the perpetrator had had the caution of a regular person. That includes the crime of manslaughter, but unlike the definition provided by the United Nations, it also includes traffic accidents that result in the death of persons. 3. Assault: is the physical attack against the body of another person. 4. Rape: is forcing sexual intercourse on a female without valid consent. Egyptian law makes a distinction between sexual assault and actual penetration and the penalty for each differs. 5. Theft is the removal of property without the property owner’s consent. “Theft” then comprises different crimes depending on the circumstances of the crime: 20 The crimes mentioned here are those reported in the periodic United Nations Surveys of Crime Trends and Operations of Criminal Justice Systems. The definitions provided pertain to the Egyptian Judicial System. Whenever the definitions coincide in meaning, the wording provided by the United Nations will be used. Other crimes are also added at the end. 7 FONDAZIONE CENSIS 11873_02 Study D2: Poverty, Informal Sector, Health and Labour - Robbery is the theft of property from a person, overcoming resistance by force or threat of force. - Burglary is the unlawful entry into someone else’s premises with the intention to commit a crime, or the lawful entry, but lingering with the intention of committing a crime. - Automobile theft is the removal of a motor vehicle without the consent of the owner of the vehicle. 6. Fraud is the acquisition of another person’s property through deception with the intention of owning that property. 7. Embezzlement is the wrongful appropriation of a public servant of public property owned by the government where the property is already in the possession of the person doing the appropriating because of his or her job. 8. Drug-related crimes is intentional acts that involve the cultivation, production, extraction, preparation, offering for sale, distribution, purchase, sale, delivery on any terms whatsoever, brokerage, dispatch, transport, importation, exportation, possession, use or facilitating the use of internationally controlled drugs. 9. Bribery and/ or corruption is requesting and/ or accepting material or personal benefits, or the promise thereof, in connection with the performance of a public function for an action, that may or may not be a violation of law and/ or promising as well as giving material or personal benefits to a public officer in exchange for a requested favor. 10. Arson is the deliberate starting of fire in a property that may or may not be in the possession of the arsonist. 11. Terrorism is the use of force, violence or threats in the execution of a criminal act with the intention of disrupting order and/ or jeopardizing public safety if the result was endangering people’s lives and/ or public or private property or impeding the application of the constitution or other laws and regulations. Note that there is a general agreement regarding the aforementioned definitions among law enforcement agencies and other relevant 8 FONDAZIONE CENSIS 11873_02 Study D2: Poverty, Informal Sector, Health and Labour stakeholders. As far as the general population is concerned, there is also an agreement concerning these definitions. However, there are certain acts that the society frowns upon, but are permissible by law, such as drinking and premarital sex for people above 18 years of age. Also, as will be mentioned in section 4.5, there are some practices that are prohibited by law, but condoned by society, such as marriage below the age of 16 and female circumcision. 4.2. Policy and Legislation Various measures and policies are being implemented in order to combat crime by dealing with different factors that lead to violence and criminal behavior. 1. Social, economic and cultural programs and policies: As will be mentioned in section 4.5, different social and economic factors such as unemployment, unjust income distribution, poverty and poor levels of education, are some of the primary reasons for the rise in the tendency towards violence and crime. Accordingly, different measures are being implemented such as: - The government is striving towards alleviating poverty (see section 3.2). - Public policies are being carried out in order to combat unemployment. Each year, new job vacancies in government offices and public enterprises and economic authorities are being provided in an attempt to absorb the increasing new entrants to the labor market as well as the already existing pool of the unemployed. Financial and non-financial incentives are being offered to youths wishing to own their own small businesses or buy land and cultivate it as a means of securing income through the various special designed programs. - The media has played a role in fighting crime through several measures. There are television programs that deal with real- life crimes and their consequences by meeting with criminals and exposing the consequences 9 FONDAZIONE CENSIS 11873_02 Study D2: Poverty, Informal Sector, Health and Labour of crime. In addition, fictional programs and movies tackle the issues and ramifications of various types of crime. Newspapers and magazines publish and report the criminal events that take place and the penalties that the perpetrators face. 2. Policies implemented by law enforcement agencies The legislation concerning fighting crime is already defined. However, the problem lies in enforcing the law and ensuring that citizens abide by the rules and regulations. Accordingly, several measures have been implemented: - Because of globalization and technological development, crimes have become more technologically advanced in nature. Due to this, the law enforcement process has been developed and provided with the technology necessary to combat crime in its new forms such as more advanced computers. - Police officers are receiving advanced training programs in combating crime. More sophisticated crime- fighting techniques and training courses and workshops that are held both locally and abroad. - Due to the fact that crime is expanding in nature and involves various aspects, departments different from the traditional criminal and political departments have been added to law enforcement agencies such as economic departments and social departments. - The Ministry of Internal Affairs provides various services and incentives to police officers in order to encourage them to carry out their jobs efficiently. For example, medical and social services are provided to officers and their families. - The Ministry of Internal Affairs has also implemented programs aimed at providing job opportunities to ex- convicts in order to discourage them from re-pursuing a life of crime and to encourage them to lead an honest living by offering them work opportunities after their release . 10 FONDAZIONE CENSIS 11873_02 Study D2: Poverty, Informal Sector, Health and Labour 4.3. Sources Due to the scarcity of data on the crime issues, limited sources are used in this context: - Encyclopedia of the explanation of the crimes of the penal code and special criminal statutes - Annual Reports of the Agency of Public Security - The National Center for Social and Criminal Research, 4th Annual Conference, “The Social and Criminal Aspects of Violence in the Egyptian Society” 4.4. Data The tables containing the data relevant to this chapter are displayed in the Statistical Annex in order to enable the adequate coverage of the issue of “Crime in Egypt”. 4.5. Phenomenology Different factors have contributed to elevating the tendency towards crime and violence in Egypt. Social, economic and political aspects as well as factors relating to the police force and the judicial system have all played a vital role in motivating violent behavior. Social, economic and political factors: Unjust income distribution has generated a wide gap between the highincome group, a small portion of society, and the low-income group, which represents a large part of the population, leading to feelings of repression and inferiority. This situation is aggravated by poor economic conditions (inflated cost of living and high levels of unemployment), poverty, poor quality of education and the population explosion. 11 FONDAZIONE CENSIS 11873_02 Study D2: Poverty, Informal Sector, Health and Labour Furthermore, a lack of democracy and the distrust directed towards the government lead to overall feelings of uncertainty and anxiety, which are translated into aggressive conduct. In addition, the unequal income distribution and the low incomes among the public officials lead to a growing tendency to accept bribery or unofficial commissions. The Corruption Perception Index21 –issued by Transparency International – ranked Egypt as having a CPI of 3.4 and as being country number 62 out of 102 countries in 2001. The value of the CPI is considered relatively significant, as it relates to perceptions of the degree of corruption as seen by business people and risk analysts, and ranges between 10 (highly clean) and 0 (highly corrupt)22. Another disturbing phenomena noticed in Egypt is the discrimination and violence directed towards women. Society condones this type of behavior for different reasons such as the misguided perception of the dictates of both religion and moral behavior. Sexual harassment, marital violence, the marriage of underage females and female circumcision are all examples of acts prohibited by Egyptian law but exercised by society, which disregards judicial regulations in favor of customs and traditions. Furthermore, sexual abuse and rape, though not yet widespread phenomena, exist due to several factors. Because of deteriorating economic conditions, marriage is becoming increasingly difficult. Therefore, the age at which males and females marry is getting higher. Accompanied by the general tendency of media agencies towards less censorship and more provocative programs, these circumstances are leading to pent-up frustration among the male portion of the population. In addition to this, there is a lack of awareness, a decline in the moral standards taught to children, and a poor quality of education received in schools, which reinforces the tendency towards violence and aggression. Factors related to the police force and the judicial system: 21 22 The TI Corruption Perceptions Index (CPI) this year ranks 102 countries in terms of the degree to which corruption is perceived to exist among public officials and politicians. It is a composite index, drawing on 15 different polls and surveys from nine independent institutions carried out among business people and country analysts, including surveys of residents, both local and expatriate. Transparency International Corruption Perception Index 2002, p.5. 12 FONDAZIONE CENSIS 11873_02 Study D2: Poverty, Informal Sector, Health and Labour One of the main problems facing law enforcement in Egypt is that people do not regard or treat it with due respect. This could be due to several factors. First, the law is not penalizing enough since perpetrators of crimes are not always punished for their deeds and loopholes in the legislature are exploited to the advantage of criminals. In addition, the legal process is extremely slow so that cases are procrastinated, and take a very long time to be settled in courts. The legal system is also characterized by the existence of some corruption, whereby several judges have been found guilty of accepting bribes, were forced to resign, and in some cases were imprisoned. In addition to this, there is a general impression that law enforcement officers take advantage of their positions and are above the law in certain areas, which gives rise to public resentment directed at the police force. Furthermore, the Ministry of Internal Affairs itself suffers from several shortcomings that impede law enforcement in Egypt such as: 1. Salaries granted to the majority of the police force are very low. 2. Law enforcement officers are constantly racked with feelings of occupational instability and insecurity because at any time and through no fault of their own, they could be used as scapegoats and are either demoted or fired. 3. There exists occupational stagnation. An officer has to spend a considerable amount of time in the same position before he could be promoted to the following rank. In addition, promotions take place according to seniority and date of graduation and not according to efficiency or merit. 4. As already mentioned, society tends to view some of the police officers as corrupt, immoral members who abuse their authority in circumventing the law. Due to this, in addition to points (1), (2), and (3), we find that: - police officers lack the incentive to improve their performance and efficiently carry out their jobs. - A significant part of the force is corrupt (bribery and immoral behavior) or misuses its power so that society’s labeling of police officers has become self-fulfilling. 13 FONDAZIONE CENSIS 11873_02 Study D2: Poverty, Informal Sector, Health and Labour 5. Volunteers and a large number of those carrying out their military service suffer from illiteracy. This prohibits them from adequately grasping and executing the orders, they are given. Even if they are literate, they have not had sufficient education and hence they lack the proper sense and logic necessary to carry out their jobs efficiently. Due to these factors, the public tends to disregard the police as an effective means of obtaining their rights, which in itself impedes the police force in carrying out its job of establishing law and order. In addition to this, in the 1990s, political crime (terrorist attacks) rose disturbingly so that the police force directed most of its budget and instruments towards fighting terrorism and political crimes. Consequently new forms of crime of social and economic nature erupted during the last decade. The new types of crime require vigorous efforts to combat them. 14 FONDAZIONE CENSIS 11873_02 5. Study D2: Poverty, Informal Sector, Health and Labour TRENDS AND CORRELATION 5.1. The evolution from the structural adjustment of the 80s After a period of unprecedented economic growth in Egypt during 19751985, the situation changed dramatically since 1984/85. The Egyptian economy enjoyed a decade of boom, mainly, due to large foreign exchange inflows because of the increased petroleum prices, export proceeds, higher Suez Canal revenues, accelerating worker’s remittances, and enhanced tourism earnings. The drop in foreign inflows was the result of unfavorable external developments, principally the decline in petroleum prices as well as in other related sources of foreign exchange, recession in the world economy, and the sharp decline in the flow of aid. Unable to respond to these external shocks due to structural weakness, Egypt experienced a dramatic fall in its growth rate and severe macroeconomic imbalances (Kheir –El-Din & ElShawarby, 2003). It became obvious that the Egyptian economy could not meet the needs of the society without external aids. In the meantime, Egypt faced a problem with its creditors, as it was not able to maintain debt service payments. The following key indicators show the extent of the crisis in the beginning of 1990, which the Egyptian economy was confronted with (CBE, 1992-1998): a) Total external debt around US $ 49 billion, b) Total external debt to GDP 150%, c) Budget deficit around 20% of GDP, d) Inflation rate higher than 20%, e) Negative real interest rate around 6%, and, f) Reserves were just over three weeks of imports. 15 FONDAZIONE CENSIS 11873_02 Study D2: Poverty, Informal Sector, Health and Labour This situation provided the background to the stabilization package in the end of the 1980s with the International Monetary Fund (IMF), formally concluded in May 1987 (Stand–by Agreement), after a long period of protracted negotiations. The main objectives of Stand-by agreement were: (1) preparing the ground for sustained economic growth, (2) reducing the rate of inflation, and (3) stabilizing the current account deficit of the balance of payment. To achieve theses objectives, various measures were stipulated, covering exchange rate, monetary and fiscal policy (Abdel-Khalek, 2001, p 25). The first Stand–by Agreement with IMF was cancelled after only three months because of the failure of the Egyptian government to meet the IMF’s requirements. According to the Fund’s officials, the Egyptian government adopted a lukewarm attitude and failed to meet performance criteria (IMF, 1991). However, Egypt was obliged to turn once again to the IMF for help, and go for another round of negotiations, which concluded in an economic reform program by the end of 1990. In April 1991, the Government of Egypt (GOE) launched a comprehensive stabilization and reform program (Economic Reform and Structural Adjustment Program ERSAP) with both the IMF and World Bank. The basic goal of the economic reform program was two-fold : to generate sufficient growth rates that would help buoy employment opportunities for the growing population - twin strands of a virtuous economic circle that will reduce income disparity and alleviate poverty. The program consisted of four overlapping phases (MOFT, 2003): 1. The first phase of the stabilization program, involved fiscal and monetary tightening, exchange rate liberalization, and price deregulation. 2. Phase two of the program has also seen further deregulation of prices, opening of markets, promoting investment, boosting and structuring of the financial sector, and granting a greater role to the private sector. 3. The third phase of the economic reform program, which has been commended by the IMF “as an achievement that has few parallels”. A fundamental policy challenge that was facing Egypt was to consolidate and extend the ongoing recovery, particularly in view of increased global 16 FONDAZIONE CENSIS 11873_02 Study D2: Poverty, Informal Sector, Health and Labour challenges. This required continued strong macroeconomic policies, accelerated structural reforms, and the promotion and diversification of exports. 4. The goals of phase four included continued fiscal reform, enhancing the instruments of monetary policy available to the CBE, increasing the pace of structural reform and enhancing transparency in the regulatory and institutional frameworks. The Government also intended to foster exportled economic growth and development. Other goals included promoting human development, improving living conditions for low-income groups and developing high skill-based industries. The key elements of this program were to (Ash, 1993; Youssef, 1996; and Road, 1997): a) Reduce the size of the public sector through privatization. b) End controls over investment and eliminate most tariffs on imports. c) Liberalize the prices of the manufactured products. d) Raise energy and transport prices to realistic levels. e) Reduce consumer subsidies and target them towards the poorest groups. f) Deregulate and simplify laws and regulations; and g) Encourage private sector activity in all sectors including financial services. In the meantime, the new agreement with the World Bank and the IMF expected the GOE to introduce several measures immediately, including (Middle East Executive Report, 1992): (1)Removing ceilings on interest rates, (2)Liberalizing exchange rates, and, (3)Introducing new sales tax. Egypt’s stand on the Gulf War did have some positive results; since it led to an increase in the international financial support (bilateral as well as 17 FONDAZIONE CENSIS 11873_02 Study D2: Poverty, Informal Sector, Health and Labour multilateral). Aid from The Gulf States flowed in for the first time since 1979 combined with writing off long-term debt to Gulf States (US $ 7 billion). In the same time, the United States wrote off a substantial amount of its military debt (US$ 6.7 billion). The Paris Club Agreement, reached with the other major official creditors (17 main creditor governments), provided that 50 per cent of their outstanding commercial debt would be written off in stages over the succeeding three years, depending on Egypt carrying out its agreement with the IMF’s economic reform program (CBE, 1992, and Road, 1997). The second IMF agreement was concluded in 1993. At the end of the fiscal year 1996/1997, the third agreement triggered the final stake of commercial debt reduction and was supported by a further 24 months financial standby arrangement. Egypt implemented its economic reform program gradually. The success achieved by Egypt’s economic reform program can be summarized in the following points: - the Egyptian external debt has been decreased significantly from US $ 49 billion in 90/91 to only US $ 26.6 billion in 97/98. - The debt ratio as a percentage of GDP has decreased significantly from 151 per cent in 90/91 to only 37.7 per cent in 97/98. - The real interest rates became positive at 5 per cent in 97/98 compared with a negative rate of interest at 6 per cent in 90/91. - The rate of inflation has declined sharply from 23.6 per cent in 90/91 to only 4.1 per cent in 97/98. - With regard to the exchange rate, Egypt, like many other developing countries, had a multiple exchange rate system (MER). After the adoption of the economic reform program, the former multiple exchange rate system was replaced by a single-rate, market-oriented system with a managed floating of the Egyptian Pound for all public and private transactions. Although the Egyptian Pound depreciated during 1991, the 18 FONDAZIONE CENSIS 11873_02 Study D2: Poverty, Informal Sector, Health and Labour exchange rate stabilized in the range between L.E. 3.35 -3.41 to US $1 from the third quarter of 1991 until the fourth quarter of 1998). - The foreign reserves increased significantly from only 3.6 billion of US $ in 90/91 to 21.8 billion of US $ in 97/98, which meant a rate of increase more than 500 per cent was achieved. - The real GDP growth rate declined sharply in the first two years of the economic reform program period to 1.9 per cent and 2.5 per cent, respectively. However, starting 1993, the real GDP growth rate has grown steadily, reaching 5.7 per cent in 97/98 (CBE, 1998). - In terms of the budget deficit, there has been a significant decrease through the period from 1990/91-1997/98, the overall deficit as a percentage of GDP has declined sharply from about 18.2 per cent in 90/91 to only 0.06 per cent in 97/98. In fact, the reduction in the overall deficit was obtained through both increasing the revenues and reduction in the expenditure. (CBE, 1998). - With regard to the privatization program, the first stage in the privatization process, which started in May 1991, was to cut off subsidies to the state-owned enterprises, followed by the removal of public enterprises from direct ministerial control (Field, 1995). The three hundred and fourteen public sector companies, were grouped (1991) under twenty-seven holding companies (now reduced to sixteen), that became responsible for all the affiliates in a particular sector (Road, 1997, and Timewell, 1991). A wide-scale privatization program started eventually. The process came almost to a halt in 1997. However, the Egyptian economy has suffered, since 1997 three well-known shocks. - The first shock was Luxor massacre in November 1997, which negatively affected tourism, - the second shock was the Far East crises June 1997, which encouraged imports from the far eastern countries and led to a massive outflow of portfolio investments, - the third shock was the sharp decline in the oil prices. 19 FONDAZIONE CENSIS 11873_02 Study D2: Poverty, Informal Sector, Health and Labour The Egyptian economy endured several additional problems (since the end of the nineties) such as the decrease in the level of savings, the decline in the level of foreign direct and indirect investment, the balance of payment deficit, the inequitable income distribution, and the increase in the public debt and accelerating budget deficit. These repercussions were coupled with a continuous lack of confidence that was associated with the serious twin crises, namely recession and foreign exchange (El-Said, Mustapha, 2003). The economic growth (5-6%) that was experienced during 1994-1997, was reduced to 3% or less in the years 2000 and afterwards. 5.2. Correlation between poverty, health, crime and other development indicators in the last decade The national and the international social and economic indicators reveal contradicting results. The Human Development Index has showed significant improvement during the nineties, as it rose from 0.572 in 1990 to 0.648 in 2001. Nevertheless, this improvement in the HDI was associated with deterioration in the ranking of Egypt from 108 in the end of the nineties to 120 in 2001. Data also show that the GDP per capita increased steadily from US$ 1015 in 1995 to US$ 1276 in 2002 at an average growth rate of 3.2%. Despite the evident progress in the previous two indicators or variables, other variables or indicators seem to give an opposite perspective: The previous analysis on poverty, crime and health indicated: - Although income poverty has decreased, the incidence of poverty increased in the beginning of the millennium. - Urban poverty is rising at a higher rate than rural poverty, though the incidence of poverty in rural areas is still higher. - Poverty is higher in Upper Egypt, whether in rural or urban areas. - Poverty is higher among the workers in the private sector. 20 FONDAZIONE CENSIS 11873_02 Study D2: Poverty, Informal Sector, Health and Labour - Female-headed households are significantly poorer than male-headed households are. - Crimes have continued to increase at a steady rate, however, new crimes related to corruption, rape, car thefts, fraud and pick-pocketing showed significant rise in their incidence during the nineties. - Despite the fact that some improvements have been achieved in the heath sector, there is a dire need for improving the health sector’s performance and providing better primary health care services. The answer to these conflicting results could be explained by two factors: Firstly, the inaccuracy of some data concerning GDP per capita, poverty, and income distribution. Secondly, the exclusion of other relevant variables such as the unemployment rates and the inflation rates. As to the first factor, it is difficult to verify the accurate data regarding GDP per capita (see the WDR, where it is estimated by US$ 1511 in 2001 and by the Ministry of Planning US$ 1276 in 2002. This contradiction in estimates could be either due to inaccuracy or due to a drastic decrease in the GDP per capita’s growth rate {15.5%} between the two mentioned years!!!). It is also as difficult to estimate the Gini coefficient, where the exact income levels (whether for the poor or rich income households) is unknown. Although recent empirical research indicate a decline in Gini coefficient at the turn of the century. In addition, two important variables should be included in the analysis, as they act as explanatory factors to the existing contradiction in data. These two variables are the unemployment and inflation rates. The Unemployment Rates Official data reveal a steady increase in the unemployment rates. The UER declined from 9.2% in 1996 (the Population Census) to 7.7% in 2000 and then picked-up again to reach a high level of 9.9% in 2002 (Annual Labor Force Sample Surveys 1997-2002). 21 FONDAZIONE CENSIS 11873_02 Study D2: Poverty, Informal Sector, Health and Labour The main essence of this kind of information is the apparent trend towards growing unemployment. This phenomenon of increasing UER started to become chronic at the end of the eighties, for three reasons: 1. The decreasing work opportunities for the Egyptians in the rich Gulf countries: This development came because of the saturation in the construction sectors –as well as others- in these countries. In addition, the growing trend to employ Asian labor (Pakistani, Afghan, Indian, Bengal, Philippine..) and to engage more of the educated natives in occupations that were usually filled by the Egyptian employment (teaching, medical services, accountants, lawyers) reduced the chances of Egyptians in the Gulf countries. 2. The decreasing work opportunities for the growing workforce in the government ranks, which came as a repercussion of the accelerating budget deficit during the end of the eighties, and the implementation of the ERSAP in 1991. These two factors led to a decrease in the employment growth rate in the Public Sector -3% during 1988-1998- as compared to 8% during 1976-1986. 3. The slow growth rate of employment in the large private sector and the FDI companies (1.5% during 1988-1998), because of their tendency to use advanced capital intensive techniques on one hand, and due the slow growth in investment spending since 1997 on the other hand. In fact the FDI showed a drastic decline in their inflows from US$1.656 Bill in 2000 to US$ .428 Bill in 200223.The only sector that revealed a continuous capacity to employ was the non-agricultural micro and small enterprise sector, which achieved an average employment growth rate equal to 4.8% annually during 1988-1998. Consequently, The stock of unemployment grew –according to official sources- from a modest 1.4 mill unemployed in 1996 to rise up to 2 mill unemployed in 2000. This situation was aggravated by the increase in the number of new entrants to the labor market from 600,000 in 1992/1993 to 900,000 in 200024. 23 24 MOFT, Economic Bulletin, 2002. Fawzy, S., “Investment Policies and Unemployment in Egypt”, The Egyptian Center for Economic Studies, Cairo, WP No.68, Sept. 2002, p.10 22 FONDAZIONE CENSIS 11873_02 Study D2: Poverty, Informal Sector, Health and Labour In addition, the unofficial estimates of unemployment rates- which are derived from special rounds of national surveys25- seem to indicate that it the UER could be significantly higher than the official figures. According to some of these estimates, the UER range between 12.0%-17.5% through the end of the nineties and until 2003. The Inflation Rates The inflation rates showed a steady decline since the beginning of the nineties from a high 20% in 1990 to a low 2.4% in the first quarter of 2002. The austerity stabilization program, which was successfully implemented in 1991 -1996/1997 helped in realizing this decrease. However, since mid 2002 the prices started to witness a steady increase, which were triggered by the shortage in foreign exchange that caused a steady depreciation of the Egyptian Pound, which was directly reflected on the prices of all imported goods, or products that had imported components. The inflationary spiral was further instigated by the decision to liberalize the Egyptian Pound (January 2003). Consequently, the value of the LE declined from 1US$=LE4.62 in January 2003 to LE6.2 in September 2003 or by 34.8% in 7 months. The devaluation is causing an escalating increase in the price levels and is significantly raising the CPI and WPI. It has an especially negative impact on the prices of the basic consumer goods. How do these developments in the UER and inflation rates relate to the previous analysis? It is obvious that despite the government’s efforts on the human development side, and despite the apparent increases in the average per capita income, both the rising UER and inflation rates had an adverse effect on the population. The combination of the high UER and the accelerating 25 See Fergany, N. (1999), “An Assessment of the Unemployment Situation in Egypt”, Al Mishkat Center for Research and Training, Research Notes, No. 13. Assaad, R. (2002), Labor Market in an Era of Transition, Cairo, AUC University Press. 23 FONDAZIONE CENSIS 11873_02 Study D2: Poverty, Informal Sector, Health and Labour inflation rates has a direct impact on both the changes that are identified in the poverty results, the deterioration in income distribution(as measured by the Gini coefficient) and the high tendency towards crimes as well as the low quality of the health services. The high poverty incidence and its rapid increase in the urban areas and all other aspects that are related to it are affected by the high UER, the decline in investment and GDP growth rates, and rapid decline in the real-mostly fixed- incomes of the poor households are basically due to the price rise and unemployment. The apparent increase in certain crimes such as thefts, pick pocketing, rape and corruption, is connected with unemployment, poverty and inability to afford a decent living. 5.3. Key issues, political agenda and perspectives Health and poverty are issues that are high on the priority list of the government’s and the National Democratic Party’s (NDP) agenda. The decentralization of service provision, the improvement of the health insurance system, the improvement and wider coverage of primary health care services, and better training of the medical service providers (physicians, nurses and administrative staff) are among the main concerns of the government and NDP. In addition, the birth control issue acquires a special attention, as the previous six years did not witness a steady reduction in the natural growth rates. The main emphasis is currently on the means to reduce the population growth rate, and thus to improve the outlook on the number of expected population in 2017, and thus to reduce the pressure on the different social services and on the budget in the near future. As to the poverty issues, they are being dealt with through the different programs, which are adopted by the various ministries, the Social Fund for Development and the NGOs working in this area of support. 24 FONDAZIONE CENSIS 11873_02 Study D2: Poverty, Informal Sector, Health and Labour As to how the Euro-Partnership Agreement could and will affect the Egyptian economy, there are both positive and negative repercussions. Positive effects of the Euro-Partnership Agreement include the wider market scope for Egyptian exports, the access to modern machinery and equipments at relatively lower costs, the possible benefit of the Industry Modernization Program on the domestic factories, possible inflow of European investments to Egypt. As to the negative effects of the EPA are numerous, but the most important of which is the fear of the inflow of manufactured products to Egypt, which could threaten the domestic production and employment. Finally, the Egyptian economy is now in a state of change, more emphasis is being directed towards strengthening the private sector, promotion of exports, augmenting the participation of the civil society, deregulation and simplification of the laws and rules that govern transactions, improving the investment climate and raising the quality of social services and their regional coverage. However, more serious and comprehensive policies should be designed to deal with the questions of unemployment, inflation, the slow movement towards more inequality of income distribution. In fact solving gradually the problem of unemployment could be a way to reduce income inequality between rural and urban areas, between the different regions of Egypt, and between the different income/expenditure strata. Improving the investment climate for both the large and the small companies, the domestic and the foreign companies, could be a contributing factor to help raise the share of investments to GDP to more acceptable levels. Investment policies should also take into consideration the reallocation of investments towards highly populated and poor regions that suffer from neglect. Another policy goal should be the concern with raising the efficiency and competitiveness of the production (industry and agriculture) sectors and with improving the quality of the service and trade activities. The globalization process could cause a substantial damage especially to the small and medium–scale industries, which operated for a long time in a protected environment. Therefore, special efficiency-raising programs 25 FONDAZIONE CENSIS 11873_02 Study D2: Poverty, Informal Sector, Health and Labour should be designed and implemented to support the small and medium enterprises. In addition, more concern should be directed towards the provision of high quality social services, as the results of empirical research indicate that better education and health services improve the chances of the individual in the labor market and raise his/her earning power. 26 FONDAZIONE CENSIS 11873_02 6. Study D2: Poverty, Informal Sector, Health and Labour REFERENCES 1. Abdel-Khalek, Gouda, (2001), Stabilization and Adjustment in Egypt: Reform or De-Industrialization?, Edward Elgar, UK & USA. 2. Ash, N., (1993), Egypt Exploits its Gulf War Bonus, Euromoney, April, PP. 138-141. 3. Assaad, R. & M. Rouchdy (1999), Poverty and Poverty Alleviation Strategies in Egypt, Cairo Papers in Social Sciences, Vol.22, Monograph 1, Spring. 4. Bishay, A. (1997), Sustainable Development & Poverty Eradication, in Kishk, M. “Poverty of Environment & Environment of Poverty”, Proceeding of the National Symposium on Poverty & Environment Deterioration in Rural Egypt. 5. CAPMAS, Central Authority for Public Mobility and Statistics, 2002. 6. CBE, Central Bank of Egypt, Annual Report, various Issues. 7. CBE, Central Bank of Egypt, Economic Bulletin, various Issues. 8. Central Bank of Egypt (CBE), Annual Economic Review, Various issues, 1992- 1998, Cairo, Egypt. 9. CSD, Civil Status Department, 2002. 10. DHS, Demographic and Health Survey, 2000. 11. Egypt: Human Development Report (EHDR), 1996, Institute of National Planning (INP). 12. Egypt: Human Development Report (EHDR), 1997/98, Institute of National Planning (INP). 13. Egypt: Human Development Report (EHDR), 2003, Institute of National Planning (INP). 27 FONDAZIONE CENSIS 11873_02 Study D2: Poverty, Informal Sector, Health and Labour 14. El-Laithy, H. (1999)Poverty Reduction Policies in Egypt: An overview, Eradicating Poverty Studies Series No.11. 15. El-Laithy, H. (2001), Evaluating the Social Fund for Development Programs to Alleviate Poverty, in Nassar, Heba & Heba El-Laithy “Socioeconomic Policies & Alleviation Programs in Egypt”. 16. El-Said Mustafa, (2003), The Twin Crises: Recession and Foreign Exchange, Presented at the Conference “Rising to the Challenge: International Crises and Economic Management in Egypt” Organized by CEFRS and USAID, Cairo, Egypt. 17. Field, M., (1995), The Slow Road to Privatization, Euromoney, Middle EastMiddle East Executive Reports (1992), (Forecasts-Part One: Current Situation), Vol. 15, No. 2, February, pp. 8-12. 18. Kheir –El-Din, Hanaa and El-Shawarby, Shierine, (2003), Trade and Foreign Exchange Regime in Egypt: A Policy Reform in Egypt, Proceedings of the Conference on “Institutional and Policy Challenges Facing The Egyptian Economy”, Organized by CEFRS and USAID, Cairo, Egypt. 19. Metwalli, M. (2001), Poverty Alleviation Programs in Egypt: Current situation and future steps, in Nassar, Heba & Heba El-Laithy “Socioeconomic Policies & Alleviation Programs in Egypt”. 20. Ministry of Foreign Trade, (2003), Egypt 2003, Cairo, Egypt. 21. Ministry of Planning 22. Nagi, S. Z. (2001), Poverty in Egypt: Human Needs and Institutional Capacities, Lexington Book. 23. Nassar, H. (2001), Social Protection for the Poor, in Nassar, Heba & ElLaithy, H. “Socioeconomic Policies & Alleviation Programs in Egypt”. 24. National Council for Negro Women (NCNW), 2000, Final Report, Egypt PVO Development Report. 28 FONDAZIONE CENSIS 11873_02 Study D2: Poverty, Informal Sector, Health and Labour 25. Osman, M. Osman (1999), Combating Poverty in Egypt: The Role of Economic Growth and Social Spending, Arab Economic Journal, No. 17, Vol. 8. 26. Roads, S., (1997), Investing in Egypt, (London: Committee for Middle East Trade, June). 27. SIS, State Information Service, Atlas of Egypt, 2003. 28. SIS, State Information Service, Fact book, Egypt, 2002. 29. Subjective Poverty and Social Capital: Towards a Comprehensive strategy to reduce poverty (2003), Ministry of Planning in cooperation with the United Nations Development program. 30. The Egyptian Cabinet Information and Decision Support Center (ECI & DSC), Monthly Economic Bulletin, Cairo, Egypt. 31. The Egyptian Ministry of Public Enterprise Sector (MPES), (1998), Privatization Program performance from the start to 24-5-1998, Cairo, Egypt. 32. Timewell, S., Egypt: It is Time to Start Letting Go, (1991), Banker, Vol. 141, No. 758, July, PP. 47-48. 33. Youssef, S., M., (1996), Structural Reform Program of Egyptian StateOwned Enterprises: Current Impact and Future Prospects, Journal of Management Development, Vol. 15, No. 5, May, PP. 88-100. 29 FONDAZIONE CENSIS 11873_02 7. Study D2: Poverty, Informal Sector, Health and Labour MAIN AFFILIATIONS WITH INTERNATIONAL ORGANIZATIONS Arab Bank for Economic Development of Africa (ABEDA), African Development Bank (ADB), Arab Fund for Economic and Social Development (AFESD), League of Arab States, Arab Monetary Fund (AMF), Council of Arab Economic Unity (CAEU), Common Market for Eastern and Southern Africa (COMESA), European Bank for Reconstruction and Development (EBRD), Economic and Social Commission for Western Asia (ESCWA), Food and Agriculture Organization of the United-Nations (FAO), G-15, G-19, G-24, G-77, International Atomic Energy Agency (IAEA), International Bank for Reconstruction and Development (IBRD), International Civil Aviation Organization (ICAO), International Fund for Agricultural Development (IFAD), International Labour Organization (ILO), International Monetary Fund (IMF), International Maritime Organization (IMO), Inmarsat, Intelsat, Interpol, International Telecommunications Union (ITU), Organization of Arab Petroleum Exporting Countries (OAPEC), Organization of the Islamic Conference (OIC), Organization for Security and Cooperation in Europe (OSCE) (partner), United-Nations (UN), United-Nations Educational, Scientific and Cultural Organization (UNESCO), United-Nations Industrial Development Organization (UNIDO), Universal Postal Union (UPU), World Federation of Trade Unions (WFTU), World Health Organization (WHO), World Meteorological Organization (WMO), World Trade Organization (WTO). 30 FONDAZIONE CENSIS APPENDIX Table 1 - Population Year No of Population * (000) 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 47751 48816 49826 50858 51911 52985 54082 55201 56344 57510 58755 60080 61341 62652 63976 65336 Growth Rate 2.23 2.07 2.07 2.07 2.07 2.07 2.07 2.07 2.07 2.16 2.26 2.10 2.14 2.11 2.13 Rate of Births (%)** 40 39 38.4 33.9 32.5 30.9 27.7 29 28.6 27.9 28.3 27.5 27.5 27 27.1 26.7 Rate of Deaths (%)** Rate of Natural increase (%)** 9.5 9.5 8.6 8.1 7.6 7.4 7.1 6.9 6.8 6.7 6.5 6.5 6.5 6.4 6.3 6.3 30.5 29.5 29.8 25.8 24.9 23.5 20.6 22.1 21.8 21.2 21.8 21 21 20.6 20.8 20.4 * Central Authority for Public Mobility and Statistics, Statistical Year Book, 2002. ** Civil Status Department Table 2 - Population Distribution by Sex (000) Year r 1986* 1996* 2002** Male Number 24709 30352 28068 Female Number % % 0.51 0.51 0.43 23545 28961 37351 0.49 0.41 0.57 Total 48254 59313 65419 * Central Authority for Public Mobility and Statistics, Statistical Year Book, 2002 ** Ministry of Health and Population Table 3 - Population by Broad Age Groups (in percent) Item 1986 1996 2000 Less than 5 5-14 14-24 25-64 65- 15.3 24.4 16.3 36.9 3.9 11.6 26.2 20.2 38.7 3.4 12 22.5 20.6 41.4 3.6 Source: CAPMAS, Statistical Yearbook, several years Table 4 - Educational Profile Item Primary enrolment Ratio (gross)% Preparatory enrolment Ratio (gross)% Secondary enrolment Ratio (gross)% Tertiary enrolment Ratio (gross)% 1996/1997 1998/1999 2000/2001 105 83.3 46.9 26.2 93.7 85.9 47.5 29.1 91.7 92.3 71.1 30.2 Source: Human Development Report, Institute of National Planning, 1997/1998 & 2002/2004 Table - 5 Selected Macroeconomic Variables year Real GDP Rate Inflation Rate Unemployment rate 1996 1997 1998 1999 2000 2001 2002 5 7.3 9.2 5.3 6.2 8.8 4.1 3.8 8.8 5.4 3.8 8.1 5.9 2.8 7.7 3.4 2.4 8.3 3.2 2.4 9.7 Source: Ministry of Planning and Central Bank of Egypt Table 6 - Distribution of GDP By Economic Activity year Total GDP at current price (L. E. billions) Agriculture Product (as % of GDP) Industrial Product (as % of GDP) Service Product (as % of GDP) 1991/1992 1996/1997 2000/2001 139.1 16.5 33.3 50.2 256.3 15.7 33.6 50.7 361.8 16.5 33.3 50.2 Source: Human Development Report, Institute of National Planning, 1997/1998 & 2002/2003 Table 7 Gross Domestic Product at Factor Cost 1/ Current prices- Annual Profile (In Millions Egyptian Pounds) GDP Total Commodity Sector Agriculture Industry & Mining Petroleum & Products Electricity Construction Total Production Services Transportation 2/ Trade, Finance, and Insurance Hotels and Restaurants Total Social Services Housing and Real Estate Utilities Other services 1990/91 108740 55260 19110 10999 18020 1506 5625 33962 921 11319 21722 10416 2141 8275 9102 1991/92 131056 65373 21680 13008 21730 2220 6735 43606 2420 14835 26351 11695 2350 9345 10383 1992/93 146160 72767 24427 13899 24420 2921 7100 48067 2675 15926 29466 13470 2585 10885 11856 1993/94 191010 80880 27500 28030 13399 3451 8500 52710 17560 32870 2280 3420 2850 570 25957 1994/95 162967 93750 32050 33330 15120 3750 9500 62250 19700 39700 2850 4140 3450 690 30870 1995/96 214,185 104,684 36,968 37,936 14,760 3,980 11,040 69,850 21,500 45,109 3,241 39,651 3,816 843 34992 Source: Ministry of Planning. 1/ Does not include net indirect taxes. 2/ Includes Suez Canal 1996/97 247,028 118,992 41,882 43,383 17,461 4,172 12,094 82,889 22,695 56,364 3,830 45,147 4,375 915 39757 1997/98 266,758 127,978 45,652 48,798 15,534 4,264 13,730 89,072 24,049 61,690 3,332 49,708 4,860 1,038 43810 1998/99 282,578 136,296 48,935 55,225 12,995 4,586 14,555 95,573 25,916 63,975 3,682 52,709 5,412 1,179 46116 1999/00 315,667 157,432 52,845 61,211 23,300 4,936 15,140 101,794 27,909 68,960 4,925 56,441 6,003 1,305 49133 2000/01 332,544 165,899 55,065 63,483 26,300 5,291 15,760 106,858 30,112 71,389 5,357 59,787 6,879 1,445 51463 2001/02 354,564 176,084 58,369 68,086 27,280 5,789 16,560 112,911 32,694 75,110 5,107 65,268 7,575 1,601 56493 Table 8a Exports and Imports 1990-2002 Year 1990/91 1991/92 1992/93 1993/94 1994/95 1995/96 1996/97 1997/98 1998/99 1999/00 2000/01 2001/02 Export (US$ millions) Import (US$ millions) Trade Balance* Export/Import* Exports/GDP Imports/GDP 3886.8 11425 -7538 32.67 3.6 10.5 3636.4 10054 -6418 32.67 2.8 7.7 3416.7 10728 -7312 32.67 2.3 7.3 3337 10647 -7310 32.67 6.5 20.6 4957 12811 -7854 32.67 8.20 21.30 4609 14107 -9498 32.67 6.80 20.90 5345 15565 -10220 34.34 7.10 20.60 5128 16899 -11771 30.34 6.20 20.50 4445 17008 -12563 26.13 4.90 18.80 6388 17860 -11472 35.77 6.50 18.10 7078 16441 -9363 43.05 7.60 17.60 6643 14644 -8001 45.36 7.60 16.60 Source: Ministry of Foreign Trade, Economic Bulletin, several issues. Table 8 b Foreign Investment Year 1994/95 Foreign Direct Invest (US$ millions) Portfolio Investment (US$ millions) Source: Central Bank of Egypt, CBE’s Bulletin, 2002 783 4 1995/96 627 258 1996/97 770 1463 1997/98 1104 -248 1998/99 711 174 1999/00 1656 473 2000/01 509 261 2001/02 428 45 Table 9 Investment and Saving during 1993-2002 Year 1993/94 1994/95 1995/96 1996/97 1997/98 1998/99 1999/00 2000/01 2001/02 15.1 16.6 15 16.2 12.7 16.1 16.9 17.6 16.7 19.5 17.2 20.8 16.3 18.9 16.3 17.7 14.9 17.6 National Saving/GDP(%) National Investment/GDP(%) Source: Ministry of Planning and CAPMAS Table 10: Income Poverty vs. Capability Poverty (1996) Income Poverty % of All Egypt Population % in Rural Egypt % in Urban Egypt 23 23 22.5 Capability Poverty 34 43 21 Source: EHDR (1996) Table 11: Deprivation Index and Poverty Index by Governorates Deprivation Index Urban Rural Cairo Alexandria Port Said Suez Damietta Dakhlia Sharkia Qalubia Kafr Elsheikh Garbia Menofia Behera Ismailia Giza Beni Suef Fayoum Menia Assuit Sohag Qena Aswan 17.18 20.17 11.84 9.20 18.43 19.06 17.24 20.62 17.34 10.73 25.42 25.29 13.24 19.76 45.96 26.23 40.88 47.07 30.07 29.41 7.613 n.a. n.a. n.a. n.a. 25.34 43.35 71.68 52.39 56.44 52.25 60.39 74.87 59.35 65.25 99.18 100 98.19 95.88 85.66 87.34 36.02 Poverty Index Urban Rural 28.27 51.13 10.85 9.71 18.45 38.92 49.14 65.74 37.25 38.53 53.12 64.87 26.12 37.01 62.01 60.70 78.98 78.56 88.71 68.41 69.62 n.a. n.a. n.a. n.a. 4.65 34.17 42.55 50.61 29.88 26.66 47.78 54.49 19.81 26.35 64.27 68.41 66.84 81.72 68.09 69.01 52.53 Rank of deprivationpoverty26 Urban Rural 3 8 -1 0 -5 5 11 15 5 11 6 13 3 1 2 7 15 11 19 13 33 n.a. n.a. n.a. n.a. -14 -11 -15 -7 -17 -18 -12 -9 -23 -24 -11 -6 -7 2 -3 -1 1 Source: El-Laity, Heba (2001) 26 The rank is according to the Headcount Index P0 and the Deprivation Index, such that lower rank indicates more poverty or deprivation. Table 12: Income, Distribution and Poverty GDP per capita (LE) Income share of lowest 40%: Total Rural 1996/97 1995/1996 1995/96 Ratio of highest 20% to lowest 20%: Total Rural 1995/96 1995/96 4.4 3.1 Gini coefficient % Total Rural 1995/96 1995/96 1995/96 1995/96 1995/96 1995/96 31.6 24.0 22.9 7.4 45.2 12.9 Poor households (as % of total) Ultra poor (as % of total households) Wages of poor households: - As % of their income - As % of total wages Source: EHDR (1997/98) Table 13: Profile of Human Deprivation (thousands) Population without access to: - Health services - Piped water - Sanitation 1996 1996 1996 n.a. 11006.9 34463.4 Children dying before age five 1996 2001 64.8 105.929 Malnourished children under five 1997 2001 798.8 161.096 Children not in basic or secondary school 1996/97 2000/01 Illiterates (10+) 1996 16378.2 Illiterates (15+): -Total - Female 2001 2001 17914.971 11167.715 Unemployed people (15+): - Total 1996 2001 1996 2001 1538.0 1698.457 535.1 571.001 - Female Source: EHDR (1996) & (1997/98) 3453.3 2383.526 4306.0 21.9 25.7 Table 14: Capability Poverty and Income Poverty in Egypt 1995(%) EGYPT All Urban All Rural Urban Gov. Lower Egypt -Urban -Rural Upper Egypt -Urban -Rural UnderWeight Unattended Births Female with no education People who are capability poor People who are income poor 12.5 9.9 14.1 9.1 9.6 8.8 9.9 16.1 11.0 17.8 43.7 32.1 67.2 30.8 48.6 24.9 56.1 67.8 40.4 77.1 35.4 20.8 47.8 20.4 33.0 18.8 38.9 48.3 24.1 59.1 33.9 20.9 43.0 20.1 30.4 17.5 35.0 44.1 25.2 51.3 22.9 22.5 23.3 16.0 17.1 21.7 15.4 34.1 35.0 33.7 Source: EHDR (1996). Table15-a: Poverty measures by educational status of household for urban areas in 2000 Using Upper Poverty Line P0 P1 P2 Illiterate Read and Write Below University University Higher than University Total 63.50 46.70 40.90 19.90 5.17 45.16 24.91 14.06 11.15 4.91 0.79 14.71 Using Lower Poverty Line P0 P1 P2 12.83 5.85 4.31 1.69 0.16 6.66 41.59 23.83 18.25 8.16 0.88 24.52 14.50 6.13 4.42 1.60 0.07 7.22 6.76 2.29 1.49 0.44 0.01 3.01 Source: El-Laithy, Heba (2001) Table 15-b: Poverty measures by educational status of household for rural areas Illiterate Read and Write Below University University Higher than University Total Using Upper Poverty Line P0 P1 P2 Using Lower Poverty Line P0 P1 P2 % no. of H.Hold 58.39 35.64 22.01 10.08 10.64 3.56 38.36 17.82 13.48 4.36 6.28 1.43 54.735 23.5000 40.19 11.30 3.82 21.64 4.79 1.36 18.062 22.08 0.00 5.82 0.00 1.86 0.00 10.10 0.00 2.21 0.00 0.61 0.00 3.642 0.061 48.40 16.67 7.42 29.46 9.35 4.04 100 Source: El-Laithy, Heba (2001) % no. of H.Hold 28.436 24.434 9.982 15.464 0.936 100 Table 15-c: Poverty measures by educational status of household (2002) Objective Poverty %Non%All Poor %Poor Illiterate Read & Write only Basic Education Intermediate Above intermediate University degree Higher university Total 41.04 15.79 26.63 14.34 0.79 1.41 0.00 100 27.92 13.82 23.20 22.37 3.34 9.23 0.14 100 30.51 14.21 23.87 20.78 2.84 7.68 0.11 100 Poverty Rate %Poor 26.55 21.93 22.01 13.62 5.50 3.62 0.00 20.40 32.39 14.55 26.10 19.16 2.58 5.14 0.00 100 Subjective Poverty %Non%All Poor 29.62 14.05 22.83 21.54 2.96 8.87 0.13 100 Source: SPSC (2003) Table 16: Household's out of pocket expenditure on education 1997/98 Pre-University As part of HH % Share expenditure Poor Middle Rich Total 0.336 1.225 1.329 2.890 University As part of HH % Share expenditure 11.6 42.4 46.0 100 0.029 0.659 1.22 1.810 1.6 35.4 62.0 100 Source: Osman (1999) Table 17: Share of income groups in Public Expenditure on Education 1997/98 (%) Pre-university Poor Middle Rich Total Government expenditure As % of GDP Source: Osman (1999) 31.0 50.0 19.0 100 3.25 Higher Education 10.0 36.3 53.7 100 1.75 Total 23.7 45.2 31.2 100 5.0 30.51 14.21 23.87 20.78 2.84 7.68 0.11 100 Poverty Rate 33.78 32.58 34.77 29.33 28.95 21.29 18.75 31.82 Table 18 : Distribution of Individuals by Sector of Employment and Poverty groups(2002) Government Economic agencies Public sector Private sector Cooperative NGOs Foreign/Joint venture Total Objective Poverty Poverty %Non%All %Poor Rate Poor Subjective Poverty Poverty %Non%All %Poor Rate Poor 13.54 0.19 1.83 84.15 0.00 0.19 0.10 100 23.74 0.63 3.64 71.55 0.19 0.19 0.06 100 26.25 0.49 4.03 68.78 0.17 0.09 0.19 100 23.93 0.44 3.63 71.58 0.14 0.11 0.18 100 10.33 8.00 9.18 21.45 0.00 33.33 10.00 20.40 24.00 0.36 3.62 71.60 0.12 0.07 0.22 100 23.93 0.44 3.63 71.58 0.14 0.11 0.18 100 27.69 40.00 28.02 27.90 37.50 50.00 10.00 31.82 Source: SPSC (2003) Table 19: Demographic Characteristics by Poverty Status %Poor Gender of household head Male headed 1.53 Female headed 8.47 Total 100 Demographic characteristics Household size 6.46 Share of children 38.64 Share of adult 31.66 males Share of adult 27.40 females Share of elderly 2.29 Source: SPSC (2003) Objective Poverty %Non%All Poor 88.63 11.37 100 89.22 10.78 100 4.28 30.49 P0 20.93 16.03 20.4 %Poor Subjective Poverty %Non%All Poor 86.19 13.81 100 9.64 9.36 100 89.22 10.78 100 4.60 32.16 4.65 33.15 4.55 31.69 4.60 32.16 32.91 32.66 31.47 33.21 32.66 32.21 31.23 31.15 31.27 31.23 4.38 3.96 4.23 3.83 3.96 P0 30.74 40.78 31.82 Table 20 : Housing conditions by poverty status (2002) Objective Poverty %Non%All %Poor Poor % of individuals living in houses with Floor covered with tiles/wood 55.53 Connected to water public 88.36 network Connected to sewerage network 28.34 Private kitchen 61.12 Shared kitchen 2.26 No special place 36.62 Area of the house 96.34 Main means of transportation On foot Private car Private transport Public transport 55.29 0.00 18.56 7.09 Subjective Poverty %Non%All %Poor Poor 81.81 76.45 61.58 80.14 76.45 93.65 92.57 92.25 92.72 92.57 58.59 83.34 1.37 15.29 93.22 52.42 78.80 1.55 19.64 93.85 57.80 73.46 1.86 24.68 78.95 49.90 81.30 1.41 17.29 100.81 52.42 78.80 1.55 19.64 93.85 39.64 5.61 21.95 15.79 42.83 4.47 21.26 14.02 43.15 0.96 20.36 20.00 42.68 6.10 21.68 11.23 42.83 4.47 21.26 14.02 Source: SPSC (2003) Table 21 : Standard of Living Indices by Poverty Status (2002) Poor Objective poverty Housing index Basic needs index Security index Standard of living index Subjective poverty Housing index Basic needs index Security index Standard of living index Source: SPSC (2003) Urban Non poor All Poor Rural Non poor All Poor Total Non poor All 86.76 68.09 38.23 94.20 89.52 67.31 93.45 87.36 64.38 49.56 80.14 55.08 56.00 89.32 65.78 54.24 86.82 62.86 56.87 77.77 51.77 73.18 89.41 66.46 69.85 87.03 63.47 20.76 31.59 30.50 24.03 28.48 27.27 23.39 29.88 28.55 92.12 79.23 55.22 94.33 92.78 70.49 93.45 87.36 64.38 50.06 70.90 51.87 55.74 92.52 66.80 54.24 86.82 62.86 6926 75.07 53.55 71.12 92.61 68.09 69.85 87.03 63.47 26.32 33.29 30.50 22.05 29.14 27.27 24.19 30.59 28.55 Table 22: Projects that Assisted Women in Obtaining Legal Documents Project Suhag CDA for Children with Special Needs”Women’s Civil rights in Maragha” Jesuits and Brothers` Benevolence Association “Women Development” Social Fund in Beni Mazar “Civil Right Women in Markaz Benimazar” World Education Marketing Link Program Suhag CDA for Children with Special Needs “Women Civil Rights in Suhag” Assiut Childhood and Development Association NGOs Service Centre in Assiut Total Birth Certificates Identity Cards Voting Cards 289 735 366 - 60 - 232 604 0 - 150 - 1597 2302 3136 300 18 2436 300 90 5141 450 300 4252 Table 23 The Number of Crimes Reported according to Type from 1990- 1995 1990 Intentional homicide Battery leading to death Battery leading to disfigurement Kidnapping Sexual harassment Rape Threats Thefts: Burglary Robbery Automobile thefts Burglaries from shops Stealing cattle Pick pocketing Other thefts Total thefts Arson Cattle poisoning Ruining crops Fraud Embezzlement Bribery Forging official documents and seals Counterfeiting currency Endangering or obstructing means of transportation Other felonies 1991 1992 1993 1994 1995 839 228 119 6 180 3 15 859 221 136 18 149 15 5 824 201 125 15 162 13 8 843 207 85 11 154 8 7 797 211 108 16 194 9 5 843 215 91 18 173 6 3 4206 370 1699 1676 390 1946 16066 26353 126 2 1954 83 55 4529 311 1612 1889 436 2078 17595 28450 115 1 2 2468 119 49 4904 312 1761 2166 376 2107 19204 30830 98 1 2552 92 40 5315 339 1503 2241 529 2672 20223 32822 109 1 2589 99 39 5772 375 1760 2432 482 2820 22353 35994 117 2776 80 60 5815 367 1808 2780 408 3166 24935 39279 160 3 2849 68 61 271 245 258 270 225 199 62 143 210 111 87 56 2 4 1 - 1 3 48 69 78 71 81 121 Table 24 The Number of Crimes Reported according to Type from 1996- 1998 1990 Automobile thefts Car thefts Robbery Burglary Sexual harassment Rape 1699 3742 370 4206 180 3 1991 1612 4203 311 4529 149 15 1992 1761 2549 312 4904 162 13 1993 1503 4847 339 5315 154 8 1994 1760 5246 375 5772 194 9 1995 1808 6287 367 5815 173 6 1996 2407 7210 477 6133 n/a n/a 1997 2567 6161 429 6352 n/a n/a 1998 2828 7813 410 6368 176 21 Source: Meliguy, A., 2000 National Center for Social and Criminal Research, Crime Experiences around the World, CRIME Rates in Egypt: A Comparative Study, Part 2 Table 25 The Transparency International Corruption Perception Index Rank 1 2 4 5 7 10 11 12 14 15 16 17 18 20 23 24 25 27 28 29 31 32 33 36 40 44 45 50 51 Country Finland Denmark New Zealand Iceland Singapore Sweden Canada Luxembourg Netherlands United Kingdom Australia Norway Switzerland Hong Kong Austria USA Chile Germany Israel Belgium Japan Spain Ireland Botswana France Portugal Slovenia Namibia Estonia Taiwan Italy Uruguay Hungary Malaysia Trinidad & Tobago Belarus Lithuania South Africa Tunisia Costa Rica Jordan Mauritius South Korea Greece Brazil Bulgaria Jamaica Peru Poland Ghana Croatia CPI 2002 score Surveys used Standard deviation High-low Range 9.7 9.5 9.5 9.4 9.3 9.3 9.0 9.0 9.0 8.7 8.6 8.5 8.5 8.2 7.8 7.7 7.5 7.3 7.3 7.1 7.1 7.1 6.9 6.4 6.3 6.3 6.0 5.7 5.6 5.6 5.2 5.1 4.9 4.9 4.9 4.8 4.8 4.8 4.8 4.5 4.5 4.5 4.5 4.2 4.0 4.0 4.0 4.0 4.0 3.9 3.8 8 8 8 6 13 10 10 5 9 11 11 8 9 11 8 12 10 10 9 8 12 10 8 5 10 9 9 5 8 12 11 5 11 11 4 3 7 11 5 6 5 6 12 8 10 7 3 7 11 4 4 0.4 0.3 0.2 0.4 0.2 0.2 0.2 0.5 0.3 0.5 1.0 0.9 0.9 0.8 0.5 0.8 0.9 1.0 0.9 0.9 0.9 1.0 0.9 1.5 0.9 1.0 1.4 2.2 0.6 0.8 1.1 0.7 0.5 0.6 1.5 1.3 1.9 0.5 0.8 0.9 0.7 0.8 1.3 0.7 0.4 0.9 0.4 0.6 1.1 1.4 0.2 8.9 - 10.0 8.9 - 9.9 8.9 - 9.6 8.8 - 10.0 8.9 - 9.6 8.9 - 9.6 8.7 - 9.3 8.5 - 9.9 8.5 - 9.3 7.8 - 9.4 6.1 - 9.3 6.9 - 9.3 6.8 - 9.4 6.6 - 9.4 7.2 - 8.7 5.5 - 8.7 5.6 - 8.8 5.0 - 8.1 5.2 - 8.0 5.5 - 8.7 5.5 - 7.9 5.2 - 8.9 5.5 - 8.1 5.3 - 8.9 4.8 - 7.8 5.5 - 8.0 4.7 - 8.9 3.6 - 8.9 5.2 - 6.6 3.9 - 6.6 3.4 - 7.2 4.2 - 6.1 4.0 - 5.6 3.6 - 5.7 3.6 - 6.9 3.3 - 5.8 3.4 - 7.6 3.9 - 5.5 3.6 - 5.6 3.6 - 5.9 3.6 - 5.2 3.5 - 5.5 2.1 - 7.1 3.7 - 5.5 3.4 - 4.8 3.3 - 5.7 3.6 - 4.3 3.2 - 5.0 2.6 - 5.5 2.7 - 5.9 3.6 - 4.0 Rank 52 57 59 62 64 66 67 68 70 71 77 81 85 Country Czech Republic Latvia Morocco Slovak Republic Sri Lanka Colombia Mexico China Dominican Rep. Ethiopia Egypt El Salvador Thailand Turkey Senegal Panama Malawi Uzbekistan Argentina Cote d’Ivoire Honduras India Russia Tanzania Zimbabwe Pakistan Philippines Romania Zambia Albania Guatemala Nicaragua Venezuela Georgia Ukraine Vietnam CPI 2002 score Surveys used Standard deviation High-low Range 3.7 3.7 3.7 3.7 3.7 3.6 3.6 3.5 3.5 3.5 3.4 3.4 3.2 3.2 3.1 3.0 2.9 2.9 2.8 2.7 2.7 2.7 2.7 2.7 2.7 2.6 2.6 2.6 2.6 2.5 2.5 2.5 2.5 2.4 2.4 2.4 10 4 4 8 4 10 10 11 4 3 7 6 11 10 4 5 4 4 10 4 5 12 12 4 6 3 11 7 4 3 6 5 10 3 6 7 0.8 0.2 1.8 0.6 0.4 0.7 0.6 1.0 0.4 0.5 1.3 0.8 0.7 0.9 1.7 0.8 0.9 1.0 0.6 0.8 0.6 0.4 1.0 0.7 0.5 1.2 0.6 0.8 0.5 0.8 0.6 0.7 0.5 0.7 0.7 0.8 2.6 - 5.5 3.5 - 3.9 1.7 - 5.5 3.0 - 4.6 3.3 - 4.3 2.6 - 4.6 2.5 - 4.9 2.0 - 5.6 3.0 - 3.9 3.0 - 4.0 1.7 - 5.3 2.0 - 4.2 1.5 - 4.1 1.9 - 4.6 1.7 - 5.5 1.7 - 3.6 2.0 - 4.0 2.0 - 4.1 1.7 - 3.8 2.0 - 3.4 2.0 - 3.4 2.4 - 3.6 1.5 - 5.0 2.0 - 3.4 2.0 - 3.3 1.7 - 4.0 1.7 - 3.6 1.7 - 3.6 2.0 - 3.2 1.7 - 3.3 1.7 - 3.5 1.7 - 3.4 1.5 - 3.2 1.7 - 2.9 1.7 - 3.8 1.5 - 3.6 Rank 88 89 93 95 96 98 101 102 Country Kazakhstan Bolivia Cameroon Ecuador Haiti Moldova Uganda Azerbaijan Indonesia Kenya Angola Madagascar Paraguay Nigeria Bangladesh CPI 2002 score Surveys used Standard deviation High-low Range 2.3 2.2 2.2 2.2 2.2 2.1 2.1 2.0 1.9 1.9 1.7 1.7 1.7 1.6 1.2 4 6 4 7 3 4 4 4 12 5 3 3 3 6 5 1.1 0.4 0.7 0.3 1.7 0.6 0.3 0.3 0.6 0.3 0.2 0.7 0.2 0.6 0.7 1.7 - 3.9 1.7 - 2.9 1.7 - 3.2 1.7 - 2.6 0.8 - 4.0 1.7 - 3.0 1.9 - 2.6 1.7 - 2.4 0.8 - 3.0 1.7 - 2.5 1.6 - 2.0 1.3 - 2.5 1.5 - 2.0 0.9 - 2.5 0.3 - 2.0 Explanatory notes A more detailed description of the CPI methodology is available at http://www.transparency.org/cpi/index.html#cpi or at www.gwdg.de/~uwvw/2002.html A CPI 2002 Score relates to perceptions of the degree of corruption as seen by business people and risk analysts, and ranges between 10 (highly clean) and 0 (highly corrupt). A Surveys Used refers to the number of surveys that assessed a country’s performance. A total of 15 surveys were used from nine independent institutions, and at least three surveys were required for a country to be included in the CPI. Standard Deviation indicates differences in the values of the sources: the greater the standard deviation, the greater the differences of perceptions of a country among the sources. High-Low Range provides the highest and lowest values of the different sources Source: www.transparency.org Table 26 Maternal Health Indicators, Egypt 2000 Indicator (% of ever married women 15 to 49) Care during pregnancy Anti Natal Care Any Regular One or more TT injection(s) Other medical care Any medical care Pregnancy care indicator by background characteristics Weighed Height measured Blood pressure measured Urine sample Blood sample Iron tablets/syrup Told where to go for complications Place of delivery Public health facility Private health facility At home Other Assistance during delivery Doctor Trained Birth attendant Relative/other No one Postnatal care by background characteristics Delivered in facility Had any postnatal checkup Had checkup within 2 days of birth Urban Rural Total 71.2 56.2 75.3 9.9 87.6 47.2 32.8 80.4 13.2 80.7 52.9 36.7 72.5 11.4 85.3 75.6 43.3 76.1 63.6 64.1 39.4 22.6 48.5 24.9 46.2 33.4 34.3 20.7 14.6 59.6 32.4 58.4 45.7 46.5 28.3 17.9 33.4 36.4 30 0.1 15.2 19.4 65.3 0 22.2 26 51.7 0 73.3 8.1 17 1.1 0.4 41 7 47.1 3.3 1.5 53.5 7.4 35.5 2.5 1.1 69.8 2.5 0.6 34.6 5.4 1.5 48.2 4.3 1.1 Table 27 Child health indicator, Egypt 2000 Indicator (% of children below 5 years) Vaccinations by background characteristics All Prevalence of diarrhea Diarrhea in the preceding two weeks Prevalence and treatment of acute respiratory infection (ARI) Percentage of children with cough and short, rapid breathing Percentage of children ill with ARI symptoms receiving “Medical care from” Any health provider Percentage of children ill with ARI symptoms receiving “Medical care from” Public sector provider Percentage of children ill with ARI symptoms receiving “Medical care from” Private sector provider Antibiotics Initial breastfeeding Percentage ever breastfed Percentage who started breastfeeding Within one hour of birth Percentage who started breastfeeding Within one day of birth Percentage who received pre-lacteal feeding Median duration of breastfeeding Among children under age three, median duration in months Any breastfeeding Among children under age three, median duration in months Exclusive breastfeeding Among children under age three, median duration in months Full breastfeeding1 Percentage of children under age two bottle fed Nutritional status by socioeconomic characteristics Severe stunting Severe or moderate stunting Prevalence of anemia among children 6-59 months Sever anemia Moderate anemia Mild anemia Not anemic Missing Urban Rural Total 92.8 91.8 92.2 6.1 7.8 7.1 7.8 10.6 9.5 77.4 60.6 66 23.3 25.1 24.5 56.1 81.6 36.7 72.5 42.9 75.4 94.8 53.5 87.6 52.2 95.9 59.1 88.5 54.4 95.5 57 88.1 53.6 17.2 19 18.4 2.2 3.6 3 2.8 18.8 4.4 13.9 3.8 15.8 4 13.8 7.7 21.8 6.2 18.7 0.1 8.7 14.8 74.6 1.8 0.3 12.8 20.9 64.5 1.6 0.2 11.2 18.5 68.4 1.7 JORDAN Royal Scientific Society 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour METHODOLOGY According to the terms of reference, this report was conducted using the three required activities: 1. Study on national literature; a list of major references is attached in annex 1. 2. Analysis of data from national sources. 3. Interviews with privileged witnesses and key-players (some of whom having responsibility for public policy decisions). Annex 2 presents a list of the interviewees. 75 FONDAZIONE CENSIS 11873_2002 1. Study D2: Poverty, Informal Sector, Health and Labour COUNTRY PROFILE: ESSENTIAL FIGURES Jordan is a small Arab country with inadequate supplies of natural resources. Since the early 1990s, Jordan has undertaken considerable stabilization and adjustment efforts. The IMF, the World Bank Group, EU, and several bilateral donors have supported these efforts. The economy’s initial response to the Government’s reform program was strong. Economic fundamentals in the first half of this decade were quite satisfactory: a high average growth rate of 7.6 percent per annum (until 1996 when it began to deteriorate). A reduction in the fiscal deficit, low inflation, and sound monetary management, which helped in the build-up of foreign exchange reserves to a healthy level (current balance of over 5 months of coverage of imports). The current account during this period remained essentially balanced. The economic situation began to deteriorate in 1996 with growth falling below the population growth rate resulting in approximately a twopercent decline in per capita income per annum during 1996-98 period. The decline occurred largely because the country faced several unfavorable factors that were outside its control, including lack of progress in the peace process, declining oil prices, thus reducing the market for Jordanian exports in neighboring countries, and spillover from the general slowdown in the Asian economies. 1.1 Population1: 5,29000 Age structure: 0-14 years: 36.6% (male 991,370; female 949,247) 15-64 years: 60% (male 1,698,568; female 1,485,261) 65 years and over: 3.4% (male 90,186; female 92,838) 1 Data are for the year 2002 unless other wise mentioned. 76 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour Population growth rate: 2.8% Birth rate: 29 births/1,000 population Death rate: 5 deaths/1,000 population Net migration rate: 7.18 migrants/1,000 population (2001 est.) Sex ratio: at birth: 1.06 male(s)/female under 15 years: 1.04 male(s)/female 15-64 years: 1.14 male(s)/female 65 years and over: 0.97 male(s)/female total population: 1.1 male(s)/female Infant mortality rate: 22.1 deaths/1,000 live births Life expectancy at birth: female: 72.4 years male: 70.6 years Total fertility rate: 3.7 children born/woman Ethnic groups: Arab 98%, Circassian 1%, Armenian 1% (Armenians only make 0.1% of the population. There are also Chechens, Turkmens, and Kurds). Religions: Sunni Muslim 92%, Christian 6% (majority Greek Orthodox, but some Greek and Roman Catholics, Syrian Orthodox, Coptic Orthodox, Armenian Orthodox, and Protestant denominations), other 2% (several small Shi’a Muslim and Druze communities) (2001 est.) 77 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour Literacy: definition: age 15 and over can read and write total population: 86.6% male: 93.4% female: 79.4% (1995 est.) 1.2. Economy - overview GDP: $9296 million, GDP - real growth rate: 4.9% GDP- per capita: $1745 GDP - composition by sector: agriculture: 3.6% industry: 27.9% services: 68.5% Inflation rate (consumer prices): 1.9% (2001) Labor force: 1.27 million. Note: in addition, at least 300,000 workers are employed abroad (2001) Labor force - by occupation: Services 83%, industry 13%, agriculture 5% (2001 est.) Unemployment rate: 14-15% Industries: Phosphate mining, pharmaceuticals, petroleum refining, cement, potash, light manufacturing, text tile, pharmaceuticals, and tourism. Agriculture - products: Wheat, barley, citrus, tomatoes, melons, olives; sheep, goats, poultry. 78 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour Exports: $21663million. Exports - commodities: phosphates, fertilizers, potash, agricultural products, manufactured goods, pharmaceuticals, and textiles. Exports - partners: Iraq 19.9%, US 18.8%, India 10.5%. Imports: $4974.1 million. Imports - commodities: crude oil, machinery, transport equipment, food, live animals, manufactured goods Imports - partners: Iraq 15.5, Germany 9.2%, US 7.2%, China 6.6. Debt - external: $7544.1 million. 1.3. Geography Area: 89,300 sq km, Neighbors: Iraq, Israel, Saudi Arabia, Syria, West Bank. Coastline: 26 km. Climate: Mostly arid desert; rainy season in west (November to April). Terrain: Mostly desert plateau in east, highland area in west; Great Rift Valley separates East and West Banks of the Jordan River. Elevation extremes: Lowest point: Dead Sea -408 m. Highest point: Jabal Ram 1,734 m. Natural resources: Phosphates, potash, shale oil. Land use: arable land: 2.87%; permanent crops: 1.52%; other: 95.61% (1998 est.) Natural hazards: droughts; periodic earthquakes. Environment - current issues: limited natural fresh water resources; deforestation; overgrazing; soil erosion; desertification. 79 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour Environment - international agreements: party to: Biodiversity, Climate Change, Climate Change-Kyoto Protocol, Desertification, Endangered Species, Hazardous Wastes, Law of the Sea, Marine Dumping, Nuclear Test Ban, Ozone Layer Protection, Wetlands. Signed, but not ratified: none of the selected agreements 1.4. Key Issues The main problems facing Jordan at present are: - Regional instability - External debts - Oil supplies - High unemployment - Rising poverty - High levels of migration into the cities - Inadequate health and social services - Low participation of women in the workforce - Inadequate business and entrepreneurial skills 80 FONDAZIONE CENSIS 11873_2002 2. Study D2: Poverty, Informal Sector, Health and Labour HEALTH 2.1. Definitions There is no special definition of Health in Jordan; the official one is the definition of the World Health Organization (WHO): “ Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” 2.2. Policy and Legislation Orientation Health care is an important component of an economy that involves the provision of goods and services by both the private and public sectors. As health care technologies have advanced rapidly in the past few decades and the demand for health care continues to grow tremendously, the Government has decide to improve and develop the health care system. Jordan performs relatively well (in comparison to the other similar countries) in terms of overall access to services, when measured by indicators such as infant mortality and life expectancy. However, the health care system in Jordan still suffers from some inefficiencies: - Clustered distribution of health care centers. - Cost-effectiveness. - Efficiency. - Quality of service delivery. As a result, the Government aims to reduce health care inefficiencies and contain growth in health expenditures, and increase the level of qualitative investments in healthcare services through: 81 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour - Improving the quality of services. - Improving the geographic distribution of resources and services. - Increasing private sector participation in the health insurance system. - Modernizing health facilities and equipment. - Developing a health information and research center. - Improving purchasing systems. The Government of Jordan has decided against passive acceptance of the status quo and instead is embarking upon a long-term reform program which will bring in all major players in the sector (the Ministry of Health, the Royal Medical Services, Jordan University Hospital, and the private sector). The first phase of this reform will focus on three key areas: (i) containing growth in health expenditures; (ii) assuring the efficient utilization of physical facilities; and (iii) improving delivery and quality of health care services. Building upon this foundation, the second phase will likely be expanded to address equity (universal health insurance), quality (medical education, regulation of the private sector), management (in the context of government-wide civil-service reform), and cost effectiveness (rationalizing the public/private mix). The five components of the project to support the first phase of the reform strategy are: - Rationalizing Jordan’s Health Delivery System. Currently, most facility rehabilitation/construction decisions are based on incomplete investment strategies, which do not systematically consider the demographic and epidemiological characteristics of the population and/or the existing resources available. Similarly, there are no standards and norms applied in the construction of facilities to ensure efficiency in the allocation of space and relative proximity of services. Rationalizing the investment strategy for health facilities in Jordan is a priority need and would lead to improved economic efficiency, clinical effectiveness and quality of health services. As a tool for rationalizing investment decisions for public sector hospitals, the Government is preparing a health facility master-plan that 82 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour incorporates norms and standards, overall needs, and existing public and private sector capacity. The master-plan will identify and prioritize all health facility investment needs. - Developing and Implementing Health Information Systems. This component will address two sets of needs: (i) for improved public health, it will help develop a national health information system which will provide the Government with relevant and timely epidemiological data; and (ii) for improved service quality and efficiency at the health facility level, help develop management information systems for patient records, services, inventory, and personnel. Financing would be provided for equipment, technical assistance, software development/purchase, and training. - Improving Hospital Financing and Management. This component will include the development and implementation of a financing system for paying hospitals and physicians, which supports the efficient use of resources. Developing this new system will involve: (i) establishing clear and consistent accounting standards that would apply to all public health facilities; (ii) setting up hospital-based financial management systems; and (iii) adopting modern approaches to pay hospitals such as case-mix adjusted global budgets and various physician incentive arrangements. The goal would be to provide hospital managers and employees’ incentives to be efficient by linking budgetary allocations to established criteria and giving managers the tools to operate autonomously and to be more responsive to current or emerging demands. The project will finance the development of management tools (e.g., financial and accounting systems), equipment, and training necessary to implement these systems. - Reforming the Pharmaceutical Sector. Pharmaceuticals account for over one-fourth of all health spending. Such high expenditures reflect inefficiency, waste, and improper use of drugs. To improve the quality and efficiency of the pharmaceutical sector, a series of reforms would be undertaken: (i) promoting generic substitution; (ii) implementing treatment protocols and training in the rational use of drugs; (iii) adopting essential drug lists; (iv) improving overall sector management and pricing policies; and (iv) reforming the processes for drug procurement, storage, distribution, and quality control. Specific inputs will include upgrading the facilities and operations of the drug quality control lab, 83 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour providing technical assistance to develop joint procurement mechanisms for the public health sector and to draft legislation which will serve as the legal framework for the pharmaceutical reform program, and providing training in the use of essential drug lists and treatment protocols. Financing would be provided for rehabilitation of the quality control laboratory, laboratory and computer equipment, technical assistance, studies, workshops, and materials development (e.g., to support treatment protocols). - Continuing the Reform Process. This project is addressing some, but not all, of the issues identified in the Health Sector Study. Sectoral reform is not a static process; it is instead to be implemented incrementally in response to evolving needs and demands. This component will support the continued preparation, evaluation, and monitoring of the sector reform program. The Project Management Unit (PMU) for health reform, in collaboration with the Higher Health Council (HHC) will commission studies and recruit technical expertise as needed to explore alternative reform proposals. In addition, this component will support effective implementation of the project activities by supporting the PMU and project implementation units (PIUs) to carry out their project management and monitoring functions. 2.3. Sources Ministry of Health (www.moh.gov.jo) National information system (www.nic.gov.jo) Ministry of Social Development (www.mosd.gov.jo) Higher Population Council Department of Statistics (www.dos.gov.jo) Ministry of planning (www.mop.gov.jo) 84 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour 2.4. Phenomenology Jordan is in the midst of an epidemiological transition with acute respiratory infections and prenatal diseases still causing a large loss of productive life while non-communicable diseases and illnesses are becoming increasingly prevalent. Infant and child mortality indicators are favorable compared with other countries in the region and with other countries at similar levels of income, although they are still high by OECD standards. Despite significant declines in fertility in recent years (from 5.6 children per woman in 1990), Jordan’s total fertility rate (TFR) of 4.6 children per woman is still quite high. Population growth is high largely as a result of high fertility, low mortality, and migration. - The Health Sector Study highlighted that while the health system performs relatively well in terms of overall access and outcomes, it is expensive and inefficient, and there are geographic maldistributions of resources. Jordan spends about 8 percent of its GDP on health care, well in excess of most middle income and even some western industrialized countries. While Jordan provides coverage for its poor and disabled, an estimated 20 percent of the population lacks formal coverage, and Government financing for health care could be better structured to reflect ability to pay. Lack of a coordinated policy apparatus and relevant data for decision-making preclude effective policy-making across Jordan’s multiple public and private financing arrangements and delivery systems. - There are significant inefficiencies in the service delivery system. There is excess overall capacity as evidenced by a hospital occupancy rate of 63 percent (69 percent in the public sector and 49 percent in the private sector; 80 percent is the generally accepted benchmark). Inappropriate hospital use results from lack of an effective referral system and a hospital-based orientation for treatment. Inefficient case management leads to costly inpatient treatment of conditions that could be treated on an outpatient basis and excessive use of expensive drugs. The centralized allocation process for supplying and equipping facilities and paying personnel in the public sector provides few incentives for the efficient delivery of services at the individual institution level. Finally, there are inefficiencies in terms of overall management, procurement, storage, distribution, pricing policies, and the rational use of pharmaceuticals, 85 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour which account for over one-fourth of health spending and two percent of GDP. - There is limited data to evaluate the quality of care and consumer satisfaction. The rapid growth in the private sector suggests dissatisfaction with the services provided through the public sector and is leading towards a two-tiered system of care (those who can afford to pay go to the private sector while those who cannot are relegated to the public health facilities). The lack of management systems (e.g., for patient records, inventory) in the public sector do not foster good case management and follow-up. Indeed, there are few incentives in the public sector for providers to be concerned about the quality of services provided. Quality could also be jeopardized by the lack of standards and norms for infrastructure. 86 FONDAZIONE CENSIS 11873_2002 3. Study D2: Poverty, Informal Sector, Health and Labour POVERTY 3.1. Definitions Poverty in Jordan was defined from the standard of living and satisfaction of basic needs perspective. The Ministry of Social Development defines poverty as a “state of physical deprivation characterized by low food consumption (quantitatively and qualitatively), and the deterioration of health and educational status, the lack of durable goods and other physical assets, in addition to the loss of reserves to face difficult conditions, like illness and disability”. The Economic and Social Commission for Western Asia (ESCWA) defines poverty as “the inability of the individual or the family to provide necessary resources to meet its basic needs”. 2 Others defined poverty as “the inability to satisfy the minimum standards of the basic needs; food, shelter, clothes, education, health, and transportation.3 Jordan River Foundation (one of the active NGOs in Jordan) defines the poorest of the poor as those families that have nothing, where the family members must take turns to eat breakfast. 3.2. Policy and Legislation Orientation The Kingdom’s new comprehensive strategy, through the collaborative efforts of specialized working groups from the private and public sectors, donor parties and non-governmental organizations, adopts a multi-sectoral approach to improving living conditions for the poor and near poor. 2 3 The Economic and Social Commission for Western Asia ESCWA Poverty in Western Asia 1997 Poverty Assessment Report: The case of Jordan ,Moh’d M. Khasawneh june 2001. 87 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour The strategy, proposes a variety of programs to upgrade health, education and capacity-building opportunities for the less privileged, also builds upon existing national initiatives for poverty reduction. Investment in education, as described in the strategy, is “one of the most powerful determinants of poverty,” and unequal access to educational opportunity “a strong correlate of income equity.” In terms of access to education and formal and non-formal attainment levels, Jordan ranks high compared with other Arab countries, as government efforts have remained steadfast since 1989 to reform its education sector and improve school infrastructure, particularly in underprivileged areas. However, while efforts to reducing illiteracy have produced positive results, availability of schools remains relatively low in rural areas. This has denied communities in these areas access to education that could improve their socio-economic status. The strategy reports that illiteracy levels are as high as 15 per cent in some urban areas and 24 per cent in rural areas. The rate of illiteracy for rural women is twice as high as those for urban men and women. Adult literacy centers established by the Ministry of Education are providing sufficient education to local communities. But the national strategy suggests that these centers be used to provide other services for community development. These would include training for better employment and courses on how to run a business as well as vocational skills, especially for women. “Adult literacy and other basic skills imparted to adults and out-of-school youth through non-formal programs directly improve family income generation and have strong impacts on family health status and children’s educational attainment and other efforts for poverty alleviation.” Similar investments are proposed to boost the vocational capacity of the near poor segments of society and young citizens, as another component of Jordan’s national strategy. Vocational training costs the government three times as much as academic education per student every year — JD600 as compared to JD200. While the government is working to reform and boost vocational training, the strategy points out, however, that this area has not been addressed in a satisfactory manner. 88 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour “It [vocational training] attracts mainly those who cannot afford the academic line or those seeking quick skills to get to work and generate income for the family.” To ensure sustainable development, the strategy stresses the necessity of enhancing the capacities of fresh graduates by initiating specific training programs to meet the competitive needs of the global market through closer cooperation with the private sector. In the same way, the strategy also suggests the use of school premises after hours, to give graduates of vocational training an opportunity to train and get more experience in the practical aspects of their work for better employment opportunities in the future. It suggests that the Higher Council for Vocational Training set criteria for ranking vocational training graduates and provide advisory services to companies as well as training centers as to what skills and professions are needed for the influx of new graduates and young Jordanians seeking employment every year in a tight private and public sector job market. This, as envisaged by the strategy, would in the long run minimize the need to bring in foreign workers. The strategy’s objective is “to serve the poor, alleviate destitution and make them productive individuals dependent only on themselves at the end of the day.” The government poverty alleviation policy The main foci of the national poverty alleviation are: - To understand, measure and evaluate poverty phenomena in order to direct policies and services in a better way. This can be done via drawing the poverty maps. - To increase the assistant level to the beneficiaries of National Aid Fund (NAF) and to expand the beneficiaries base through the restructuring of NAF and establishing a database to connect all aid funds in Jordan. 89 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour - Moving from assistant oriented program to work oriented programs via replacing cash assistance by the supplementary income program. - Coordination with the Ministry of Labor to provide the poor with training and employment opportunities. - Support the micro-finance programs - Increase the employment opportunities in rural areas through developing the rural communities. - To reduce the role of the public sector in generating jobs and establish a public – private sector partnership to solve labor market problems. - To make sure that the poor get a better health care and family planning services. - Increase cooperation with government and NGOs and international organization to control population growth rate. - To work with local communities to identify their problems and to enhance their health conditions using several programs like the Health Village Program. - To ensure the educational system response to the needs of the poor through: improving the school infrastructure, provide children feed programs; provide the poor children with school requirements, etc. - Widen awareness of the effort to alleviate poverty. - Develop and activate the social development centers 3.3. Sources Department of Statistics (www.dos.gov.jo) National Information System (www.nic.gov.jo) Ministry of Social Development (www.mosd.gov.jo) 90 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour The Economic and Social Commission for Western Asia (ESCWA) (www.escwa.org.lb) 3.4. Phenomenology In the struggle to fight poverty, several challenges will be facing Jordan in the coming years. The first one is to reach a widely acceptable definition for poverty, and to come up with solid poverty line or lines according to the different geographical areas. The second challenge is to move from the concept of poverty to the concept of deprivation. Many researchers tends to believe that Jordan has reached a state of development that enables it to make this move. Another aspect to be mentioned is the equality issue. There is a wide belief that development in the last decade caused an increase in inequality, and the fall of the middle class. The results of the income & expenditures survey of 2002/2003 may answer most of these questions. 91 FONDAZIONE CENSIS 11873_2002 4. Study D2: Poverty, Informal Sector, Health and Labour CRIME 4.1. Definitions In Jordan, crime is every act that the law considers to be a crime. No punishment can be imposed without a statement in the law. Jordanian Criminal Code The Criminal Code adopted in 1956, which had been amended many times, contained the bulk of the country’s criminal law. In addition, certain codified civil statutes also prescribed penalties for acts such as libel, adultery, and publication of material endangering the security of the kingdom. Individuals could not be punished except for acts made criminal by virtue of penalties prescribed by law. Other than where specified, a person could also not be punished for committing a criminal act in the absence of criminal responsibility or intent, both of which were defined by the code. As a safeguard of personal liberty, the government had the burden of proving both the defendant’s commitment of the act and the admissible intent of the defendant before guilt could be established. The criminal code, in traditional French form, divided criminal offenses into three categories according to the severity of the applicable punishments. In English common law these categories are equated roughly to felonies, misdemeanors, and minor violations. Punishments for felonies ranged from death by hanging to imprisonment for periods ranging from three years to life. Punishments for misdemeanors included imprisonment for periods ranging from three weeks to three years and a variety of fines. Minor violations could be punished by imprisonment for less than three weeks, small fines, or reprimands by the court. In cases involving misdemeanors or minor violations, a judge also could invoke preventive measures including detention for psychiatric examination, forfeiture of material goods, or closure of a place of business. The Criminal Code provided for minimum penalties for all major infractions rather than relying on the discretion of the courts. 92 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour The death penalty was authorized for murder, arson of an inhabited building, assassination of the king (or attempts on his life), and a broad range of serious crimes defined as threats to the security of the state. These latter offenses included acts such as treason, espionage on behalf of an unfriendly foreign power, and armed insurrection. Imprisonment for life was imposed for such felonies as lesser crimes against national security, homicide during commission of a misdemeanor or that resulted from torture, and the more serious forms of theft. Shorter imprisonment was prescribed for these same offenses if mitigating circumstances are warranted. Such punishment also was authorized for terrorist activity, membership in subversive organizations, counterfeiting, forgery of official documents, and abduction. Misdemeanors included such offenses as gambling in public places, bribery, perjury, simple forgery, slander, embezzlement, assault and battery, and disturbing the peace. The influence of sharia was still evident in the imposition of prison sentences for desertion of a child, abortion, marrying a girl under the age of sixteen, openly ridiculing the Prophet Muhammad, and breaking the fast of Ramadan. Sharia also was important in the criteria for justifiable homicide. No penalty was imposed for the immediate killing of someone who defiled a person’s or a family’s honor. Minor violations covered by the code included traffic violations, seeking redress for a crime without recourse to civil authorities, public drunkenness, and violations of administrative regulations such as licensing and safe housing requirements. These infractions were punishable with or without proven intent. Most minor violations resulted in fines being assessed against the offender. 4.2. Policy and Legislation Orientation The government policy to face crime and to protect the Jordanian community from its evils is divided into two tracks; the first is to adopt preventive measures throughout the development of the justice authorities and the continuous support to the security forces in Jordan and providing it with its needs in terms of advanced weapons and equipments, and to develop its manpower throughout the extensive training programs. In 93 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour addition to monitoring criminal statistics, which is the main way to understand the crime phenomena and its relation with other socio-economic indicators. The second track is the capture of criminals and the imposition of legal punishments. In 1986, the concept of the prison system was revolutionized with the establishment of modern and well-equipped rehabilitation centers overseen by a specialized department – the Department of Rehabilitation Centers, with the following duties and objectives: 1. Overseeing the procedures of inmate admission and release. 2. Overseeing the legal and administrative procedures concerning the treatment of inmates. 3. Administering aftercare for released inmates and their families. 4. Providing vocational training and literacy classes. 5. Preparing statistical reports relating to inmates. Objectives: - Reinforcing the positive aspects of an inmate’s character, with the aim to transform him/her into a sociable, law-abiding citizen. - Administering medical care to convicts. - Narrowing down the chances of inmates becoming repeat offenders. - Providing religious education to inmates. Presently, there are 10 rehabilitation centers in Jordan. 94 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour 4.3. Sources Department of Statistics (www.dos.gov.jo) National Information System (www.nic.gov.jo) Ministry of Social Development (www.mosd.gov.jo) Department of Public Security www.psd.gov.jo Interpol: www.interpol.com 4.5. Phenomenology The most critical issue regarding crime prevention in Jordan is the challenge of facing the continuous growth in the crime phenomena and their increasing cost. The incidence of crime has increased in Jordan from 626 crimes per 100,000 in 1988 to 1,016 in 1997, while the cost to the governmental departments involved in crime prevention formed 6.5% of the total governmental expenditures in 1997. Organized crime in Jordan is growing, and it is no longer limited to smuggling or drugs, which is causing strains in the judicial system, which needs more improvements. One of the most critical and debatable issues in Jordan nowadays is the phenomenon of the so-called crime of honor. The law in Jordan reduces the punishment of the man who finds his wife or close relatives with another man in an indecent situation and commits murder as a result, and many times he would get off scot-free. The original intent of the law was to help those who were forced to commit such a crime because they are very angry and can’t control their acts. However, this right was misused, as several women were killed by their husbands or relatives for reasons that had no relation to ethics or honor. The Government amended the law in the absence of the parliament, but the new parliament rejected it, and the issue is still pending. 95 FONDAZIONE CENSIS 11873_2002 5. Study D2: Poverty, Informal Sector, Health and Labour TRENDS AND CORRELATIONS 5.1. The evolution from the structural adjustment of the 1980s Economic Developments During the 1970s and early 1980s, Jordan enjoyed relatively high growth rates in real GDP; as well as an expansion in the basic infrastructure and welfare services. These achievements were assisted by external assistance, mainly from oil-exporting Arab countries as a result of the increase of oil prices, workers’ remittances, and the expansion of the Jordanian agricultural and manufacturing exports to these markets. However, despite these achievements, Jordan could not overcome the basic imbalances in its economic structure, namely budget and balance of trade deficits. The increase in GNP led to increase in total consumption to levels higher than GDP levels, resulting in negative domestic savings and large imports. Accordingly, dependency on external resources increased to bridge the consumption gab and to finance the gross domestic capital formation. As a result of the decline in oil prices in 1983, the region was hit with recession. The economy of Jordan was affected negatively by the reduced demand for its exports to these markets, lowering the demand for Jordanian workers, and reducing regional assistance to Jordan due to the decline in revenues. These factors produced a decline in real GDP growth rates from about 11 percent in the 1973-1980 period, to about 2.5 percent during 1983-1987, and as a result per capita income decreased and unemployment increased to about 9 percent in 1988. As the situation continued to deteriorate, and grants and workers’ remittances continued to decline. In addition to the withdrawal of foreign exchange reserves at the Central Bank, the government covered its deficits (trade and budget deficits) by internal and external borrowing, where total external debt constituted about 173 percent of the GDP, and 303 percent of the exports of goods and services in 1988. As a result, the foreign reserves at the Central Bank declined considerably and the Jordanian Dinar devalued by about 50 percent. In consequence, the cost of living increased 96 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour by 6.6 percent compared with zero percent in 1986 and 1987. As the measures taken by the government to improve the foreign exchange position and the budget deficit were not sufficient without debt rescheduling and external resources, the costs of these measures would prove to be too high. Accordingly, the government reached an agreement with IMF and the WB for an economic adjustment program for the 1989-1993 period in order to revitalize economic activity and overcome the economic crisis. This program was amended in the 1992-1998 period, because of the Gulf Crisis in 1990. These measures included rationing public expenditure, increasing the tax base to include more items and increasing tax rates for certain items. Due to a weak industrial base, the performance of the Jordanian economy on average during the program period was below the targeted levels. Therefore, the government adopted a privatization program in order to enhance the efficiency of the economy by greater role of the private sector. This program was extended on a yearly basis until this year 2003. The government stated that next year a national reform program will replace the previous arrangements with the IMF and WB. Poverty in Jordan Before mid-1980s, poverty in Jordan was not seen as a problem, where the interest was to emphasize income distribution. Due to the economic and social achievements during the 1970s and early 1980s, Gini (?) co-efficient decreased from about 38 percent in 1973 to about 32 percent in 1982 (Haddad, 1990). However, since the mid-1980s poverty became one of the challenges facing the Jordanian economy, due to certain policies and procedures undertaken to tackle the economic deterioration. These policies, which were a helpful ones from an economic perspective, were harmful ones for low-income and vulnerable groups in society. Combating Poverty Within the national policy framework to alleviate poverty, nongovernmental organizations (NGOs) and international agencies were encouraged to participate to support governmental programs. The main concern of the NGOs is to help certain groups to improve their quality of life, by enhancing voluntary work and women’s participation, especially in 97 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour the rural and poor areas. This is done through soft loans for family projects and training programs. However, due to weak performance of some current programs, the government adopted in 1997 a Social Productivity Program. A minimum wage Law was approved, where the minimum wage was set at JD 80 per month4. Health Despite the fiscal constraints, strong Government commitments to health, education, and other social programs, have resulted in impressive social indicators. With a literacy rate of over 80 percent and well-developed human resource base, Jordan has compensated for its poor natural resource endowments by exporting its surplus labor to the neighboring oil-exporting countries. This proposed project focuses on Jordan’s health sector, a sector with critical human and economic implications that currently accounts for almost 8 percent of Jordan’s economy. The Health Sector Studies highlighted that while the health system performs relatively well in terms of overall access and outcomes, it is expensive and inefficient, and there are geographic maldistributions of resources. Jordan spends about 8 percent of its GDP on health care, well in excess of most middle income and even some western industrialized countries. While Jordan provides coverage for its poor and disabled, an estimated 20 percent of the population lacks formal coverage, and Government financing for health care could be better structured to increase this coverage. Lack of a coordinated policy apparatus and relevant data for decision-making preclude effective policy-making across Jordan’s multiple public and private financing arrangements and delivery systems. As a result of the expansion of the health services provided all over the country, as well as public awareness campaigns regarding family planning, and the increasing number of doctors and technical assistant staff, the infant mortality rate declined from about 7.8 percent in 1973 to about 2.8 percent in 1999. The life expectancy at birth increased, for both male and female, from about 57.4 years for males and 59.8 years for females in 1973, to about 4 Moh’d M. Khasawneh, ‘Poverty Assessment Report: The case of Jordan’, June 2001. 98 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour 69 for males and 71 for females in 1999 (DOS, 1999). Due to the increase in number of doctors and assistants staff, the number of inhabitants per doctor decreased from about 2,480 in 1973 to about 506 in 1999, and that per nurse from about 870 in 1973 to about 334 in 1999. However, these services have been provided, in addition to the Ministry of Health, by both the private sector and the military through 84 hospitals with 8,726 beds (population/bed ratio is 566 persons/bed), and comprehensive health centers (46), primary health centers (335), peripheral health centers (266), and maternity and childhood centers (337). 5.2. Correlations between poverty, health, crime and other development indicators in the last decade During the last decade, poverty became the major issue for policy-makers and to society. Crime incidence witnessed some increase following the first Gulf War and the return of 300,000 Jordanians, most of whom were born and raised outside Jordan. In addition, health services started to face increasing pressure. These three phenomena are interrelated, but poverty remains the father of all evil. Most of the studies that deal with poverty in Jordan reported a bad health situation in the poor communities, and the relation between health and poverty can go in both directions. Poverty produces poor health condition, and bad health conditions (serious disease or bad injuries) can drive semi- or near poor individuals and their families under the poverty line. Thanks to strong government commitment for socio-economic development for protecting Jordan from the hazardous effects of such phenomena, Jordan developed a social protection net, to protect the poor from the negative impacts of such a program. Cash assistance to the poor, training and retraining programs play a major role in this regard. Of course, these reforms have strong impacts on the low-income groups in Jordanian society, and many steps need to be taken in this regards. As for crime, it is well known theoretically that poverty and unemployment can be motives for committing crimes. In Jordan, criminal statistics show 99 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour that the unemployed formed about 36% of the total crime offenders in 1997. In the last decade, when economic growth was relatively very slow in Jordan, the crime rate increased from 626 crimes per 100,000 citizens in 1988 to 1,016 in 1997, and to 1,255 in 1999. Maybe the question is this: how can we improve the current situation regarding these themes? Are they heavily interrelated? Can we identify one theme to focus on and make improvements? Or do we need a comprehensive strategy to alleviate poverty and crime and to improve or increase the health and welfare. 5.3. Key issues, political agenda and perspectives Regarding the current situation of the three themes of this report, namely health, poverty, and crime, it can be characterized as acceptable; of course there are several difficulties and insufficiency here and there, but if we compare Jordan to other countries with similar levels of income and conditions, we find that Jordanian achievements were amazing. Unfortunately, Jordanian figures lay behind those of the European countries, especially in health and poverty. Therefore, one can expect in the near future a sincere effort from our partners in Europe to help Jordan in improving the socio-economic conditions in order to achieve a higher growth rates, which in turn would enable Jordan to improve the health services provided to Jordanian citizens, and to alleviate poverty. As for crime, it is true that the Jordanian figures is below the international levels, but the rapid increase in crime, helped by the incredible development in communication, which have turned the world into a small village, requires international cooperation to stop or fight the new types of crimes, such as money laundry, internet crimes, and international terrorism. Therefore, Jordan is looking forward to the partnership agreement with the EU countries to provide the necessary financial and technical assistance to improve its performance in all the three themes health, poverty, and crime. 100 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour ANNEX 1: REFERENCES - The central Bank of Jordan, Annual Report, 2002. - The Ministry of Health, Annual Report, 2002. - Ministry of Planning, unpublished data (this is not accept acceptable as a reference?). - Ministry of Social Development, Poverty Alleviation for a Stronger Jordan: A Comprehensive National Strategy, May 2002. - Poverty in Western Asia The Economic and Social Commission for Western Asia (ESCWA), 1997. - Poverty Assessment Report: The case of Jordan, Moh’d M. Khasawneh, the Royal scientific society, June 2001. - The Cartographic Crime Science , Brakat al-Nemer, Dar Majdalawi Pub. & Dis. 2000. - Abdel Ellah Jae’fer, ‘The Cost of Crime and its Consequences on the Development of Jordanian Society’, The Arab Magazine for Security & Training, issue 30, November 2000. - The General Security Department, unpublished data. 101 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour ANNEX 2: INTERVIEWS In order to complete the report, the team has met with several Jordanian experts in the three themes of the report: health, poverty, and crime. For the poverty part the experts were: - Dr. Mohammad el Saqour, a former minister of social development in Jordan and the head of the team who conducted the first poverty assessment study in Jordan in 1987. - Mr. Mohammad Khasawneh from the Ministry of Planning, a wellknown expert on poverty in Jordan. For the health section, the expert was Dr. Ayyob S. As-Sayaideh from the Ministry of Health/the partnership restructuring program of the health sector in Jordan. As for the crime section, the expert was Dr. Barakat Al–Nemer from the Ministry of Interior (researcher in the science of crime). 102 FONDAZIONE CENSIS STATISTICAL ANNEX Population Projection 2000 – 2005 Year Estimated Population in 000 Estimated Growth Rate 1998 1999 2000 2001 2002 2003 2004 2005 4756 4900 5039 5182 5323 5468 5617 5770 3.32 3.0 2.8 2.8 2.7 2.7 2.7 2.7 * DOS Home * DOS-NIS: Population and Housing * DOS-NIS: Population Copyright 2001 by Department of Statistics, Amman (Jordan). All rights reserved. Source: Department of Statistics (Jordan) Department of Statistics (Jordan) - NIS Focal Point: Housing and Population Population Changes Population Density 51.5 Person / km 2 Source: (Technical Notes on Population Projections of Jordan 1995-2025 ) By: Dr. Arjoon Adlakha, Dr Timothey Flowler & DOS Staff Crude Birth Rate (C.B.R) Crude Death Rate (C.D.R) Life Expectancy at Birth Natural Increase 30 Per Thousand 5 Per Thousand 68 Years for Male 70 Years for Female 25 Per Thousand Source: Jordan Population Family Health Survey (J.P.F.H.S.) 1997 Total Fertility Rate (T.F.R) Infant Mortality Rate (I.M.R) 4.4 Birth / Woman 29 Per Thousand DOS Home * DOS-NIS: Population and Housing * DOS-NIS: Population Copyright 2001 by Department of Statistics, Amman (Jordan). All rights reserved. Source: Statistical Year Book 1997 Distribution of Population Living in Jordan by Age (in Single Years), Nationality and Sex 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Total Total Male Female Total 123,768 128,980 126,301 121,521 115,454 116,653 115,412 112,461 112,206 109,103 110,953 105,756 107,454 103,099 101,297 101,663 99,158 95,167 93,270 91,237 92,127 89,166 90,806 85,850 87,073 83,489 78,953 73,545 69,503 66,754 64,346 56,587 56,338 63,282 66,220 64,596 62,497 59,249 59,686 58,911 57,484 57,499 55,869 56,354 54,454 55,087 52,760 52,267 51,926 50,780 49,634 48,635 47,622 48,107 46,595 47,749 45,845 47,828 45,848 43,368 40,302 37,954 35,854 34,667 29,682 29,977 60,486 62,760 61,705 59,024 56,205 56,967 56,501 54,977 54,707 53,234 54,599 51,302 52,367 50,339 49,030 49,737 48,378 45,533 44,635 43,615 44,020 42,571 43,057 40,005 39,245 37,641 35,585 33,243 31,549 30,900 29,679 26,905 26,361 117,258 122,303 119,753 115,336 109,489 110,922 110,076 107,301 107,137 104,196 106,238 101,395 103,112 99,009 97,198 97,465 94,989 90,123 86,609 83,670 83,484 81,121 81,749 76,034 74,581 70,714 67,157 61,821 59,315 57,327 53,851 49,263 49,037 Jordanians Male Female Total 59,947 62,751 61,237 59,316 56,218 56,746 56,227 54,938 54,897 53,352 53,930 52,222 52,799 50,606 50,080 49,724 48,460 46,610 44,190 42,438 42,070 41,093 41,322 38,500 37,848 35,603 33,866 30,952 29,955 28,544 26,582 24,218 24,528 57,311 59,552 58,516 56,020 53,271 54,176 53,849 52,363 52,240 50,844 52,308 49,173 50,313 48,403 47,118 47,741 46,529 43,513 42,419 41,232 41,414 40,028 40,427 37,534 36,733 35,111 33,291 30,869 29,360 28,783 27,269 25,045 24,509 6,510 6,677 6,548 6,185 5,965 5,731 5,336 5,160 5,069 4,907 4,715 4,361 4,342 4,090 4,099 4,198 4,169 5,044 6,661 7,567 8,643 8,045 9,057 9,816 12,492 12,775 11,796 11,724 10,188 9,427 10,495 7,324 7,301 Non jordanians Male Female 3,335 3,469 3,359 3,181 3,031 2,940 2,684 2,546 2,602 2,517 2,424 2,232 2,288 2,154 2,187 2,202 2,320 3,024 4,445 5,184 6,037 5,502 6,427 7,345 9,980 10,245 9,502 9,350 7,999 7,310 8,085 5,464 5,449 3,175 3,208 3,189 3,004 2,934 2,791 2,652 2,614 2,467 2,390 2,291 2,129 2,054 1,936 1,912 1,996 1,849 2,020 2,216 2,383 2,606 2,543 2,630 2,471 2,512 2,530 2,294 2,374 2,189 2,117 2,410 1,860 1,852 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 Total Total Male Female Total Jordanians Male Female Total 43,769 47,740 40,477 40,543 38,043 34,613 33,255 32,655 27,429 28,002 25,488 26,590 23,050 26,822 25,417 24,989 26,244 26,945 22,321 22,163 18,255 23,813 19,479 19,068 15,970 18,195 18,341 16,201 12,694 12,570 9,814 16,432 10,112 8,877 8,163 6,610 23,043 25,018 20,709 20,424 20,259 18,174 17,431 17,024 14,173 14,490 13,185 13,422 11,477 12,711 12,707 12,661 12,928 14,003 12,282 11,967 10,231 12,012 10,516 9,826 8,460 9,841 9,249 7,928 6,831 6,750 5,596 7,953 5,543 4,790 4,618 3,671 20,726 22,722 19,768 20,119 17,784 16,439 15,824 15,631 13,256 13,512 12,303 13,168 11,573 14,111 12,710 12,328 13,316 12,942 10,039 10,196 8,024 11,801 8,963 9,242 7,510 8,354 9,092 8,273 5,863 5,820 4,218 8,479 4,569 4,087 3,545 2,939 38,250 41,420 34,780 35,826 33,939 30,543 29,861 28,439 24,684 24,881 23,077 23,823 20,629 24,502 23,496 23,263 24,455 25,032 21,017 20,839 17,321 22,458 18,467 18,216 15,203 17,354 17,593 15,291 12,187 12,048 9,410 15,781 9,643 8,590 7,787 6,331 18,978 20,364 16,603 17,100 17,450 15,414 15,108 14,112 12,305 12,329 11,581 11,547 9,849 11,256 11,466 11,523 11,820 12,778 11,448 11,122 9,630 11,167 9,846 9,335 7,978 9,373 8,839 7,422 6,558 6,459 5,371 7,663 5,294 4,653 4,409 3,523 19,272 21,056 18,177 18,726 16,489 15,129 14,753 14,327 12,379 12,552 11,496 12,276 10,780 13,246 12,030 11,740 12,635 12,254 9,569 9,717 7,691 11,291 8,621 8,881 7,225 7,981 8,754 7,869 5,629 5,589 4,039 8,118 4,349 3,937 3,378 2,808 5,519 6,320 5,697 4,717 4,104 4,070 3,394 4,216 2,745 3,121 2,411 2,767 2,421 2,320 1,921 1,726 1,789 1,913 1,304 1,324 934 1,355 1,012 852 767 841 748 910 507 522 404 651 469 287 376 279 Non jordanians Male Female 4,065 4,654 4,106 3,324 2,809 2,760 2,323 2,912 1,868 2,161 1,604 1,875 1,628 1,455 1,241 1,138 1,108 1,225 834 845 601 845 670 491 482 468 410 506 273 291 225 290 249 137 209 148 1,454 1,666 1,591 1,393 1,295 1,310 1,071 1,304 877 960 807 892 793 865 680 588 681 688 470 479 333 510 342 361 285 373 338 404 234 231 179 361 220 150 167 131 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98+ Unspec. TOTAL Total Total Male Female Total Jordanians Male Female Total 8,329 8,567 4,692 4,710 3,703 7,867 3,698 3,500 2,552 2,220 2,501 3,318 1,236 1,435 1,182 3,062 1,175 783 642 604 732 1,038 327 338 392 634 105 42 35 685 3,318 4,110,0 21 4,088 3,653 2,475 2,349 1,878 3,229 1,763 1,959 1,315 1,212 1,242 1,278 639 715 630 1,341 506 413 354 359 376 427 199 185 206 317 44 25 15 286 1,870 2,135,8 39 4,241 4,914 2,217 2,361 1,825 4,638 1,935 1,541 1,237 1,008 1,259 2,040 597 720 552 1,721 669 370 288 245 356 611 128 153 186 317 61 17 20 399 1,448 1,974,1 82 8,022 8,130 4,504 4,487 3,565 7,611 3,567 3,420 2,445 2,146 2,442 3,173 1,198 1,370 1,143 2,954 1,129 759 616 582 701 992 316 328 383 606 101 40 35 667 2,155 3,795,0 56 3,954 3,463 2,395 2,242 1,824 3,129 1,712 1,917 1,270 1,182 1,221 1,224 624 688 612 1,297 494 402 343 344 366 415 195 179 204 310 43 24 15 278 963 1,926,7 71 4,068 4,667 2,109 2,245 1,741 4,482 1,855 1,503 1,175 964 1,221 1,949 574 682 531 1,657 635 357 273 238 335 577 121 149 179 296 58 16 20 389 1,192 1,868,2 85 307 437 188 223 138 256 131 80 107 74 59 145 38 65 39 108 46 24 26 22 31 46 11 10 9 28 4 2 0 18 1,163 314,965 Non jordanians Male Female 134 190 80 107 54 100 51 42 45 30 21 54 15 27 18 44 12 11 11 15 10 12 4 6 2 7 1 1 8 907 209,068 173 247 108 116 84 156 80 38 62 44 38 91 23 38 21 64 34 13 15 7 21 34 7 4 7 21 3 1 10 256 105,897 * Definitions * DOS Home * DOS-NIS: Population and Housing * DOS-NIS: Population * How to Download/Print the Table? * Note: All values are absolute figures collected in the above-mentioned census Source: General Census of Population and Housing of Jordan 1994 Table 2 Economic Growth Rates (Percentages) Current Prices GDP at GNDI* market prices 1997 1998 1999 2000 (1) 2001(1) *: 4.6 9.2 2.8 3.9 4.5 5.1 6.6 5.5 7.7 2.8 Constant Prices (1994=100) GDP at GNDI* market prices 3.3 3.0 3.1 4.0 4.2 3.8 0.6 5.8 7.8 2.6 Represents GDP at market prices plus net workers’ remittances, net investment income, and net current transfers. (1) : Preliminary. Table 3 - Growth Rates of Economic Sectors (at Constant Basic Prices)* (Percentages) 1997 Agriculture Mining and quarrying Manufacturing Electricity and water Construction Total commodity producing sectors Trade, restaurants, and hotels Transport and communications Finance, real estate, and business services Social services Producers of government services Non-profit institutions Domestic services of households Total services sectors GDP at constant basic prices *: Based on the Department of Statistics data. (1): Preliminary. -8.5 13.2 10.8 5.5 -7.9 3.2 5.2 1.6 2.6 20.9 3.2 -0.8 -10.5 3.8 3.6 1998 13.0 1.8 9.3 2.8 -17.0 3.2 -14.3 18.8 5.3 10.7 2.0 3.3 27.5 3.1 3.1 1999 -29.3 2.8 4.9 6.6 7.0 -0.2 5.0 6.4 0.1 7.9 3.3 2.3 20.0 4.1 2.8 2000(1) 2001(1) 6.4 -1.3 5.8 4.0 1.9 4.3 8.6 4.6 4.1 1.8 6.6 -16.2 25.5 5.0 4.8 1.1 4.1 4.9 2.3 11.1 5.2 4.4 5.6 3.7 5.9 1.7 7.1 -4.9 3.8 4.2 Table 4 The Relative Importance of Economic Sectors to GDP (at Constant Basic Prices)* (Percentages) 1997 Agriculture Mining and quarrying Manufacturing Electricity and water Construction Total commodity-producing sectors Trade, restaurants, and hotels Transport and communications Finance, real estate, and business services Producers of government services Other services Total services sectors GDP at basic prices * : Based on the Department of Statistics data. (1) : Preliminary. 4.5 3.2 14.5 2.6 6.3 31.1 13.5 14.7 20.2 17.4 3.1 68.9 100.0 1998 4.9 3.2 15.3 2.6 5.1 31.1 11.2 17.0 20.6 17.2 2.9 68.9 100.0 1999 3.3 3.2 15.7 2.7 5.3 30.2 11.5 17.5 20.1 17.3 3.4 69.8 100.0 2000(1) 3.4 3.0 15.8 2.7 5.1 30.0 11.9 17.5 20.0 17.6 3.0 70.0 100.0 2001(1) 3.3 3.0 15.9 2.6 5.5 30.3 11.9 17.8 19.8 17.2 3.0 69.7 100.0 Contribution of Economic Sectors to Economic Growth (at Constant Basic Prices)* (Percentage Points) 1999 Agriculture Mining and quarrying Manufacturing Electricity and water Construction Total commodity producing sectors Trade, restaurants, and hotels Transport and communications Finance, real estate, and business services Producers of government services Other services Total services sectors GDP at constant basic prices -1.44 0.09 0.76 0.17 0.36 -0.06 0.56 1.09 0.02 0.57 0.62 2.86 2.80 2000(1) 0.21 -0.04 0.91 0.11 0.10 1.29 0.98 0.81 0.83 1.14 -0.25 3.51 4.80 2001(1) 0.03 0.12 0.77 0.06 0.57 1.55 0.52 0.99 0.74 0.30 0.10 2.65 4.20 * : Based on the Department of Statistics data. (1): Preliminary. Inflation Rates of Main Component Groups of the Cost of Living Index (Percentages) Groups 1997 Percentage change in the index 1998 1999 2000 2001 Food items Housing Clothing and footwear Other goods and services General index 6.6 0.8 -3.6 1.8 3.0 4.0 1.8 3.8 2.6 3.1 0.3 1.8 1.2 4.7 1.8 -0.9 0.8 5.3 2.0 0.6 -0.7 1.4 0.6 2.8 0.7 Economic developments in 2001 Table 1 Main Economic Indicators (JD Million) 1997 Population (In Thousands) Output and Prices Gross National Product (GNP) at Current Market Prices Gross Domestic Product (GDP) at Current Market Prices Growth Rate of GDP at Constant Market Prices (%) Nominal Gross National Disposable Income (GNDI) Growth Rate of GNDI at Constant Market Prices (%) Change in Cost of Living Index (%) Change in GDP Deflator (%) Ratio of Total Consumption to GDP at Current Market Prices (%) Ratio of Gross Fixed Investment to GDP at Current Market Prices (%) Ratio of Domestic Saving to GDP at Current Market Prices (%) Money and Banking (1) Average JD Exchange Rate against US Dollar Money Supply (M2) Net Foreign Assets of Banking System Net Domestic Assets of Banking System Claims on Government (Net) Claims on Private Sector (Resident) Other Items (Net) (2) Deposits in JD Held at Banks Deposits in F.C Held at Banks Rediscount Rate (%) Interest Rate on 3-month Treasury Bills (%) Interest Rate on 6-Month Treasury Bills (%) Interest Rate on 3-Month CDs (%) (3) Interest Rate on 6-Month CDs (%) (3) 1998 1999 2000 2001 4,600 4,756 4,900 5,039 5,182 5,090.2 5,137.6 3.3 6,302.3 3.8 3.0 1.2 96.5 25.8 3.5 5,604.0 5,609.8 3.0 6,718.3 0.6 3.1 6.0 97.6 21.2 2.4 5,758.6 5,767.3 3.1 7,086.9 5.8 0.6 -0.2 92.7 23.5 7.3 6,087.6 5,992.1 4.0 7,636.1 7.8 0.7 -0.1 99.5 25.6 0.5 6,391.5 6,258.8 4.2 7,851.1 2.6 1.8 0.3 N.A N.A N.A 1.410 5,576.6 2,263.5 3,313.1 501.1 3,535.3 -723.3 4,076.7 2,311.2 7.75 8.90 6.25 6.50 1.410 6,026.3 2,374.8 3,651.5 1,052.3 3,872.6 -1,273.4 4,178.5 2,632.9 9.00 9.20 9.45 9.50 1.410 6,747.6 3,003.4 3,744.2 1,157.3 4,062.1 -1,475.2 4,681.4 2,821.0 8.00 6.00 6.00 8.25 1.410 7,434.7 3,852.1 3,582.6 1,070.8 4,243.9 -1,732.2 5,000.2 3,224.3 6.50 5.88 6.00 6.05 1.410 7,866.1 3,991.0 3,875.1 1,276.0 4,723.6 -2,124.5 5,203.7 3,517.6 5.00 3.924 3.90 4.00 Table 1 Main Economic Indicators (Contd.) (JD Million) Public Finance Total Revenues and Grants Ratio to GDP (%) Total Expenditures and Net Lending Ratio to GDP (%) Deficit/ Surplus (Excluding Grants) Ratio to GDP (%) Deficit/ Surplus (Including Grants) Ratio to GDP (%) Gross Domestic Public Debt Ratio to GDP (%) External Public Debt Outstanding (4) Ratio to GDP (%) External Trade and Balance of Payments Commodity Exports (f.o.b.) Commodity Imports (c.i.f.)(5) Trade Deficit Ratio to GDP (%) Workers’ Remittances Receipts Current Account Ratio to GDP (%) Capital Account Ratio to GDP (%) Change in Net Foreign Assets/ Surplus (-) (1): (2): (3): (4): (5): 1997 1998 1999 2000 2001 1,574.9 30.7 1,906.1 37.1 -536.2 -10.4 -331.2 -6.4 4,580.6 89.2 1,699.5 30.3 2,055.1 36.6 -558.6 -10.0 -355.6 -6.3 1,119.0 19.9 5,009.8 89.3 1,783.8 30.9 2,007.4 34.8 -422.1 -7.3 -223.6 -3.9 1,024.0 17.8 5,186.2 89.9 1,800.9 30.0 2,004.7 33.5 -444.0 -7.4 -203.8 -3.4 1,203.0 20.1 4,794.7 80.0 1,885.1 30.1 2,075.5 33.2 -437.4 -7.0 -190.4 -3.0 1,369.0 21.9 4,742.8 75.8 1,301.4 2,906.5 -1,605.1 -31.2 1,173.5 20.8 0.4 211.9 4.1 -499.1 1,277.9 2,712.4 -1,434.5 -25.6 1,093.8 15.5 0.3 205.3 3.7 -127.5 1,298.8 2,622.5 -1,323.7 -23.0 1,179.8 287.1 5.0 133.3 2.3 -656.4 1,346.6 3,245.2 -1,898.6 -31.7 1,308.2 41.5 0.7 408.1 6.8 -840.7 1,625.7 3,407.3 -1,781.6 -28.5 1,426.0 40.1 0.6 -86.5 -1.4 -130.8 New classification for both government and public entities accounts at the banking system has been adopted since January 2000. Data for 1998 and 1999 was reclassified accordingly. Includes claims on public entities, claims on financial institutions, and other items (net) as shown in the Monetary Survey Table. Represents unified interest rate on the last issue. Figures represent disbursed loans minus repayments (excluding collateralized Brady Bonds). Excluding imports of non-residents. Sources : Monthly Statistical Bulletin / Central Bank of Jordan. Table 1 Industrial Origin of Gross Domestic Product at Current Prices (JD Million) 1997 Agriculture Mining and Quarrying Manufacturing Electricity and Water Construction Trade, Restaurants, and Hotels Transport and Communications Finance, Insurance, Real Estate, and Business Services Social and Personal Services Producers of Government Services Producers of Private Non-Profit Services for Households Domestic Household Services Less: Imputed Bank Service Charge GDP at Basic Prices Net Taxes on Products GDP at Market Prices Net Factor Income from Abroad GNP at Market Prices Source : Department of Statistics. (1) : Preliminary. 1998 1999 2000(1) 2001(1) 148.3 169.9 621.6 117.9 240.5 510.4 672.7 144.7 170.4 742.0 121.2 214.6 532.4 717.1 115.9 163.8 750.2 129.4 207.1 543.2 762.2 116.7 157.4 792.0 134.6 203.9 602.5 831.6 115.9 156.9 828.7 135.1 227.2 650.5 876.7 918.6 178.3 896.1 979.1 200.3 943.2 990.5 224.3 995.7 1,071.2 242.9 1,079.1 1,136.2 265.0 1,112.7 52.9 5.2 -81.0 4,451.4 686.2 5,137.6 -47.4 5,090.2 56.1 6.6 -107.5 4,720.2 889.6 5,609.8 -5.8 5,604.0 57.4 7.9 -93.5 4,854.1 913.2 5,767.3 -8.7 5,758.6 63.2 9.7 -108.5 5,196.3 795.8 5,992.1 95.5 6,087.6 73.5 9.2 -116.6 5,471.0 787.8 6,258.8 132.7 6,391.5 Table 2 Expenditure on Gross Domestic Product at Current Prices (JD Million) Total Consumption Public Private Gross Capital Formation Gross Fixed Capital Formation Buildings and Constructions Machines and Equipments Change in Stocks Total Domestic Demand Net Exports of Goods and Non-Factor Services Exports Imports GDP at Market Prices Source : Department of Statistics. (1): Preliminary. 1997 1998 1999 2000(1) 4,959.7 1,312.5 3,647.2 1,321.8 1,325.1 809.7 515.4 -3.3 6,281.5 -1,143.9 2,532.8 3,676.7 5,137.6 5,477.4 1,367.0 4,110.4 1,225.4 1,189.8 656.4 533.4 35.6 6,702.8 -1,093.0 2,515.7 3,608.7 5,609.8 5,348.2 1,386.7 3,961.5 1,451.6 1,353.5 688.1 665.4 98.1 6,799.8 -1,032.5 2,505.4 3,537.9 5,767.3 5,964.2 1,502.9 4,461.3 1,630.4 1,532.3 677.5 854.8 98.1 7,594.6 -1,602.5 2,507.0 4,109.5 5,992.1 Table 28 Summary of Government Budget (JD Million) 2001 Budget Law Preliminary 1997 1998 1999 2000 Total Revenues and Grants Domestic Revenues Tax Revenues Non-tax Revenues Foreign Grants Total Expenditures and Net Lending Current Expenditures, of which: Interest Payments (Commitment) Capital Expenditures Net Lending Primary Deficit/Surplus Current Deficit/Surplus Current Deficit/Surplus, Excluding Interest 1,574.9 1369.9 798.5 571.4 205.0 1,906.1 1,524.8 268.7 287.4 93.9 -267.5 -154.9 113.8 1,699.5 1496.5 858.6 637.9 203.0 2,055.1 1,644.6 247.7 365.5 45.0 -310.9 -148.1 99.6 1,783.8 1585.3 884.2 701.1 198.5 2,007.4 1,643.1 278.1 299.0 65.3 -144.0 -57.8 220.3 1,800.9 1560.7 961.9 598.8 240.2 2,004.7 1,718.3 293.1 288.4 -2.0 -150.9 -157.6 135.5 2,079.1 1,837.1 1,059.0 778.1 242.0 2,257.6 1,843.1 300.0 445.1 -30.6 -120.4 -6.0 294.0 1,885.1 1,638.1 1,020.0 618.1 247.0 2,075.5 1,786.9 275.0 325.5 -36.9 -162.4 -148.8 126.2 Overall Deficit/Surplus, Excluding Grants -536.2 -558.6 -422.1 -444.0 -420.5 -437.4 Overall Deficit/Surplus, Including Grants Rescheduled Interest Overall Deficit/ Surplus (Cash Basis) -331.2 67.8 -263.4 -355.6 59.0 -296.6 -223.6 83.2 -140.4 -203.8 84.0 -119.8 -178.5 73.6 -104.9 -190.4 68.8 -121.6 Source : Ministry of Finance. Table 30 Components of Public Expenditures (JD Million) 1- Current Expenditures Wages and Salaries Purchases of Goods & Services Interest Payments (Commitment Basis) Internal External Food Subsidies Other Transfers Pensions Social Security Decentralized Agencies Relief Operations Universities & Municipalities Other Defense and Security Others 2- Capital Expenditures Wages and Salaries Studies and Research Equipment, Machines, Apparatuses, and Supplies Lands, Buildings & Constructions, and Other 3- Net Lending Gross Lending Repayments Total Expenditures and Net Lending 1997 1998 1999 2000 1,524.8 342.0 68.5 268.7 19.1 249.6 71.2 287.9 213.4 7.2 44.8 7.9 14.6 444.5 42.0 287.4 18.6 5.2 46.7 216.9 93.9 139.8 -45.9 1,906.1 1,644.6 339.0 63.1 247.7 26.0 221.7 38.0 371.4 235.0 8.2 62.7 5.8 43.0 16.7 491.0 94.4(2) 365.5 19.8 4.3 45.5 295.9 45.0 77.6 -32.6 2,055.1 1,643.1 343.4 72.6 278.1 47.3 230.8 15.0 376.7 238.5 9.3 66.8 5.1 43.0 14.0 512.1 45.2 299.0 18.9 6.3 46.4 227.4 65.3 97.4 -32.1 2,007.4 1,718.3 366.0 72.2 293.1 48.6 244.5 0.0 408.4 268.6 9.8 67.2 5.0 43.0 14.8 531.2 47.4 288.4 19.9 5.7 40.9 221.9 -2.0 47.4 -49.4 2,004.7 Source Ministry of Finance. (1) : Preliminary. (2) : Includes JD 64.0 million for domestic payments arrears on public sector. 2001 (1) 1,786.9 380.3 81.7 275.0 56.0 219.0 0.0 452.5 292.7 10.7 77.4 9.0 48.0 14.7 537.2 60.2 325.5 20.3 5.3 40.2 259.7 -36.9 35.1 -72.0 2,075.5 Table 31 Central Government Domestic Debt (Budgetary Central Government and Own-Budget Agencies) (JD Million) Gross Domestic Debt 1) Budgetary Central Government A) Treasury Bills and Bonds Bank Sources Non-Bank Sources B) Development Bonds Bank Sources Non-Bank Sources C) Loans & Advances Central Bank Licensed Banks Non-Bank Sources 2) Own-Budget Government Agencies A) Corporate Bonds Bank Sources Non-Bank Sources B) Direct Credit Facilities Bank Sources Gross Government's Deposits with the Banking System 1) Budgetary Central Government's Deposits A) Ministry of Finance With the Central Bank(1) With Licensed Banks B) Other Ministries With the Central Bank With Licensed Banks 2) Own-Budget Government Agencies Deposits Net Budgetary Central Government Domestic Debt(2) Net Central Government Domestic Debt(3) (Budgetary and Own-Budget Agencies) 1998 1999 2000 2001 1,119 1,007 238 184 54 156 80 76 613 509 79 25 112 25 18 7 87 87 300 142 -92 -118 26 234 141 93 158 865 1,024 889 330 319 11 137 74 63 422 322 79 21 135 61 32 29 74 74 146 -8 -318 -345 27 310 187 123 154 897 1,203 1,120 480 412 68 172 85 87 468 272 119 77 83 31 22 9 52 52 291 114 -225 -277 52 339 195 144 177 1,006 1,369 1,261 740 629 111 160 69 91 361 272 79 10 108 63 51 12 45 45 250 94 -256 -307 51 350 207 143 156 1,167 819 878 912 1,119 Source : Ministry of Finance. (1): Represents net treasury overdraft (treasury overdraft account minus Ministry of Finance gross deposits with the Central Bank). (2): epresents gross domestic debt of budgetary central government minus gross budgetary central government's deposits with the banking system. (3): Represents gross domestic debt minus gross government's deposits with the banking system. Table 32 Outstanding External Public Debt (1) (JD Million) 1) Long-Term Loans A) Arab and Foreign Governments, of which: Saudi Arabia Germany Japan France United Kingdom United States B) Multilateral Institutions, of which: Arab Fund for Economic and Social Development Islamic Development Bank IBRD and IDA IMF European Investment Bank C) Foreign Banks & Companies 2) Short-Term Loans 3) Other(2) Outstanding External Public Debt (Excluding collateralized Brady Bonds) Collateralized Brady Bonds Outstanding External Public Debt (Including Collateralized Brady Bonds) Source : Ministry of Finance. (1): Represents balance of disbursed loans minus repayments. (2): Includes bonds and leases. 1997 1998 1999 2000 2001 4,276.1 2,913.7 120.4 286.4 1,121.0 493.0 398.1 109.6 1,289.0 218.1 86.5 540.2 286.8 90.9 73.4 304.5 4,580.6 417.5 4,998.1 4,698.8 3,142.6 120.5 316.6 1,270.4 533.2 408.7 89.2 1,506.6 266.4 88.3 580.1 332.5 163.7 49.6 311.0 5,009.8 323.9 5,333.7 4,868.2 3,179.5 88.5 270.5 1,438.6 478.9 417.7 87.1 1,646.2 337.7 87.1 647.9 353.4 154.6 42.5 318.0 5,186.2 323.9 5,510.1 4,669.0 3,036.5 233.3 1,270.4 410.4 397.7 232.8 1,597.0 339.3 81.7 633.5 328.1 162.5 35.5 125.7 4,794.7 251.0 5,045.7 4,634.9 2,963.4 219.3 1,106.1 408.3 382.6 280.8 1,643.1 341.7 72.1 705.6 307.1 164.4 28.4 107.8 4,742.8 226.6 4,969.4 Table 33 Distribution of External Loans Disbursed in 2001 According to Source Source Industrial Countries: United States Spain Japan Germany Denmark Italy Other Multilateral Institutions, of which: IBRD IMF Arab Fund for Economic and Social Development European Investment Bank Arab Monetary Fund Islamic Development Bank Other Total Source : Ministry of Finance. Disbursements (JD Million) Relative Share (%) 80.6 39.8 13.8 11.0 6.3 3.5 3.2 3.0 203.0 112.5 27.3 22.5 16.7 14.0 6.1 3.9 283.6 28.4 14.0 4.9 3.9 2.2 1.2 1.1 1.1 71.6 39.7 9.6 7.9 5.9 4.9 2.2 1.4 100.0 Table 34 Distribution of External Loans Contracted in 2001 According to Source and Economic Sector (JD Million) Foreign Governments Adjustment Program Imports Financing Education Water & Irrigation Health Transportation Total Source : Ministry of Finance 6.7 39.7 30.4 7.1 5.0 4.1 93.0 Multilateral Institutions 126.5 16.5 143.0 Total 133.2 39.7 30.4 23.6 5.0 4.1 236.0 Relative Share (%) 56.4 16.8 12.9 10.0 2.1 1.8 100.0 GREECE Dr. Nicholas P. Glytsos 11873_2002 1. Study D2: Poverty, Informal Sector, Health and Labour COUNTRY PROFILE: ESSENTIAL FIGURES 1.1. Population According to the 2001 Greek population census, the population of Greece was 10,964,020, of which 5,431,816 were men and 5,532,204 were women. The population is aged, with people over 65 representing 17.1 per cent of the total and children below 14 representing 5.4 per cent, whereas 31 per cent of the population is between 40 and 64 years of age (Table A1). Between 1991 and 2001, population grew at an annual average rate of 0.67 per cent compared to a corresponding growth rate, in the previous decade, of 0.52 per cent. Greece, as the other Western European countries, has been experiencing a declining natural population growth. During the period 19912001, the average annual growth rate was of the order of 0.4 per cent. Particularly in recent years, the situation has been aggravated, with the number of deaths exceeding since 1997 the number of births. The birth rate, in 2001, has dropped to 0.98 per cent and the death rate has climbed to 1.01 per cent. The total fertility rate per woman of reproduction age, from an average of 2.3 children, during 1970-75, dropped to 1.3 children during 1995-2000. Thus, if it wasn’t for immigration, the Greek population would have been roughly at the same level as 10 yeas ago. Net migration, calculated as the difference of population between 1991 and 2001 minus the total number of births plus the total number of deaths during the decade, was of the order of 700,223. The 2001 census of population registered 796,713 persons (436,225 men and 360,488 women) with a foreign citizenship, the Albanians representing 56 per cent of all foreigners (Table A2). In reality, however, the number of foreigners in Greece is believed to approach 1,000,000, given first, the considerable number that did not apply for legalization in the recent government call, becoming thus ‘’invisible” during the census day, and second, the additional arrivals in the meantime. The overwhelming majority (98 per cent) of population is ethnic Greeks and 94 per cent belong to the Greek Orthodox Christian persuasion. The official and spoken language is Greek of which the immigrants of various nationalities seem to get rather quickly at least a minimum knowledge for the bare communication with the native population. 124 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour Due to the demographic deterioration and the ageing population, the number of children in primary education decreased from about 900,000 in 1981 to 647,000 in 1999 and remained pretty stable thereafter, most probably because of the rising enrollments of immigrant children. The number of pupils in secondary general education is also down, from 716,000 in 1991 to 590,000 in 2002. However, at the same time, the number of students in secondary technical and vocational education has increased by about 16.5 per cent, from 135,000 in 1991 to 157,000 in 2001, pushed by the rising unemployment of youth with only secondary general education. In tertiary education, despite the demographic hold down effect of enrollments at the earlier educational levels, the demand for higher education has been rising to a considerable degree. Thus, the number of students in Universities from 86,000 in 1981 climbed to 117,000 in 1991 and to 149,000 in 2001, experiencing an increase of 27.4 per cent in the last ten years. Analogous is the situation with the third level technical education, in which the number of students increased from 29,000 in 1981 to 78,000 in 1991 and to 91,000 in 2001. In addition, due to the numerus clausus restriction in Greek tertiary education, a very substantial number of Greek students are studying currently in foreign universities. Illiteracy is now insignificant in Greece and concerns very high ages. The adult literacy rate (% of age 15 and above), although high even by mid1980s (93.2 per cent), has increased by the year 2000 to 97.2 per cent, whereas the youth literacy rate (% of ages 15-24) is now 99.8 per cent, up from 99.4 per cent in 1985. Adult women literacy rate is only very slightly lower than that of men (female/male ratio 0.97 in 2000), while female youth literacy is the same as male youth. We may note in this context, that the female enrollment in secondary and tertiary education is higher than the enrollment of male (female as a % of male 103 and 107, respectively for the two levels of education, in 1998). Although the inability to read and write has been eradicated in Greece, the ‘’functional illiteracy’’ is widespread, creating problems of integration in the labour market. 1.2. Economy and Labour The Greek GDP was, in 2002, of the order of 141 billion Euros, divided by major economic sector as follows: agriculture 9.1 billion (6.4 per cent); 125 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour industry 27.7 billion (19.6 per cent); and services 104.3 billion (74.0 per cent) (table 1). In the same year, the gross national per capita income was 12,923 Euros and the net per capita national disposal income 11,957 Euros. The average annual growth rate of GDP per capita was, 0.9 per cent, during the period 1975-2000, doubled to1.8 per cent, between 1990 and 2000. The share of investment in GDP has been rising in recent years, ending up in 2002 with a 23.2 per cent. The share of private consumption expenditure has been declining since 1995 to reach 67.3 per cent in 2002, while public consumption expenditure is more or less stable around 15.5 per cent. The share of exports in GDP declined by almost 4.5 percentage points, but the share of imports declined even more, by 5.0 percentage points (Table 2). As table 1 shows, employment amounted to 3,917,500 persons, in 2001, representing 52.8 per cent of the 15-64 years old population. The lion’s share in employment 61.8, in 2002, belongs to services, 15.8 per cent to agriculture and 13.7 per cent to industry. The unemployment rate was, in 2002, 9.6 per cent, dropping from 11.7 per cent in 1999. Female unemployment rate is more than double the male unemployment rate (14.6 per cent as against 6.2 per cent). Youth unemployment is much higher than the average for the whole population. At the end of 2002, the less than 25 years old youth had an unemployment rate of 21.0 per cent. Inflation (change in the consumer price index) averaged, during the period 19902000, 9.0 per cent per annum, dropping to an average of 3.2 per cent over the 1999-2000 period, whereas in 2002 rose by 3.6 per cent. Exports of goods from Greece amounted, in 2002, to 29.0 billion Euros and imports of goods to 37.9 billion Euros, generating a trade deficit of 8.9 billion Euros. Exports were equal to 20.5 per cent of GDP and imports equal 26.8 per cent of GDP. Compared to 2001, exports decreased by 2.4 per cent and imports by 1.2 per cent, widening thus the balance of trade deficit. But things have subsequently changed. During the first quarter of 2003, despite the increased exports, the increased value of imports including oil led to a deterioration in the overall balance of current account, raising the deficit from 3.7 billion EUR, the first quarter of 2002 to 4.3 billion EUR in the first quarter of 2003 (Table 3). 126 FONDAZIONE CENSIS Table 1 - Industrial Composition (%) of GDP and Employment in Greece, in selected years of the period 1980-2002 Economic Sector GDP 1980 1990 2000 2002 Primary 25.0 10.5 6.6 6.4 Mining 0.6 0.9 0.5 0.5 Manufacturing 15.2 15.3} 12.5} 12.2 Utilities 1.8 2.7 0.8 1.0 Construction 7.7 7.6 6.5 7.4 Services 49.7 63.0 74.4 74.0 Total 100.0 100.0 100.0 100.0 Size1 4,477 34,729 121,628 141,132 1981 Employment 1991 2001 2002 30.7 22.2 16.015.8 0.5 0.5 19.3 19.2 14.2 13.7 0.9 0.8 8.3 6.8 7.3 7.4 40.4 50.3 61.1 61.8 100.0 100.0 100.0 100.0 3,529.3 3,632.4 3,917.5 3,948.9 Sources: Ministry of Economics and Finance, National Accounts Statistics (various issues) Statistical Service of Greece (NSSG), Labour Force Survey (various issues) 1 GDP at current prices, in million EUR. Employment in thousand persons Table 2 - The Composition of Greek GDP by Expenditure Category, 2000-2002 (At current prices) Expenditure Category Years 1995 Private Consumption Public Consumption Investment Exports Imports GDP Size of GDP (million EURO) 73.1 15.3 18.9 17.6 -24.9 100.0 79,927 2000 69.5 15.7 22.5 24.1 -31.8 100.0 121,628 Source: Greek National Accounts Statistics (www.statistics.gr tables/S900). 2001 68.4 15.3 22.9 22.7 -29.3 100.0 130,927 2002 67.3 15.8 23.2 20.5 -26.8 100.0 141,132 Table 3. Greek Balance of Payments (million EUR) Items Balance of Current Account Balance of Trade (without oil) Balance of Oil Exports Imports 2001 -2,441.7 -6,057.6 -1,143.1 3,712.7 10,913.4 January-April 2002 2003 -3,722.1 -6,381.8 -1,156.7 3,350.5 10,889.0 -4,330.9 -5,856.5 -1,687.0 3,627.5 11,171.0 Source: Kathimerini, 21.6.2003 (original source: Bank of Greece) 2003/2002 (%) 16.35 -8.23 45.85 8.27 2.59 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour 1.3. Geography and Territorial Characteristics Greece’s surface is 131,957 sq. km. Islands – more than 2000 in number of which only 170 are inhabited – occupy 20 per cent of this surface. Eighty per cent of the land is mountainous, whereas Greece’s very long coastline sums to 13,700 km. Cultivated fields and orchards occupy about 30 per cent of the territory. The climate of Greece varies substantially among its regions. In southern and central Greece the climate is Mediterranean with hot dry summers and mild winters. In northern Greece, winters are colder. Regions in the west receive far more rain compared to the east. The average annual rainfall in Athens and central Greece is 400 mm, whereas the mountains receive much snow. The average temperature in Athens is in January 10 degrees centigrade and in July 28 degrees centigrade. Greece is divided into 9 geographic departments, the two of which, Attica and Macedonia are respectively dominated by the two large cities of the country, Athens and Thessaloniki, with a corresponding population of 3.0 and 2.3 million, representing 52 per cent of the country’s 11 million population. The third major department is Peloponnesos with 1.2 million, while the other 6 departments have each a population ranging between 215,000 and 796,000 inhabitants (Clogg, 2003). The principal natural resources of the country include lignite, with an annual production of 58 to 62 million tons. The certain reserves of lignite number 9,500 million tons, but are not all exploitable. Lignite is used almost exclusively for electricity production. There is also bauxite, whose production, in recent years, reaches roughly 1.8-1.9 million tons a year. Minerals, such as chromium, copper, uranium and magnesium are also present in small quantities. Petroleum also exists in very small quantities while there are no considerable reserves of natural gas (ibid.). Mild forms of energy, i.e. solar, aeolic and geothermic, exist in substantial quantities bur are only very little exploited. Water resources give annually about 65-69 trillion m3, of which 80-84 per cent are used for irrigation, 13-15 per cent in households and 2.5-4.0 per cent for energy production. However, the distribution of water resources is unequal and creates often tensions, although things are getting better over time. Greece cannot cover all its energy needs from local natural sources and depends on imported energy. Finally, the islands and the coasts of Greece supporting the tourist industry are also, in a way, part of its natural resources. 130 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour Concerning the environment, the per capita emissions of carbon dioxide from a level that was 10 per cent lower than the European average, in 1990, today it exceeds substantially that average, despite the lower than the European per capita consumption of energy. This is due to the heavily polluting energy mix of lignite for electricity production and the conventional oil use in transportation. Air pollution becomes at times severe in the larger cities, Athens being the champion. Due to the industrial activity and the densely populated city, in conjunction with the great number of circulating automobiles compared to the capacity of the streets, Athens suffers considerably from air pollution, which has implications to the health of its inhabitants, particularly those suffering from respiratory problems. It also damages the Greek antiquities, primarily Parthenon. The city’s industrial wastes and sewage find an outlet in the gulf of Saronikos in the vicinity of Athens (Clogg, 2003). It is true that as a result of an antipollution policy, poisonous air emissions have been reduced in recent years, but Greece is still far above the European average. In respect to solid wastes, Greece has doubled in ten years’ time the production of wastes, which is though lower than in Europe as a whole. Furthermore, the increased use of fertilizers and pesticides in agriculture deteriorates the water horizon, whereas industry has a rather low share in air pollution, i.e. 17 per cent in carbon dioxide and 16 per cent in sulphur dioxide emissions. It is evident, that the energy sector has the main responsibility for all categories of pollutants. Overall, the ratio of energy consumption to GDP is about double the European average, indicating the non-efficient use of energy in the Greek economy (Kathimerini, 20.6.2003, referring to a report of the National Center of Environment). Regarding the social consciousness on environmental issues and the reaction of people to environmental problems, a recent opinion poll conducted at the New York College in Athens showed that these issues are placed seventh in terms of importance on a priority list of contemporary problems. Environment is preceded by unemployment, the economy, education, criminality, drugs and poverty. Emphasis was given in this poll on the lack of adequate information concerning the nature and the various aspects of environmental degradation, as well as the factors that cause it. A majority of 73 per cent of the interviewees are of the opinion that despite the efforts made by the state, the environment continues to deteriorate, due primarily to industrial activity and to a lesser extent the automobiles. The poll further showed that the participation of youth in environmental organizations is 131 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour practically non-existed, while the participation in volunteer programmes for environmental issues is small. 1.4. Key Issues Apart from the significant problems of health, poverty and crime to be discussed shortly, some other important issues for consideration are highlighted in this section. The ‘’historical’’ paternalism and nepotism characterizing Greek politics dominates the ‘’way of doing things’’ in Greece. This, and the large scale interconnection between politicians and the business community do not allow the healthy development of class politics and the unaffected decision making in government for the general good. This kind of situation makes often politicians shy away from the real practical problems of the people, while the political debate often refers either to the general abstract ideals of freedom, democracy and socialism or to the past historical behaviour of opposing political parties, taking sometimes the form of personal confrontation. Related to this is the corruption, at a small or larger scale, of public officials. Due to the bureaucracy and the malfunctioning of the various government departments, citizens are often forced by the circumstances to pay either for avoiding delays in having their problems solved or bribing for illegal or irregular favours. The GRECO (2002) group of the Council of Europe maintains that ‘’corruption appears to merge into the much more global problem of administrative malfunctioning, in which individual acts of corruption pass unnoticed’’. It continues to say that ‘’the problem of transparency of rules and regulations seem to be crucial and is likely to contribute to the persistence of certain forms of corruption’’ (page 18). In regard to transparency, GRECO is placing Greece as 42nd on a list of countries, which is the lowest place among EU members. Particular Public Services that are often discussed in the press as nests of corruption are the city planning authorities, the internal revenue service and the police, among others. The ageing population and the low reproduction rate have become chronic problems of concern in the Greek society. Any rise in population comes from the inflow of immigrants in the country. However, as it is generally accepted, immigration cannot, in the long run, contain demographic deterioration. 132 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour The environment, already touched upon earlier, particularly the pollution in the larger cities, notably Athens, although reduced a little in recent years as a result of appropriate policies, its level is still unacceptable and much higher than the European average. At the macroeconomic level, a particular problem that raises concern is the difficulty to overcome low competitiveness of the Greek economy vis-à-vis its partners in the EU and the third countries that are associated with it. The low productivity and the relatively higher inflation of Greece compared to its European partners are major contributing factors. This leads to the chronic problems in the balance of payments, accumulating the external public debt. Persisting unemployment, especially of youth even educated youth, but also women, is a disturbing and painful problem affecting a considerable number of households, has economic, social and psychological implications and is a factor contributing to deviance and crime. The large number of illegal immigrants that still exist, despite the recent two efforts for their legalization, is a concern both of the government and the general public, and is also a source of poverty and crime, as will be further discussed in this report. 133 FONDAZIONE CENSIS 11873_2002 2. Study D2: Poverty, Informal Sector, Health and Labour HEALTH 2.1. Definitions, Facts and Figures The health care services are provided in Greece by a mixed public-private system consisting of the National Health System (NHS), established in 1983, the health units of certain Social Insurance Funds - the largest of which is IKA, covering just about half of the population – the military hospitals and a private network of health care facilities, which include physicians with specialties, clinics, diagnostic centers and laboratories. Part of the NHS are the Health Centers, located all over the country, particularly for servicing the countryside, providing primary health care and prevention. In the NHS that includes the public hospitals and the primary health care centers, all services are provided free of charge to everyone. In 2002, the health care capacity of the country consisted of 59,518 hospital beds, of which 36,621 (67.7 per cent) belonged to the NHS and 15,397 (25.9 per cent), contained in 234 hospitals, to the private sector. Primary health care is serviced by about 25,000 private practices and laboratories, and 250 diagnostic centers. Half of these centers are situated in Athens and are equipped with high quality expensive medical technology. They are financed by signing contracts with the social insurance Funds, on a case by case basis. Most of the private hospitals are general and maternity units and are financed, as the diagnostic centres, by the social insurance funds through contracted arrangements and also by the patients themselves. Greece, with 5.44 hospital beds per 1000 inhabitants holds a low place among the EU countries. It has however the lowest occupancy rate (70.4 per cent), stable over the last decade. Concerning the medical and nursing staff of health care delivery in Greece, a study by the National School of Public Health in Athens shows the existence of a ‘disequilibrium’ between physicians with specialties and general physicians and family doctors. According to this study, Greece has 41.5 physicians per 10,000 inhabitants, but only one general practitioner. General practitioners make up 1.8 per cent of the total number of physicians in the country. This compares very badly with, for instance, Great Britain where 46 per cent of all physicians are general practitioners. Analogous, unfavorable for Greece, is the comparison with other countries, such Austria, Portugal and Italy, with correspondingly 50, 31 and 34 per cent of 134 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour general practitioners (Kathimerini, 22.6.2003). More specifically, the above study finds a ‘surplus’ of 34 per cent of special physicians and a great shortage of general and family doctors who should increase six times if this gap is to be bridged. Nurses and related personnel are also lacking and should be doubled to come to a satisfactory level. This study is also pointing out the lop-sided emphasis on the NHS hospitals and the neglect of preventive efforts concerning the risks of the modern way of living (smoking, lack of exercise, overweight, drugs, etc.), which are responsible, as it is noted, for the 90 per cent of premature deaths. Finally, the study recommends the connection between the health care services and the social services, given that several health problems, especially the chronic ones, are related to social factors. One very important aspect of the health insurance in Greece is the inequality in insurance benefits among different insurance funds, and consequently, the different burden on family budgets for health cost. Among the 40 or so health insurance funds, 5 are the major ones (Table 4). Each one of these funds has its own rules and regulations; some funds are healthier and more generous to their beneficiaries, others weaker and less generous. This has implications on health care delivery, particularly with respect to the primary health care. Despite the efforts made by the government for the unification of some of these funds, the task is difficult, facing the opposition of the beneficiaries of the more wealthy funds. The IKA that is the major fund for private employees, having by far the largest number of beneficiaries, of the order of 5.5 million people, has, as we noted, its own polyclinics for the delivery of health care. However, the quality of services offered and the accessibility of patients to this system is not satisfactory. In a survey, it was found that 40 per cent of patients at the IKA clinics visit at least once a year a private physician either because of lack of confidence (41.1 per cent) or for getting a second opinion (19.4 per cent) (Theodorou, 1993, p.127). 135 FONDAZIONE CENSIS Table 4: Health (and Pension) Insurance Funds in Greece, 2001 Insurance Funds Insured Population Proportion of Beneficiaries (%) Social Insurance Fund (IKA) Social Insurance Fund for Farmers (OGA ) Fund for Merchants, Business Owners, taxi and Lorry drivers, etc. (OAEE) Fund for Civil Servants (OPAD) Fund for Sailors and Shipment Rest of Funds TOTAL 5,530,000 2,150,000 1,422,000 46.5 18.1 12.0 1,289,000 10.8 203,000 1.7 1,300,000 10.9 11,894,0002 100.0 Source: Ministry of Health and Welfare, Health, Health Care and welfare in Greece, 2003, p.39 (Adjusted and complemented). 2 The number of beneficiaries of all funds together exceeds, the size of the population, due to the fact that, for various reasons, in some cases one person may be registered to more than one fund. 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour The OGA for farmers, with 2.2 million insured persons, has no clinics of its own, its beneficiaries having a free access to the Health Centers of the NHS. The beneficiaries of the fund for civil servants have a free of charge access to any physician on a list of contracting physicians paid by the fund on a case by case basis with very low fixed fees. Finally, the beneficiaries of the fund for merchants and business owners may visit physicians of 9 specialties who are paid by the fund according to the number of patients registered with them. Apart from these, the rest of the numerous funds cover special groups of beneficiaries, such as employees of banks, public utilities, or certain occupational groups, such as lawyers, physicians, engineers, etc. Among them, they offer health insurance coverage to about 1.3 million people. A few of them have their own clinics. Turning to the financial issues of health care, we may note that the NHS is financed by the state budget, the Social Insurance Funds in a case by case manner and the households that make use of the health services. Despite the supposedly free of charge services to all citizens by the NHS, a high share of the overall cost for health is incurred by households, feeding a flourishing private sector supply of health services. By 1989, the share of each of the above three sources of finance was roughly one-third of total expenditure. These shares changed however over time. In 2000, social insurance funds represented 46 per cent of total health expenditure, the private sector 42 per cent and the rest 12 per cent came directly from the government budget. In other words, the two major sources of finance took a much higher burden than in the past. Concerning the allocation of expenditure, the non-private spending, i.e. social insurance funds plus the government budget, goes mostly to hospital treatment (56 per cent in 1998), whereas primary health care absorbed only 28 per cent. Households’ medical expenses are heavily (72 per cent) directed to the primary health care, including dental treatment that takes almost half of it (34 percentage points). Households spent 12 per cent of their health expenditure for hospital treatment and 15 per cent for pharmaceuticals, just about the same proportion as paid by the public sector at large (table 5). 137 FONDAZIONE CENSIS Table 5: Composition (%) of Health Care Expenditure in Greece, 1998 Category Hospital Expenses Primary Health Pharmaceuticals Care Public expenditure (Including social insurance) Private expenditure Total Expenditure 55.91 28.27 15.82 100.0 12.36 37.11 72.26 47.26 15.38 15.63 100.0 100.0 Source: Ministry of Health and Welfare, Health, Health Care and Welfare in Greece, 2002. Total 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour In 2000, total public and private health care expenditure in Greece represented 9.1 per cent of GDP, up from 4.2 per cent in 1990. This figure is considered by researchers as an underestimate of the actual expenses by 11.5 per cent of GDP, due to the inaccurate calculation of the private expenditure – missing the underground economy in health care in the form of expenses not included in GDP or tax evasion. These expenses are under the table payments for quicker access to NHS or extra charges by the physicians in public hospitals, e.g. for an operation or tips to nurses. For instance, by mid-1990s, the ‘’unregistered’’ expenditure on health was estimated to represent 1.1 per cent of GDP (table 6). 2.2. Policy and Legislation The NHS was established in 1983 (L. 1397/1983) after the socialist government took office, setting as a basic principle that health care is a social good not subjected to the laws of profit and is offered free of charge equally to each and every citizen independently of his or her socioeconomic position. The protection of the citizens’ health is the exclusive responsibility of the state. The law sets in motion a process of decentralization of health services; their integrated planning; the development of primary health care at the Health Centers; and the institution of the hospital physician with ‘full and exclusive’ employment. Private hospitals that until then were subsidized by the government were turned into state hospitals. Over time, it was realized that the NHS was not functioning in the way expected and the provisions of the law were, for a number of reasons, not properly implemented. Thus, in 1992, a new law (L. 2071/1992) was passed by the conservative government that came to power, for the ‘modernization’ and organization of the NHS. Changing partly the philosophy of the previous system, the new legislation moved towards a more ‘neoliberal’ approach. They tried, in effect, to fix some of the weaknesses and flaws of the NHS after ten years’ experience with it. 139 FONDAZIONE CENSIS Table 6 Estimated ‘’Unregistered’’ Health Expenditure as a Proportion of GDP and of Total Expenditure on Health Years 1982 1988 1994 Unregistered health Expenditure as % of GDP Total health expenditure 1.06 1.56 1.13 17.5 25.1 16.9 Note: Unregistered health expenditure is taken as the difference between expenditure on health given in the household survey and income from the National Accounts Statistics. Source: Souliotis, 2002 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour The new legislation made an effort for a more competitive market in health care services and a better control of public expenditure, limiting the responsibility of the state. This resulted in a greater share of households in health care expenditure. The new legislation introduced, in parallel with the ‘full and exclusive’ employment of the previous regime, the practice of ‘part-time employment’ of physicians, allowing them in compensation to have also a private practice. Every physician of the NHS had, in effect, the option of either of the two possibilities. Due to the much lower wages of the part-time alternative, the response of physicians to it was very small. Furthermore, the new law allowed, under certain qualitative conditions, the operation of private clinics and hospitals. After the socialist government returned to power anew, legislation (L. 2194/1994) was passed to restore the NHS to its original philosophy, abolishing, in effect, the 1992 law, but with the ambition of setting the NHS to a new operational framework. Subsequently, with the purpose of fixing some of the malfunctioning of the system, after consideration of the findings of a Commission of International Experts, a new legislation (L. 2519/1997) was voted, in 1997. This law established some Organs for the protection of the rights of hospital patients; emphasized the preventive health care and the need for more and better information, and it provided for the development of facilities for the care of children’s health. Attention was also given to the continuous training of the health personnel and the cooperation of public health services with the welfare and social protection services. The new legislation further provided for regional workshops of public health and a better finance management and control of hospitals and other medical units. In this framework, physicians of general practice were hired in clinics and Health Centers of primary health care, while as an innovative initiative, networks of primary health care were connected with the NHS hospitals. Finally, the National Organization of Drugs prepared an exclusive list of medicines that could be financed by the various health insurance funds, on behalf of their beneficiaries. One step further, new legislation (L. 2889/2001) followed, in 2001, with the main objective of changing the organizational structure and management of the NHS. Administrative managers were appointed in all public hospitals, while health care facilities were further decentralized, by creating a ‘Regional Health System’ (PeSYs). The purpose was to create unified and comprehensive quality regional services in all stages of health care, including medical care at home. The PeSYs, 17 in number, have, according to the law, extensive responsibilities for the coordination of regional 141 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour activities and the effective organization and management of all health care units within their jurisdiction. All health care units operate as decentralized and independent units of the PeSYs they belong to (Ministry of Health and Welfare Report). Specific actions in this context include the ‘’Asterias Programme’’, which promotes networking between local authorities in order to strengthen services to citizens and the ‘’Hippocrates Programme’’ that improves the access of small islands to health care services (EC, 2002, p. 66). Another important innovation of this legislation is the instituted possibility of physicians to receive patients in hospitals after regular hours in the afternoon, charging a predetermined fee that is allocated to the hospital and those involved in the after hours practice. At no other circumstances may the physicians of the NHS exercise private practice in or out of the hospital. According to a recent statement of the undersecretary of the Ministry of Health and Welfare, the main policy objective for 2003 is prevention, subscribing to the philosophy that it is better to have fewer patients in hospitals rather than more hospital beds. A ‘’smoke free environment everywhere’’ and a warning to people, especially the young generation, about the harmful effects of modern dietic habits and alcohol, as well as the benefits of more exercise are the primary concern. Building new hospitals in various parts of the country and staffing them with the appropriate medical and nursing personnel are also in the agenda of this year’s activities. 142 FONDAZIONE CENSIS 11873_2002 3. Study D2: Poverty, Informal Sector, Health and Labour POVERTY 3.1. Definitions, Facts and Figures The EU considers as poor “persons, families or groups of persons who have so limited means (material, cultural and social) that they are excluded from the minimum bearable mode of life in the countries where they live” (OKE, 2000, p.20). This abstract conception is conventionally quantified by Eurostat, defining as “the line of poverty the 50 per cent of the arithmetic mean of equivalent adult per capita net monetary income, on the basis of a country’s measurement”. The 50 per cent definition seems to be preferred in Greece, for policy purposes, as also in most of the EU countries and the OECD. We may note here the emphasis given by the Greek Economic and Social Committee (OKE) on the qualitative rather than the quantitative aspect of poverty, claiming that ‘’the qualitative dimension of poverty refers to the inability of access of an individual in the basic social, political, cultural and professional opportunities and possibilities of a society at a particular time period’’ (OKE, 2000, p.3). On the basis of this definition, Eurostat data from a European wide investigation show that, by the end of 2000, 1,000,000 people, i.e. 10 per cent of the population fell, for three consecutive years, below the poverty line (http://ta-nea.dolnet.gr). Although this seems to be the prevalent, it is not the only quantification of the poverty line, since the alternative of the 60 per cent mean is also used, giving 17 per cent of Greeks below the poverty line (Eurostat August, 2000). Of them, one-fourth were 16-24 years of age, 61 per cent 25-49 and 14 per cent 50-64 (the corresponding figures for the EU were 20, 62 and 19 per cent) (www.in gr/news,2000/Greece). As is noted, however, these figures underestimate the true poverty, because official statistics don’t include the foreigners, who would raise, as is guessed, the proportion of poor by 43 per cent. Being that as it may, the NAP for social inclusion makes it clear that Greece has neither adopted an official definition of poverty line nor has it arranged for a universal minimum guaranteed income. We may note in this context that a Eurostat Task Force on Social Exclusion and Poverty Statistics ‘’declined to define social exclusion arguing that this was just not possible’’ (Micklewright, 2000, p.8). Although in Greece, relative poverty is measured by various studies on the basis of either consumption or income, the use of 143 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour consumption is justified, because it incorporates to some extent some of these missing elements (EC, 2002, p. 79). However, as it appears, this consumption-income dichotomy in calculating poverty in Greece has some meaning only for the 50 per cent definition or below, concerning people for whom the non-inclusive elements just described are relatively more noticeable (Table 7). In counterpart, and aside from official income statistics, a more accurate assessment of the actual dimensions of poverty, particularly for international comparisons, would require the consideration of some additional elements not included in these figures. Such elements refer to the high proportion of self-occupancy housing, even among poor households, the still considerable agricultural sector and the extra non-registered income of various groups, such as farmers working seasonally in tourism or others in jobs in the unregistered economy that is flourishing in Greece (it is estimated to about 30 per cent of GDP). As noted in the Greek Action Plan for Social Inclusion 2001-2003, counting the contribution of the owner-occupied housing alone, would reduce the proportion of poor by 3 percentage points, or 15 per cent. This suggests that the poverty measured by the official statistics is very likely overestimated, especially when it is calculated from the internal revenue data collection. Among the causes of poverty, it is found that unemployment is, par excellence, the major contributor, whereas 31 per cent of the pensioners live at the margin of poverty. What is even more disturbing is that these proportions tend to increase over time. Other groups exposed to poverty include the uninsured, the elderly, the ill and persons with disabilities (The Nea, 17.10.2000). The incidence of poverty is much lower for working household heads, while is not terribly different from the overall average for unemployed household heads, given that the majority of unemployed in the country do not belong to this group. In contrast, poverty is found to be remarkably higher for households with female than male head (Glytsos and Kanellopoulos, 1999). 144 FONDAZIONE CENSIS Table 7 Poverty line in Greece according to alternative definitions. (Calculated from the Greek Household Survey 1998/1999) Definition of Proportion of people On the basis On the basis below the poverty line: of of income consumer expenditure poverty line 40% of median income 50% of median income 60% of median income 70% of median income Gini coefficient 4.9 10.7 17.9 25.6 0.307 6.0 11.2 17.3 25.1 0.322 Source: Adapted from the Greek National Action Plan for Social Inclusion Note: Expenditure and income are per equivalent adult in the household, taking account of the size and the age composition of the household, on the basis of the OECD scale. 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour Comparing Greece with the EU average shows that the risk of poverty (60 per cent definition) is 23 per cent against 16 per cent for the Union. The risk of poverty varies among different groups of people. For example, unemployed males have a risk of 45 per cent-the highest- the retired females 40 per cent; and the economically inactive males 29 per cent. The corresponding average figures for the Union are, 43, 19 and 25 per cent. While the figures for unemployed males and inactive males are only a little higher than those of the Union, the risk of poverty of retired females is double the figure of the Union (EC, 2002, pp.186, 188). In Greece, 46 per cent of one-person households over 65 live below the poverty line as against an average of 27 per cent for the EU (50 per cent definition of poverty line). Poor men over 65 represent 37.8 per cent of all aged men and poor women 59.6 per cent of all aged women. It is particularly interesting that the level of education of the Greeks who are below the poverty line is much higher than the corresponding average of the EU. About 23 per cent of the poor Greeks have a relatively higher level of education compared to a corresponding 9 per cent in the EU (Eurostat, August, 2000). 3.2. Policy and Legislation Let me note at the outset the interesting observation that the Greek National Action Plan for Social Inclusion, which is, in effect, directly and indirectly a plan for poverty, is the responsibility of five ministries, namely Labour and Social Security as coordinator; Health and Welfare; Interior, Public Administration and Decentralization; National Education and Religion; and the National Economy and Finance. The lack of a specific official definition of poverty for policy purposes, explains, according to the NAP for social inclusion, the co-existence of a great variety of policies and income transfer schemes to certain population groups, which in fact include people with a high incidence of poverty (Glytsos and Kanellopoupos, 1999). Such measures, with evidently other objectives that in reality alleviate poverty include welfare assistance; jobs for the unemployed; training; solidarity pay to low pension beneficiaries; tax reductions; family allowances based on the number of children, or income transfers to persons with disabilities, unemployed, ex-prisoners, uninsured, women, etc. It must be emphasized in this context that the particular weight of the Greek social security system on work, is making it incapable of sufficiently covering those with a poor employment record, including young job seekers, the long term unemployed 146 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour and persons with disabilities. The unification of policies and the application of uniform criteria to the disparate benefits, as the Plan goes, remains a task for the future (p. 106). The NAP for Social Inclusion identifies key issues and concentrates on certain target groups in a nexus of economic, employment and social reforms. New targeted initiatives, such as income support to households, and low pension receivers, or cash benefits to long– term unemployed aged 45-65 and to families with children in school up to 16 years of age, are all part of this effort. The Eurostat Task Force, mentioned above, suggests that the statistical analysis concerning exclusion should focus on the labour market, given ‘’the importance of employment as the core of the social tie, as the entrance to social protection, as it gives a social identity, social status, satisfaction social contacts and prevents families from long term poverty’’ (Micklewright, 2000, p. 8). This, and the recognition that ‘’participation in employment is emphasized by most member states [including Greece] as the best safeguard against poverty and social exclusion’’ (EC, 2000, p.12), led to a two-way link between the NAP for Social Inclusion and the NAP for Employment. On the one hand, the aim is to increase employability and create new job opportunities, and on the other to focus on actions facilitating participation in employment for individuals, groups, or communities found at a distance from the labour market. The trend towards more active and preventive policies reflects experience gained under the Luxembourg process (ibid.). In this spirit, the Greek Action Plan for Social Inclusion considers as the major challenge and a policy priority the preservation of social cohesion, including measures for the smooth integration of immigrants. The policies adopted in the NAP for Employment for the purpose of fighting unemployment are to the direction of meeting this challenge. But apart from these rather general measures, the NAP for Social Inclusion proposes also a series of more concrete reforms linked to exclusion (health, welfare, education, social security, public administration and decentralization).A case in point is the development of a system in schools offering second opportunities for the reintegration of persons over 18 in the educational system through individual teaching, as an alternative to basic qualifications. Furthermore, for acquainting people in remote areas and islands with computers, certain internet information centers are conveniently located for the promotion of ‘’eInclusion’’, including possibilities that favour the access of persons with disabilities to information and communications technologies. 147 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour Adopting the proposition of ‘higher employment for lower poverty’, the Action Plan for Health and Welfare initiates and encourages policies “aiming primarily at the prevention and eradication [sic] of phenomena of poverty and social exclusion”. In this respect, the plan discusses active measures for employment and social inclusion on an “individual basis” and promotes equal opportunities to employment, improving the access of sensitive groups of people and of women to the labour market. This is pursued with family-friendly measures of employment in a decentralized system of social protection, aiming at the “support of the individual or groups of individuals in a context of self-determination and active involvement vis-à-vis the problem emerged”. The welfare system favours the “open” as opposed to institutionalized care of sensitive groups, making also provisions for the association of the welfare services with the NHS and the psychiatric health services, as well as with the services that promote employment and the prevention of social, economic and labour market exclusion. The OKE report, mentioned above, maintains that although poverty in Greece is considerable, the attention given to it by the political and social dialogue is not up to the severity of the problem, maintaining that ‘’the Greek state but also the Greek society never had a comprehensive policy for poverty as an autonomous phenomenon’’(p. 6). They continue to suggest that existing policies on poverty involve passive financial assistance without offering outlets of escaping it. Poverty is basically attributed by OKE to technological unemployment, globalization and, to a considerable extent, the inadequacy of the educational system to reorient the labour force to alternative directions of employment. Relevant active policies ought, as the report goes, to fight poverty along with social exclusion, the two being an undivided issue. The EU project EQUAL for fighting discrimination and inequalities with respect to the labour market is certainly expected to have some relief on poverty. This programme is targeted to groups that are usually consisting of persons exposed to high risks of poverty, such as high unemployment youth and women; persons with low education; asylum seekers; deviants; exprisoners; drug addicts etc. In this project Greece participates with 40 partnerships most of which concern ‘’employability’’. Among the objectives of several of these partnerships are the access and return to the labour market of discriminated against workers and the fighting against racism and xenophobia in respect to the labour market. The theme “equal opportunities for men and women’’ concerns family-friendly employment projects and the 148 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour eradication of professional distinction between the sexes. Some of the more specific actions taken are the cooperation and networking of bodies supportive of employment; improvement of the systems that promote employment of disadvantaged persons; programmes of long-term training for such groups, and many more. In the framework of adopted or planned policies just discussed, a sample of very specific measures, taken or proposed, targeted to various disadvantaged groups, but working towards alleviating poverty, are now presented. Some of them are ‘’passive’’ and others ‘’active’’. To begin with, since 1996, all receivers of low pensions (below 6,340 Euros in 2003) get an Allowance of Social Solidarity (EKAS), ranging inversely according to the level of pensioner’s income, between 27.80 to 111.18 Euros in 2003, under the condition that the family taxable income is below a certain level (11,511 Euros in 2003). About 360,000 persons are currently the beneficiaries of this allowance. In the summer of 2002 started a new programme providing financial assistance to 270,000 household heads of extremely poor families in mountainous and disadvantaged areas. The allowance amounts to 300-600 Euros annually, depending on the beneficiaries’ income. In addition, a school allowance of 300 Euros is given per child of poor families until finishing the 9-year compulsory education, in case the annual family income is below 3,000 Euros (Kathimerini, 3.7.2002). One recent active measure, on which special emphasis is given in the draft of the Action Plan for Employment 2003, is part-time employment – in Greece it is only 5 per cent of total employment - in the public sector, with the expressed objective of containing poverty and safeguarding social cohesion (Kathimerini, 24.7.2003. The part-time employment is considered appropriate by the government on grounds that an unemployed person is 2.15 times more at risk of being poor compared to someone holding a job. Furthermore, a housewife who welcomes part-time employment is given this outlet, reducing substantially her household risk of poverty and social exclusion. Currently, the Greek government is preparing a bill – to be submitted to the parliament this Fall – that proposes a three-year programme of incentives, for the establishment of ‘’social cooperatives’’. These incentives - social security contribution allowances - are addressed to ‘’groups of high unemployment’’ and to ‘’socially vulnerable groups’’. More specifically, the beneficiaries are planned to be mainly women, young people, long-term 149 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour unemployed, persons with disabilities, one-parent families and ex-drug addicts. These cooperatives of social scope may offer a range of services and products. They will be able to contract with private enterprises, the public sector and local authorities for the purpose of developing the ‘’third sector’’, which in other Mediterranean countries is known to have contributed to employment creation, as claimed by the planners of this policy. 150 FONDAZIONE CENSIS 11873_2002 4. Study D2: Poverty, Informal Sector, Health and Labour CRIME 4.1. Definitions, Facts and Figures In the last 20 or so years crime has been rising at a rather fast pace. Figures presented by the Vice-Chief of Police show a rapid rise of criminal activity, particularly of heavy crimes. Until the late 1980s, 87-90 homicides were committed annually. In 1990, homicides reached 104, in 1997, 251 and in 1998, 258. He concluded that foreigners, especially the Albanians, had a significant share in these crimes. Analogous has been the situation with robberies. As he stated, until 1995, there were 825 robberies on the average per annum. From 1996 onwards, the number started to increase, reaching 2,368 robberies in1998. The Vice-chief further stated that the organized crime has no solid organizational structures and strategies in Greece and does not operate through an integrated and stable network. (www.patris.gr/archive/99/10/23/1stpage.htm). This exacerbation of criminal activity has subsequently receded, at least for heavy crime. In 2002, homicides were 94; attempted homicides 115, rapes 222 and robberies 2,266, but other crimes have increased. Per 100,000 of population, total recorded crimes were 834.62, in 2002, which is the same as in 1996 (Table 8). We may point out that with reference to 1996, although homicides dropped substantially by the year 2002 - and the same is true for thefts and burglaries - rapes and robberies have increased. Referring to more recent years, the major opposition party of New Democracy suggested that criminal activity of heavy crime has increased in 2002.They presented data in the parliament, according to which, in the 11month period of 2002 the number of burglaries amounted to 44,211 compared to 41,000 in the corresponding period of the previous year, robberies reached 1,800 up from 1,500 in 2001. Without disputing these figures - they are official in any case – the Minister of Public Order stated in the parliament that, nevertheless, ‘’Greece is the last country in criminal activity and the more secure in Europe. It is the least violent country in the world’’. He went on to say that criminality, especially homicides, has decreased in recent years. In the city of Thessaloniki alone, the drop reached 50 per cent, compared to the previous year, recognizing, however, that the problem exists with robberies in Greater Athens. 151 FONDAZIONE CENSIS Table 8 Crimes recorded in criminal (police) statistics, including attempts to commit crimes Crime category Grand total of recorded crimes Homicides completed Homicides attempted Frauds Rapes Animal thefts Thefts-Burglaries Automobile thefts Contraband Robberies Sexual assault Drug offences Other crimes3 Number of Crimes 1991 1996 2002 59,897 138 93 587 243 575 42,938 8,653 99 1,207 974 2,449 1,941 87,312 169 149 544 183 599 63,699 12,498 186 1,531 564 4,695 2,495 90,874 94 115 821 222 559 49,641 17,889 471 2,266 409 10,424 7,963 Rate per 100,000 inhabitants 1991 1996 2002 587.22 1.35 0.91 5.75 2.38 5.64 420.96 84.83 0.97 11.83 9.55 24.00 19.03 834.32 1.61 1.42 5.20 1.75 5.72 608.68 119.42 1.78 14.63 5.39 44.86 23.84 Source: Ministry of Public Order, Crime Statistics (http://www.ydt.gr/main). 3 Includes smuggling of antiquities, blackmail, beggaring, copyright, forgery, guns. 834.62 0.86 1.05 7.54 2.04 5.13 455.92 164.30 4.32 20.81 3.76 95.74 73.14 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour One important issue widely debated in Greece is the extent to which immigrants are involved in criminal activities. Popular belief, formed partly by exaggerating TV reports, has it that illegal immigrants are responsible for the majority of crimes. Relevant figures show that among arrested criminals, illegal immigrants committed, in 1999, 34 per cent of homicides, 25 per cent of rapes, 42 per cent of thefts-burglaries and 35 per cent of robberies (Eleftherotypia, 5.4.2000, presenting data of the Ministry of Public Order). It is believed that these comparative figures give an underestimate of the true share of foreigners in crime, due to the relative difficulty of apprehending them (no papers, no fingertips, no specific address, etc). Data from the ministry of Public Order, referring to the wanted by the police criminals in Athens and Thessaloniki show that out of the 643 robberies, in 2002, 64 per cent were committed by foreigners, and out of 105 rapes, 51 were committed by foreigners too. In the attempted 47 homicides, the offenders are foreigners in 33, whereas of the 266 premeditated murders, 207 were committed by foreigners, in which the Albanians have the higher share. For the ‘’lighter’’ crimes, on the other hand, such as theft and drugs, the Greeks have the greater responsibility (Ethnos, 25.10.2000). A report submitted by the ministry of Public Order to the President of the Greek Parliament, indicates a high share of foreigners in organized crime, pointing out the particular threat of Albanian, Russian and Turkish gangs (1998). It is very disturbing that, according to the special Juvenile Tribunal of Athens, juvenile crime climbed up in the region of Attica, mostly Athens conurbation, by 23 per cent in 2001. Of the 5,106 cases processed by the court, 4,885 concerned boys over half of which aged 13-17 years. Robberies increased by 23 per cent and violence (body injuries) by 14 per cent. Driving misdemeanors went up by 56 per cent, beggaring 21 per cent, and theft 9 per cent. Drugs concerned only 5 per cent of the cases in the Juvenile court, but the problem is believed to be in reality much more severe. Most of young criminals have a low educational level, including dropouts and they come from disturbed families, living mostly in the poor neighbourhoods of Greater Athens. There is a great concern about the criminality of teenagers 15-19 years of age that is related to drugs. Some consider TV as a major causing factor, acquainting youth with crime as a means of success. Data show that the deaths o youngsters below 17 caused by the use of drugs have increased, in ten years’ time, 1987-97, by a factor of 11, while the access to drugs of 16 year olds increased 20 times, between 1991 and 1997, and of people of all ages the access has tripled. 153 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour A study of the Council of Europe by GRECO, referring to the case of Greece, maintains that corruption is not limited to the ‘’little envelop’’ got by certain civil servants for complementing their income, but it has become wide scale, taking advantage of international networks, including those of organized crime. This is the case, for instance, with illegal migration trafficking and prostitution networks (p. 17). According to this report, no official study exists on corruption in Greece. The GRECO evaluation team (GET) refers however to a 1998 study, drafted on the initiative of a parliamentarian, showing that ‘’corruption was on a larger scale than had been imagined, affecting in particular the police, the tax authorities and the construction sector’’. Furthermore, from the replies to a questionnaire, corruption takes the form of bribery (passive or active). Among the different forms is the bribery of public officials to assist people to get subsidies or aid from the EU funds, or to help immigrants from Central and Eastern Europe to obtain the Greek citizenship. On the basis of these developments, it is suggested that Greece needs a global comprehensive strategy, not a fragmentary one, against corruption (p.25). Money laundering is a separate criminal offense (L. 2331/1995). This law has established a body responsible for centralizing information on laundering operations (GRECO, p.6). The ‘’Section 7 Committee’’ is an independent administrative authority funded by the ministry of finance. Crime is proved to be a lucrative business endeavour. Data presented in a colloquy at the Technical University of Crete in Greece, in 1999, show that about 1000 persons were murdered, in the preceding five years and 6,200 were injured by criminals during the process of crimes and terrorists’ attacks. It is estimated that out of the 292,000 criminal acts, robberies, burglaries, etc, criminals made about 323 million Euros. This figure does not include the proceeds from the sale of drugs and the trafficking of women and illegal migrants, neither the proceeds from the counterband of cigarettes, cosmetics and alcoholic beverages, all of which are a flourishing business in Greece. On a world-wide basis, UNICEF presents data of the annual trafficking of women and children for the purpose of prostitution, amounting respectively to 700,000 and 1,000,000, with Greece having a fare share at least for women trafficking from Central and Eastern Europe. Out of this global crime, it is noted that traffickers make about 30,000 USD per head, totaling a revenue of the order of 51 billion USD annually. 154 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour 4.2. Policy and Legislation In support of the government efforts, the Minister of Public Order claims that the policy adopted in recent years against crime was effective and has decreased considerably criminal activity. He admits, nevertheless, the rising uneasiness of citizens regarding crime. Summarizing the measures taken against crime, the Vice-chief of the police referred particularly to the steps made for the modernization of police methods and technology; improvement in the organization of the police and the training and retraining of the police force; the disengagement of police from non-policing services; the learning from the good practices applied in other EU countries; the putting into effect already signed bilateral agreements with neighbouring countries and other Central and Eastern European countries for deterring trafficking of people, drugs and guns and he pointed out the active involvement of citizens in fighting crime. Recent legislation (L. 2928/2001) on the ‘’Protection of Citizens from Criminal Acts committed by Criminal Organizations’’ is a law against organized crime and terrorism, providing new court practices and much stiffer penalties than the previous legislation. The Vice-chief of the police also drew the attention to the priority given in enhancing the pedestrian and mounted police patrols as a deterrent to robberies, theft and other crimes. For small crime prevention, the ‘’neighbourhood policeman’’ in cooperation with people and local bodies intervenes for solving problems of security and reassuring the feeling of safety to the citizens. This new police service was put in force on a pilot basis on 17 March this year in 35 police precincts in Attica and 2 in Thessaloniki, involving 354 policemen in an equal number of neighbourhoods. Before starting, these policemen attended special seminars on the philosophy of this institution and their specific duties. So far, the results of this experiment are judged encouraging by the competent ministry and they plan to expand the project to the rest of the country (Table A3). A new institution, announced by the Minister of Public Order, is the establishment of Local Councils of Criminal Prevention, which is a policy, decided three years ago, but had not the expected appeal to the municipalities. Through the Councils, the government offers its support for the drafting of local preventive programmes. As the minister explained, the idea is not that the Councils ‘’take the law in their own hands, neither to create islands of informers’’. Their main role is to register and study the 155 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour criminality in their neighbourhood and prepare an annual report; to encourage citizens to participate in programmes of prevention; to assist in the social action of the police; to develop social solidarity; to establish centers of assistance and information, in cooperation with local social bodies, for the crime victims (Kathimerini, 19.5.2002). These Councils can be created in localities with more than 3,000 inhabitants and are staffed with volunteer scientists and functionaries of the region. As the initiators of this idea note, the experience of other countries has shown that this is a difficult task to accomplish, since the Councils run the risk of becoming bureaucratic and have their role confused with that of the police. The prevention of youth criminality falls under the domain of the ministry of justice and its Societies of Adolescence Protection (EPA), established in1940 and brought up to date with recent legislation (L. 2298/1995, L. 2331/1995). These societies are public entities under the supervision and finance – except of some donations - of the ministry of justice, and they are situated at the seats of the courts of First Instance. Their task is to prevent the commitment of juvenile crimes by the antisocially behaving youth, or youth who, according to their family and social conditions, are in danger of becoming offenders or victims. Another body with responsibilities ‘’after the fact’’ is the Supervisor Service (L. 378/1976 and Presidential Decree 49/1979) at the Juvenile Courts. This is the most important noninstitutionalized caretaker of adolescences who have committed offenses or are in danger of doing so. In the competence of the ministry of justice also belong the 2 Special Centers for Therapy (L. 2721/1999) of imprisoned youth with drug offenses. These centers can accommodate in all 610 persons. Their therapy goes through four different stages of treatment of 26 month duration until they are prepared and ready to reintegrate into the society. For helping the discharged persons to integrate into the labour market, the ministry of justice in cooperation with the ministry of labour and social security has programmes of subsidizing new jobs for them. Speaking on behalf of the EU, in a UN conference for the prevention of crime, during the recent Greek presidency, the Greek Minister of Justice emphasized the role of the newly established European Network for the Prevention of Crime, pointing out its significance for juvenile delinquency and the criminality in the cities. He praised the progress made in dealing with the trafficking of women and children and its connection with the cross-border organized crime, which is this year’s primary objective. This effort, as he stated, cannot be successful without cooperation between the state and the citizens and without international cooperation. Greece is 156 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour greatly concerned with this kind of criminal activity and welcomes and shares in any EU relevant policies and interventions. In this respect, Greece supports and has participated actively in the project of ‘’small arms and light weapons’’ (SALW) control concerning the South East Europe. Technical support was also offered and seminars were given to the Albania police, and in addition, Greece is financing the SALW programme for Albania with 50,000EUR annually for the period 2002-2006. Furthermore, Greece is cooperating under a bilateral agreement with Bulgaria police on border control issues. Similar agreements are also signed with Russia and Ukraine (europa.eu.int/smartapi/cgi/sga_doc). The two consecutive legalizations of immigrants in 1998 (Presidential Decrees 357 and 358/1997) and in 2001 (L. 2910) seem to have contributed to the containment of their criminal activity, by offering them the possibility of making some first steps to their gradual integration into the Greek economy and society. A byproduct of this legalization is that it facilitates the search and control of immigrants’ criminal activity through the requirement that the applicants are fingerprinted. The legalization also contributes to the reduction of their poverty and the related to it tendency of offensive behaviour and criminal actions. 157 FONDAZIONE CENSIS 11873_2002 5. Study D2: Poverty, Informal Sector, Health and Labour TRENDS AND CORRELATION 5.1. Evolution and Structural Developments over time Health: Five major laws for the reformation of the health care system in Greece were passed in the last 20 years (1983-2003). This series of legislation started up, in1983, with the establishment of the NHS and ended in 2001, with the setting up of major Regional Health Systems. The creation of the NHS in 1983 was by itself, despite its several weaknesses and inefficiencies, a great step towards the democratization of health care delivery in Greece. It put an order to the previous situation of a disorganized and inaccessible to all citizens health care system, and offered a relief to the low income and poor people. Of particular interest has been the decentralization introduced with the establishment of NHS, which was more recently enhanced by the regional organisation and coordination of health care by the creation of the Regional Health System (PeSYs). The increasing attention over time to the primary health care and the connection of primary health care networks to the NHS hospitals has also been a welcomed development. The improvement in the management of the system by appointing, in 2001, administrative managers in the NHS hospitals and the hiring of more physicians of general practice filled partly a long standing gap in primary health care. Positive is also the cooperation of public health services with the welfare and social protection services, introduced in 1997. The part-time employment of NHS physicians, introduced in 1992, did not seem to work due to low wages, whereas the possibility of full-time physicians to receive private patients in after hours inside the hospitals they work is a controversial issue, standing to criticism on grounds that it refutes the essential NHS philosophy of free health services for all. It serves however the practical purpose of keeping the interests of good doctors to the NHS alive, without an excessive financial burden to the system that would have been necessary for raising salaries to a competitive level. The rising share of the state, over time, in total health expenditure, although very far from satisfying the principle of free health services for all, is in the right direction. The establishment of the exclusive list of approved medicines, to be paid by the social insurance funds for their beneficiaries, is an effort to control the tremendous expenses for pharmaceuticals, aiming at a more efficient use of the funds’ financial resources devoted to health care. 158 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour Without disregarding the various weaknesses of the health care system, the government seems to be content with the progress made so far. They consider as a satisfactory development the creation of modern infrastructure at the regional level, succeeding in covering geographically the needs of the population and reducing regional inequalities, as a result of which the flow of patients to the city hospitals has been declined. They believe that the regional improvements in the health care facilities are ‘’a prerequisite for the balanced social and economic development of the regions’’ (Action Plan for Health and Welfare, p. 20). The government finds also adequate the coverage of needs in the secondary and tertiary health care. All these developments and improvements in the health care supply services leave, however, much to be done for satisfying the patients and restore their confidence in NHS. Their dissatisfaction is very vividly indicated by the still high ‘unofficial’ private health expenses, representing, as we have mentioned, 1.1 per cent of GDP. Poverty: Although, in the 1970s, poverty was mostly a characteristic of farmers, it has increasingly become, in the 1980s and 1990s, an urban characteristic as well, due mainly to the rise of urban unemployment. Between 1982 and 1994, poverty of scientists and executives more than doubled, has increased for office clerks, and has declined a little for farmers and blue collar workers. This notwithstanding, farmers continued to have the highest incidence of poverty, 36.3 per cent (1994) as compared to scientists and executives who carry the lowest incidence rate, 19.0 per cent (Table A4). Using the Greek Household Survey data, an econometric study found that, between 1974 and 1994, income inequality and poverty (absolute and relative) was reduced. The reduction took place particularly during the period 1974-82, then, after an intermittent increase it was reduced again (Mitrakos and Tsakloglou 2000). Taking, in addition, into account a number of non-monetary welfare indexes (housing conditions, durable consumer goods, etc), the standard of living of the poor has been continuously improving. A primary contributing factor is considered by these authors the rise of the educational level and the greater urbanization (ibid. p. 46). According to other econometric findings (Sarris and Zografakis, 1997), presented in table A4, education is indeed a reducing factor of poverty in Greece. In 1994, the incidence of poverty for household heads without primary education was 40.8 per cent; for those with primary education 28.4 per cent; with secondary education 13.6 per cent and with tertiary education 7.7 per cent. However, over time, especially since 1989, the situation of 159 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour secondary and tertiary education degree holders has substantially deteriorated, while people with primary education have seen their poverty to decline slightly. The intensity of poverty changes are inversely related with age. For persons under 24, the incidence of poverty almost doubled, whereas for ages 55-64 poverty has increased slightly and for persons over 65 declined a bit. A distinctive and varied role in poverty has been played over time by emigration from and immigration to Greece. First, the exodus of Greeks, in the 1960s and early 1970s, reduced the number of poor, while the inflows of migrant remittances raised the incomes of their poor families at home. Second, the termination of the great emigration had on both counts a reverse negative impact on poverty. Third, the great inflows of unskilled foreigners, starting in the early 1990s and continued to the present time, raise both inequality and poverty. Apart from adding to the cohorts of poor with their presence, the illegal immigrants among them, working often for low wages, displace to some extent unskilled Greek workers (see, for instance, Glytsos and Katseli, 2003). To answer the question whether the various government transfers to low income people reduces poverty and to what extent, if any, consider the following information. According to Eurostat data presented by ESSPROS, Greece has increased social protection expenditure to 24.5 per cent of GDP in 1998 (EU average is 27.7 per cent). More than half of social expenditure goes to old age and survivors’ pensions (52.6 per cent, as against 45.7 per cent in EU), leaving fewer resources for funding other social transfers. The greater proportion of pensions in Greece, such as the minimum IKA pension and the farmers’ (OGA) pensions, which are at or near the poverty line, are, in fact, for their major part, social welfare payments. They are justified as a means of reducing poverty for people over 65, which is the main age group affected by poverty. It has been estimated that this kind of state ‘’intervention’’, including the EKAS, i.e. the allowance of social solidarity for receivers of low pensions, has cut in half the 1999 proportion of poor (50 per cent definition), from 22.6 per cent without these transfers to 11.4 per cent after they are counted in the relevant calculations. As a result, the proportion of poor was kept stable in the face of an increasing poverty trend (1988-1999) without these transfers (National Action Plan for Social Inclusion, 2001). In absolute terms, on the basis of the 1994 poverty line, the proportion of poor has been reduced by 34 per cent, the above transfers having contributed to this reduction (ibid.). Let me note, in this context, the government’s claim that the cost for Greece’s accession to the European 160 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour Monetary Union was not borne by the poor since their economic conditions had improved during the adjustment period for satisfying the Maastricht criteria. They explained this by the increasing social expenditure that took place, notwithstanding the efforts for the accession. Eurostat’s findings show, however, that, apart from the redistributing impact of pensions, any other state transfers, in the context of the welfare policies, have very weak redistributive effects, reducing the proportion of people below the poverty line only by one percentage point. This figure is the lowest among the EU countries, in which such transfers reduce poverty even up to 18 percentage points. In the same spirit, the Greek Economic and Social Committee (OKE) has expressed the ‘’opinion’’ that the taxation system in Greece is incapable of playing its redistributive role, on grounds that the share of the indirect taxes in total tax revenue is high. In addition, the great tax evasion, particularly within the extensive unregistered economy, is not a poverty reducing factor. In the same tone, the leading daily newspaper Kathimerini (20.11.2002), discussing the 2003 Greek government budget, expressed doubts about its poverty relieving possibilities. As the argument goes, the expected increase of indirect taxes, weighing heavily on total tax burden falls unequally on the poor, whereas the proposed income tax cut, does not in reality concern the poor without a taxable income. On the other hand, the proposed increases in wages and pensions or the unemployment benefits would give only a marginal relief to the main part of the poor who are chronically in that situation. Crime: Up until the 1980s, Greece was a country experiencing a very limited criminal activity, mainly light offenses and minimal heavy crime, the offenders being Greeks, without imported crime. Along with economic development and the restructuring of the economy towards more urbanized production, in the following years, there came higher urban unemployment, greater income inequality and urban poverty, as well as the invasion of drugs and the uncontrolled flocking of illegal immigrants from neighbouring and Eastern European countries. These developments and the collapsed regimes in the countries just referred to, have also opened up the possibility of a lucrative business of cross-boarder trafficking of illegal workers, women for prostitution and drugs, through established inter-country networks of smugglers and traffickers, as well as a rising mobilization of foreign criminals within Greece. As a result, criminal activity of all sorts was accelerated, particularly in the 1990s. Foreigners and foreign organized gangs – mostly from Central and Eastern Europe – have more than a fare share in the criminal activity in Greece, particularly in homicides, robberies 161 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour and burglaries. Juvenile crime, which is an altogether different type of crime, to some extent with different motives and modes of operation, has, in recent years, increased greatly, especially in certain Athens neighbourhoods. The overwhelming majority of these crimes are not however related to drugs, despite their tremendous proliferation in these years. Several measures have been taken for fighting crime in the past couple of years, including legislation for improving courts efficiency, prison infrastructure and management and providing for more stiffening penalties for certain crimes. The police have been reorganized, better equipped with modern technology and adopted new police practices for policing and investigation. Many illegal immigrants have been legalized, which helps them to be better integrated in the Greek economy and society, and by implication, reduce their poverty and the tendency to commit crime. All these measures seem to have contributed to the drop of crime. Although in 2002 a resurgence of burglaries and robberies is observed, homicides, as well as the overall criminal activity are reduced considerably compared to the 1998 level. Despite the recession in criminal activity, Greeks consider crime as one of the most serious problems in the country (Kathimerini, 19.5.2002). A relevant opinion poll, in 1999, indicated that crime is the second most serious problem after the economy but before unemployment. They are not generally convinced, about this crime setback, and they connect the overall rising criminality, in the last decade, to the presence of large numbers of immigrants in the country. Newspaper reports suggest, however, that despite the impressions given by TV, statistics show that the crimes committed by foreigners are a much lower proportion than the crimes committed by Greeks. One of the reasons for the ‘’explosive’’ criminality is, according to this view, the unprepared police, including the inadequate training, despite the serious steps of improvements made. It is suggested – and this is another angle to the problem in hand - that the police has been socially disgraced, originally during the seven-year dictatorship, but also afterwards by the socialist and leftist political parties. It is interesting, however, that today there is no political party of the extreme right persuasion to have extravagant views and propose ‘’radical’’ measures against crime, especially with respect to immigrants. The Youth Club of the New Democracy party, now in opposition, underlines the increasing criminality after 1994 and the inability of the government to deal with it. Referring to a recent opinion poll, they note that 76.9 per cent of people are scared and feel unprotected even in their own 162 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour neighbourhood. The Club is disputing the international statistics, which show that Greece occupies a low position on a list of European countries regarding crime. They explain their view on grounds that the Greeks don’t trust the effectiveness of the police to resort to when they become victims of certain criminal acts. An opinion poll by the Greek section of Transparency International, in February 2001, presented evidence that 83 per cent of the 920 interviewees considered Greek society to be infected by corruption, 45 per cent had given a bribe or ‘’backhander’’ and 18 per cent admitted of having used connections. This survey found however no connection between corruption and organized crime. On a scale of 0-10 (10 being the best – the least corrupted), Greece with a score of 4.2, occupied, in 2001, the 42nd place in the Transparency International Corruption Perception Index, which is the lowest place among the EU countries. 5.2. Correlation Between poverty, Health and Crime Despite the improvements made in the poverty front, the EC maintains that ‘’as a result of the problems in labour market, and of structural developments – such as the change from a rural to an urban society, the ageing population, the weakening of family support mechanisms and the strong immigration flows – poverty and social exclusion continue to represent a serious challenge’’ (EC, 2002). Greece is experiencing the wellknown connection between long –term unemployment and low income, which makes it vulnerable to poverty, in fact, ‘’this risk is considered as a major factor behind poverty and social exclusion [in Greece]’’ (ibid., p. 24). The malfunctioning of the Greek labour market and the related to it unemployment are key factors in generating poverty and of keeping many young people for lengthy period of times out of work. Economically suffering households constitute an unhappy and miserable environment for raising children who become vulnerable to bad influences that may push them to social deviance and crime. A good experiment that economic and social exclusion tends to offensive behaviour, and, conversely, that economic and social integration and employment contains criminality. For instance, the legalization of immigrants may affect their social conduct. Stepping out of illegality and being treated equally with the Greeks in the labour market, they won’t have to resort to crime for their survival. Not that 163 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour legalization solves all the problems of immigrants, but it makes them equal at least in the eyes of the law, giving them the opportunity to have social insurance, better paid jobs and working conditions, in other words, a first serious step for their integration into the Greek society and the sense of belonging and not being always on the run. Several studies confirm the a priori positive association of economic growth with poverty reduction. This connection varies among countries according to income inequality. In countries of low income inequality, ‘’growth is twice as effective in reducing poverty as in countries with high inequality’’ (Lusting and Stern, 2000, p.3). And inversely, reducing inequalities in people’s assets, including land and education, can improve efficiency and growth, while reforms bringing down inflation and raising growth are good for the poor (ibid. p.4). These authors also suggest that the containment of bureaucracy and corruption encourages private investment. Pursuing policies that benefit small firms and small producers makes market work better for the poor (ibid.). Other writers maintain as a general corollary that growth benefits the poor and poverty reduction is good for growth. In general, policies such as investment in primary education; rural infrastructure; health and nutrition that increase the income of the poor tend to enhance the productive capacity of the whole economy, boosting the incomes of all groups (Rodrik, 2000, p.8). This seems to fit the case of Greece. The NAP for social inclusion, highlights the strong correlation between poor health and poverty and exclusion. An EU-wide survey found that of people below the poverty line, 13 per cent had bad health as against 9 per cent of people above the poverty line. On the controversial issue of the connection between globalization and poverty, Berg and Krueger (2002), discussing cross-country evidence and reviewing some of the vast microeconomic literature on the effects of trade liberalization on income distribution, reached the conclusion that ‘’there is no systematic relationship between openness and the income of the poorest, beyond the positive effect of openness on overall growth’’ (p.18). The income of the poor is growing one-for -one with average income. They note, however, that in some countries the poor do better than average and in others worse than average. It has been argued that corruption is higher in countries where domestic firms are sheltered from foreign competition, while trade liberalization ‘’combats the corruption that flourishes wherever there is too much red tape and protectionism’’ (Sutherland, 2002). A report of the ‘’Transparency International’’, called ‘’World Barometer of Corruption’’ concludes that, generally, ‘’the poor suffer more seriously and 164 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour more directly from political corruption compared with their privileged fellow countrymen’’. In this context, interpreted properly, our preceding analysis gives some clues as to the implications of various factors, such as macroeconomic development, social and political changes, and the policies adopted on health, poverty and crime, on Greece’s structural development, growth and quality of life. Inferences may also be made regarding the interconnection among these three issues and their feedback effects on the economy and society. The linking of the NAPs for Social Inclusion, Employment and Health and Welfare in a concerted action for attacking this complex set of problems is evidence that the Greek government is well aware of the connection between employment and social exclusion, with all the undesirable ramifications that entails with respect to poverty and crime and their interrelationships. However, in certain respects, a better tighting of policies would probably be needed. The NAP for Social Inclusion gives some hints on such inconsistencies, noting that the measures proposed ‘’to prevent the risks of exclusion’’ cover most population groups at risk of poverty, but they appear to be fragmented and not tied up to the measures proposed for employment and the access to resources. For instance, the policy ‘’to help the most vulnerable’’ has ‘’no evident link between the actions foreseen and the accompanying social support services that are needed for the specific groups’’ (ibid.). Although most of the particular measures are targeted to specific population groups, some of them are innovative with an integrated approach. A case in point is the Integrated Action Plan for Roma, which combines infrastructural investment and investment in human and social capital. In the administrative context, the Plan provides a decentralized delivery mechanism of 50 Employment Promotion Centers. As it has been observed, if decentralization is accompanied by the provision of financial resources, technical assistance and participatory mechanisms ‘’can make state institutions more responsive to poor people by increasing the interaction with them’’ (Lusting and Stern, 2000, p.6). The mixture of the policies, in this framework, concern economic and social measures; the improvements made in the NHS and the educational system; the legalization of immigrants; the technical and organizational updating of police methods and practices for crime prevention and the apprehension of criminals; and the intensified participation of Greece in transnational projects and networks against crime. This collection of policies has the potentials – and there are already some good signs – of improving the 165 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour economic wellbeing of disadvantaged people and of weakening the povertycrime-poverty vicious circle in the years to come. One characteristic of the Greek society and its mode of operation, which needs particular consideration in the context of this report, is that many problems are beautifully solved in paper by laws and regulations, but if one looks at the real world, things are not working as they are supposed to. Law requires, for instance, that all workers, irrespective of nationality etc, should be treated equally, are socially insured and they and their employers pay social security contributions. And yet, the reality is different for thousands of Greeks and legalized immigrants alike, who may still work without social security and at wages below the legal minimum, or long hours without analogous pay. Thence, equality and regularization in paper may solve some of the problems of workers in general, but do not necessarily help them escape poverty or remove the causes of crime. The ‘paper-versus-reality’ situation is vivid in Greece in the case of the NHS. Its philosophy expressed practically in the law by the declaration that all citizens have a free of charge access to the NHS is in its implementation, for various reasons, far from being true. As a result, poor people who cannot afford the private health care services may not have the appropriate medical attention, with implications on their health condition. By the same token, people are inadequately protected against various diseases by the ineffective primary health care and the unsuccessful efforts of preventive medicine, in respect to smoking, drinking, drugs, dietary habits, lack of exercise, which are all important factors of sickliness. Recall the non-negligible proportion of poor that are found with health problems. People found in that situation have difficulties with the labour market, which in turn leads to more poverty with feedbacks in a process of poverty-health-poverty vicious circle. Another ‘’free of charge’’ public good supposed to be equally accessible to all, according to the law, is education from kindergarten all the way up to the university. In reality, however, students bear a considerable cost of their education for extra-school private tutorials, which is an old tradition in Greece, signalizing the inadequacies in all levels of public education. In addition, students enrolling in higher education institutions incur additional living expenses - especially when they have to study in a place other than the place of their parents’ residence - or are deprived of their education by lack of family finance or the non-affordable foregone income. This situation is equivalent to an actual inequality in the access to education, raising the risk of unemployment, with further implications on poverty, youth delinquency and crime, already mentioned. As our earlier presentation has 166 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour shown, low education workers with low wages, at the margin of the labour market, have a high participation in the cohorts of poor people. The taxation system in Greece is not generally a successful policy instrument for redistributing income in favour of the poor. Although various income tax arrangements are often made in the name of low income households, the exceptionally high proportion of indirect taxes in total tax revenue renders the taxation system as a whole regressive, turning it against the poor. Furthermore, any transfers by the government to low income people, except pensions, have only a marginal beneficial effect on poverty. 5.3. Key issues, political agenda and perspectives Health: Although the chain legislation of the last 20 years brought considerable improvements in health care delivery, it has been incapable of resolving certain chronic problems and inadequacies of the system. A Commission of foreign experts appointed by the government in 1994 to study the NHS drew the attention to the underdevelopment of the system; the unprofessional behaviour of the staff; the excessive number of specialists; the unsatisfactory organization of the supply of primary health care; and the low satisfaction of patients. They also noted the problems generated by the discontinuity and inconsistency of health care policies and legislation over time. Such inadequacies that pose today a big challenge concern the infra-structure, staffing and management of the NHS, in particular the excessive number of physicians in hospitals and clinics in the large cities and the shortages in regional and rural areas; the general shortages of nurses all around; and the inadequacies of primary and preventive health care. While the Health Centers in the countryside are inadequately staffed with personnel that lacks the appropriate professional experience, in the cities the problem is that there is no integrated network system of primary health care, which has negative implications on the quality and the cost of the services offered (Action Plan on Health and Welfare). Furthermore, the traditional form of management and the slow introduction of information technologies, particularly in the public sector, contain the effectiveness and efficiency of the primary health care system. The lack of a coherent system with a core stable framework has left unresolved major problems, such as great inequalities in the accession to health care services, which among others is the consequence of the 167 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour inequality in health insurance by different social security funds, resulting in unequal health care coverage and imposing excessive financial burdens on the beneficiaries of the weaker funds. It is thus pertinent to improve the efficiency and accessibility for all in the NHS, so that low and middle income patients are not forced to resort to the expensive private clinics. This is a problem to which relatively more attention should be given both in the cities and the countryside. The situation could be improved by the merging of certain funds, a difficult task that has been unsuccessfully attempted by the government, meeting strong opposition by the more wealthy funds and their beneficiaries. For avoiding some of the disadvantages in the supply of health services, it has been suggested that it would be better – less expensive and more efficient - that certain social security funds, which have their own clinics, such as IKA, ‘buy’ health services at good prices and offer them to their beneficiaries. Certain efforts made by the government to that direction were, however, met with strong opposition by the management and the employees’ organizations, having reservations as to the ways of implementing this cooperation, or simply opposing the idea of surrendering their sovereignty. Our analysis has shown that appropriate staffing of hospitals and clinics should be a priority. Particularly pertinent is the increase in the ratio of general physicians over specialists, which at present is extremely low, and the setting into operation the institution of the ‘’family doctor’’. At the regional level, and in the framework of the recent Regional Health System, a more complete and balanced staffing with physicians and nurses is needed, safeguarding a necessary minimum of specialties in regional hospitals –recall that in Athens they are in surplus. This way, the large city hospitals, notably in Athens and Thessaloniki, would not be overcrowded by patients from all over the country. Particular attention should be given, in this respect, to the reformation of the IKA clinics – the major social security fund in the country – in all aspects of health care delivery, but more so in staffing and the accessibility of patients to the system without long delays and queues. According to a survey of the Greek National Center for the Quality of Life, concerning the satisfaction of patients with the NHS, half of the interviewees characterize as ‘’very bad’’ the cleanness of the hospitals and 39 per cent as ‘’very bad’’ the information offered inside the hospitals. Thirty-five per cent characterize the accessibility of the hospital health services as below average. Only 6.8 per cent is satisfied with the accessibility to these facilities (Medical Press, 1999). This forces several 168 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour people to resort to expensive health services abroad. According to an older opinion poll, 72.3 per cent of those hospitalized in Greece expressed their intention of going abroad (Douli et al, 1992). I believe that things have improved materially since then, so that the number of patients to seek hospitalization in other countries has decreased. This is indicated by an opinion poll, a couple of years ago, which showed that 85,9 per cent of the sample were satisfied with the standards of the private health services, as against 59.2 per cent with the NHS hospitals (Souliotis, 2000, p.260). Some of the more specific aspects of these inadequacies, detected by the Greek ombudsman concern great delays in medical appointments for planned nonemerging tests, both at the NHS hospitals and the IKA clinics The fact that all appointments are fixed for the same hour, results to a long waiting until one’s turn comes around, whereas absenteeism or delays in arrival of physicians in their posts are also witnessed. All these inefficiencies can explain why patients are resorting to private health care services. Poverty: There is no specific official definition of poverty for policy purposes in Greece, probably because there is no targeted policy for poverty per se. This notwithstanding, various measures addressed to different groups of people, such as the unemployed, the low educated, the low pension receivers, the large families, persons with disabilities or ex-prisoners, to mention only some, seem to cut across the poor segment of society, given that these are the groups with a high incidence of poverty in any way it may be conceived. As we have seen, the unemployed workers, particularly men, experience the highest risk of poverty along with retired women and people over 65 years of age. Several of the measures that, one way or another, may alleviate poverty offer passive relief assistance rather than constituting an active effort for helping the poor escape long-term poverty. On the side of active policies are the measures proposed by the link between the NAP for Employment and the NAP for Social Inclusion, offering a potential outlet from poverty. Measures related to education and training, or ‘’family friendly employment’’, such as the currently decided part-time employment openings in the public sector, favouring especially women, are pointing to this direction. How effective they would be remains to be seen, since until now no follow up studies exist to give some clues. One important corollary of our presentation is that the poverty line, defined on the basis of official statistics, leaves out some significant elements of income or wellbeing, which in a country as Greece are contributing to the standard of living of individuals and families. The non-inclusion of these 169 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour elements in the calculation of poor results in an overestimation of the extent of poverty computed from official statistics. Missing wellbeing elements of this category include self-consumption by the still high number of farmers; the high proportion of owner-occupied housing; probably the unregistered incomes from the extensive underground economy in Greece; and, finally, certain incomes from the seasonal and occasional employment in tourism. This situation is problematic both for knowing the extent of the true poverty in the country and for valid international comparisons with countries in which such sources of income or wellbeing are limited. EC has proposed for fighting poverty in Greece what seems to be the obvious to say but not so easy to implement, by suggesting that ‘’the major challenge lying ahead is to elaborate and implement specific policies to improve the interventions in the social protection area in favour of all those citizens at risk of social exclusion and poverty. Other major challenges are to promote the employment prospects of the most vulnerable population groups, given the link between unemployment and situations of poverty and social exclusion, and the need for a major pensions reform to safeguard pensions adequacy and sustainability in the long term’’ (EC, 2002, p. 104). In this framework, one must take seriously into consideration that Greece is moving rapidly towards the knowledge economy. New technologies have the power of restructuring the skill pattern of labour demand – rendering obsolete certain traditional skills - and of increasing productivity, but the bad news come first. The various inflexibilities in the Greek labour market and the educational system prolong the required restructuring of the labour force, as a result of which the response of supply is dragging behind the new labour demand. This process may hold back the positive effects of the new technologies and most probably postpone the ‘’eInclusion’’ process, with further implications on labour market mismatches, persisting unemployment and a slow moving exit from poverty. Any emerging low pay job opportunities for unskilled workers are filled by immigrants, since Greeks have relatively high reservation wages for this kind of jobs. They can afford this through the protective role of the family that finances the waiting during the search for good employment opportunities. The Greek government itself admits, in its Action Plan for Employment 2001, that ‘’despite the implementation of a plethora of measures for the labour market, unemployment and particularly the discrimination and inequalities in the labour market are sustained at high levels’’. 170 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour The increasing flow of immigrants in Greece has accumulated a disproportional number of foreign workers compared to the native workforce. This is particularly the case in certain depopulated and small areas of the country, e.g. islands. This concentration, although economically desirable, generates various cultural, religious and educational problems that may have potential serious implications on policies that aim at social inclusion and the strengthening of social cohesion (EC, 2002). The Commission has stressed that ‘’failure to develop an inclusive and tolerant society which enables different ethnic minorities to live in harmony with the local population of which they form part leads to discrimination, social exclusion and the rise of racism and xenophobia’’ (ibid. p. 23). Crime: Although overall criminal activity has dropped substantially in the very recent years, juvenile crime, e.g. robberies, body injuries and theft is in the rising in the large cities. Drugs are only a limited cause of this increase Youth with low education coming from unstable family environments and poor city neighbourhoods are mainly the criminal offenders. Organized crime has no deep roots in Greece and there is no network to operate through. Corruption exists in various departments of the Greek administration, some forms of which, such as trafficking of illegal immigrants and women for the purpose of prostitution, are connected to international networks. And yet, the knowledge concerning the extent of the various forms of corruption is still scanty, since there is no comprehensive study on the issue but only bits and pieces of evidence and popular belief. Efforts for fighting crime come from various directions, namely the EU; international cooperation; bilateral agreements between Greece and Central and Eastern European countries; and at the national level, the Greek legislation and the Greek police. Policies concern both the prevention of crime and the apprehension of criminals. Preventive measures with reference to youth are taken by the Ministry of Justice, while for the population as a whole, new police practices are introduced, including pedestrian police patrols and the ‘’neighbourhood policeman’’. The latter, in cooperation with local authorities, various local bodies and the citizens has the job of preventing light crimes and provide relief assistance to victims. The experience is still short to have any solid information on the effectiveness of these practices. The legalization of immigrants seems also to play some positive role in containing their criminal activity. Some important policy actions concern as much the courts, as the police and the prison system, all of which are characterized by major inefficiencies and need adjustment and reformation. Legal regulations have become recently 171 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour more severe for crimes committed by ‘’criminal organizations’’. A recent law (L. 2928/2001) is passed for expediting the prosecution of cases related to organized crime and terrorism. These cases are judged in the Court of Appeals by professional judges without jury. The heavy burden of cases to be processed, in conjunction with the inadequate staffing of the courts, make for a very slowly moving award of justice and a long waiting before cases come to the hearing. The prison system needs great reformation both in terms of improving its operational effectiveness and for preventing prisons overcrowded as they are - of becoming schools of crime and drug trafficking. In this respect, the idea of privatized prisons of the type already existing in France and England has been thrown on the table to be tried on a pilot basis. The proponents of this idea evoke the experience of good practice in these two countries. Apart from the comparatively lower cost of running these prisons, they are very effective in reforming prisoners, as evidenced by the fact that only 3 per cent of the discharged convicts from these prisons revert to criminal activity. Despite its potential benefits, this is an institution that, for reasons of trust, would probably be difficult to introduce in Greece. At the police level, new technologies, new training and new more systematic methods of investigation have made the police more effective in fighting crime and eradicating terrorism. Witness to this is the successful dismantling of the terrorist group 17N. This progress notwithstanding, there are still several technical and organizational inadequacies and practical malfunctioning to fix, so that police becomes up to date. A case in point is police corruption that should be dealt with the development and improvement of Internal Affairs, a service introduced in recent years in the Greek police. 172 FONDAZIONE CENSIS 11873_2002 6. Study D2: Poverty, Informal Sector, Health and Labour SOURCES AND DATA 6.1. Health Sources WHO, The World Health Statistics (annual) WHO, The World Health Report 2000: Health Systems, Improving Performance Ministry of Health and Welfare, Yearbook of Statistics on Health Ministry of Health and Welfare (various pieces of information) Ministry of Labour and Social Security, Social Budget (annual) [Data on number of beneficiaries, pensioners, social security agencies, expenditure on health and social welfare] NSSG, Social Welfare and Health Statistics (Series) NSSG, Annual Survey of Activities of Organizations of Social Security NSSG, Household Surveys Social Insurance Fund (IKA) Social Insurance Fund for Civil Servants Social Insurance Fund for Farmers (OGA) Various Surveys and Opinion Polls 173 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour Data Let me note, in a way of introduction, that the Greek data on health are inadequate or, in certain cases, unreliable or non-existed. As a consequence, the figures provided to European and international organizations, such as Eurostat or WHO, often cover a limited spectrum of statistical information, thence the blank spaces in data presentation. Category Population using adequate sanitation facilities Population using improved water resources Population with access to essential drugs Oral rehydration therapy use rate Contraceptive prevalence Births attended by skilled health staff Physicians (per 100, 000 people) Health expenditure per capita n.a.4 n.a. Undernourished people Children underweight of age (% under 5) Infants with low birth weight (%) People living with HIV/AIDS 15-49 years of age Malaria cases Tuberculosis cases (per 100,000people) Cigarette consumption per adult (annual average) Health expenditure, public (%GDP) Health expenditure, private (%GDP) n.a. n.a. Years Number 1999 95- 100 1990-02 2000 392 1,349 (PPP.USD) Proportion n.a. n.a. n.a. 1995-00 2001 1998 2001 1992-00 7.00 0.17 18 11 3,230 2000 2000 4.6 3.7 Source: U.N. Development Report: Greece 2003 (www.undp.org) NSSG, Household Survey, 1998/99 NSSG, Social Welfare and Health Statistics, 1997 (published 2001). 4 not available 174 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour 6.2. Poverty Sources NSSG, Household Surveys [This is the main statistical source, appearing at four to five years’ intervals, from which one can calculate income distribution and poverty, on the basis of income or expenditure. The figures given in this publication have some advantages of better accuracy compared to the European Community Household Panel (ECHP). This is because, as we maintained earlier, in a country like Greece, at least some of the incomes generated in the still considerable small agriculture and the related self-consumption, the seasonal employment of farmers and the incomes in the significant unregistered economic activity, as well as the value of the high owneroccupied housing, are calculated in the Greek Household Survey but not in the European.] Ministry of Finance, Internal Revenue Service [The taxation figures of the Internal Revenue Service can and, on occasion, have been used in research on income distribution and poverty. However, using these data, one runs the risk of getting a gravely distorted picture of income distribution and poverty due to the high income tax evasion of the more wealthy people.] Eurostat, European Social Statistics: Income, poverty and Social Exclusion, Luxembourg, EC Eurostat Task Force, Recommendations on Social Exclusion and Poverty Statistics, CPS 98/31/2, December 1998, Eurostat, Luxembourg, 1998. 175 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour Data Category Human poverty index (HPI) value Probability at birth of not surviving to age 60 (% cohort) Adult illiteracy rate (% age 15+) % of population not using improved drinking water sources Underweight children under age-five Population below income poverty line -50% definition-(%) Human poverty index rank People who are functionally illiterate Long-term unemployment (as % of labour force) Year Figures 2000-05 2001 9.1 2.7 1998/99 11.2 2002 5.1 n.a. n.a. n.a. n.a. n.a. Sources: U.N. Human Development Report, 2003. NSSG, Labour Force Survey, 2002 (www.statistics.gr) 6.3. Crime Sources Ministry of Public Order, Statistical Yearbook [Criminal statistics, police statistics, statistics on foreigners]. Juvenile Tribunal of Athens [Data on juvenile delinquency and crime] Ministry of Justice, Supervisor Services for Adolescence). [It provides figures on adolescence criminal activities, the number of cases and the causes of adolescence deviant behavior.] 176 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour Data Category Police Offenses Committed crimes indictable offenses Prosecution Number of cases presented for trial (Administrative courts) Courts Decisions issued Persons sentenced (For indictable offenses or crime) Prison Accommodating capacity of prisons (1/1/2001) Number of prisoners Prisoners pending trial Foreign prisoners Juvenile Crimes Property crimes (see table 8) Robbery Sexual assault Assault Bribery (corruption) Proportion per 100,000 Population Year Figures 1999 1999 1999 373,680 4,994 368,686 3,809 51 3,758 1996 214,147 2,185 1996 1996 72,228 88,974 737 908 4,825 # # # # 8,295 2,296 3,783 570 # # # n.a. Sources: NSSG, Statistical Yearbook for Greece, 2001 (published 2002). 177 FONDAZIONE CENSIS 7. STATISTICAL ANNEX Table A1. Population of Greece by sex and age, 2001 Age brackets 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90-94 95-99 100+ Total Population Both sexes 531,636 547,241 588,011 728,440 834,026 843,609 871,496 784,426 781,319 711,697 684,288 553,901 630,687 615,964 547,672 337,373 195,493 114,571 45,047 11,944 5,179 10,964,020 Age Composition (%) 4.8 5.0 5.4 6.6 7.6 7.7 7.9 7.2 7.1 6.5 6.2 5.1 5.8 5.6 5.0 3.1 1.8 1.0 0.4 0.1 0.05 100.0 Source: Greek Census of Population, 2001 Males 272,548 281,642 306,528 382,115 436,128 436,427 443,413 393,477 388,232 356,192 338,540 272,177 299,755 291,567 246,413 143,230 76,444 43,813 16,594 4,385 2,196 5,431,816 Females 259,088 265,599 281,483 346,325 397,898 407,182 428,083 390,949 393,087 355,505 345,748 281,724 330,932 324,397 301,259 194,143 19,049 70,758 28,453 7,559 2,983 5,532,204 Table A2 - Population in Greece by Country of Citizenship Country of citizenship Both sexes Total population 10,964,020 5,431,816 5,532,204 Greek citizenship Greek and other (double) Australia Georgia USA Canada Cyprus Ukraine Russian federation Rest of the world 10,077,722 89,207 8,699 8,666 13,314 7,111 3,280 3,083 9,507 35,547 4,955,613 39,796 4,020 4,070 6,146 3,351 1,457 1,027 4,207 15,518 5,122,109 49,411 4,679 4,596 7,168 3,760 1,823 2,056 5,300 20,029 796,713 443,550 37,230 15,303 23,159 22,507 15,308 19,084 14,149 11,192 13,378 23,066 18,219 8,297 6,861 7,846 7,808 9,677 6,513 7,409 7,188 7,953 6,909 5,898 5,638 52,571 436,225 261,502 15,058 6,525 9,980 11,013 6,450 9,031 3,633 10,703 6,140 13,176 6,901 4,338 1,942 6,087 3,648 4,580 2,733 6,876 5,062 3,962 3,337 1,799 4,464 27,285 360,488 182,048 22,172 8,778 13,179 11,494 8,858 10,053 10,516 489 7,238 9,890 11,318 3,959 4,919 1,759 4,160 5,097 3,780 533 2,126 3,991 3,572 4,099 1,174 25,286 Foreign Citizenship Albania Bulgaria Germany Georgia USA United Kingdom Cyprus Ukraine Pakistan Poland Rumania Russian Federation Turkey Philippines Egypt Armenia Australia France India Iraq Italy Canada Moldavia Syria Rest of the world Source: NSSG, Census of Population, 2001 Males Females Table A3 - Activities of the Neighborhood Policeman in the Region of Attica in Greece, during the period 17.3-30.5.2003) Action Taken Communication with representatives of Local Authorities, Associations, Institutes, Organizations and other bodies and citizens Response to requests by various bodies and citizens Cooperation with pedestrian and riding police patrols Intervention in cases of offenses and conduct with victims Interventions or assistance in various occurrences Participation in local events Direct intervention in other Services, public and private Organizations or public enterprises Reports on problems in neighborhoods, with actions taken and results Cases of intervention from the office Cooperation with Psychologists and Social Workers Source: Ministry of Public Order (www.ydt.gr/main/Article.jsp?) Number of Cases 31,550 2,493 919 856 828 455 270 165 123 66 Table A4 - Incidence of Poverty (Percentage of people below the poverty line of corresponding categories) Household Head Characteristics 1982 Incidence of poverty (%) 1988 1994 Education Tertiary Secondary Primary Not-completed Primary 4.2 9.6 29.1 38.0 5.1 9.6 29.4 39.5 7.7 13.6 28.4 40.8 Age Under 24 25-34 35-44 45-54 55-64 65-74 75+ 7.7 25.4 27.6 23.3 21.3 26.8 37.5 4.2 22.2 24.6 22.5 21.0 29.1 38.6 14.2 19.5 27.2 22.1 23.5 25.7 35.0 Occupation Scientists and Executives Office Clerks Farmers Blue collar workers Not employed 7.5 11.5 40.4 27.6 24.4 8.5 11.0 41.5 24.6 27.1 19.0 16.2 36.3 26.4 24.7 Source: Adapted from Sarris and Zografakis, 1997 11873_2002 8. Study D2: Poverty, Informal Sector, Health and Labour ESSENTIAL BIBLIOGRAPHY General Clogg Richard, (2003). ‘Greece’ Microsoft ® online Encyclopedia 2003 (http: //Encarta.msn.com) GRECO, Council of Europe, 17.5.2002. Kathimerini, 20.6.2003 Kathimerini, 21.6.2003 (original source: Bank of Greece) Ministry of Economics and Finance, National Accounts Statistics (various issues) Ministry of Economics and Finance, National Accounts Statistics (www.statistics.gr tables/S900). National Statistical Service of Greece (NSSG), Labour Force Survey (various issues) NSSG, Census of Population, 2001 Health Douli A, B. Kyritsis, N. Polyzos and N. Christopoulou (1992). ‘’Demand for Health Services Abroad’’, Health Review, vol.3, No. 2, March-April, Athens (in Greek). ΕΚΠΟΙΖΩ (1999). ‘’The Satisfaction from the Health Services in Greece’’. Medical Press, No. 211, January, Athens (in Greek). European Commission (2002). Joint Report on Social Inclusion. Employment and Social Affairs, Social Security and Social Integration, European Commission, Belgium. Georgoussi E. Kyriopoulos G. and Bearoglou (Editors) (2000). Society and Health, Themelio, Athens (in Greek). ICAP (1999). Sectoral Studies: Private Health Services, Athens, February (in Greek). 183 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour Kathimerini, 22.6.2003 Kyriopoulos G. and Geitona M. (1995). The Crossborder Flow of Patients in Greece and Europe, Exantas, Athens (in Greek). Medical Press , January 1999 (in Greek) (no author) Ministry of Health (1999). Health Care in Greece, Athens. Ministry of Health and Welfare (2001). National Action Plan: HealthWelfare. 3rd Community Support Framework, 2000-2006, Athens (in Greek). Ministry of Health and Welfare (2003). Health, Health Care and Welfare in Greece, Report, Athens. Niakas D. (1994).‘’The Health Policy in Greece and the Suggestions of the Foreign Experts’ Committee’’. In Society, Economy and Health, vol.3, No. 3, July-September. (in Greek). NSSG, Household Survey, 1998/99 NSSG, Social Welfare and Health Statistics, 1997 (published 2001). Review on Health (2003).( Various articles – no authors), March-April (in Greek). Soulis S. (1998). Economics of Health, Papazissis, Athens (in Greek). Souliotis K. (2000), The Role of Private Sector in the Greek Health System. Papazissis, Athens.(in Greek). Themelion (publisher) Health Policy in Greece: At the cross-road of choices (no author, no date) (in Greek). Theodorou, M. (1993). “Primary Health Care in IKA: A Comparative Investigation of two Types of Organising the Family Doctor”, IMOSY (in Greek). Theodorou M, M. Sarris and S. Soulis (1996). Systems of Health and the Greek Reality, Athens (in Greek). Tountas, John (2003). ‘’Primary Health Care at a Critical Crosssroad’’. Eleftherotypia (daily newspaper), 21.2.2003. U.N. Development Report: Greece 2003 (www.undp.org) 184 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour Poverty Berg A. and a. Krueger (2002). ‘’Lifting All Boats: Why Openness Helps Curb Poverty’’. Finance and Development, September. Case, Anne and Angus Deaton (2003), Consumption, Health, Gender and Poverty, World Bank Policy Research, Working Paper 3020, Washington DC, April. Chryssakis M. (1999). ‘’Social Exclusion and Educational Inequalities ‘In Karantinos et al. (in Greek). Economic and Social Committee (OKE) (2000). Poverty in Greece, Report, Athens, 13 July (in Greek). ESSPROS (European System of integrated Social Protection Statistics). European Commission (2002). Joint Report on Social Inclusion. Employment and Social Affairs, Social Security and Social Integration, European Commission, Belgium. Eurostat (2000), August. (www.in gr/news,2000/Greece). Glytsos, Nicholas P. and C. Kanellopoulos (1999).Aspects of Inequality and Poverty in Greece: Conceptual Approaches and Measurement. Report on behalf of the Femise Project on Poverty, Athens, November, mimeo Glytsos, Nicholas P. and Louka T. Katseli, (2003). “Greek Migration: The Two Faces of Janus”. In K.F.Zimmermann (editor), European Migration: What Do We Know? , Oxford University Press (forthcoming. Greek National Action Plan (NAP) for Fighting Poverty and Social Exclusion, Athens Kanellopoulos, C. (Coordinator) (1999). Distribution, Redistribution and Poverty, KEPE, Athens, December (in Greek), mimeo. Karantinos D, I.Maratou-Alipranti, and E. Fronimou (Editors) (1999). Dimensions of Social Exclusion in Greece: Main Issues, vols I and II, Athens, EKKE, Second Edition (in Greek). Kathimerini, 3.7.2002; 20.11.2002; 24.7.2003. Katsejopoulou M. and N.Bouras (1999). ‘’Labour Market Function and Social Exclusion’’. In Karantinos et al. (in Greek). 185 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour Lusting Nora and N. Stern (2000). ‘’Broadening the Agenda for Poverty Reduction: Opportunity, Empowerment, Security’’. Finance and Development, IMF, December. Micklewright John (2002). Social Exclusion and Children: A European View for a US Debate. Innocenti Working Papers, No.90, Unicef, February. Ministry of Health and Welfare (2001), National Action Plan for Social Inclusion Ministry of Health and Welfare (2001). National Action Plan: HealthWelfare. 3rd Community Support Framework, 2000-2006, Athens (in Greek). Ministry of Labour and Social Security (2001) National Action Plan for Employment Ministry of Labour and Social Security (2003). Draft National Action Plan for Employment Mitrakos T. and P. Tsakloglou (2000), ‘’Changes in Total Inequality and Poverty in Greece, after the Restoration of Democracy’’’. In EMOP (in Greek). Nolan B. (1999).’’Targeting Poverty: Lessons from Ireland on Setting a National Poverty Target’’. New Economy, 6(1): 44-49. NSSG, Labour Force Survey, 2002 (www.statistics.gr) Rodrik Dani (2000). ‘’Growth versus Poverty Reduction: A Hollow Debate’’. Finance and Development, IMF, December Rowlands D. (1998), ‘’Poverty and Environmental Degradation as Root Causes of International Migration: A Critical Approach’’. In UN-IOM, Technical Symposium on International Migration and Development. The Hague, 29 June. Sarris A. and zografakis S. (1997). ‘’Poverty and Income Inequality in Greece after the Restoration of Democracy’’. Paper presented at the 5th Colloquy of IMOP (in Greek), mimeo. The Nea, 17.10.2000. Tsakloglou P. and G. Panopoulou (1998), ‘’Who are the Poor in Greece: Analysing Poverty under Alternative Concepts of Resources and Equivalence Scales’’, Journal of European Social Policy, 8, pp.229-252. U.N. Human Development Report, 2003. 186 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour Workshop of Economic Policy Studies (EMOP) (2000). The Redistributive Role of the State in Greece, No. 5 (in Greek). World Bank (2001). World Development Report 2000/2001: Attacking Poverty, Washington DC. World Bank (2002). Globalisation, Growth and Poverty, A World Bank Policy Research Report, Washington, DC. www.in gr/news, 2000/Greece Crime Eleftherotypia, 14.3.1998; 5.4.2000; 5.11.2000 Ethnos, 25.10.2000 europa.eu.int/smartapi/cgi/sga_doc GRECO (Group of States against corruption), Council of Europe, Evaluation Report on Greece, Strasbourg, 17.5.2002. Kathimerini, 25.4 1998; 19.5.2002; Ministry of Public Order (www.ydt.gr/main/Article.jsp?) Ministry of Public Order, Crime Statistics (http://www.ydt.gr/main). NSSG, Statistical Yearbook for Greece, 2001 (published 2002). Pontiki, 9.9.1999. Sutherland, P. D. (2002). “Why We Should Embrace Globalisation”, Finance and Development, September. The Nea, 18.12.1999. U.N. Office of Drugs and Crime, Seventh U.N. Survey of Crime Trends and Operations of Criminal Justice Systems, Covering the Period 1998-2000. http://ministryofjustice.gr/modules.php? http://www.patris.gr/archive/99/10/23/1 stpage.html http://www.petsalnikos.gr/delt 130503.htm http://www.prin.gr/561/561_18.htm http://www.medium.gr/articles 187 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour http://www.e-grammes.gr/ideology/immigration.htm http://ta-nea.dolnet.gr/neaweb/ www.ydt.gr/main/Article.jsp?Article www.onned.gr/Text/politikh.doc www.presspoint.gr/release.asp?.id=18619 www.unodc.org/unodc/index 188 FONDAZIONE CENSIS ITALY Dr. Rosario Sapienza Dr. Marta Picarozzi 11873_2002 1. Study D2: Poverty, Informal Sector, Health and Labour PROFILO DEL PAESE: DATI ESSENZIALI 1.1. Popolazione La popolazione italiana al 1 gennaio 2001 conta 57.844.017 persone, di cui 29.749.160 femmine e 28.094.857 maschi. L’Italia è oggi il Paese con l’indice di vecchiaia più alto del mondo (133 persone di 65 anni e oltre ogni 100 persone sotto i 15 anni). Quasi un italiano su cinque ha più di 65 anni (il 18,5% della popolazione). La popolazione con meno di 15 anni rappresenta soltanto il 14,4% del totale (Istat). Secondo stime Eurostat, l’indice di accrescimento della popolazione italiana è nel 2001 del 3 per mille. La presenza degli stranieri in Italia è in crescita. Tuttavia, rispetto agli altri paesi dell’Unione Europea, la popolazione straniera residente in Italia, che conta 1.464.589 persone, rappresenta ancora una quota poco rilevante della popolazione (2,5% nel 2001 rispetto alla media europea del 5,2). Il tasso di natalità del 2001 è del 9,4 per mille mentre quello di mortalità del 9,3. Il numero medio di figli per donna è in diminuzione e questo calo della riproduttività risulta agli studi come un fenomeno di lungo periodo, il più radicato fra tutti i Paesi sviluppati, associato alla progressiva posticipazione del momento del primo parto nella vita media delle donne. L’età media delle madri alla nascita del primo figlio è, infatti, di oltre 27 anni (Istat). Nel 2001, secondo stime Eurostat, il numero medio di figli per donna è di 1,24, con livelli leggermente più elevati al Sud Italia e più bassi al Centro e al Nord Italia. Il tasso di mortalità infantile, relativo al primo anno di vita, è del 4,3 per 1000 nati vivi. La speranza di vita alla nascita ha raggiunto quasi i 77 anni per gli uomini e 83 per le donne, senza grandi differenze a livello regionale. Il legame tra nuzialità e riproduttività è ancora molto forte, oltre il 90% dei figli nasce ancora all’interno del matrimonio (Istat). Le unioni coniugali sono instabili: ogni anno, ogni quattro matrimoni celebrati viene pronunciata una sentenza di separazione e sono quasi 2,5 milioni gli italiani che hanno sperimentato nel corso della loro vita lo scioglimento del 190 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour matrimonio (Istat, 2001). Il numero di famiglie è aumentato negli ultimi anni (sono quasi 22 milioni nel 2001, secondo l’Istat), sebbene le loro dimensioni si stiano riducendo (2,6 componenti in media). 1.2. Economia e lavoro I dati sull’economia italiana nel 2001 rispecchiano l’andamento negativo del ciclo economico mondiale e in particolare dei Paesi più industrializzati. La crescita del Prodotto interno lordo nel 2001 è dell’1,8%, mentre quella del 2000 era stata del 2,9%. La crescita dell’agricoltura nel 2001 è negativa, 1%, mentre l’industria cresce dello 0,5% e i servizi del 2,5% (Istat). L’andamento dell’inflazione in Italia ha risentito della conversione dei prezzi dalla lira all’euro, la moneta unica europea entrata in circolazione nel gennaio del 2002. In base a stime Eurostat, il tasso di inflazione è stato del 2% nel 1998, 1,7% nel 1999, 2,6% nel 2000 e 2,3% nel 2001, mentre secondo l’Istat è stato del 2,5% nel 2000, 2,7% nel 2001 e 2,5% nel 2002. Tuttavia, l’inflazione percepita dagli italiani e le stime delle associazioni dei consumatori sono di molto superiori alle stime ufficiali. Il rallentamento della congiuntura internazionale ha prodotto nel 2001 una battuta d’arresto del commercio internazionale. Le esportazioni, dopo l’eccezionale incremento del 17,8% registrato nel 2000, sono cresciute nel 2001 solo del 3,6%. Le importazioni sono invece cresciute nello stesso anno dello 0,6%, un valore modesto grazie soprattutto al calo dei prezzi dei prodotti energetici. L’ammontare delle esportazioni nel 2001 è di 269.634 milioni di euro, mentre l’ammontare delle importazioni è di 260.162 milioni di euro. Il saldo tra esportazioni e importazioni è quindi positivo e ammonta a 9.472 milioni di euro. Lo stesso dato nel 2000 era di 1.852 milioni di euro e nel 1999 di 14.679 milioni di euro (Istat). La pressione fiscale nel 2002 è pari al 41,6% del prodotto interno lordo (Istat). 191 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour 1.3. Geografia e caratteristiche territoriali L’Italia è una penisola di 301.333 Kmq, con una estensione massima di 1.200 Km. Il 35% del territorio è montagnoso e il 42% collinare. Gran parte del territorio è bagnata dal mare e l’estensione delle coste marine è pertanto molto elevata, 7.375 Km, di cui il 65,7% balneabile. Da un punto di vista amministrativo, l’Italia si divide in 20 regioni, 103 province e 8.100 comuni. La densità media della popolazione è di 192 abitanti per Kmq. Le città più popolose sono Milano (4.251.000 abitanti), Napoli (3.012.000 abitanti), la capitale Roma (2.646.000 abitanti) e Torino (1.294.000 abitanti). La superficie forestale è di 68.475 Kmq. Il patrimonio boschivo, che nel 2000 è di 6.853 migliaia di ettari, è ubicato per il 59,4% in montagna, per il 35,5% in collina e per il 5,1% in pianura. La superficie italiana ad alta sismicità è pari a 14.463 Kmq, quasi il 23% della superficie totale. A luglio 2000, le aree protette iscritte nell’Elenco ufficiale risultano 669 con un’estensione territoriale pari a 3.013.944 ettari. Il clima in Italia è generalmente temperato. Solo raramente si hanno temperature più alte di 40 gradi centigradi d’estate, o temperature inferiori ai 10 gradi sotto lo zero d’inverno. Essendo molto estesa da Nord a Sud, l’Italia può essere divisa in tre fasce climatiche distinte: a) il Nord, ovvero la parte compresa tra le Alpi e l’Appennino Tosco-Emiliano, è la zona meno influenzata dall’azione temperante del mare e ha un clima molto rigido d’inverno, mentre l’estate è molto calda e con alti livelli di umidità; b) il Centro, compreso approssimativamente tra la Liguria e Roma, ha un clima temperato, che non presenta grandi differenze tra le stagioni estreme, anche se si può passare da un inverno piuttosto rigido ad una stagione estiva molto calda; c) il Sud (che comprende anche le isole maggiori, la Sicilia e la Sardegna) ha un clima 192 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour secco e generalmente caldo, con scarse precipitazioni e periodi di vera e propria siccità. Il Mediterraneo ha una grande influenza sul clima italiano: le zone costiere sono meno calde durante l’estate e meno fredde durante l’inverno rispetto alle zone interne. Le differenze climatiche contribuiscono ad aumentare le differenze socioeconomiche nelle tre aree della penisola. I minerali di cui l’Italia è ricca sono mercurio, potassio, marmo e zolfo. Nel 2000 le riserve di greggio ammontano a 621,8 milioni di barili. La produzione di energia elettrica è di 247.679 milioni di kWh nel 2001. La quota di produzione interna di energia rispetto all’offerta totale, necessaria a soddisfare le esigenze del paese, è più limitata che negli altri paesi europei. Nel 1990 la quota di produzione di energia sull’offerta totale di energia primaria è del 16,2%, all’incirca uguale a quella del 1999 (16,4%). La produzione in Italia di energia da fonti rinnovabili costituisce il 38% circa della produzione totale. I risultati di un’indagine Istat sulle famiglie nel 2001 mostrano come i problemi ambientali maggiormente sentiti dalle famiglie sono il traffico (47,6%), la possibilità di bere acqua dal rubinetto (42,0%), la difficoltà di parcheggio (41,6%), l’inquinamento dell’aria (39,9%) e il rumore (38,5%). Minore rilevanza viene data ad aspetti quali la sporcizia nelle strade (33,8%), il rischio di criminalità (30,8%) e le difficoltà di collegamento con i mezzi pubblici (30,9%), mentre l’irregolarità nell’erogazione dell’acqua viene considerato un problema dal 16,3% delle famiglie. Quest’ultimo fenomeno è molto più diffuso nel Mezzogiorno ed in particolare in Calabria (51,1%), Sardegna (42,8%) e Sicilia (39,6%). 1.4. Temi chiave La bassa fecondità e l’invecchiamento della popolazione espongono l’Italia a grandi rischi per quanto riguarda la sostenibilità dei sistemi di welfare e in particolare di quelli pensionistici. L’economia è specializzata in settori a basso contenuto tecnologico. Le imprese sono scarsamente propense a una crescita di dimensioni e hanno spesso una visione locale del mercato. Il Sud Italia versa ancora in grandi difficoltà rispetto al resto del Paese, nonostante alcuni segnali positivi in anni recenti come una riduzione del tasso di disoccupazione e una crescita del Pil superiore alla media nazionale: le migrazioni verso il Centro-Nord del paese sono ricominciate e 193 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour la quota di disoccupati di lunga durata è sensibilmente più alta rispetto al resto d’Italia. Si possono notare alcuni segnali positivi quali la vitalità delle piccole e medie imprese e lo sviluppo dell’occupazione femminile, che ha trainato il mercato del lavoro. 1.5. Fonti - Censis, 36° Rapporto sulla situazione sociale del Paese 2002, (www.censis.it) - Istat, Annuario Statistico Italiano 2002 (www.istat.it) - Istat, Italia in cifre 2002 (www.istat.it) - Istat, Rapporto annuale sulla situazione del Paese 2002 (www.istat.it) - Istat, Relazione Generale sulla Situazione Economica del Paese (www.istat.it) - Eurostat (europa.eu.int/comm/eurostat) - Istituto Tagliacarne (www.tagliacarne.it) - Nucleo di valutazione spesa previdenziale (www.welfare.gov.it) 194 FONDAZIONE CENSIS 11873_2002 2. Study D2: Poverty, Informal Sector, Health and Labour HEALTH 2.1. Definitions Secondo l’Art. 32, la Repubblica Italiana tutela la salute come fondamentale diritto dell’individuo e interesse della collettività, e garantisce cure gratuite agli indigenti. Al di là di questo presupposto generale la legislazione in ambito sanitario è estesa e in continua evoluzione perché rincorre i cambiamenti che si susseguono in campo medico e nella ricerca scientifica i quali arrivano a mutare ruoli e contesti tradizionali, implicano maggiore attenzione al rapporto medico paziente e aprono sempre nuovi interrogativi sul diritto universale alla Salute. 2.2. Policy and Legislation Le principali leggi che attualmente ordinano la materia sono: Legge 23.12.1978, n. 833 Istituzione del servizio sanitario nazionale Riordino della disciplina in materia sanitaria, a norma D. Lgs. 30.12.1992, n. 502 dell’articolo 1 della legge 23 ottobre 1992, n. 421. Razionalizzazione della organizzazione delle amministrazioni pubbliche e revisione della disciplina in Decreto Legge 03.02.1993, n. 29 materia di pubblico impiego a norma dell’art. 2 della legge 23 ottobre 1992, n.421. Modificazioni al Decreto Legislativo 30.12.1992 n. 502 D. Lgs. 07.12.1993, n. 517 recante riordino della disciplina in materia sanitaria, a norma dell’art. 1 della Legge 23.10.1992 n. 421. Norme per la razionalizzazione del Sistema Sanitario D. Lgs. 19.06.1999, n. 229 Nazionale, a norma dell’art. 1 della legge 30.11.1998, n. 419 (riforma Bindi). D. Presidente consiglio dei Definizione dei livelli essenziali di assistenza. Ministri 29.11.2001 Piano sanitario nazionale 2002Presentato al Consiglio dei Ministri il 28/03/2002 2004 Approvazione del Piano Sanitario Nazionale 2003-2005 D.P.R. 23/05/2003 (G.U. n. 139 del 18/06/2003). 195 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour 2.3. Fonti - Istat, Indagine Multiscopo (www.istat.it) - Istat, Stili di vita e condizioni di salute, anno 2001 (www.istat.it) - Istat, Sistema sanitario e salute della popolazione, anno 2002 (www.istat.it) - Istituto Superiore di Sanità (www.iss.it) - Ministero della Salute (www.ministerosalute.it) - Farmindustria (www.farmindustria.it) 2.4. Dati In base a un’indagine effettuata dall’Istat, il 74,9% della popolazione italiana dichiara nel 2001 di essere in buona salute, mentre il resto della popolazione è affetto da una o più malattie croniche. Rispetto al totale dei cronici, il 19,1% di essi è affetto da artrosi o artrite, l’11,7% da ipertensione, l’8,2% da malattie allergiche. Sono invece scarsamente diffusi il diabete (3,9% dei malati cronici), le malattie del cuore (3,7%) e i disturbi nervosi (4%). Oltre il 90% della popolazione con meno di 35 anni e oltre il 50% di quella con meno di 65 anni è in stato di buona salute. La fascia di età compresa tra i 65 e i 74 anni è in buona salute per il 43,3% mentre oltre i 75 anni la percentuale di persone in buona salute scende al 27,5%. La percentuale di uomini in buona salute è superiore in media di quasi 7 punti percentuali a quella delle donne e questa differenza tra i sessi è più accentuata nelle fasce di età più elevate. Secondo l’Istituto Superiore di Sanità, nel 2001 i casi notificati di Aids in Italia sono 2,9 ogni 1000 residenti, più al Nord e al Centro Italia (3,6) rispetto al Sud (1,4). Dal 1995 (in cui ogni 1000 residenti si avevano 9,6 casi) ad oggi i casi sono costantemente diminuiti. 196 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour La causa principale di decessi è attribuibile alle malattie del sistema circolatorio (41,6 decessi ogni 10.000 abitanti nel 2000), seguita dai tumori (27,7 decessi ogni 10.000 abitanti). Tutte le altre cause di decesso provocano meno di 6,5 decessi ogni 10.000 abitanti. I dati riguardanti i decessi a causa di malattie del sistema circolatorio e di tumori sono rimasti sostanzialmente invariati negli ultimi sei anni. In Italia esistono 778 istituti di cura pubblici e 530 istituti accreditati che, rispettivamente, hanno a disposizione 236.308 e 51.317 posti letto, 5,05 ogni 1.000 abitanti (dati del Ministero della Sanità, 2001). Il numero più elevato di posti letto si registra al Centro Italia (5,51 ogni 1.000 abitanti) e il più basso al Sud (4,41). Il Sud dispone tuttavia di un numero più elevato di strutture sanitarie pubbliche diverse dagli ospedali, 4.036, rispetto al Centro (3.399) e al Nord (3.472). Sempre secondo i dati del Ministero della Sanità, nel 2001 ogni medico generico aveva 1.065 adulti residenti e ogni pediatra 1.075 bambini in cura, con differenze scarsamente rilevanti tra le aree geografiche del paese. Secondo dati Farmindustria, la spesa farmaceutica pubblica e privata in Italia nel 2001 ammonta a 296.805 milioni di euro ed è in crescita (nel 1999 era di 247.726 milioni di euro e nel 2000 di 264.460 milioni di euro). 2.5. Phenomenology «Più mercato e meno Stato» è lo slogan che, dalla seconda metà degli anni Ottanta, accompagna anche in Italia una radicale rivisitazione della Pubblica Amministrazione. L’Italia è attualmente in una fase di drastico ridimensionamento delle spese sanitarie per ridurre il debito pubblico. L’orientamento liberista ha però in Italia un profilo meno esplicito che nel mondo anglossassone. Il ripensamento nei confronti del vecchio “Stato sociale” si è soprattutto concentrato a ridurre le disfunzioni ed anche le degenerazioni del sistema politico che sono culminate negli scandali della fase di Tangentopoli nella prima metà degli anni ‘90. La spinta a contenere la spesa e a correggere alcune involuzioni gestionali trova in Italia una mai risolta esigenza di riforme che dalla prima metà degli anni ‘90 hanno affrontato le principali questioni lasciate irrisolte dalla Legge 197 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour n. 833, che nel 1978 aveva istituito il Servizio Sanitario Nazionale (SSN). Tali questioni possono essere così riassunte: - il problema di separare le funzioni di finanziamento e di programmazione da quelle di gestione e di organizzazione dei servizi; - la regionalizzazione della spesa; - l’incremento di un sistema misto, attraverso la creazione di Aziende Sanitarie Locali (ASL) in competizione tra loro e con le strutture private accreditate; - l’introduzione del sistema di rimborso più funzionale e meno oneroso da parte degli utenti; Tali argomenti, delicati e difficili da risolversi, sono inseriti in un contesto politico e legislativo instabile e contraddittorio, soprattutto per quel che riguarda i rapporti tra pubblico e privato, e in un quadro di drastica contrazione delle risorse pubbliche per la salute. La Legge 502/1992 segna, ad esempio, il passaggio da un diritto alla tutela della salute costituzionalmente garantito a un diritto finanziariamente condizionato. A partire dalla riforma del 1992 la spesa diventa una variabile indipendente (stabilita annualmente dal Governo in funzione delle compatibilità economiche e finanziarie del Paese), mentre i bisogni di salute rappresentano una variabile dipendente. Alle nuove Aziende Sanitarie Locali (ASL) viene affidato il compito di garantire anzitutto il pareggio del bilancio, a prescindere dai risultati di salute degli assistiti. Il metodo delle risorse definite ex ante produce una inevitabile e costante riduzione dei fondi a disposizione e il finanziamento pubblico risulta decisamente sottostimato rispetto al fabbisogno. Per quanto riguarda il rapporto tra pubblico e privato, la competizione è affidata a un modello di accreditamento delle strutture private debole, svincolato dalla programmazione, ancorato ai soli criteri quantitativi; sul versante pubblico, essa fa perno sulla separazione degli ospedali dalle aziende territoriali e sulla loro trasformazione in aziende ospedaliere autonome, le cui prestazioni sono pagate secondo tariffe prestabilite. È il primo passo verso la separazione tra la funzione di programmazione e di tutela della salute e la funzione di erogazione delle prestazioni. La concorrenza tra aziende pubbliche e strutture private accreditate non è 198 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour compiuta ma risulta fittizia perché chi finanzia, ovvero rimborsa la struttura pubblica e quella privata accreditata, è alla resa dei conti sempre il Servizio Sanitario Nazionale. In definitiva, il mercato sanitario è un mercato assistito in cui non esiste un vero e proprio rischio d’impresa. Altro aspetto problematico, l’organizzazione dei servizi privilegia le strutture ospedaliere piuttosto che la prevenzione, la medicina di base, la riabilitazione, e più in generale tutti i servizi territoriali (salute mentale, cura tossicodipendenze, consultori familiari, assistenza a persone portatrici di handicap, ecc.). Anche sul versante della spesa i tentativi di riforma sono tutt’altro che «virtuosi» e, insieme al drastico sottofinanziamento della Sanità, comportano un aumento considerevole dei deficit delle Regioni. Anche la regionalizzazione del sistema procede in modo del tutto insoddisfacente, pur essendo la Sanità il terreno più avanzato di autonomia organizzativa e gestionale. La maggiore autonomia locale produce conflittualità a tutti i livelli: tra Regioni e Comuni, perché i sindaci non hanno alcuna voce in capitolo sulle scelte regionali; tra Governo centrale e Governi regionali, impegnati soprattutto in una estenuante contrattazione delle risorse sempre più scarse. Le Regioni procedono in ordine sparso e il Ministero non ha né strumenti efficaci di verifica e controllo sullo stato di attuazione del processo di riordino, né poteri per sanzionare i ritardi e le omissioni. Ad esempio, dal 1988 al 1996, la maggioranza delle Regioni ha utilizzato poco o male i fondi per l’edilizia sanitaria e il Ministero non aveva strumenti per sanzionare i ritardi. Si accentuano il divario tra Nord e Sud del Paese e le disuguaglianze nelle opportunità di cura. Si impone l’esigenza di correggere le ambiguità e le contraddizioni di un modello di aziendalizzazione e regionalizzazione che rischia di aggravare il debito senza migliorare la qualità. La Sanità italiana si trova oggi davanti a un bivio: abbandonare il sistema universalistico, sostituendolo con forme assicurative private più o meno estese, o rafforzare il SSN e gli strumenti di governo del sistema. 199 FONDAZIONE CENSIS 11873_2002 3. Study D2: Poverty, Informal Sector, Health and Labour POVERTY 3.1. Definitions Sono molti gli strumenti forniti dalla Costituzione della Repubblica Italiana a sostegno delle politiche contro la povertà e l’esclusione sociale: Articoli 1, 4, 35, 36, 37, 38, 39, 40 per il diritto al lavoro Articoli 29, 30, 31 - diritti della famiglia, matrimonio, tutela genitoriale, maternità, l’infanzia e la gioventù Articoli 3, 37, 38, per le pari dignità sociali ed i diritti di pari opportunità per categorie svantaggiate Articoli 34, diritto all’istruzione E’ probabilemte l’Articolo 3 quello che più incarna il principio ispiratore delle politiche di welfare e di inclusione sociale : “Tutti i cittadini hanno pari dignità sociale e sono eguali davanti alla legge, senza distinzione di sesso, di razza, di lingua, di religione, di opinioni politiche, di condizioni personali e sociali. È compito della Repubblica rimuovere gli ostacoli di ordine economico e sociale, che, limitando di fatto la libertà e l’eguaglianza dei cittadini, impediscono il pieno sviluppo della persona umana e l’effettiva partecipazione di tutti i lavoratori all’organizzazione politica, economica e sociale del Paese.” 3.2. Policy and Legislation Anche il sistema del welfare sta subendo una rapida e drastica evoluzione e i principali più recenti provvedimenti legislativi riguardano il diritto al lavoro e la previdenza sociale, il diritto alla cittadinanza degli immigrati e alle pari opportunità per categorie svantaggiate. Anche il sistema della pubblica istruzione è al centro di una serie di dibattiti parlamentari e di riforme. Per 200 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour ciascuno di questi ambiti sono allo studio nuove proposte di legge e i temi vengono discussi intorno ad alcune questioni chiave: - Per le politiche sul lavoro e sulla previdenza sociale la recente Legge 14 febbraio 2003, n.30 “Biagi” apre a nuovi scenari di flessibilità rispetto ad un sistema tradizionale italiano caratterizzato da forti garanzie per i lavoratori e buone condizioni previdenziali per gli ex lavoratori che non risulta però più sostenibile; - Per le pari opportunità ed il diritto alla cittadinanza degli immigrati la recente Legge 30 luglio 2002 n.189 “Bossi/Fini” ha legato strettamente i flussi di entrata allo status di lavoratore, inasprendo le sanzioni contro la immigrazione irregolare e imponendo l’emersione dalla black economy; - Il sistema della pubblica istruzione in seguito alla legge del Legge 28 marzo 2003, n. 53 sta sperimentando nuove forme in sintonia con il resto delle politiche del welfare verso una maggiore autonomia degli organi periferici ed un’apertura al settore privato; E’ opinione diffusa il fatto che su tutti questi ambiti si sia in mezzo ad un processo avviato ma i cui risultati a regime stentano a percepirsi. 3.3. Fonti - Censis, 36° Rapporto sulla situazione sociale del Paese 2002, (www.censis.it) - Istat, La povertà in Italia nel 2002, 2003 (www.istat.it) - Istat, Quanto hanno speso le famiglie nel 2002, (www.istat.it) - Istat, Annuario Statistico Italiano 2002 (www.istat.it) - Istat, Italia in cifre 2002 (www.istat.it) - Istat, Rapporto annuale sulla situazione del Paese 2002 (www.istat.it) 201 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour 3.4. Data Nel 2002, in base a dati Istat, l’11% delle famiglie italiane e 7.140 mila individui vivono sotto una soglia relativa di povertà, fissata a 823,45 euro di spesa mensile per una famiglia di due componenti; il 4,2% delle famiglie e 2.916 mila individui vivono invece al di sotto di una soglia assoluta di povertà basata sul valore monetario di un paniere di beni e servizi fissato a 573,63 euro mensili per una famiglia di due componenti. La povertà colpisce soprattutto il Mezzogiorno, le famiglie più numerose e le famiglie di anziani. Al Sud Italia il 22,4% delle famiglie è al di sotto della povertà relativa. Le famiglie con tre o più figli sono povere nel 25% dei casi all’incirca. Le famiglie con due o più anziani sono povere nel 17,4% dei casi. Riguardo all’Istruzione, in Italia la scuola è obbligatoria dai 6 ai 15 anni. Nel 2002, secondo i dati dell’Istat, la popolazione italiana senza alcun titolo di studio o con la sola licenza elementare è il 30% (il 24,8% dei maschi e il 34,8% delle femmine) mentre il 32,9% ha raggiunto la licenza media (il 36,4% dei maschi e il 29,7% delle femmine); il 29,6% della popolazione ha terminato la scuola superiore (il 30,8% dei maschi e il 28,5% delle femmine) mentre solamente il 7,5% ha concluso gli studi universitari (l’8% dei maschi e il 7,1% delle femmine). Il reddito pro capite del 2001 è di 15.037 euro, con differenze rilevanti tra le aree geografiche del paese: 17.903 euro al Nord-Ovest, 16.977 euro al Nord-Est, 16.620 euro al Centro e 11.100 euro al Sud. Nel 2002, in base a dati Istat, l’11% delle famiglie italiane e 7.140 mila individui vivono sotto una soglia relativa di povertà, fissata a 823,45 euro di spesa mensile per una famiglia di due componenti, e il 4,2% delle famiglie e 2.916 mila individui vivono al di sotto di una soglia assoluta di povertà basata sul valore monetario di un paniere di beni e servizi fissato a 573,63 euro mensili per una famiglia di due componenti. La povertà colpisce soprattutto il Mezzogiorno, dove il 22,4% delle famiglie è al di sotto della povertà relativa, le famiglie più numerose e le famiglie di anziani. Circa il 25% delle famiglie con tre o più figli risulta povero. Le famiglie con due o più anziani sono povere nel 17,4% dei casi. 202 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour Il tasso di disoccupazione negli ultimi anni ha iniziato a scendere. Nel 2001 le persone disoccupate erano 2.267.000 (9,1% in meno rispetto al 2000) e il tasso di disoccupazione era del 9,5% (10,6% nel 2000, dati Istat). Nel 2002 i disoccupati sono 2.163.000 (4,6% in meno rispetto al 2001) e il tasso di disoccupazione è del 9%. Tuttavia, il tasso di disoccupazione tocca livelli preoccupanti al Sud, dove è ancora del 18,3% nel 2002 (al Nord e al Centro è rispettivamente del 4% e del 6,6%, secondo dati Istat). La disoccupazione riguarda le donne più degli uomini: nel 2002 il tasso di disoccupazione femminile è del 12,2%, rispetto al 7% degli uomini, e al Sud Italia è addirittura del 26,4%. I lavoratori indipendenti sono nel 70,8% dei casi uomini e i lavoratori dipendenti di alto livello (dirigenti e direttivi-quadri) sono ugualmente, nel 70,7% dei casi, uomini (Istat 2002). Il tasso di disoccupazione giovanile in Italia è del 27,2%, 31,4% tra le donne e 24% tra gli uomini. Anche in questo caso le differenze regionali sono notevoli: al Sud i giovani tra 15 e 24 anni sono disoccupati nel 49,4% dei casi (Istat, 2002). Si può tuttavia osservare negli ultimi anni una tendenza decrescente del tasso di disoccupazione giovanile: nel 1999 era infatti del 56,6%, nel 2000 del 55% e nel 2001 del 50,8% (Istat). La spesa pensionistica per i lavoratori dipendenti ha raggiunto nel 2001 i 138.015 milioni di euro (nel 2000 l’importo era di 130.846 milioni di euro). La pensione media annua è di 17.250 euro (nel 2000 era di 16.500 euro) ma esistono differenze a seconda delle tipologie di lavoratori: il fondo pensioni lavoratori dipendenti dell’Inps dà diritto in media a soli 8.000 euro l’anno mentre l’istituto giornalisti a 44.000 euro l’anno (dati del Nucleo di valutazione spesa previdenziale). Per quanto riguarda i lavoratori autonomi e i professionisti, la spesa nel 2001 ammonta a 26.161 milioni di euro (25.043 milioni nel 2000) con una pensione media annua di 5800 euro l’anno (dati del Nucleo di valutazione spesa previdenziale). 203 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour 3.5. Phenomenology La crisi che dagli anni ‘70 si è sempre più configurata nei termini di una rottura dell’equilibrio che la protezione sociale, attraverso la sua continua espansione, garantiva nei decenni precedenti caratterizzati da una fotre espansione economica. Questa crisi sembra avere, in linea di principio, due ordini di cause: a) il problema della crisi fiscale dello Stato, dello squilibrio tra le entrate e le spese delle istituzioni; b) l’unificazione dei mercati delle monete e del credito e l’accelerazione dell’innovazione tecnologica ed organizzativa Entrambe queste cause hanno ridotto i margini di manovra a disposizione degli Stati nazionali per trasformare i vincoli generati dall’economia mondiale in opportunità di sviluppo da cogliere localmente. I nuovi scenari sembrano inoltre minare gli equilibri storici del mercato del lavoro e produrre nuova incertezza per quote sempre più ampie della popolazione locale, anche nelle asce medie tradizionalmente al riparo da regimi di incertezza sconosciuti negli ultimi 50 anni. Lo stesso mercato del lavoro premia la soggettività personale, declinata in termini di individualismo e di flessibilità, in un contesto che appare contraddistinto da una crescita esponenziale della competitività, il cui effetto è un sempre più accentuato declino delle coscienze collettive e delle solidarietà di classe, dei corpi intermedi e di tutti gli organi di rappresentanza, con una segmentazione molecolare dei gruppi sociali che esprimono domande e bisogni sempre più spesso diversificati, se non addirittura opposti, e la creazione di una fascia di “nuova povertà” formata da esclusi spesso incapaci di, o impossibilitati a, far sentire la propria presenza sullo scenario della politica sociale. L’effetto di tale crisi è dirompente e trascende l’impressione di un semplice malfunzionamento. I fattori di crisi più sopra richiamati sembrano avere l’effetto di svuotare di contenuti la stessa concezione di Welfare. L’Italia è entrata in un’epoca di transizione perpetua, nella quale il cambiamento non è più immediatamente interpretabile in termini di progresso, di sviluppo dell’individuo e della società, ma è piuttosto generatore di incertezza, di confusione, di insicurezza, di disintegrazione sociale. La fase di crisi, che si è acuita dagli anni ‘90, non riguarda soltanto l’ambito dei diritti sociali, ma investe anche le dimensioni dei diritti politici con una spirale che coinvolge e si alimenta nello svuotamento di contenuti della partecipazione politica. Persino i diritti civili, a causa dell’aumento dell’incertezza personale in tutti gli ambiti 204 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour connessi al well-being producono ulteriori incertezze, fragilità, esclusione sociale e devianza, con la conseguente perdita del controllo e della perdita di efficacia dell’intero impianto della protezione sociale. In simili circostanze è sempre più difficile, in Italia così come negli altri paesi con una economia avanzata, “quadrare il cerchio” che i principi laici e democratici hanno legato, almeno nella concezione della Repubblica, il benessere economico alla coesione sociale ed alla libertà politica. Tale difficoltà diventa macroscopica ed ancora più scomoda se proiettata nelle contraddizioni del sistema nazionale di protezione sociale, dove ad un periodo di espansione del welfare, della cittadinanza, della spesa pubblica, si va gradatamente sostituendo un sistema che è stato beffardamente definito “Stato asociale” (Boeri 2000), che dissemina di “trappole” (cfr. Ferrera 1998) il percorso di sviluppo della società italiana, anziché promuovere garanzie. Nuove opportunità di inserimento sociale – ad esempio per le donne -, e nuove speranze di riscatto della povertà – per gli immigrati che provengono dalle società “in via di sviluppo” – si accompagnano a crescenti rischi di emarginazione o di autentica esclusione in una società che – con maggiore evidenza nei contesti urbani - diviene sempre più complessa, sempre più interdipendente, sempre più pervasa da ambiguità e incertezze che troppo spesso vengono declinate in termini di precarietà nelle chances di vita. 205 FONDAZIONE CENSIS 11873_2002 4. Study D2: Poverty, Informal Sector, Health and Labour CRIME 4.1. Definitions Nella Costituzione della Repubblica Italiana l’Articolo 27 precisa che “la responsabilità penale è personale. L’imputato non è considerato colpevole sino alla condanna definitiva. Le pene non possono consistere in trattamenti contrari al senso di umanità e devono tendere alla rieducazione del condannato. Non è ammessa la pena di morte, se non nei casi previsti dalle leggi militari di guerra. Altri articoli, (111, 112 e 113) regolano le “Norme sulla giurisdizione” ed il primo di essi regola i diritti dell’accusato: “Nel processo penale, la legge assicura che la persona accusata di un reato sia, nel più breve tempo possibile, informata riservatamente della natura e dei motivi dell’accusa elevata a suo carico; disponga del tempo e delle condizioni necessari per preparare la sua difesa; abbia la facoltà, davanti al giudice, di interrogare o di far interrogare le persone che rendono dichiarazioni a suo carico, di ottenere la convocazione e l’interrogatorio di persone a sua difesa nelle stesse condizioni dell’accusa e l’acquisizione di ogni altro mezzo di prova a suo favore; sia assistita da un interprete se non comprende o non parla la lingua impiegata nel processo”. La legge penale italiana è regolata dal Codice penale ed obbliga tutti coloro che, cittadini o stranieri, si trovano ne l territorio dello Stato, salve le eccezioni stabilite dal diritto pubblico interno o dal diritto internazionale. 4.2. Policy and Legislation La legge penale italiana obbliga altresì tutti coloro che, cittadini o stranieri, si trovano all`estero, ma limitatamente ai casi stabiliti dalla legge medesima o dal diritto internazionale. Le pene principali stabilite per i delitti sono l’ergastolo, la reclusione (fino a 24 anni), la multa, l’arresto e l’ammenda. Sotto la denominazione di pene detentive o restrittive della libertà personale la legge comprende: l’ergastolo, la reclusione e l’arresto. Sotto la denominazione di pene pecuniarie la legge comprende: la multa e l’ammenda. 206 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour 4.3. Fonti - Censis, Sviluppo e legalità nel Mezzogiorno (www.svileg.censis.it) - Istat, Annuario Statistico Italiano 2002 (www.istat.it) - Istat, Italia in cifre 2002 (www.istat.it) - Istat, Statistiche giudiziarie penali, anno 2001 (www.istat.it) - Istat, Statistiche giudiziarie civili, anno 2001 (www.istat.it) 4.4. Data Secondo i dati dell’Istat, nel 2001 i reati denunciati alle autorità giudiziarie dalle forze dell’ordine sono 2.163.826, 41.956 in meno rispetto al 2000. Sempre nel 2001, al Nord sono denunciati 1.048.781 reati, al Centro 459.419 e al Sud 655.626. Le denunce sono in media 38 ogni 1.000 abitanti, più frequenti al Nord e al Centro (rispettivamente 41 e 42,1 ogni 1.000 abitanti), rispetto al Sud (32 denunce ogni 1.000 abitanti). La popolazione carceraria, secondo dati Istat relativi al 2001, ammonta a 55.751 persone, 16.511 delle quali straniere (il 29,6%). Solamente il 4,3% delle persone detenute è di sesso femminile; tra le donne detenute, la percentuale delle straniere è molto più alta rispetto agli uomini (il 41,5% rispetto al 29,1%). Nel complesso, nel 2001, i detenuti sono il 16,7% in più rispetto al 1995 e gli stranieri detenuti, addirittura il 102,7% in più rispetto allo stesso anno. Il numero più elevato di detenuti si registra al Sud (23.441 rispetto ai 21.243 del Nord e i 11.067 del Centro) ma il numero maggiore di detenuti stranieri si trova al Nord (8.709 rispetto ai 4.322 del Centro e i 3.480 del Sud). 207 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour 4.5. Phenomenology Il delicato rapporto tra giustizia e politica, seppure in questi ultimi anni ha acceso molte polemiche e fratture fra alti rappresentanti del potere esecutivo e giudiziario del Paese, ha posto le condizioni per una riflessione sui mali della giustizia penale italiana. Fra le questioni recentemente in Italia emerse nel dibattito sulla Giustizia degli ultimi anni: - la riforma di una sentenza di assoluzione attraverso la mera rivisitazione dei giudici d’appello degli stessi elementi di prova raccolti nel contraddittorio e nell’oralità dai primi giudici; - la separazione delle carriere tra giudici e pubblici ministeri; - l’immunità parlamentare; - la possibilità, in condizioni di “legittimo sospetto”, di rimette il processo ad altro giudice, su richiesta motivata del procuratore generale, del pubblico ministero o dell’imputato stesso; - la pronuncia di una sentenza di condanna a più di 20 anni dal fatto; - l’abuso del ricorso allo strumento della misura cautelare. Numerose sono le voci che hanno espresso la volontà di affrontare costruttivamente le delicate questioni oggetto del dibattito su una riforma della Giustizia nella convinzione della necessità di una riforma organica che renda il sistema più rapido ed efficiente e che allo stesso tempo garantisca la separazione ed autonomia del potere giudiziario dai sistemi esecutivo e legislativo del Paese. Le condizioni per tale riforma non sono particolarmente propizie nell’Italia di oggi, dove la questione della Giustizia assume delle accese valenze di carattere politico, e dove le obiezioni espresse e le soluzioni auspicate fuoriescono dagli ambiti tecnici di una riforma e trovano cassa di risonanza sull’acceso dibattito politico di questi ultimi anni. Se da un lato le forze politiche di maggioranza si sono impegnate in interventi riformatori di breve respiro, spesso ispirati al soddisfacimento di interessi particolari, d’altro lato le forze politiche di minoranza non hanno saputo immaginare alternative alla tentazione di demonizzare ogni ipotesi di riforma anche prescindendo 208 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour dal suo contenuto. Il coinvolgimento della stessa Magistratura in tale dibattito politico non gioca a favore di una riflessione costruttiva. Superare le sterili contrapposizioni e affrontare con concretezza i nodi del sistema giudiziario italiano appare una scommessa tanto auspicabile quanto ardua. 209 FONDAZIONE CENSIS 11873_2002 5. Study D2: Poverty, Informal Sector, Health and Labour TRENDS AND CORRELATIONS 5.1. The evolution from the ‘80s Al di là delle problematiche connesse al funzionamento dei sistemi previdenziali, sanitari e giudiziari, nell’ultimo ventennio l’Italia ha attraversato una fase caratterizzata da fenomeni di una certa stabilità. Nonostante i grossi cambiamenti intercorsi nell’economia, nella sfera politica e nella congiuntura internazionale, la ricchezza procapite è andata aumentando in modo costante, fino ad una prima recente battuta d’arresto nel 2002 (tab. 1). Tab. 1 - Analisi della povertà in Italia - Anni 1980-2002 Indicatore sintetico di ricchezza (valore aggiunto per ab.in mgl di euro a prezzi 1995) Anno 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 11,6 11,6 11,7 11,8 12,1 12,4 12,7 13,0 13,5 13,9 14,1 14,5 14,6 14,4 14,7 15,2 15,3 15,6 15,8 16,1 16,5 17,0 17,0 Fonte: elaborazione Censis su dati Istat 210 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour La ricchezza in Italia (v.a. per abitante in migliaia di euro) Anni 1980-2002 18,0 17,0 16,0 15,0 14,0 13,0 12,0 11,0 20 02 20 00 19 98 19 96 19 94 19 92 19 90 19 88 19 86 19 84 19 82 19 80 10,0 Anni Anche la spesa delle famiglie per salute e spese sanitarie, sebbene si dimostra meno lineare dell’incremento della ricchezza, registra una tendenza positiva e piuttosto ciclica, con delle avanzate della spesa negli anni 1987, 1993, 1995-96, un calo evidente nel 2000 ed una netta ripresa negli ultimi anni (tab. 2). 211 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour Tab.2 – Analisi della salute in Italia (spesa delle famiglie) Anni 1980-2002 Anno Indicatore sintetico salute (spesa delle famiglie per servizi sanitari in mln di euro a prezzi 1995 per 100.000 famiglie) 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 35,8 37,2 37,2 38,3 40,3 39,6 43,2 43,1 47,0 50,1 51,4 56,6 65,3 66,8 73,7 81,2 82,3 84,1 85,0 84,4 84,0 87,4 89,4 Fonte: elaborazione Censis su dati Istat 212 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour Spesa delle famiglie residenti in Italia per servizi sanitari (milioni di euro) Anni 1980-2002 90,0 80,0 70,0 60,0 50,0 40,0 20 02 20 00 19 98 19 96 19 94 19 92 19 90 19 88 19 86 19 84 19 82 19 80 30,0 Anni La diffusione della criminalità, invece, registrata attraverso in numero di delitti per abitante, dimostra un andamento assai più irregolare, con un picco mai più eguagliato nel 1991 di quasi 47 delitti ogni 1000 abitanti, un netto calo fino al 1994, e poi una netta ripresa seguita da una morbida flessione fino al 2001, anno in cui ha inizio una ripresa che arriva ad oggi (tab. 3). Le oscillazioni non sono semplici da spiegare, specialmente a causa delle diverse concause fra le quali è possibile elencare: - le evoluzioni legislative, con importanti modificazioni delle leggi penali vigenti; - l’aumento della compagine sociale e dell’incidenza di popolazione immigrata irregolare con basse possibilità di inserimento regolare; - il frammentarsi della criminalità organizzata ed il suo evolversi verso crimini diversi; - l’aumento della microcriminalità ed il suo distribuirsi nella penisola rispetto a fenomeni classici di maggiore concentrazione nelle aree metropolitane meridionali. 213 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour Tab. 3 – Analisi della criminalità in Italia - Anni 1980-2002 Indice di diffusione della criminalità (delitti per 1.000 abitanti) Anno 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 32,9 35,7 43,3 46,7 42,0 39,6 38,0 39,5 42,2 42,4 42,1 41,2 38,1 38,0 38,9 Fonte: elaborazione Censis su dati Istat e Ministero dell’interno Il livello di difusione della criminalità initalia (delitti per 1.000 abitanti) Anni 1988-2002 50,0 45,0 40,0 35,0 30,0 25,0 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 Anni 214 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour Oltre a quanto rilevato per l’indicatore sintetico di ricchezza, calcolato attraverso il valore aggiunto per abitanti, è possibile calcolare anche l’indicatore sintetico di povertà che stabilisce l’incidenza delle famiglie povere sul totale delle famiglie italiane. Dal 1995 al 2001 l’incidenza oscilla intorno ad una media dell’11,5% e sembra indifferente all’incremento della ricchezza, all’aumento della spesa per la salute delle famiglie (tab. 4). L’indice di criminalità diffusa, calcolato sulla percentuale dei “piccoli crimini” su quelli più gravi, segue un andamento tendente all’incremento del tutto sganciato da quello della criminalità in generale, e quasi speculare, con incrementi nel 1998 e 1999 anni in cui la criminalità in generale era stabile o in decremento, e con una espansione nel 1997 che non trova riscontro nei dati complessivi dei reati rispetto alla popolazione. Tab. 4 - Analisi della povertà, salute e criminalità in Italia - Anni 1995-2001 Indicatore sintetico povertà (incidenza % delle famiglie povere) Anno 1995 1996 1997 1998 1999 2000 2001 10,6 10,3 12,0 11,8 11,9 12,3 12,0 Indice di criminalità diffusa (furti e rapine meno gravi in % dei delitti) 60,1 58,6 58,6 62,3 63,8 63,5 61,8 Fonte: dati Istat 215 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour Famiglie povere in Italia (val. %) Anni 1995-2001 12,5 12,0 11,5 11,0 10,5 10,0 9,5 9,0 1995 1996 1997 1998 1999 2000 2001 Indice di criminalità diffusa in Italia (val. %) Anni 1995-2001 65,0 64,0 63,0 62,0 61,0 60,0 59,0 58,0 57,0 56,0 55,0 1995 1996 1997 1998 1999 2000 2001 216 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour 5.2. Correlation between poverty, health crime and other development indicators in the last decades Alta ed indiscutibile è la correlazione fra ricchezza e spesa sanitaria delle famiglie italiane, con un tasso di correlazione dello 0,9216. L’aumento della ricchezza delle famiglie si traduc, pressochè automaticamente, in un aumento della spesa per servizi sanitari (tab. 5). Tab. 5 - Analisi della povertà e salute in Italia - Anni 1980-2002 Anno Indicatore sintetico di richezza (valore aggiunto per ab.in mgl di euro) 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 11,6 11,6 11,7 11,8 12,1 12,4 12,7 13,0 13,5 13,9 14,1 14,5 14,6 14,4 14,7 15,2 15,3 15,6 15,8 16,1 16,5 17,0 17,0 Indicatore sintetico salute (spesa delle famiglie per servizi sanitari in mln di euro per 100.000 famiglie) 35,8 37,2 37,2 38,3 40,3 39,6 43,2 43,1 47,0 50,1 51,4 56,6 65,3 66,8 73,7 81,2 82,3 84,1 85,0 84,4 84,0 87,4 89,4 Fonte: elaborazione Censis su dati Istat 217 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour La ricchezza e la spesa sanitaria delle famiglie residenti in Italia Anni 1980-2002 2 R = 0,9216 100,0 90,0 80,0 70,0 60,0 50,0 40,0 30,0 20,0 10,0 0,0 10,0 11,0 12,0 13,0 14,0 15,0 16,0 17,0 18,0 Viceversa, un dato significativo è rappresentato dalla completa mancata correlazione, né positiva né negativa, dell’aumento della ricchezza con l’aumento, o il diminuire, dell’indice di diffusione della criminalità, pari all 0,0089. Indipendentemente dal cambiare della condizione di ricchezza delle famiglie, l’indice di criminalità sembra rispondere ad altre logiche che non comunicano con l’incremento o la riduzione della ricchezza. Una debolezza simile, anche se meno accentuata si riscontra fra criminalità e presenza o meno di famiglie povere, dove il tasso di correlazione sale allo 0,3842 (tab. 6). 218 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour Tab. 6 - Analisi della povertà e criminalità in Italia - Anni 1988-2002 Indicatore sintetico di richezza (valore aggiunto per ab.in mgl di euro) Anno 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 Indice di diffusione della criminalità (delitti per abitante per 1.000 abitanti) 13,5 13,9 14,1 14,5 14,6 14,4 14,7 15,2 15,3 15,6 15,8 16,1 16,5 17,0 17,0 32,9 35,7 43,3 46,7 42,0 39,6 38,0 39,5 42,2 42,4 42,1 41,2 38,1 38,0 38,9 Fonte: elaborazione Censis su dati Istat e Ministero dell’interno La ricchezza e il livello di diffusione di criminalità in Italia Anni 1988-2002 R2 = 0,0089 50,0 48,0 46,0 44,0 42,0 40,0 38,0 36,0 34,0 32,0 30,0 12,0 13,0 14,0 15,0 16,0 17,0 18,0 219 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour Analisi della povertà, salute e criminalità in Italia - Anni 1980-2002 Indicatore sintetico povertà (incidenza % delle famiglie povere) Anno 1995 1996 1997 1998 1999 2000 2001 2002 10,6 10,3 12,0 11,8 11,9 12,3 12,0 Indice di criminalità diffusa (furti e rapine meno gravi in % dei delitti) 60,1 58,6 58,6 62,3 63,8 63,5 61,8 Fonte: dati Istat Famiglie povere in Italia e livello di diffusione di criminalità Anni 1995-2001 65,0 R2 = 0,3842 64,0 63,0 62,0 61,0 60,0 59,0 58,0 10,0 10,5 11,0 11,5 12,0 12,5 Analoga debolezza di correlazione si riscontra fra la spesa della salute delle famiglie ed I tassi di criminlaità rispetto alla popolazione, confermando l’esistenza di 3 elementi la cui correlazione non è nè diretta nè lineare e che per essere rintracciata ha bisogno di tecniche di analisi più articolate come l’analisi della correlazione delle componenti principali (ACP) che è stata condotta sul compesso dei paesi del Mediterraneo nella Parte Seconda della presente ricerca. 220 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour Tab. Analisi della salute e criminalità in Italia - Anni 1980-2002 Indicatore sintetico salute (spesa delle famiglie per servizi sanitari in mln di euro a prezzi 1995 per 100.000 famiglie) Anno 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 Indice di diffusione della criminalità (delitti per abitante per 1.000 abitanti) 47,0 50,1 51,4 56,6 65,3 66,8 73,7 81,2 82,3 84,1 85,0 84,4 84,0 87,4 89,4 32,9 35,7 43,3 46,7 42,0 39,6 38,0 39,5 42,2 42,4 42,1 41,2 38,1 38,0 38,9 Fonte: elaborazione Censis su dati Istat e Ministero dell’interno La spesa sanitaria delle famiglie residenti in Italia e il livello di diffusione di criminalità Anni 1988-2002 2 R = 0,0208 50,0 48,0 46,0 44,0 42,0 40,0 38,0 36,0 34,0 32,0 30,0 40,0 50,0 60,0 70,0 80,0 90,0 100,0 221 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour 5.3. Key issues, political agenda and perspectives L’analisi teorica ed empirica sulla protezione sociale, sulla possibile ridefinizione del punto di equilibrio fra esigenze di welfare e crisi dello sviluppo economico e sue interconnessioni con la sicurezza individuale e la criminalità, è di immediato e condiviso interesse per la comunità scientifica internazionale, sia quella afferente a contesti sulla via dello sviluppo sia quella che riflette sul cammino dei Paesi più avanzati del bacino del mediterraneo. La sfida che sta di fronte a studiosi e ricercatori appare triplice: - per un verso si tratta di combinare una varietà di concetti e di strumenti prelevati dalla “cassetta degli attrezzi” delle scienze sociali – e dunque della sociologia, dell’economia, della scienza politica, della statistica, della giurisprudenza, della demografia – per interpretare i processi in corso, individuare le cause dei problemi, valutare le possibili alternative, proporre ipotesi di intervento; - per un altro, bisogna tenere presente una varietà di livelli di analisi e di proposta: dal livello globale, al quale già si affaccia l’ipotesi di una cittadinanza mondiale portatrice di istanze di riequilibrio della sovranità del mercato mondiale autoregolato, a quello delle istituzioni sovranazionali, che riguarda particolarmente l’Italia in quanto impegnata nel processo di costruzione di una “cittadinanza europea”, a quello dello Stato nazionale, che in ciascun Paese rappresenta tuttora la porzione più cospicua del sistema della protezione sociale; a quello dei contesti locali, sui quali paiono scaricarsi i costi umani e sociali dei cambiamenti in questione e che tuttavia presentano opportunità che è importante cogliere per la riattivazione di interventi di protezione sociale e di percorsi di inserimento e di partecipazione che possono assumere un’importanza notevole nel quadro delle trasformazioni in corso; - per un altro ancora, occorre studiare, con l’ausilio degli strumenti in precedenza menzionati, ai diversi livelli sopra citati, e con il ricorso ad una metodologia comparativa d’indagine, gli effetti prodotti dai mutamenti che intervengono nella protezione sociale sugli assetti e sugli orizzonti dei contesti più avanzati, in maniera da delineare i livelli di sicurezza e di coesione disponibili e l’articolazione di questi in rapporto alle diverse fasce della popolazione. 222 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour Il che significa ricondurre il problema della cittadinanza sociale alla questione della “giusta tutela”, e quindi in sostanza dei contenuti effettivamente fruibili dei diritti che definiscono la cittadinanza in ciascun contesto storico-sociale e che possono consentire di difendere, e forse anche di promuovere, la libertà e l’eguaglianza nel rispetto della diversità. Il che significa affrontare, con strumenti interdisciplinari ed avendo riguardo alle interazioni ed alle interferenze tra i molteplici livelli territoriali dell’analisi e della ricerca sul campo, il problema dell’integrazione tra i diversi comparti della politica sociale – il sistema dell’istruzione e della formazione professionale, le misure di inserimento sociale ed occupazionale, il settore della previdenza, la politica dell’abitazione ecc. – e tra questa e la più generale politica del Paese – ad esempio, l’interazione tra la politica sociale, la politica fiscale, la politica economica, la politica di coesione regionale e di sviluppo. 223 FONDAZIONE CENSIS 6. ANNESSO STATISTICO DATI GENERALI Tab. 1 - Struttura per età della popolazione residente in Italia per ripartizione territoriale al 01/01/2001, Maschi - (v.a. e val. %) 0 - 14 15 - 64 65 e oltre Totale v.a. % v.a. % v.a. % v.a. % Nord Centro Sud e isole 1.670.278 747.908 1.852.400 13,3 13,9 18,2 8.857.299 3.727.130 6.928.785 70,7 69,2 68,1 2.008.999 913.735 1.388.323 16,0 17,0 13,7 12.536.576 5.388.773 10.169.508 100,0 100,0 100,0 Italia 4.270.586 15,2 19.513.214 69,5 4.311.057 15,3 28.094.857 100,0 Fonte: elaborazione Censis su dati Istat Tab. 2 - Struttura per età della popolazione residente in Italia per ripartizione territoriale al 01/01/2001, Femmine - (v.a. e val. %) 0 - 14 15 - 64 65 e oltre Totale v.a. % v.a. % v.a. % v.a. % Nord Centro Sud e isole 1.576.008 705.548 1.751.762 11,9 12,2 16,4 8.680.992 3.772.163 7.017.809 65,3 65,4 65,7 3.040.707 1.293.099 1.911.072 22,9 22,4 17,9 13.297.707 5.770.810 10.680.643 100,0 100,0 100,0 Italia 4.033.318 13,6 19.470.964 65,5 6.244.878 21,0 29.749.160 100,0 Fonte: elaborazione Censis su dati Istat Tab. 3 - Struttura per età della popolazione residente in Italia per ripartizione territoriale al 01/01/2001, Totale - (v.a. e val. %) 0 - 14 15 - 64 65 e oltre Totale v.a. % v.a. % v.a. % v.a. % Nord Centro Sud e isole 3.246.286 1.453.456 3.604.162 12,6 13,0 17,3 17.538.291 7.499.293 13.946.594 67,9 67,2 66,9 5.049.706 2.206.834 3.299.395 19,5 19,8 15,8 25.834.283 11.159.583 20.850.151 100,0 100,0 100,0 Italia 8.303.904 14,4 38.984.178 67,4 10.555.935 18,2 57.844.017 100,0 Fonte: elaborazione Censis su dati Istat Tab. 4 - Struttura demografica dei Paesi dell'Unione Europea - Anni 1995-2002 (v.a.e val. %) Popolazio ne al 1 gennaio in migliaia di abitanti Quota % sul totale Eur15 Tasso di accrescime nto per 1.000 abitanti Quota % 0-19 anni Quota % 20-59 anni Quota % 60 anni e oltre Anni Belgio Danimarca Germania Grecia Spagna 1995 10.130,6 5.215,7 81.538,6 10.442,9 39.177,4 Francia Irlanda Italia Lussemburgo Paesi Bassi Austria Portogallo Finlandia Svezia Regno Unito 58.020,1 3.594,7(1) 57.268,6 406,6 15.424,1 8.039,9 9.912,1 5.098,8 8.816,4 58.500,2 3.615,6(1) 57.333,0 412,8 15.493,9 8.054,8 9.920,8 5.116,8 8.837,5 58694,0 (1) 3.652,2 (1) 57.461,0 418,3 15.567,1 8.067,8 9.934,1 5.132,3 8.844,5 58.901,8 (1) 3.694,0 (1) 57.563,4 423,7 15.654,2 8.075,0 9.957,3 5.147,3 8.847,6 59.089,6 (3) 3.734,9 57.612,6 429,2 15.760,2 8.082,8 9.979,5 5.159,6 8.854,3 59.391,1 (3) 3.776,6 57.679,9 435,7 15.864,0 8.102,6 9.997,6 5.171,3 8.861,4 59.623,4 3.826,2 (1) 57.844,0 441,3 15.987,1 8.121,3 10.262,9 5.181,1 8.882,8 59.894,2 (3) 3.884,2 (2) 58.017,9 (2) 446,4 (2) 16.100,3 (1) 8.140,0 (2) 10.355,6 (1) 5.194,9 8.909,1 60.113,9 (3) Eur 15 371.586,7 (2) 372.653,6 (1) 373.713,4 (1) 374.582,8 (2) 374.978,6 (2) 375.973,6 (2) 378.036,6 (2) 379.600,7 (2) 58.255,9 (1) 58.491,6 (1) 58.726,9 (1) 58.494,0 (1) 58.744,1 (1) 59.037,2 (1) 59.344,0 (1) 1996 10.143,0 5.251,0 81.817,5 10.465,1 39.241,9 1997 10.170,2 5.275,1 82.012,2 10.486,6 39.298,6 1998 10.192,3 5.294,9 82.057,4 10.511,0 39.347,9 1999 10.213,8 5.313,6 82.037,0 10.521,7 39.394,3 2000 10.239,1 5.330,0 82.163,5 10.542,8 39.441,7 2001 10.263,4 5.349,2 82.259,5 10564,7 (1) 40.127,7 2002 10.307,3 (2) 5.638,4 82.431,0 10.598,3 (2) 40.409,3 2002 2,7 1,5 21,7 2,8 10,6 15,6 1,0 15,3 0,1 4,2 2,1 2,7 1,4 2,3 15,8 100,0 1995 1,2 6,8 3,4 2,1 1,6 4,1(1) 5,8(1) 1,1 15,1 4,5 1,9 0,9 3,5 2,4 3,3(2) 2,9 1996 2,7 4,6 2,4 2,1 1,4 4,0 (1) 10,1 2,2 13,3 4,7 1,6 1,3 3,0 0,8 3,4 (1) 2,8 (1) 1997 2,2 3,7 0,6 2,3 1,3 4,0 (1) 11,4 (1) 1,8 12,8 5,6 0,9 2,3 2,9 0,4 3,1 2,3 (1) 1998 2,1 3,5 -0,2 (1) 1,0 1,2 3,3 (1) 11,0 (1) 0,9 12,9 6,7 1,0 2,2 2,4 0,8 5,1 (1) 2,2 (1) 1999 2,5 3,1 1,5 2,0 1,2 4,3 11,1 1,2 15,0 6,6 2,4 1,8 (3) 2,3 0,8 3,9 2,7 (1) 2000 2,4 3,6 1,2 1,0 (1) 9,7 4,9 (1) 13,0 (1) 2,8 12,8 7,7 2,3 6,3 1,9 2,4 4,5 (3) 4,1 (2) 2001 4,3 (2) 3,6 2,1 (3) 3,2 (3) 7,1 5,2 (1) 15,1 (2) 3,0 (2) 11,4 (2) 7,1 (1) 2,3 (2) 7,1 (1) 2,7 3,0 3,7 (3) 4,1 (2) 1990 24,8 24,3 21,8 27,0 28,8 27,8 36,7 24,5 23,2 25,7 24,3 29,3 25,4 24,5 25,9 25,5 1995 24,1 23,6 21,5 24,4 25,0 26,1 33,8 21,5 23,8 24,4 23,3 26,1 25,5 24,7 25,3 23,9 1998 23,8 23,6 21,5 22,8 22,8 25,8 (1) 32,0 20,2 24,2 24,3 23,1 24,3 25,0 24,4 25,4 23,3 (1) 1999 23,7 23,6 21,4 22,3 22,2 25,7 31,4 20,0 24,3 24,4 23,0 23,9 24,8 24,3 25,4 23,1 2000 23,6 23,7 21,3 21,8 21,7 25,6 30,8 19,8 24,4 24,4 22,8 23,5 24,7 24,2 25,3 23,0 1990 54,7 55,3 57,9 53,3 52,5 53,2 48,0 55,0 57,9 57,1 55,5 52,2 56,2 52,6 53,3 54,6 1995 54,6 56,6 57,8 54,1 54,4 53,8 51,0 56,2 57,1 57,9 57,0 54,0 55,6 53,3 54,2 55,5 1998 54,5 56,8 56,6 54,6 55,8 53,9 (1) 52,8 56,7 56,7 57,8 57,2 55,4 55,6 53,6 54,2 55,5 (1) 1999 54,5 56,7 56,2 54,9 56,3 53,9 53,4 56,5 56,6 57,6 57,2 55,6 55,6 53,6 54,2 55,5 2000 54,5 56,6 55,7 55,1 56,7 53,9 54,1 56,3 56,5 57,5 56,8 55,9 55,5 53,6 54,3 55,4 1990 20,5 20,4 20,3 19,7 18,7 19,0 15,3 20,5 18,9 17,2 20,2 18,5 18,4 22,9 20,8 19,9 1995 21,3 19,8 20,7 21,5 20,6 20,1 15,2 22,3 19,1 17,7 19,7 19,9 18,9 22,0 20,5 20,6 1998 21,7 19,6 21,9 22,6 21,4 20,3 15,2 23,1 19,1 17,9 19,7 20,3 19,4 22,0 20,4 21,2 1999 21,8 19,7 22,4 22,8 21,5 20,4 15,2 23,5 19,1 18,0 19,8 20,5 19,6 22,1 20,4 21,4 2000 21,9 19,7 23,0 23,1 21,6 20,5 15,1 23,9 19,1 18,1 20,4 20,6 19,8 22,2 20,4 21,6 (1) Dati provvisori; (2) Stima Eurostat; (3) Stima nazionale Fonte: elaborazione Censis su dati Eurostat Tab. 5 - Principali indicatori socio-demografici europei - Anni 1970-2001 (v.a.e val. %) Anni Belgio Danimarca Germania Grecia Spagna Francia Irlanda Italia Lussemburgo Paesi Bassi Austria Portogallo Finlandia Svezia Regno Unito Eur 15 Tasso di natalità (nati per 1.000 abitanti) 1970 1980 1990 1995 1996 1997 1998 1999 2000 2001 14,7 12,6 12,4 11,3 11,4 (1) 11,4 11,2 11,1 11,3 (1) 11,2 (2) 14,4 11,2 12,4 13,4 12,9 12,8 12,5 12,4 12,6 12,2 13,4 11,1 11,4 9,4 9,7 9,9 9,6 9,4 9,3 8,9 (3) 16,5 15,5 10,1 9,7 9,6 9,7 9,6 9,6 9,6 (3) 9,5 (2) 19,7 15,3 10,3 9,2 9,1 9,2 (1) 9,2 (1) 9,6 (1) 9,9 (1) 10,1 (3) 16,8 14,9 13,5 12,5 12,6 (1) 12,4 (1) 12,7 (1) 12,7 (1) 13,2 (1) 13,1 (1) 21,9 21,8 15,1 13,5 13,9 14,2 (1) 14,4 14,2 14,3 (1) 15,0 (2) 16,8 11,4 10,0 9,1 9,2 9,2 (1) 9,3 9,1 9,4 9,4 (2) 13,0 11,5 13,0 13,3 13,7 13,1 12,6 12,9 13,1 12,3 (2) 18,4 12,9 13,3 12,4 12,2 12,3 12,7 12,7 13,0 12,7 (1) 15,1 12,0 11,8 11,0 11,0 10,4 10,1 9,7 9,6 9,3 (2) 20,8 16,3 11,7 10,8 11,1 11,4 11,4 11,6 (3) 11,7 10,9 (1) 14,0 13,2 13,2 12,4 11,8 11,5 11,1 11,1 11,0 10,8 13,8 11,7 14,5 11,7 10,8 10,2 10,1 10,0 10,2 10,3 16,3 13,4 13,9 12,5 12,5 12,3 12,1 11,8 11,4 (3) 11,2 (3) 16,2 13,1 12,0 10,8 10,8 (1) 10,8 (1) 10,7 (1) 10,6 (1) 10,8 (3) 10,6 (2) Tasso di mortalità (decessi per 1000 abitanti) 1970 1980 1990 1995 1996 1997 1998 1999 2000 2001 12,3 11,5 10,5 10,3 10,4 (1) 10,2 10,2 10,3 10,2 10,1 (2) 9,8 10,9 11,9 12,1 11,6 11,3 11,0 11,1 10,9 10,9 12,5 12,2 11,6 10,8 10,8 10,5 10,4 (3) 10,3 10,2 10,0 (3) 8,4 9,1 9,3 9,6 9,6 9,5 9,7 (3) 9,8 9,8 (2) 9,7 (2) 8,3 7,8 8,6 8,7 8,9 8,9 (1) 9,1 (1) 9,4 (1) 9,0 (1) 8,7 (3) 10,7 10,2 9,3 9,2 9,2 (1) 9,1 (1) 9,2 (1) 9,2 (1) 9,1 (1) 8,9 (1) 11,4 9,9 8,9 8,8 8,7 8,6 (1) 8,3 (1) 8,4 8,2 (1) 7,7 (2) 9,7 9,8 9,6 9,6 9,5 9,6 (1) 10,0 (1) 9,9 9,7 9,3 (2) 12,3 11,3 9,9 9,3 9,4 9,3 9,0 8,8 8,6 8,4 (2) 8,5 8,1 8,7 8,8 8,9 8,7 8,7 8,9 8,8 8,7 (1) 13,3 12,3 10,8 10,1 10,0 9,8 9,7 9,7 9,5 9,2 (2) 10,7 9,8 10,4 10,5 10,8 10,6 10,7 10,8 (3) 10,3 10,6 (1) 9,6 9,3 10,1 9,7 9,6 9,6 9,5 9,6 9,5 9,4 10,0 11,1 11,2 10,7 10,6 10,6 10,5 10,7 10,5 10,5 11,8 11,8 11,2 11,0 10,8 10,7 10,6 (3) 10,6 10,2 (3) 10,1 (3) 10,8 10,5 10,2 10,0 10,0 (1) 9,8 (1) 9,9 (1) 9,9 (1) 9,7 (2) 9,5 (2) Tasso migratorio per 1000 abitanti 1995 1996 1997 1998 1999 2000 2001 0,3 (1) 1,6 (1) 0,9 1,1 (1) 1,6 1,3 (1) 3,2 (2) 5,5 3,3 2,3 2,1 1,8 1,9 2,3 4,9 3,4 1,1 0,6 (3) 2,5 2,0 3,2 (3) 2,0 2,1 2,1 1,2 (3) 2,3 1,2 (3) 3,3 (2) 1,2 (1) 1,2 (1) 0,9 (1) 1,1 (1) 1,0 (1) 8,8 (3) 5,8 (3) 0,7 (1) 0,6 (1) 0,7 (1) -0,1 (1) 0,8 (1) 0,8 (1) 1,0 (1) 1,1 3,7 (1) 5,7 (1) 5,0 (1) 5,3 7,0 (2) 7,8 (2) 1,6 (1) 2,6 (1) 2,2 (1) 1,6 (1) 2,0 3,1 2,9 (2) 11,2 8,9 9,1 9,4 10,9 8,3 7,5 (2) 1,0 1,4 1,9 2,8 2,8 3,6 3,1 (1) 0,9 0,6 0,4 0,6 2,4 2,1 2,2 (2) 0,5 1,0 1,5 1,5 1,0 (3) 4,9 6,3 (1) 0,8 0,8 0,9 0,9 0,7 0,5 1,2 1,3 0,7 0,7 1,2 1,5 2,7 3,2 1,8 (1) 1,7 (1) 1,5 3,6 (1) 2,8 3,3 (3) 2,6 (3) 2,1 2,0 (1) 1,4 (1) 1,4 (1) 2,0 (1) 3,1 (2) 3,1 (2) Nati fuori dal matrimonio (per 1.000 nati vivi) 1970 1980 1990 1995 1996 1997 1998 1999 2000 2001 27,7 41,2 116,1 150,0 186,0 201,0 (2) 220,0 (2) - 110,3 331,7 464,0 464,7 462,8 451,0 448,0 449,0 446,0 446,0 72,3 118,9 153,2 160,6 171,2 180,0 200,0 221,0 234,0 236,0 (3) 11,1 14,6 21,7 30,4 32,7 35,0 38,0 39,0 41,0 (2) - 13,6 39,3 96,1 107,6 117,0 131,0 141,0 (2) 170,0 (2) - 68,6 113,8 300,5 372,0 388,0 (1) 401,0 (1) 407,0 (1) 417,0 426,0 - 26,5 50,3 146,4 227,4 247,7 (1) 266,0 (1) 283,0 309,0 318,0 (1) 312,0 (1) 21,8 42,9 64,7 80,6 83,4 (1) 89,0 (1) 87,0 (1) 92,0 96,0 (2) - 40,1 59,7 127,8 131,3 149,6 168,0 175,0 186,0 219,0 223,0 20,8 41,1 113,8 155,2 169,9 192,0 208,0 227,0 249,0 277,0 (1) 127,7 177,8 235,5 273,7 280,2 288,0 295,0 305,0 313,0 331,0 73,3 92,0 147,1 186,7 186,6 196,0 201,0 (1) 208,0 222,0 238,0 58,3 130,8 252,4 331,2 353,8 365,0 372,0 387,0 392,0 395,0 185,6 397,2 470,0 529,6 538,8 541,0 547,0 553,0 553,0 555,0 80,4 115,2 279,0 335,7 355,1 367,0 376,0 388,0 395,0 401,0 (1) 55,9 96,3 195,5 233,6 243,3 (1) 251,0 (2) 260,0 (2) 272,0 (2) 284,0 (2) - Segue tab. 5 Segue tab. 5 Tasso di mortalità infantile (morti primo anno di vita per 1.000 nati vivi) Anni Belgio Danimarca Germania Grecia Spagna Francia Irlanda Italia Lussemburgo Paesi Bassi Austria Portogallo Finlandia Svezia Regno Unito Eur 15 1970 1980 1990 1995 1996 1997 1998 1999 2000 2001 21,1 12,1 8,0 6,1 5,6 (1) 6,1 5,6 4,9 4,8 (1) 5,0 (1) 14,2 8,4 7,5 5,1 5,6 5,3 4,7 4,4 5,3 4,9 22,5 12,4 7,0 5,3 5,0 4,9 4,7 (1) 4,5 4,4 4,5 (3) 29,6 17,9 9,7 8,1 7,2 6,4 5,7 (3) 6,2 6,1 (3) 5,9 (3) 28,1 12,3 7,6 5,5(2) 6,0 5,6(1) 5,7 (1) 4,9 (1) 3,9 (1) 3,9 (2) 18,2 10,0 7,3 4,9(1) 4,8 4,8 (1) 5,2 (1) 4,8 (1) 4,6 (2) 4,6 (2) 19,5 11,1 8,2 6,4 5,5 6,2(1) 6,2 (1) 5,5 5,9 (1) 5,8 (1) 29,6 14,6 8,2 6,2(1) 5,9 5,5(1) 5,3 (1) 5,2 4,5 4,3 (2) 24,9 11,5 7,3 5,5 4,9 4,2 5,0 4,7 5,1 5,9 12,7 8,6 7,1 5,5 5,7 5,0 5,2 5,2 5,1 5,3 (1) 25,9 14,3 7,8 5,4 5,1 4,7 4,9 4,5 4,8 4,8 55,5 24,3 11,0 7,5 6,9 6,4 6,0 5,6 5,5 5,0 13,2 7,6 5,6 3,9 4,0 3,9 4,2 3,6 3,8 3,2 11,0 6,9 6,0 4,1 4,0 3,6 3,5 3,4 3,4 3,2 18,5 12,1 7,9 6,2 6,1 5,9 5,7 (1) 5,8 5,6 (1) 5,5 (1) 23,4 12,4 7,6 5,6 5,5(1) 5,3(1) 5,2 (2) 5,0 (1) 4,7 (2) 4,6 (2) (1) Dati provvisori (2) Stima Eurostat (3) Stima nazionale Fonte: elaborazione Censis su dati Eurostat Tab.5 (segue)- Principali indicatori socio-demografici europei - Anni 1970-2001 (v.a.e val. %) Tasso di fecondità totale (nati per donna in età feconda) Tasso di nuzialità (per 1.000 abitanti) Segue tab. 5 Anni Belgio Danimarca Germania Grecia Spagna Francia Irlanda Italia Lussemburgo Paesi Bassi Austria Portogallo Finlandia Svezia Regno Unito Eur 15 1970 2,25 1,95 2,03 2,39 2,9 2,47 3,93 2,42 1,98 2,57 2,29 2,83 1,83 1,92 2,43 2,38 1980 1,68 1,55 1,56 2,21 2,2 1,95 3,25 1,64 1,49 1,6 1,62 2,18 1,63 1,68 1,9 1,82 1990 1,62 1,67 1,45 1,39 1,36 1,78 2,12 1,34 1,61 1,62 1,45 1,57 1,78 2,13 1,83 1,57 1995 1,55(2) 1,8 1,25 1,32 1,18(1) 1,7(1) 1,86(2) 1,17 1,69 1,53 1,4 1,4 1,81 1,73 1,7(2) 1,43 1996 1,55 (3) 1,75 1,32 1,3 1,15 (3) 1,72(1) 1,88 (1) 1,21 (3) 1,76 1,53 1,42 1,43 1,76 1,6 1,72 1,44 (2) 1997 1,55 1,75 1,37 1,31 1,16(1) 1,71(1) 1,92(1) 1,22(1) 1,71 1,56 1,37 1,46 1,75 1,52 1,72 1,45(2) 1998 1,53 (1) 1,72 1,36 1,29 1,15 1,75 (1) 1,93 (1) 1,20 (1) 1,68 1,63 1,34 1,46 1,7 1,51 1,72 1,45(2) 1999 1,61 1,74 1,37 1,3 1,20 (1) 1,77 (1) 1,89 1,23 1,71 1,64 1,32 1,49 1,73 1,5 1,68 1,45 (1) 2000 1,66 1,77 1,36 (3) 1,29 (3) 1,23 (1) 1,88 (1) 1,89 (1) 1,24 (3) 1,78 1,72 1,34 1,52 1,73 1,54 1,64 1,48 (2) 2001 1,65 (2) 1,74 1,29 (2) 1,29 (3) 1,25 (3) 1,90 (1) 1,98 (1) 1,24 (2) 1,70 (1) 1,69 (1) 1,29 (2) 1,42 (2) 1,73 1,57 1,63 (3) 1,47 (2) 1970 7,6 7,4 7,4 7,7 7,3 7,8 7 7,3 6,4 9,5 7,1 9,4 8,8 5,4 8,5 7,7 1980 6,7 5,2 6,3 6,5 5,9 6,2 6,4 5,7 5,9 6,4 6,2 7,4 6,1 4,5 7,4 6,3 1990 6,5 6,1 6,5 5,8 5,7 5,1 5,1 5,6 6,1 6,4 5,8 7,2 5 4,7 6,5 6 1995 5,1 6,6 5,3 6,1 5(1) 4,4 4,3(1) 4,9(1) 5,1 5,3 5,3 6,6 4,6 3,8 5,5(1) 5,1 1996 5 6,8 5,2 4,3 4,9 4,8 (1) 4,5 4,7 5,1 5,5 5,2 6,4 4,8 3,8 5,4 5,1 (1) 1997 4,7 6,5 5,2 5,8 4,9 4,9 (1) 4,3 4,8 (1) 4,8 5,4 5,1 6,6 4,6 3,7 5,3 (1) 5,1 (1) 1998 4,4 6,5 5,1 5,3 5,1 (1) 4,8 (1) 4,5 4,8 (1) 4,8 5,5 4,7 6,9 4,7 3,6 5,1 (1) 5,0 (2) 1999 4,3 6,7 5,2 5,8 5,2 (1) 4,9 (1) 4,9 - 4,8 5,7 4,9 6,9 (3) 4,7 4 5,1 5,1 (1) 2000 4,4 7,2 5,1 4,3 (3) 5,3 (1) 5,2 (1) 5,0 (1) 4,9 4,9 5,5 4,8 6,2 5,1 4,5 5,1 5,1 (2) 2001 4,1 (2) 6,6 4,7 (3) 5,4 (2) 5,2 (3) 5,1 (1) 5,0 (2) - 4,5 (2) 5,1 (1) 4,2 (2) 5,7 (1) 4,8 4 - - Segue tab. 5 Età media al primo matrimoni o (uomini) Età media al primo matrimoni o (donne) Tasso di divorzialit à (divorzi per 1.000 abitanti) Lussemburgo Paesi Bassi Regno Unito Anni Belgio Danimarca Germania Grecia Spagna Francia Irlanda Italia 1970 24,4 25,3 24,9 28,7 27,4 24,7 27,4 27,4 - 25 25,6 26,6 25,3 26,4 1980 24,3 27,2 25,7 27,9 25,9 25,1 27,1 27,1 - 25,5 25,9 25,4 26,5 28,6 25,2 26 1990 26,3 30 27,9 28,7 27,5 27,5 28,3 28,6 26,9 28,2 27,4 26 27 29,9 27,2 27,8 1995 27,4 31,4 29,1 29,8 28,9 28,9 29,7 29,6 28,9 29,4 28,6 26,7 28,9 31,1 28,5 29 1996 27,7 32 29,2 29,9 29,2 29,4 - 29,8 28,8 29,2 28,8 26,9 29,2 31,3 28,8 1997 27,8 31,6 29,3 30,2 29,4 29,6 30 30 29,3 29,8 28,9 27 29,3 31,6 29 1998 27,8 31,7 29,5 30,3 (1) 29,4 29,6 30,0 (1) 30,0 (1) 29,6 30 29,2 27,1 29,5 31,7 29,2 29,6 (1) 1999 28,9 32,5 30,9 - 29,5 31,2 - - 30,7 30,7 30,3 27,2 30,5 32,9 29,6 30,3 (3) 1970 22,4 22,8 22,5 23,7 24,7 22,6 25,3 23,9 - 22,9 22,9 24,3 23,4 23,9 - 23,2 1980 22,3 24,6 22,9 - 23,5 23 24,7 23,9 - 23,2 23,2 23,1 24,4 26 - 23,3 1990 24,3 27,6 25,3 24,7 25,3 25,6 26,5 25,6 25,4 25,9 24,9 23,9 25 27,5 25 25,3 1995 25,4 29 26,4 25,7 26,8 26,9 27,9 26,7 26,6 27,1 26,1 24,8 27 28,7 26,4 26,5 1996 25,6 29,7 26,6 26 27,1 27,4 - 26,8 26,5 26,7 26,3 24,9 27,3 28,9 26,7 - 1997 25,7 29,9 26,7 26,3 27,4 27,6 28,2 27,1 27,1 27,4 26,5 25 27,3 29,1 26,9 27,2 1998 25,7 29,4 26,9 26,5 (1) 27,4 27,6 28,2 (1) 27,1 (1) 1999 26,6 30,1 28,2 - 27,6 29,1 - 1970 0,7 1,9 1,3 0,4 - 0,8 1980 1,5 2,7 1,8 0,7 - 1,5 1990 2 2,7 2 0,6 0,6 1995 3,5 2,5 2,1 1,1 0,8(1) 1996 2,8 2,4 2,1 0,9 0,8 1997 2,6 2,4 2,3 0,9 1998 2,6 2,5 2,3 0,8 1999 2,6 2,5 2,3 0,9 - 2 2000 2,6 2,7 2,4 0,9 (1) 1 2,0 (4) 2001 2,9 (2) 2,7 - 0,9 (2) - - - (1) Dati provvisori (2) Stima Eurostat (3) Stima nazionale (4) 1999 Fonte: elaborazione Censis su dati Eurostat Austria Portogallo Finlandia Svezia Eur 15 25,9 29,5 27,2 27,6 26,7 25,1 27,5 29,3 27 27,3 (1) - 28,3 28,3 27,9 25,5 28,3 30,4 27,5 28,1 (3) - - 0,6 0,8 1,4 0,1 1,3 1,6 1,1 0,8 - 0,2 1,6 1,8 1,8 0,6 2 2,4 2,8 1,4 1,9 - 0,5 2 1,9 2,1 0,9 2,6 2,3 2,9 1,7 2(1) - 0,5 1,8 2,2 2,3 1,2 2,7 2,6 2,9(1) 1,8 2,1 (1) - 0,6 2 2,3 2,2 1,4 2,7 2,4 2,9 1,8 (3) 0,9 2,0 (1) - 0,6 2,4 2,2 2,2 1,4 2,6 2,4 2,7 (1) 1,8 (2) 0,9 (1) 2,0 (1) - 0,6 (1) 2,4 2,1 2,2 1,5 2,7 2,3 2,7 (1) 1,8 (2) - 0,6 2,4 2,1 2,3 1,8 (3) 2,7 2,4 2,7 1,8 (2) 0,7 (1) 0,7 2,3 2,2 2,4 1,9 2,7 2,4 2,6 1,9 (2) - 2,3 (2) 2,3 (1) - 1,8 (1) 2,6 2,4 - - Tab. 6 - Cittadini stranieri residenti in Italia per ripartizione geografica (al 1° gennaio dell'anno) - Anni 1995-2001 (v.a. e val. per 1000 ab.) 1996 1995 v.a. per 1.000 abitanti Nord-Ovest Nord-Est Centro Sud ed Isole 216.086 133.309 212.269 123.805 Italia 685.469 Fonte: elaborazione Censis Istat 1997 v.a. per 1.000 abitanti 14,4 12,8 19,3 5,9 231.351 149.176 226.338 130.928 12,0 737.793 1999 1998 v.a. per 1.000 abitanti v.a. per 1.000 abitanti 15,4 14,3 20,6 6,3 272.806 179.109 274.894 157.746 18,2 17,1 24,9 7,5 316.674 205.725 296.830 172.449 12,9 884.555 15,4 991.678 2000 v.a. per 1.000 abitanti 21,1 19,5 26,9 8,2 366.491 236.616 328.910 184.377 17,2 1.116.394 2001 v.a. per 1.000 abitanti v.a. per 1.000 abitanti 24,3 22,4 29,7 8,8 420.423 279.442 363.433 207.255 27,8 26,3 32,8 9,9 489.038 332.034 417.890 225.627 32,3 31,1 37,4 10,8 19,4 1.270.553 22,0 1.464.589 25,3 Tab. 7 - Popolazione per classe d'età e titolo di studio - Maschi - Anno 2002 (val%) Senza titolo e licenza elementare Licenza Media Diploma Laurea Totale 15-19 20-24 25-29 30-59 60 e oltre 4,7 2,9 3,4 15,3 63,7 82,0 31,9 35,4 40,1 18,7 13,3 64,1 51,7 33,8 11,8 0,0 1,1 9,6 10,8 5,8 100,0 100,0 100,0 100,0 100,0 Totale 24,8 36,4 30,8 8,0 100,0 Fonte: elaborazione Censis su dati Istat Tab. 8 - Popolazione per classe d'età e titolo di studio -Femmine- Anno 2002 (val%) Senza titolo e licenza elementare Licenza Media Diploma Laurea Totale 15-19 20-24 25-29 30-59 60 e oltre 3,9 2,6 3,6 21,4 76,4 81,0 23,0 29,6 35,2 13,0 15,1 72,4 53,8 32,8 8,0 0,0 1,9 13,0 10,5 2,5 100,0 100,0 100,0 100,0 100,0 Totale 34,8 29,7 28,5 7,1 100,0 Fonte: elaborazione Censis su dati Istat Tab. 9 - Popolazione per classe d'età e titolo di studio -Totale-Anno 2002 (val%) Senza titolo e licenza elementare Licenza Media Diploma Laurea Totale 15-19 20-24 25-29 30-59 60 e oltre 4,3 2,7 3,5 18,4 71,0 81,5 27,5 32,5 37,7 15,5 14,2 68,2 52,7 33,3 9,7 0,0 1,5 11,3 10,7 3,9 100,0 100,0 100,0 100,0 100,0 Totale 30,0 32,9 29,6 7,5 100,0 Fonte: elaborazione Censis su dati Istat Tab. 10 - Andamento del Prodotto Interno Lordo - Anni 1995-2001 (v.a. in mld di lire dal 1995, mln di euro e mld di lire per gli anni 1999-2000-2001, var. %) 1995 1996 1997 1998 1999 2000 2001 lire euro lire euro lire euro PIL ai prezzi di mercato PIL ai prezzi di mercato (prezzi 1995) Numero indice (1995=100) var. % (in termini reali) 1.787.278 1.902.275 1.987.165 2.077.654 2.146.350 1.108.497 2.255.303 1.164.767 2.355.634 1.216.583 1.787.278 1.806.815 1.843.426 1.876.497 1.906.388 984.567 1.961.058 1.012.802 1.996.120 1.030.910 100,0 101,1 103,1 105,0 106,7 2,9 1,1 2,0 1,8 1,6 109,7 2,9 111,7 1,8 Fonte: elaborazione Censis su dati Relazione Generale sulla Situazione Economica del Paese Tab. 11 - Valore aggiunto ai prezzi di mercato - Valori a prezzi correnti - Anni 1995-2002 (milioni di euro dal 1999; milioni di eurolire per gli anni precedenti) 1995 Agricoltura, silvicoltura e pesca Industria in senso stretto Costruzioni Commercio, riparazioni, alberghi e ristoranti, trasporti e comunicazioni Intermediazione monetaria e finanziaria; attività immobiliari ed imprenditoriali 1996 1997 1998 1999 2000 2001 2002 26.285 251.345 45.704 27.121 257.877 49.218 26.984 265.875 49.562 27.286 276.279 49.959 27.631 279.920 51.502 27.131 288.625 54.172 28.132 299.441 58.051 28.068 300.947 60.584 206.408 217.585 225.303 235.111 239.305 252.774 267.310 273.514 211.967 233.658 246.900 258.596 272.356 293.880 308.815 328.303 Altre attività di servizi 167.007 182.247 192.286 198.670 206.169 214.214 227.007 236.085 Valore aggiunto ai prezzi di mercato (al lordo SIFIM) 908.716 967.706 1.006.909 1.045.902 1.076.883 1.130.796 1.188.756 1.227.501 Valore aggiunto ai prezzi di mercato (al netto SIFIM) 868.856 926.986 965.800 1.005.078 1.037.844 1.087.365 1.140.754 1.176.596 Prodotto interno lordo ai prezzi di mercato 923.052 982.443 1.026.285 1.073.019 1.107.994 1.166.548 1.220.147 1.258.349 Fonte: Istat Tab. 12 - Reddito disponibile - Anno 2001 (v. a. in mln di euro e v.pro capite in euro) V.A. V. pro capite Piemonte ValleAosta Lombardia Trentino Alto Adige Veneto Friuli Venezia Guilia Liguria Emilia Romagna Toscana Umbria Marche Lazio Abruzzo Molise Campania Puglia Basilicata Calabria Sicilia Sardegna 73.092 2.147 162.294 14.238 71.141 19.903 29.880 75.325 60.160 12.323 22.587 86.279 16.501 4.004 62.308 44.687 6.286 21.871 53.101 18.880 17.348 17.959 17.966 15.138 15.705 16.816 19.032 18.904 17.203 14.915 15.354 16.861 13.071 12.495 10.929 11.118 10.522 10.883 10.694 11.577 Nord-Ovest Nord-Est Centro Sud 267.413 180.607 181.349 227.638 17.903 16.977 16.620 11.100 Italia 857.008 15.037 Fonte: elaborazione Censis su dati Istituto Tagliacarne Tab. 13 - Variazione armonizzata dei prezzi al consumo nei principali paesi europei - Anni 1998-2002 (var. %) 1998 1999 2000 2001 2002* Italia Germania Francia Regno Unito UE 15 2,0 1,7 2,6 2,3 2,5 0,8 0,6 2,1 2,4 1,7 0,7 0,6 1,8 1,8 2,1 1,6 1,3 0,8 1,2 1,5 1,3 1,2 2,1 2,3 2,2 *Media aritmetica dei dati relativi ai mesi di gennaio, febbraio, marzo, aprile, maggio. Per il Regno Unito il dato relativo al mese di maggio non è disponibile. Fonte: elaborazione Censis su dati Eurostat. Tab. 14 - Popolazione secondo la ripartizione territoriale e la condizione socio-economica -Anni 2000-2002 (v.a. in migliaia e var.%) Nord Forze lavoro Cemtro Sud 1999 2000 20001 2002 11.316 11.442 11.553 11.675 1,1 4.594 4.638 4.693 4.737 0,9 7.451 7.495 7.535 7.581 0,6 23.361 23.575 23.781 23.993 0,9 10.704 10.907 11.090 11.213 1,1 4.172 4.255 4.345 4.424 1,8 5.816 5.918 6.079 6.192 1,9 20.692 21.080 21.514 21.829 1,5 611 535 463 462 -0,2 422 384 348 313 -10,1 1.636 1.576 1.456 1.389 -4,6 2.669 2.495 2.267 2.163 -4,6 426 370 315 320 1,6 317 288 265 241 -9,0 1.333 1.266 1.178 1.126 -4,4 2.076 1.924 1.758 1.687 -4,1 185 165 148 142 -4,1 105 96 83 72 -13,8 303 310 278 263 -5,3 593 571 509 477 -6,4 14.035 14.005 14.020 13.986 -0,2 6.365 6.356 6.353 6.354 0,0 13.317 13.252 13.194 13.141 -0,4 33.717 33.614 33.567 33.482 -0,3 6.315 6.170 6.054 5.940 -1,9 2.937 2.886 2.842 2.815 -0,9 6.535 6.492 6.440 6.382 -0,9 15.787 15.548 15.336 15.137 -1,3 227 202 204 192 -5,7 217 205 187 179 -4,1 759 804 784 754 -3,9 1.203 1.211 1.175 1.125 -4,2 737 736 506 (1) 299 (2) -40,9 363 361 286 162 -43,3 941 937 839 634 -24,4 2.041 2.034 1.631 1.095 -32,8 1999 2000 20001 2002 Var.% 01-02 1999 2000 20001 Italia Var.% 01-02 2002 Var.% 01-02 1999 2000 20001 2002 Var.% 01-02 di Occupati Persone in cerca di occupazione - Disoccupati e in cerca I° occupazione Altre persone in cerca di lavoro Non forze di lavoro In eta' 15-64 anni cercano lavoro non attivamente -disposte a lavorare a partic. condiz. - non aventi poss. o interesse a lavorare (*) In eta' non lavorativa 5.351 5.233 5344 (1) 5448 (2) 2,0 2.357 2.320 2.369 2.474 4,4 4.835 4.751 4.817 4.994 3,7 12.543 12.304 12.530 12.916 3,1 7.720 7.835 7.966 8.046 1,0 3.428 3.470 3.511 3.539 0,8 6.782 6.760 6.753 6.759 0,1 17.930 18.066 18.230 18.345 0,6 Popolazione presente 25.351 25.447 25.573 25.661 0,3 10.959 10.995 11.046 11.091 0,4 20.768 20.747 20.729 20.722 0,0 57.078 57.189 57.348 57.474 0,2 (*) Con riferimento all'anno 2002 la definizione è la seguente: "non vogliono lavorare o non immediatamente (1) Con la rilevazione di aprile 2001 è stata modificata la domanda relativa alla disponibilità al lavoro che è richiesta essere immediata. (2) Con la rilevazione di aprile 2002 la disponibilità viene rilevata solo se sussiste il desiderio di lavorare. Fonte : elaborazione Censis su dati Istat Tab. 15 - Occupati per posizione nella professione e sesso - Anno 2002 (val.% e var. %) Val.% 2002 Var % 2000-2002 Maschi Femmine Totale Maschi Femmine Totale Imprenditori Liberi professionisti Lavoratori in proprio Soci di cooperativa di produzione Coadiuvanti 78,8 73,9 75,8 62,6 45,8 21,2 26,1 24,2 37,4 54,2 100,0 100,0 100,0 100,0 100,0 16,2 5,4 -3,5 -29,8 7,9 20,0 15,0 -4,1 -17,4 5,1 17,0 7,8 -3,6 -25,6 6,4 Totale indipendenti 70,8 29,2 100,0 0,0 1,9 0,5 Dirigenti Direttivi-Quadri Impiegati o Intermedi Operai, Subalterni ed assimilati Apprendisti Lavoranti a domicilio per conto imprese 78,3 63,1 47,9 68,5 59,4 22,2 21,7 36,9 52,1 31,5 40,6 77,7 100,0 100,0 100,0 100,0 100,0 100,0 -6,3 5,3 5,8 1,8 -6,1 -23,7 0,3 8,6 9,7 4,0 1,6 -16,0 -5,0 6,5 7,8 2,5 -3,1 -17,9 Totale dipendenti 59,0 41,0 100,0 3,1 7,3 4,7 Totale 62,3 37,7 100,0 2,1 6,1 3,6 Fonte: elaborazioni Censis su dati Istat Tab. 16 - Tassi di disoccupazione per sesso e ripartizione territoriale - Anni 1999-2002 (val.%) Maschi Femmine Totale 1999 2000 2001 2002 1999 2000 2001 2002 1999 2000 2001 2002 Nord-Ovest Nord-Est Centro Sud 3,8 2,8 6,6 17,3 3,4 2,4 6,1 16,3 2,9 2,3 5,4 14,8 3,0 2,2 4,7 14,1 9,2 7,1 13,2 31,3 8,0 5,9 11,6 30,4 6,3 5,4 10,3 28,1 6,4 4,9 9,4 26,4 6,0 4,6 9,2 22,0 5,3 3,8 8,3 21,0 4,3 3,6 7,4 19,3 4,4 3,3 6,6 18,3 Italia 8,8 8,1 7,3 7,0 15,7 14,5 13,0 12,2 11,4 10,6 9,5 9,0 Fonte: elaborazione Censis su dati Istat Tab. 17 - Tassi di disoccupazione giovanile (15-24) della popolazione per sesso e ripartizione territoriale - Anni 1999-2002 (val.%) Maschi Femmine Totale 1999 2000 2001 2002 1999 2000 2001 2002 1999 2000 2001 2002 Nord-Ovest Nord-Est Centro Sud 14,1 8,9 24,6 51,0 12,4 7,6 21,0 49,3 11,1 7,2 21,3 44,2 11,5 6,4 18,7 42,6 22,3 14,6 35,8 64,5 20,2 12,9 32,4 63,1 14,3 11,9 27,6 60,0 15,6 9,9 26,0 59,5 18,0 11,6 29,6 56,6 16,1 10,1 26,3 55,0 12,6 9,3 24,2 50,8 13,3 8,0 22,0 49,4 Italia 29,2 27,6 25,0 24,0 37,4 35,4 32,2 31,4 32,9 31,1 28,2 27,2 Fonte: elaborazione Censis su dati Istat Tab. 18 - Assicurati e pensionati, spesa pensionistica (Lavoratori dipendenti) - Anni 2000-2001 (v.a. in mgl, mgl di euro e mln di euro) Numero assicurati Numero pensioni Pensione media annua Importo pensioni * 2000 2001 2000 2001 2000 2001 2000 2001 mgl mgl mgl mgl mgl € mgl € mln € mln € Inps Fondo Pensioni Lavoratori Dip. 11.380 Fondo Trasporti 113 Fondo Telefonici 91 Fondo Elettrici 77 Fondo Volo 12 Fondo Imposte di consumo 2 Fondo Enti Pubblici Creditizi 74 11.520 115 83 72 12 2 74 10.020 121 52 94 5 11 32 10.047 121 55 97 5 11 32 8 16 20 19 31 13 25 8 16 21 20 32 13 25 79.154 1.929 1.052 1.792 138 133 816 82.385 1.977 1.157 1.895 145 138 816 Totale dipendenti Inps 11.747 11.877 10.334 10.368 8 9 84.740 89.161 Altri fondi Istituto Dirigenti di Azienda Istituto Giornalisti Ente Lavoratori Spettacolo 80 14 211 82 15 214 84 5 57 87 5 56 39 43 11 40 44 12 3.239 213 640 3.488 223 657 Totale fondi 305 311 145 148 28 30 4.097 4.366 Inpdap Cassa Dipendenti Enti Locali Cassa Insegnanti di Asilo Cassa Sanitari Cassa Ufficiali Giudiziari Dipendenti dello Stato 1.350 20 113 6 1.800 1.350 20 113 6 1.794 875 12 44 2 1.379 894 12 46 2 1.412 13 13 31 14 17 14 13 33 14 18 11.643 153 1.370 30 23.584 12.339 162 1.519 32 24.985 Totale dipendenti Inpdap 3.289 3.283 2.313 2.366 16 17 36.775 39.044 Altri fondi pubblici Dipendenti delle FFSS Dipendenti delle Poste e Tel. 111 183 107 173 268 103 268 108 14 13 15 14 3.858 1.364 3.987 1.467 Totale dipendenti fondi pubblici 293 280 371 376 14 15 5.234 5.445 dipendenti altri altri * Ottenuto moltiplicando la pensione media per il numero delle pensioni Fonte: elaborazioni Censis su dati del Nucleo di valutazione spesa previdenziale Tab. 19 - Assicurati e pensionati, spesa pensionistica (Lavoratori autonomi e professionisti) - Anni 1999-2000 (v.a. in mgl, mgl di euro e mln di euro ) Numero assicurati Numero pensioni Pensione media annua Importo pensioni * 2000 2001 2000 2001 2000 2001 2000 2001 mgl mgl mgl mgl mgl € mgl € mln € mln € Inps Fondo Artigiani Fondo Commercianti Fondo CDCM 1.833 1.785 652 1.850 1.800 646 1.162 1.035 2.033 1.186 1.068 2.000 6,3 5,6 4,9 7 6 5 7.319 5.798 9.960 7.946 6.304 10.201 Totale autonomi Inps 4.271 4.296 4.230 4.255 5,5 5,7 23.263 24.251 Liberi professionisti Cassa Avvocati Cassa Notai Cassa Ingeneri e Architetti Cassa Geometri Cassa Dottori Commercialisti Cassa Ragionieri e P. C. Ente Consulenti Lavoro Ente Veterinari Ente Farmacisti Fondo Spedizionieri 89 5 87 94 33 31 19 18 61 - 94 5 93 96 35 31 19 19 63 - 20 2 14 18 3 3 5 6 26 2,1 21 2 14 19 4 4 5 6 26 2 14,8 44,7 9,9 8,4 16,1 16,4 5,6 3,1 5,1 9,5 16 50 11 9 19 17 6 3 5 9,6 299 107 139 150 55 56 26 20 131 20 323 120 154 165 67 60 28 20 134 20 Totale liberi professionisti 436 455 100 102 10 10,7 999 1.086 Medici 303 304 121 123 5,7 5,9 692 728 Clero 21 21 15 15 5,8 6,1 89 91 1.897 2.070 5 8,7 -- 0,5 -- 4 Parasubordinati * Ottenuto moltiplicando la pensione media per il numero delle pensioni Fonte: elaborazioni Censis su dati del Nucleo di valutazione spesa previdenziale SALUTE Tab. 20 - Andamento della condizione di salute della popolazione italiana - Anni 1993-2001 (val %) % sul totale dei residenti In buono stato di Con una malattia salute (*) cronica o più 1993 1994 1995 1996 1997 1998 1999 2000 2001 Nord Centro Sud Italia 72,0 76,0 75,3 75,9 76,0 75,2 75,5 73,7 74,0 72,2 77,4 74,9 35,4 35,4 36,0 36,9 35,3 33,5 34,9 36,1 35,9 37,3 34,6 35,7 % sul totale dei cronici Con due malattie Cronici in buona croniche o più salute 18,2 18,1 18,1 18,8 17,6 16,6 16,8 18,7 17,7 19,4 19,4 18,6 (*) Esprimono un voto 4 o 5 in una scala 1=stato peggiore; 5=stato migliore Fonte: indagine Multiscopo, Istat 44,0 47,1 46,3 47,8 48,0 47,0 46,0 45,8 48,4 45,3 48,3 47,8 Tab. 21 - Andamento della diffusione delle principali malattie croniche nella popolazione italiana -Anni 1993-2001 (val. %) 1993 1994 1995 1996 1997 1998 1999 2000 2001 Nord Centro Sud Italia Diabete Ipertensione Bronchite cronica* Artrosi Artrite Osteoporosi Malattie del cuore Malattie allergiche Disturbi nervosi Ulcera gastrica e duodenale 3,4 3,4 3,4 3,4 3,4 3,5 3,5 3,8 3,4 4,1 4,3 3,9 10,0 9,7 10,2 10,3 10,3 10,3 11,1 12,1 11,7 11,8 11,7 11,7 7,4 6,9 6,9 6,9 6,3 6,0 6,0 6,4 5,8 6,4 6,9 6,3 20,5 19,7 20,3 20,6 19,3 17,8 18,1 19,0 17,5 20,4 20,4 19,1 4,6 4,6 4,8 5,2 5,2 5,0 5,3 6,4 5,6 7,1 6,8 6,3 3,7 4,0 3,8 3,8 3,8 3,7 3,8 3,9 3,9 3,4 3,6 3,7 6,8 6,3 6,8 7,2 7,1 6,6 7,7 8,1 8,6 8,6 7,7 8,2 5,1 5,2 4,9 4,9 4,4 3,8 4,2 4,3 3,6 3,8 4,7 4,0 3,8 4,0 3,9 3,9 3,5 3,0 3,2 3,6 3,1 3,4 3,1 3,2 * Inclusa asma bronchiale Fonte: indagine Multiscopo, Istat Tab. 22 - Condizioni di salute della popolazione italiana per sesso e classi di età - Anno 2001 (val. %) % sul totale dei residenti % sul totale dei cronici Con due malattie croniche o più Con una malattia cronica o più In buono stato di salute (*) Cronici in buona salute Maschi Femmine Totale Maschi Femmine Totale Maschi Femmine Totale 0-14 15-17 18-19 20-24 25-34 35-44 45-54 55-59 60-64 65-74 75 e più 91,6 95,0 93,0 93,7 91,6 86,1 78,4 68,1 60,8 47,7 31,4 92,3 94,9 95,0 91,9 88,8 83,7 72,0 62,0 52,6 39,7 25,2 91,9 94,9 94,0 92,8 90,2 84,9 75,2 65,0 56,6 43,3 27,5 9,0 11,4 10,6 12,5 15,7 23,1 37,0 51,2 62,2 71,8 80,1 6,9 10,3 11,7 13,4 15,1 24,8 43,0 60,9 71,3 79,9 87,5 8,0 10,9 11,2 13,0 15,4 23,9 40,1 56,1 66,9 76,3 84,8 1,2 1,6 2,2 2,4 3,1 6,2 13,7 24,3 32,3 44,5 57,6 0,9 1,1 1,9 2,6 3,6 7,8 19,4 34,8 45,3 58,7 69,2 1,0 1,4 2,1 2,5 3,3 7,0 16,6 29,6 39,0 52,4 64,9 85,7 88,6 83,1 82,7 78,4 67,0 59,3 52,1 49,1 38,4 23,5 84,5 91,1 87,6 77,2 71,0 64,5 53,8 48,4 41,4 32,7 21,3 85,2 89,8 85,4 79,9 74,8 65,8 56,3 50,1 44,9 35,1 22,0 Totale 78,3 71,6 79,9 32,3 38,9 35,7 14,7 22,4 18,6 52,5 44,0 47,8 (*) Esprimono un voto 4 o 5 in una scala 1=stato peggiore; 5=stato migliore Fonte: Indagine Multiscopo, Istat Maschi Femmine Totale Tab. 23 - Andamento dei casi di Aids notificati (1) per regione - Anni 1995-2001 e I semestre 2002 (val. per 1000 abitanti) 1995 1996 1997 1998 1999 2000 2001 (2) I semestre 2002 (2) Piemonte Valle d'Aosta Lombardia Trentino A.A. Bolzano Trento Veneto Friuli V.G. Liguria Emilia Romagna Toscana Umbria Marche Lazio Abruzzi Molise Campania Puglia Basilicata Calabria Sicilia Sardegna 8,6 5,9 18,7 6,8 5,3 8,2 7,2 3,3 17,1 14,5 10,3 5,8 6,2 14,1 3,7 1,5 3,6 5,4 3,1 2,7 4,3 11,3 8,1 8,4 16,8 6,0 5,9 6,0 6,3 4,1 15,6 12,6 8,1 6,3 5,5 12,7 3,2 0,6 3,1 5,6 3,3 2,9 3,4 8,8 5,3 2,5 10,5 4,4 3,7 5,1 4,0 2,4 9,7 7,9 5,8 3,2 3,8 9,4 2,4 0,6 2,3 3,7 1,1 1,5 3,1 5,6 3,7 4,2 7,1 2,9 2,8 3,0 2,6 1,3 6,6 5,7 4,0 2,9 3,1 6,8 1,4 0,9 2,2 2,5 1,8 1,3 2,5 3,1 3,2 4,2 6,9 1,7 1,5 1,9 2,3 1,9 5,2 4,2 4,5 2,3 2,9 5,8 1,9 0,3 1,6 2,2 1,3 0,7 1,7 2,7 3,1 1,7 6,1 1,7 2,4 1,0 1,7 1,5 4,4 5,2 3,1 2,5 2,8 4,7 1,2 1,5 1,6 2,0 0,5 0,5 1,8 2,4 2,8 2,5 5,4 1,4 1,5 1,3 1,8 0,8 4,9 4,2 3,0 1,7 2,5 4,7 1,3 0,6 1,2 1,7 0,7 1,2 1,4 2,4 0,5 0,0 1,6 0,6 0,2 1,0 0,6 0,3 0,8 1,3 1,2 0,9 0,8 1,1 0,6 0,3 0,5 0,7 0,2 0,4 0,3 1,0 Nord-Ovest Nord-Est Centro Sud 15,5 9,4 11,3 4,6 14,1 8,4 9,8 4,1 8,8 5,3 7,1 2,9 6,0 3,7 5,1 2,2 5,7 2,9 4,7 1,7 5,0 3,0 3,8 1,6 4,6 2,5 3,6 1,4 1,2 0,8 1,1 0,5 9,6 8,6 5,7 4,0 3,6 3,2 2,9 0,8 Italia (1) casi notificati al 31/12 dell'anno di riferimento, riguardanti i residenti in Italia per i quali sia stato accertato il luogo di residenza (2) la popolazione di riferimento è quella del Censimento 2001 Fonte: elaborazione Censis su dati dell'Istituto Superiore di Sanità Tab. 24 - Andamento dei decessi per causa - Anni 1995-2000 (val. per 10.000 abitanti 1995 1996 1997 1998 1999 2000 0,5 26,9 0,5 27,3 0,6 27,3 0,6 27,6 0,6 27,5 0,6 27,7 Malattie del sistema circolatorio Malattie dell'apparato respiratorio Malattie dell'apparato digerente Altri stati morbosi Sintomi segni e stati morbosi mal definiti Cause esterne dei traumatismi e avvelenamenti 3,3 42,4 5,9 4,7 7,1 1,5 4,9 3,4 41,8 5,6 4,6 7,2 1,4 4,9 3,6 42,4 6,2 4,5 6,7 1,4 4,9 3,9 43,9 6,5 4,6 6,6 1,2 4,8 3,9 42,7 6,8 4,5 6,5 1,3 4,7 4,0 41,6 6,5 4,3 6,4 1,2 4,5 Totale 97,1 96,6 97,5 99,7 98,5 97,0 Malattie infettive e parassitarie Tumori Disturbi psichici e malattie del sistema nervoso e degli organi dei sensi Fonte: elaborazione Censis su dati Istat Tab. 25 - Distribuzione degli istituti di cura pubblici e privati accreditati e dei posti letto per regione - Anno 2001 (v.a. e val.%) Numero istituti Numero posti letto pubblici effettivi Pubblici Accreditati Non acceditati Day Hospital Piemonte Valle d'Aosta Lombardia Trentino A.A. Bolzano Trento Veneto Friuli V.Giulia Liguria Emilia Romagna Toscana Umbria Marche Lazio Abruzzo Molise Campania Puglia Basilicata Calabria Sicilia Sardegna 44 1 71 21 7 14 75 19 25 42 41 11 38 75 23 7 66 68 11 37 70 33 38 0 54 10 5 5 16 5 2 41 28 5 14 94 13 2 76 30 1 38 50 13 7 0 11 4 4 0 3 0 9 5 5 0 0 37 0 0 6 5 0 0 10 0 1.927 45 3.554 423 111 312 2.065 517 818 2.007 1.496 506 547 2.559 484 21 1.327 1.236 184 703 2.107 574 11,0 8,8 8,7 9,1 5,0 12,9 9,4 9,0 9,6 11,5 10,0 14,6 8,4 11,7 8,8 1,4 8,8 7,2 7,1 10,9 12,0 8,4 Nord Ovest Nord Est Centro Sud Italia 141 157 165 315 778 94 72 141 223 530 27 12 42 21 102 6.344 5.012 5.108 6.636 23.100 9,4 10,1 10,9 9,1 9,8 Fonte: elaborazione Censis su dati Ministero della Salute % Day Degenza Hospital ordinaria sul totale Totali % posti letto pubblici sul totale posti letto pubblici e privati x 1.000 abitanti Numero posti letto accreditati Degenza pagamento Totali Day Hospital % Day Degenza Hospitals ordinaria ul totale 15.289 467 36.639 4.146 2.031 2.115 19.068 5.041 7.680 15.311 13.116 2.944 5.920 19.171 4.803 1.457 13.761 15.623 2.378 5.755 15.377 6.164 224 2 578 80 80 0 722 213 28 117 344 16 29 113 196 0 63 210 15 13 77 64 17.440 514 40.771 4.649 2.222 2.427 21.855 5.771 8.526 17.435 14.956 3.466 6.490 21.843 5.483 1.478 15.151 17.069 2.577 6.471 17.561 6.802 81 0 477 0 0 0 56 28 0 112 124 18 0 378 1 0 236 58 0 26 0 18 2,2 0,0 5,3 0,0 0,0 0,0 4,4 4,4 0,0 2,3 5,3 6,9 0,0 3,9 0,3 0,0 3,5 2,9 0,0 0,8 0,0 1,2 3.556 0 8.465 692 259 433 1.206 608 128 4.732 2.229 244 1.074 9.351 294 93 6.518 1.910 60 3.335 3.725 1.484 3.637 0 8.942 692 259 433 1.262 636 128 4.844 2.353 262 1.074 9.729 295 93 6.754 1.968 60 3.361 3.725 1.502 82,74 100,00 82,01 87,04 89,56 84,86 94,54 90,07 98,52 78,26 86,41 92,97 85,80 69,18 94,89 94,08 69,17 89,66 97,72 65,82 82,50 81,91 5,00 4,30 5,50 5,68 5,36 5,99 5,10 5,41 5,51 5,59 4,95 4,51 5,14 6,17 4,58 4,90 3,84 4,74 4,41 4,89 4,29 5,09 60.075 43.566 41.151 65.318 210.110 832 1.132 502 638 3.104 67.251 49.710 46.755 72.592 236.308 558 196 520 339 1.613 4,4 2,6 3,9 1,9 3,1 12.149 7.238 12.898 17.419 49.704 12.707 7.434 13.418 17.758 51.317 84,11 86,99 77,70 80,35 82,16 5,35 5,37 5,51 4,41 5,05 Tab. 26 - Distribuzione regionale delle strutture sanitarie pubbliche per tipo di assistenza erogata - Anno 2001 (*) (v.a.) Piemonte Valle d'Aosta Lombardia Trentino A.A. Bolzano Trento Veneto Friuli V.G. Liguria Emilia Romagna Toscana Umbria Marche Lazio Abruzzo Molise Campania Puglia Basilicata Calabria Sicilia Sardegna Attività clinica Diagnostica strumentale Attività di laboratorio Consultorio maternoinfantile Assistenza psichiatrica Assistenza per tossicodipendenti Assistenza Aids Assistenza anziani Assistenza disabili fisici Assistenza disabili psichici Totale strutture 353 6 455 174 142 32 242 101 239 129 3 194 74 59 15 99 24 76 127 2 155 23 12 11 96 20 30 261 24 336 74 57 17 318 31 124 211 5 628 19 8 11 256 82 71 0 1 97 5 4 1 50 22 27 0 0 24 1 1 0 7 5 3 50 0 52 1 0 1 21 21 16 15 0 38 1 0 1 54 6 4 24 0 90 4 4 0 79 23 8 1.170 41 2.069 376 287 89 1.222 335 598 236 444 88 158 313 103 22 286 261 60 199 290 169 74 107 28 68 165 43 16 119 99 16 61 147 53 69 82 23 65 123 51 12 118 89 17 63 130 42 194 266 47 45 200 34 6 152 142 32 45 163 73 201 242 52 67 222 22 11 139 80 12 45 216 58 50 71 13 22 44 5 5 39 29 2 14 36 13 2 8 2 3 9 0 0 4 1 1 1 6 0 182 119 15 34 6 3 1 14 0 0 2 7 1 72 56 13 11 5 0 1 10 13 6 15 5 11 53 84 22 21 36 2 0 20 18 5 17 12 21 1.133 1.479 303 494 1.123 263 74 901 732 151 462 1.012 441 118 225 174 28 545 57 133 85 61 336 122 159 163 95 539 3.878 3.066 3.399 4.036 14.379 Nord Ovest 1.053 402 314 745 915 125 27 Nord Est 753 271 208 617 558 127 15 Centro 1.003 368 293 558 583 150 22 Sud 1.390 554 522 647 583 143 13 Italia 4.199 1.595 1.337 2.567 2.639 545 77 (*) Dal totale è esclusa una struttura sanitaria rilevata in Toscana ed una in Calabria che erogano assistenza idrotermale Fonte: elaborazione Censis su dati Ministero della Salute Tab. 27 - Attività di medicina di base - Medici generici e pediatri. Assistibili per medico generico e per pediatra - Anno 2001 (v.a.) V.A. INDICI Adulti residenti Bambini per per medico pediatra generico Medici generici Pediatri Piemonte Valle D'Aosta Lombardia Trentino A.A. Bolzano Trento Veneto Friuli V.G. Liguria Emilia Romagna Toscana Umbria Marche Lazio Abruzzo Molise Campania Puglia Basilicata Calabria Sicilia Sardegna 3.544 104 7.310 590 230 360 3.517 1.027 1.394 3.225 3.077 710 1.206 4.700 1.033 280 4.509 3.275 506 1.722 3.971 1.327 416 15 956 112 41 71 522 102 171 477 396 102 169 713 196 38 780 592 72 295 845 230 1.075 1.020 1.095 1.359 1.699 1.141 1.129 1.035 1.049 1.110 1.028 1.049 1.072 980 1.078 1.012 1.055 1.051 1.019 999 1.068 1.079 1.157 965 1.170 1.262 1.815 943 1.089 1.231 929 902 973 938 1.046 980 856 1.150 1.313 1.091 1.241 1.095 988 940 Nord-Ovest Nord-Est Centro Sud Italia 12.352 8.359 9.693 16.623 47.027 1.558 1.213 1.380 3.048 7.199 1.083 1.126 1.012 1.053 1.065 1.138 1.043 983 1.097 1.075 Fonte: elaborazione Censis su dati Ministero della Salute Tab. 28 - Spesa farmaceutica pubblica e privata in diversi Paesi - Anni 1999-2001 (mld di lire correnti e mln di euro) 1999 Spesa totale 2000 lire euro lire euro Italia 27.623 14.266 29.536 Francia 43.047 22.232 Germania 53.120 27.434 Regno Unito 30.303 Belgio Olanda 2001 1999 Spesa pro-capite 2000 lire euro lire euro lire euro 15.254 33.240 17.167 479.664 247.726 512.066 46.776 24.158 51.447 26.570 734.539 379.358 56.265 29.058 60.192 31.087 647.383 334.345 15.650 35.585 18.378 38.870 20.075 513.543 6.452 3.332 6.890 3.558 7.245 3.742 - - 7.000 3.615 7.689 3.971 2001 1999 Indice spesa 2000 2001 % spesa farmaceutica 1999 2000 2001 lire euro 264.460 574.694 296.805 100,0 100,0 100,0 1,30 1,31 776.062 400.803 873.582 451.167 153,1 151,6 152,0 1,66 1,73 1,82 685.425 353.992 732.807 378.463 135,0 133,9 127,5 1,39 1,43 1,52 265.223 600.723 310.248 653.266 337.384 107,1 117,3 113,7 1,20 1,20 1,26 633.702 327.280 674.066 348.126 706.554 364.905 132,1 131,6 122,9 1,45 1,44 1,45 - - 451.984 233.430 482.795 249.343 - 88,3 84,0 - 1,08 1,01 1,41 Spagna 16.952 8.755 18.524 9.567 19.604 10.125 431.086 222.637 469.938 242.703 496.731 256.540 89,9 91,8 86,4 1,54 1,58 1,56 USA 266.792 137.787 512.562 264.716 629.764 325.246 1.011.219 522.251 1.878.357 970.090 2.286.957 1.181.115 210,8 366,8 397,9 2,29 2,45 2,87 Giappone 159.235 82.238 216.312 111.716 148.163 76.520 1.262.107 651.824 1.707.466 881.833 1.167.382 602.902 263,1 333,4 203,1 1,55 1,54 1,64 Fonte: Farmindustria POVERTÀ Tab. 29 POVERTÀ NEL TEMPO E SUL TE Fonte: Istat Tab. 30 Fonte: Istat Tab. 31 Fonte: Istat Tab. 32 Fonte: Istat Tab. 33 Fonte: Istat Tab. 34 Fonte: Istat Tab. 35 Fonte: Istat Tab. 36 Fonte: Istat Tab. 37 Fonte: Istat Tab. 38 Fonte: Istat Tab. 39 Fonte: Istat Tab. 40 Fonte: Istat Tab. 41 Fonte: Istat Tab. 42 Fonte: Istat Tab. 43 Fonte: Istat CRIMINALITÀ Tab. 44 - Reati denunciati alle Autorità giudiziarie dalle Forze dell'ordine, provincia - Anni 1995-2001 (v.a.) 1995 1996 1997 1998 1999 2000 2001 Torino Vercelli Biella Verbano-Cusio-Ossola Novara Cuneo Asti Alessandria 102.850 7.336 11.441 13.119 4.902 10.466 107.551 4.332 6.264 5.175 9.139 15.158 8.066 12.081 137.561 4.022 4.921 5.675 8.356 15.548 9.179 12.290 130.270 5.476 5.942 5.144 9.605 17.126 7.816 11.015 119.270 5.150 6.935 5.813 11.230 17.392 9.490 12.926 133.330 5.377 6.945 5.810 11.708 17.813 9.145 12.406 134.364 4.669 6.339 5.509 12.423 17.035 7.914 13.715 PIEMONTE Aosta VALLE D'AOSTA Varese Como Lecco Sondrio Milano Bergamo Brescia Pavia Lodi Cremona Mantova 150.114 3.492 3.492 27.756 24.014 4.760 259.825 28.088 40.468 12.384 8.389 5.419 167.766 4.316 4.316 27.160 16.312 12.104 5.122 288.042 27.380 61.925 12.212 5.920 8.175 6.302 197.552 4.320 4.320 25.773 17.065 12.714 4.891 299.723 27.703 37.891 13.451 7.747 9.747 6.737 192.394 4.368 4.368 28.379 18.064 12.996 4.881 265.146 29.560 39.405 13.918 7.042 8.874 8.887 188.206 3.693 3.693 30.813 20.552 10.616 5.178 249.325 31.458 52.178 14.597 6.869 9.254 7.900 202.534 2.951 2.951 28.628 17.225 10.116 3.821 187.720 24.839 45.032 16.176 4.757 8.003 7.883 201.968 3.684 3.684 27.762 17.305 9.280 4.073 190.947 28.633 43.163 14.847 5.003 7.320 6.648 LOMBARDIA Bolzano Trento TRENTINO-ALTO ADIGE Verona Vicenza Belluno Treviso Venezia Padova Rovigo VENETO Pordenone Udine Gorizia Trieste FRIULI-VENEZIA GIULIA Imperia Savona Genova La Spezia 411.103 14.784 11.240 26.024 25.864 26.508 5.832 21.582 37.586 26.340 5.665 149.377 8.811 23.834 4.088 13.608 50.341 11.820 10.972 57.822 6.473 470.654 13.633 12.174 25.807 27.977 27.708 5.914 29.155 38.198 33.447 5.093 167.492 8.570 25.854 5.921 14.741 55.086 11.340 15.276 65.151 7.744 463.442 13.637 10.574 24.211 31.006 24.534 5.508 26.289 37.800 32.761 5.061 162.959 8.867 21.433 6.497 12.877 49.674 12.580 13.829 62.590 6.780 437.152 14.482 10.951 25.433 37.468 28.038 5.654 34.041 41.608 34.560 4.973 186.342 8.061 22.513 7.453 12.517 50.544 13.392 18.714 66.117 7.266 438.740 14.528 12.712 27.240 38.737 26.798 6.509 23.986 46.956 36.112 5.632 184.730 8.364 17.838 7.589 10.916 44.707 19.401 15.685 53.452 7.221 354.200 12.023 10.685 22.708 25.880 25.529 6.562 25.206 36.954 28.300 7.101 155.532 7.571 14.704 5.987 10.199 38.461 11.510 16.451 57.655 6.766 354.981 11.946 10.812 22.758 24.639 23.747 7.029 24.322 38.733 31.781 6.482 156.733 7.825 15.187 6.319 11.056 40.387 12.820 17.496 50.209 7.327 Segue tab. 44 Segue tab. 44 LIGURIA Piacenza Parma Reggio nell'Emilia Modena Bologna Ferrara Ravenna Forlì-Cesena Rimini EMILIA - ROMAGNA Massa-Carrara Lucca Pistoia Firenze Prato Livorno Pisa Arezzo Siena Grosseto TOSCANA Perugia Terni Segue tab. 44 1995 1996 1997 1998 1999 2000 2001 87.087 5.572 9.625 10.011 18.533 56.495 10.851 17.850 32.394 161.331 5.558 14.859 9.350 51.581 12.017 12.630 5.767 5.110 4.503 121.375 13.850 4.234 99.511 6.359 9.462 10.613 19.259 60.864 13.097 17.237 9.719 28.688 175.298 5.944 15.368 10.291 58.215 9.650 14.317 14.998 6.093 6.137 5.651 146.664 16.016 3.784 95.779 6.592 8.614 12.360 25.018 78.050 15.436 13.605 12.301 29.707 201.683 7.184 14.962 10.990 59.129 12.838 13.009 12.348 7.046 6.216 4.896 148.618 15.476 4.279 105.489 6.301 9.527 15.300 24.828 75.780 12.173 16.760 11.013 24.810 196.492 6.635 9.831 10.582 62.003 12.478 12.855 12.943 9.287 6.198 5.287 148.099 14.658 5.233 95.759 7.174 9.309 12.607 23.708 63.240 12.839 19.949 13.354 19.421 181.601 6.794 10.239 9.886 52.800 10.654 13.094 13.481 9.949 6.590 5.341 138.828 19.412 6.582 92.382 6.905 11.487 13.999 24.315 62.242 12.209 16.791 13.530 19.433 180.911 6.575 10.345 6.491 48.746 8.612 13.384 12.412 9.259 6.903 6.100 128.827 18.891 5.613 87.852 7.038 12.944 14.435 24.244 62.328 12.344 15.833 11.975 19.277 180.418 5.382 11.839 7.549 46.183 9.049 13.514 12.769 8.105 6.436 6.642 127.468 20.085 6.601 Segue tab. 44 UMBRIA Pesaro e Urbino Ancona Macerata Ascoli Piceno MARCHE Viterbo Rieti Roma Latina Frosinone LAZIO L'Aquila Teramo Pescara Chieti ABRUZZO Isernia Campobasso MOLISE Caserta Benevento Napoli Avellino Salerno CAMPANIA Foggia Bari Taranto Brindisi Lecce PUGLIA Potenza Matera Segue tab. 44 1995 1996 1997 1998 1999 2000 2001 18.084 7.321 9.381 7.201 9.098 33.001 7.232 3.224 276.944 16.637 9.537 313.574 4.936 10.744 9.649 6.965 32.294 1.589 4.774 6.363 18.430 5.568 163.635 10.211 31.314 229.158 22.812 74.895 28.494 15.056 20.461 161.718 7.786 4.592 19.800 7.395 9.879 7.611 11.079 35.964 7.195 3.460 284.909 16.847 10.146 322.557 5.886 9.718 10.293 6.406 32.303 1.353 5.249 6.602 23.836 6.170 158.269 10.211 30.773 229.259 21.978 70.922 22.175 14.179 21.466 150.720 7.225 4.315 19.755 7.038 8.987 7.024 11.355 34.404 8.943 3.948 252.605 18.897 11.001 295.394 5.692 8.973 11.831 6.477 32.973 1.200 5.646 6.846 31.694 4.655 185.818 8.741 28.911 259.819 22.740 52.521 16.840 13.540 20.148 125.789 6.855 4.353 19.891 6.334 10.218 8.652 11.702 36.906 7.969 2.993 235.465 20.783 10.954 278.164 6.243 10.997 11.506 6.705 35.451 1.209 4.520 5.729 32.909 4.857 181.263 8.660 26.554 254.243 21.734 58.673 17.182 17.142 19.887 134.618 6.782 4.430 25.994 7.781 9.899 8.994 11.699 38.373 8.197 3.625 241.933 18.107 11.070 282.932 6.689 8.604 10.952 7.185 33.430 973 4.732 5.705 23.441 4.582 149.603 9.307 33.739 220.672 23.338 57.946 20.172 18.217 20.467 140.140 6.847 3.720 24.504 9.182 12.062 8.721 11.173 41.138 7.229 4.190 227.960 18.238 11.693 269.310 7.295 9.167 10.476 7.431 34.369 1.508 4.277 5.785 23.198 5.508 127.743 8.135 33.837 198.421 27.218 53.903 16.498 18.870 21.672 138.161 6.162 3.875 26.686 8.220 10.212 7.292 10.603 36.327 8.767 3.253 225.529 19.109 12.280 268.938 6.521 9.313 10.481 7.087 33.402 1.532 3.895 5.427 23.092 4.845 122.802 8.719 31.420 190.878 24.726 50.838 16.448 16.385 22.841 131.238 7.813 4.451 Segue tab. 44 BASILICATA Cosenza Crotone Catanzaro Vibo Valentia Reggio di Calabria CALABRIA Trapani Palermo Messina Agrigento Caltanissetta Enna Catania Ragusa Siracusa SICILIA Sassari Nuoro Oristano Cagliari SARDEGNA Nord Centro Sud e Isole Italia Fonte: Istat 1995 1996 1997 1998 1999 2000 2001 12.378 15.651 18.334 21.807 55.792 14.827 56.799 19.617 9.837 7.887 4.198 38.337 7.518 17.266 176.286 18.591 7.643 3.565 38.797 68.596 11.540 13.936 5.059 11.029 5.674 20.851 56.549 14.205 62.405 19.355 10.577 8.877 4.078 39.906 6.942 16.113 182.458 15.452 7.809 3.854 35.530 62.645 11.208 16.150 5.153 10.245 5.409 19.915 56.872 13.013 60.124 20.107 9.642 8.866 4.447 40.799 6.522 23.276 186.796 15.007 7.843 4.909 34.901 62.660 11.212 17.097 5.122 12.125 5.644 20.107 60.095 13.457 64.339 19.752 9.548 8.698 3.811 39.642 8.000 13.054 180.301 16.366 8.975 4.562 32.922 62.825 10.567 18.335 5.610 12.458 6.065 19.926 62.394 12.052 63.085 20.967 9.867 9.414 3.918 41.883 7.752 16.261 185.199 19.199 9.492 4.303 32.062 65.056 10.037 17.221 5.963 12.886 5.203 16.860 58.133 12.256 68.268 21.518 8.667 8.991 3.722 42.452 7.625 13.277 186.776 17.884 8.962 4.846 28.950 60.642 12.264 19.166 5.818 12.040 5.108 20.534 62.666 12.891 49.787 20.174 9.137 7.839 3.388 40.945 7.331 12.013 163.505 18.342 8.926 3.655 25.323 56.246 1.038.869 486.034 742.585 1.165.930 524.985 732.076 1.199.620 498.171 742.963 1.198.214 483.060 744.474 1.164.676 486.127 723.163 1.049.679 463.779 692.324 1.048.781 459.419 655.626 2.267.488 2.422.991 2.440.754 2.425.748 2.373.966 2.205.782 2.163.826 Tab.45-Reati denunciati alle Autorità giudiziarie dalle Forze dell'ordine, provincia - Anni 1995-2001 (valori per 1.000 abitanti) 1995 1996 1997 1998 1999 2000 2001 Torino Vercelli Biella Verbano-Cusio-Ossola Novara Cuneo Asti Alessandria 46,3 40,2 33,7 23,8 23,4 24,2 48,4 23,8 32,9 32,1 26,8 27,4 38,4 27,8 62,0 22,2 25,9 35,2 24,5 28,0 43,7 28,4 58,8 30,3 31,4 31,9 28,0 30,8 37,2 25,5 53,9 28,5 36,6 36,2 32,7 31,2 45,1 30,0 60,2 29,8 36,7 36,2 33,9 31,9 43,4 28,9 62,1 26,4 33,9 34,7 36,2 30,6 38,0 32,8 PIEMONTE Aosta VALLE D'AOSTA Varese Como Lecco Sondrio Milano Bergamo Brescia Pavia Lodi Cremona Mantova 35,0 29,4 29,4 34,4 45,2 26,9 69,8 30,0 38,0 25,0 25,3 14,7 39,1 36,2 36,2 33,5 30,6 39,7 28,9 77,3 29,0 57,7 24,6 30,9 24,7 17,0 46,0 36,1 36,1 31,7 31,9 41,6 27,6 80,2 29,2 35,1 27,2 40,1 29,4 18,2 44,9 36,4 36,4 34,9 33,6 42,3 27,5 70,6 30,9 36,2 28,0 36,2 26,6 23,9 43,9 30,7 30,7 37,7 38,1 34,3 29,2 66,4 32,6 47,5 29,3 35,1 27,7 21,1 47,2 24,5 24,5 34,9 31,7 32,5 21,5 49,7 25,5 40,5 32,4 24,1 23,8 21,0 47,9 30,8 30,8 34,2 32,2 29,8 23,0 51,5 29,4 38,9 30,1 25,3 21,8 17,6 LOMBARDIA Bolzano Trento TRENTINO-ALTO ADIGE Verona Vicenza Belluno Treviso Venezia Padova Rovigo VENETO Pordenone Udine Gorizia Trieste FRIULI-VENEZIA GIULIA Imperia Savona Genova La Spezia 46,1 32,7 24,3 52,5 30,0 26,2 51,6 29,8 22,6 48,4 31,5 23,3 48,4 31,4 26,8 38,8 25,8 22,4 39,3 25,8 22,6 28,5 32,3 34,7 27,5 28,5 46,0 31,5 23,1 33,7 31,9 45,8 29,6 53,4 28,1 34,7 36,0 27,9 38,2 46,8 39,9 20,8 37,6 31,0 49,8 43,0 58,3 26,2 38,2 31,7 26,0 34,2 46,3 38,9 20,7 36,5 32,0 41,3 47,1 51,3 27,4 45,9 35,9 26,8 43,9 51,1 40,9 20,4 41,5 29,0 43,4 54,0 50,3 29,1 47,2 34,0 30,8 30,6 57,6 42,5 23,1 40,9 29,8 34,4 54,9 44,1 24,1 31,2 32,1 31,1 31,8 45,3 33,2 29,2 34,3 26,8 28,3 43,1 41,4 24,2 29,8 29,9 33,6 30,5 47,8 37,4 26,7 34,6 27,3 29,3 46,3 45,7 42,3 54,5 38,8 62,0 28,7 46,4 52,2 54,2 70,3 34,5 41,9 58,0 49,2 68,0 30,3 42,7 61,8 66,7 72,4 32,7 37,7 89,7 56,1 58,9 32,5 32,4 53,2 58,8 63,8 30,5 34,1 62,5 64,2 57,3 34,0 Segue tab. 45 Segue tab. 45 LIGURIA Piacenza Parma Reggio nell'Emilia Modena Bologna Ferrara Ravenna Forlì-Cesena Rimini EMILIA - ROMAGNA Massa-Carrara Lucca Pistoia Firenze Prato Livorno Pisa Arezzo Siena Grosseto TOSCANA Perugia Terni UMBRIA Pesaro e Urbino Ancona Macerata Ascoli Piceno MARCHE Viterbo Rieti Roma Latina Frosinone LAZIO L'Aquila Teramo Pescara Chieti ABRUZZO Isernia Campobasso MOLISE Caserta Benevento Napoli Avellino Salerno Segue tab. 45 1995 1996 1997 1998 1999 2000 2001 52,5 20,9 24,6 23,3 30,4 62,4 30,5 51,0 92,5 41,1 27,6 39,6 35,2 54,1 35,7 32,8 18,2 20,3 20,8 34,4 23,0 18,9 21,9 21,6 21,3 24,1 24,9 22,9 25,0 21,4 73,4 33,4 19,5 60,3 16,2 37,5 33,0 17,9 25,4 17,2 20,0 19,2 21,9 18,8 52,8 23,1 28,8 60,3 23,9 24,0 24,4 31,4 67,0 37,0 49,3 27,7 107,7 44,5 29,6 40,9 38,6 61,2 43,3 42,6 39,0 19,2 24,4 26,1 41,6 26,4 16,9 23,9 21,7 22,4 25,4 30,2 24,8 24,8 23,0 75,3 33,5 20,7 61,8 19,3 33,8 35,2 16,5 25,4 14,7 22,0 20,0 28,1 20,9 50,9 23,1 28,2 58,3 24,8 21,9 28,2 40,6 85,7 43,9 38,9 35,0 110,9 51,1 35,9 39,8 41,1 62,1 57,2 38,8 32,1 22,1 24,7 22,6 42,1 25,4 19,2 23,8 20,6 20,3 23,4 30,9 23,7 30,7 26,2 66,4 37,4 22,4 56,3 18,7 31,0 40,4 16,6 25,8 13,0 23,7 20,8 37,2 15,8 59,6 19,8 26,5 64,6 23,7 24,1 34,5 40,0 83,0 34,8 47,9 31,2 92,2 49,6 33,2 26,2 39,5 65,2 55,2 38,4 33,6 29,0 24,6 24,5 42,0 24,0 23,5 23,9 18,5 23,1 28,7 31,7 25,4 27,3 19,9 61,8 40,9 22,2 52,9 20,6 38,0 39,2 17,2 27,8 13,2 19,1 17,4 38,5 16,5 58,3 19,6 24,3 58,9 27,0 23,4 28,1 37,9 69,0 36,8 56,9 37,7 71,4 45,6 34,0 27,3 36,7 55,3 46,7 39,2 34,9 30,9 26,1 24,8 39,3 31,7 29,5 31,1 22,6 22,3 29,7 31,6 26,3 28,0 24,1 63,4 35,5 22,4 53,7 22,0 29,6 37,2 18,4 26,1 10,6 20,0 17,4 27,4 15,6 48,3 21,1 30,9 57,0 25,9 28,7 30,7 38,4 67,5 35,1 47,7 37,9 70,8 45,1 33,0 27,5 24,0 51,0 37,4 40,1 32,0 28,6 27,2 28,3 36,3 30,6 25,2 29,2 26,4 27,0 28,6 30,1 28,0 24,6 27,7 59,2 35,5 23,7 50,8 24,0 31,4 35,5 19,0 26,8 16,5 18,1 17,7 27,1 18,8 41,2 18,5 31,0 56,0 26,7 32,9 31,7 38,2 68,1 35,9 45,5 33,4 70,8 45,3 27,3 31,8 28,1 49,5 39,6 41,4 33,2 25,1 25,5 31,5 36,5 33,1 30,0 32,3 23,4 22,8 24,2 28,7 24,7 30,3 22,0 60,9 38,9 25,3 52,6 21,9 32,4 35,5 18,6 26,5 17,1 16,9 16,9 27,1 16,9 40,1 20,3 29,3 Segue tab. 45 CAMPANIA Foggia Bari Taranto Brindisi Lecce PUGLIA Potenza Matera BASILICATA Cosenza Crotone Catanzaro Vibo Valentia Reggio di Calabria CALABRIA Trapani Palermo Messina Agrigento Caltanissetta Enna Catania Ragusa Siracusa SICILIA Sassari Nuoro Oristano Cagliari SARDEGNA Nord Centro Sud e Isole Italia 1995 1996 1997 1998 1999 2000 2001 39,8 32,6 48,0 48,1 36,4 25,0 39,6 19,4 22,1 20,3 20,8 47,7 37,7 26,9 34,2 45,8 28,7 20,7 27,9 22,6 35,2 25,3 42,5 34,6 40,5 28,0 22,5 50,4 41,3 39,6 31,4 45,3 37,5 34,3 26,2 36,9 18,1 20,8 19,0 18,5 28,4 28,7 31,7 36,0 27,3 32,6 50,2 28,4 22,3 31,3 22,1 36,5 23,2 39,7 35,8 33,6 28,7 24,3 46,0 37,7 44,8 32,6 33,5 28,5 32,6 24,6 30,8 17,0 21,0 18,4 21,5 29,0 26,6 30,2 34,4 27,5 29,9 48,3 29,5 20,3 31,2 24,2 37,2 21,7 57,4 36,6 32,6 28,8 31,0 45,3 37,7 43,9 31,2 37,3 29,2 41,5 24,3 32,9 16,9 21,4 18,4 22,8 29,0 31,6 31,7 34,9 29,1 31,0 51,8 29,1 20,2 30,7 20,8 36,1 26,6 32,2 35,4 35,7 33,2 28,9 42,9 38,0 38,2 33,6 36,8 34,3 44,3 25,1 34,3 17,1 18,0 17,4 24,6 32,2 32,6 34,3 34,8 30,4 27,8 51,0 31,0 21,0 33,4 21,6 38,1 25,7 40,3 36,4 41,8 35,2 27,4 41,9 39,4 34,3 39,3 34,1 28,1 45,9 26,6 33,8 15,4 18,8 16,6 23,2 34,4 33,8 29,6 29,6 28,5 28,3 55,3 31,9 18,6 31,8 20,6 38,5 25,2 33,0 36,8 39,0 33,4 30,9 37,9 36,8 33,5 35,8 32,6 28,4 40,7 29,0 32,7 19,9 21,8 20,5 26,1 33,6 32,6 30,0 36,4 31,2 30,3 40,3 30,5 20,4 28,7 19,1 38,8 24,8 30,3 32,9 40,5 33,7 23,9 33,3 34,5 40,8 44,2 35,6 45,7 47,6 35,0 46,9 45,1 35,5 46,7 43,6 35,6 45,3 43,8 34,7 40,6 41,6 33,2 41,0 42,1 32,0 39,5 42,2 42,4 42,1 41,2 38,1 38,0 Fonte: elaborazioni Censis su dati Istat Tab. 46 - Detenuti Presenti al 31 dicembre negli istituti di prevenzione e di pena per adulti, per cittadinanza, sesso e regione - Anni 1995-2001 (v.a.) Maschi Piemonte Valle d'Aosta Lombardia Trentino-Alto Adige Veneto Friuli-Venezia Giulia Liguria Emilia-Romagna Toscana Umbria Marche Lazio Abruzzo Molise Campania Puglia Basilicata Calabria Sicilia Sardegna Nord Centro Sud e isole Italia segue Femmine Totale 1995 1996 1997 1998 1999 2000 2001 1995 1996 1997 1998 1999 2000 2001 1995 1996 1997 1998 1999 2000 2001 3.838 3.695 3.854 3.755 4.222 4.039 4.230 179 162 160 133 175 150 152 4.017 3.857 4.014 3.888 4.397 4.189 4.382 115 141 168 135 218 242 232 11 4 0 0 1 0 0 126 145 168 135 219 242 232 6.642 6.468 6.309 6.144 6.598 6.747 7.412 504 477 442 431 495 532 597 7.146 6.945 6.751 6.575 7.093 7.279 8.009 296 320 309 283 352 345 332 26 23 8 0 18 17 15 322 343 317 283 370 362 347 1.847 1.841 1.892 2.021 2.148 2.269 2.416 111 118 131 120 146 192 171 1.958 1.959 2.023 2.141 2.294 2.461 2.587 506 576 699 706 701 750 743 40 26 31 30 21 21 24 546 602 730 736 722 771 767 1.610 1.078 1.041 1.311 1.480 1.614 1.536 1.523 57 71 73 77 97 86 87 1.135 1.112 1.384 1.557 1.711 1.622 2.831 2.644 2.884 2.849 3.107 3.201 3.197 97 104 87 79 86 132 112 2.928 2.748 2.971 2.928 3.193 3.333 3.309 3.519 3.597 3.596 3.426 3.615 3.980 3.950 102 117 138 113 157 145 164 3.621 3.714 3.734 3.539 3.772 4.125 4.114 775 814 884 776 846 948 1.020 70 60 53 44 40 38 51 845 874 937 820 886 986 1.071 752 609 672 734 853 815 731 11 13 9 6 9 18 14 763 622 681 740 862 833 745 4.210 4.342 4.813 4.481 4.842 4.899 4.771 289 325 336 326 355 344 366 4.499 4.667 5.149 4.807 5.197 5.243 5.137 1.170 1.353 1.396 1.314 1.519 1.627 1.544 37 34 32 29 54 44 52 1.207 1.387 1.428 1.343 1.573 1.671 1.596 238 294 286 303 342 361 362 3 7 6 5 10 8 4 241 301 292 308 352 369 366 5.493 5.975 6.021 6.135 6.358 6.544 6.663 261 210 207 221 229 222 230 5.754 6.185 6.228 6.356 6.587 6.766 6.893 2.958 3.238 3.783 3.166 3.456 3.486 4.121 132 106 120 93 100 144 151 3.090 3.344 3.903 3.259 3.556 3.630 4.272 419 496 498 505 576 590 586 9 11 9 6 25 19 17 428 507 507 511 601 609 603 1.510 1.597 1.822 1.852 1.890 2.070 1.986 24 15 16 16 15 27 30 1.534 1.612 1.838 1.868 1.905 2.097 2.016 5.116 5.368 5.554 5.551 5.895 5.880 5.900 116 114 95 113 112 127 125 5.232 5.482 5.649 5.664 6.007 6.007 6.025 2.304 2.106 1.783 1.680 1.528 1.394 1.611 63 52 40 35 45 50 59 2.367 2.158 1.823 1.715 1.573 1.444 1.670 17.153 16.726 17.426 17.373 18.960 19.129 20.085 985 932 870 1.13 0 545 1.15 8 595 18.178 17.711 18.358 18.243 19.999 20.259 21.243 9.256 9.362 9.965 9.417 10.156 10.642 10.472 1.02 5 472 515 536 489 1.03 9 561 9.728 9.877 10.501 9.906 10.717 11.187 11.067 19.208 20.427 21.143 20.506 21.564 21.952 22.773 645 549 525 518 590 641 668 19.853 20.976 21.668 21.024 22.154 22.593 23.441 45.617 46.515 48.534 47.296 50.680 51.723 53.330 2.14 2 2.04 9 1.99 3 1.87 7 2.19 0 2.31 6 2.42 1 47.759 48.564 50.527 49.173 52.870 54.039 55.751 segue Maschi Femmine 1995 1996 1997 1998 1999 2000 2001 Piemonte 805 837 910 1.159 1.420 1.463 1.575 Valle d'Aosta 33 50 54 45 90 132 1.390 1.600 1.819 1.903 2.205 2.188 Lombardia 1995 1996 1997 Totale 1998 1999 2000 2001 1995 1996 1997 1998 1999 2000 2001 Di cui stranieri 25 24 24 32 55 60 76 830 861 934 1.191 1.475 1.523 1.651 110 1 2 0 0 0 0 0 34 52 54 45 90 132 110 2.677 105 115 108 151 170 205 255 1.495 1.715 1.927 2.054 2.375 2.393 2.932 Trentino-Alto Adige 99 120 127 121 143 164 153 4 0 2 0 9 4 4 103 120 129 121 152 168 157 Veneto 495 603 751 881 996 1.089 1.188 29 27 50 41 57 92 88 524 630 801 922 1.053 1.181 1.276 Friuli-Venezia Giulia 155 168 264 356 339 397 353 8 10 6 16 11 10 8 163 178 270 372 350 407 361 Liguria 353 393 534 651 695 745 737 13 13 24 16 39 36 39 366 406 558 667 734 781 776 Emilia-Romagna 724 726 943 990 1.081 1.292 1.382 20 29 30 31 42 80 64 744 755 973 1.021 1.123 1.372 1.446 Toscana 946 990 1.086 1.101 1.263 1.517 1.578 21 33 41 27 61 67 79 967 1.023 1.127 1.128 1.324 1.584 1.657 Umbria 149 177 247 214 213 343 424 16 12 11 12 11 8 27 165 189 258 226 224 351 451 Marche 104 103 176 211 286 275 251 4 2 3 1 4 11 9 108 105 179 212 290 286 260 1.112 1.242 1.455 1.490 1.697 1.791 1.758 95 122 134 143 176 191 196 1.207 1.364 1.589 1.633 1.873 1.982 1.954 236 301 360 333 384 505 468 4 6 2 1 9 9 12 240 307 362 334 393 514 480 Lazio Abruzzo Molise 22 53 34 47 66 81 73 0 2 2 5 3 5 2 22 55 36 52 69 86 75 Campania 446 403 473 446 453 574 718 31 38 41 35 34 49 56 477 441 514 481 487 623 774 Puglia 106 165 351 297 462 441 462 8 4 6 14 26 53 48 114 169 357 311 488 494 510 Basilicata 11 38 54 107 191 216 180 0 0 0 0 17 13 9 11 38 54 107 208 229 189 Calabria 31 57 112 140 272 397 358 2 2 2 5 1 3 9 33 59 114 145 273 400 367 Sicilia 148 222 203 382 731 797 686 3 3 5 7 4 14 8 151 225 208 389 735 811 694 Sardegna 392 547 299 435 325 252 376 1 2 1 2 9 13 15 393 549 300 437 334 265 391 Nord 4.054 4.497 5.402 6.106 6.969 7.470 8.175 205 220 244 287 383 487 534 4.259 4.717 5.646 6.393 7.352 7.957 8.709 Centro 2.311 2.512 2.964 3.016 3.459 3.926 4.011 136 169 189 183 252 277 311 2.447 2.681 3.153 3.199 3.711 4.203 4.322 Sud e isole 1.392 1.786 1.886 2.187 2.884 3.263 3.321 49 57 59 69 103 159 159 1.441 1.843 1.945 2.256 2.987 3.422 3.480 7.757 8.795 10.252 11.309 13.312 14.659 15.507 390 446 492 539 738 923 1.00 4 8.147 9.241 10.744 11.848 14.050 15.582 16.511 Italia Fonte: Istat Tab. 47 - Condannati per distretto di Corte di Appello - Maschi - Anni 1995-2001 (v.a.) Torino Milano Brescia Trento Bolzano (Sez.) Venezia Trieste Genova Bologna Firenze Perugia Ancona Roma L'Aquila Campobasso Napoli Salerno Bari Lecce Taranto (Sez.) Potenza Catanzaro Reggio di Calabria Palermo Messina Caltanissetta Catania Cagliari Sassari (Sez.) Italia 1995 1996 1997 1998 1999 2000 2001 17.259 15.820 5.597 3.407 16.286 5.580 8.927 17.596 16.395 2.625 5.479 21.055 6.293 2.212 20.237 3.355 11.059 4.779 4.730 1.967 3.557 2.134 8.325 3.849 1.941 8.179 5.204 1.877 225.724 18.281 18.472 7.481 1.659 1.612 14.461 6.680 8.967 11.582 12.737 2.246 4.737 16.444 5.618 1.329 14.866 3.409 9.179 6.496 3.429 2.190 2.481 2.239 9.358 2.154 1.265 8.531 4.613 1.850 204.366 23.233 21.624 5.715 1.613 2.086 12.984 5.345 10.197 12.846 12.345 2.714 4.870 18.821 5.879 1.467 29.448 5.269 9.681 4.455 6.600 2.305 5.866 2.086 13.743 2.446 1.295 12.329 4.193 1.529 242.984 22.599 25.607 7.993 1.545 1.837 14.745 5.831 8.690 12.946 13.009 2.459 5.285 23.135 5.739 1.622 28.295 5.626 10.448 5.425 4.440 2.407 5.910 1.764 13.447 2.225 1.461 9.320 4.353 3.099 251.262 19.589 16.877 6.129 1.254 1.859 11.564 4.994 7.620 12.543 11.403 2.120 4.144 37.321 5.498 1.184 26.384 4.488 8.698 4.510 5.209 1.978 4.319 1.919 10.694 1.540 1.993 8.987 5.304 2.677 232.799 12.704 14.751 4.766 1.077 1.150 8.784 3.382 6.844 10.065 8.983 1.558 2.773 102.502 2.863 785 16.734 3.329 6.013 3.637 3.780 1.591 3.103 2.795 10.977 2.504 1.247 8.162 2.336 2.256 251.451 14.449 22.691 6.035 1.313 1.730 13.673 4.725 9.169 12.447 12.457 2.537 3.988 21.738 4.615 1.242 15.566 3.220 7.667 4.832 4.006 1.673 2.974 1.633 11.118 3.208 1.723 7.366 4.901 2.112 204.808 (a) I dati si riferiscono alle iscrizioni che vengono effettuate, nel corso dell'anno di riferimento, presso il Casellario Centrale Giudiziale e risentono, pertanto, del volume di attività svolto. Fonte: Istat Tab. 48 - Condannati per distretto di Corte di Appello - Femmine - Anni 1995-2001 (v.a.) Torino Milano Brescia Trento Bolzano (Sez.) Venezia Trieste Genova Bologna Firenze Perugia Ancona Roma L'Aquila Campobasso Napoli Salerno Bari Lecce Taranto (Sez.) Potenza Catanzaro Reggio di Calabria Palermo Messina Caltanissetta Catania Cagliari Sassari (Sez.) Italia 1995 1996 1997 1998 1999 2000 2001 3.346 3.276 1.165 559 2.703 1.131 941 1.276 3.262 561 1.255 2.989 1.341 290 4.510 635 673 671 634 260 621 330 1.327 236 309 1.743 556 236 36.836 3.604 4.529 1.755 290 293 2.833 1.229 1.855 2.252 2.893 505 1.004 2.976 1.359 258 3.046 667 1.322 962 343 353 529 556 2.112 424 253 1.935 680 239 41.056 4.945 4.386 1.230 254 346 2.520 1.064 1.953 2.521 2.700 564 1.059 3.506 1.385 290 6.768 1.104 1.536 795 597 355 1.149 807 3.420 537 250 3.160 555 240 49.996 4.360 5.220 1.555 209 300 2.991 1.257 1.585 2.463 2.928 508 1.078 4.640 1.336 316 6.779 1.379 1.539 957 531 378 1.088 353 3.357 501 267 2.445 618 466 51.404 3.599 2.965 1.109 182 293 1.929 1.005 1.309 2.013 2.525 447 790 9.029 1.273 205 5.819 904 1.142 452 706 276 752 375 2.670 259 423 2.303 699 408 45.861 2.079 2.129 806 175 170 1.569 617 1.044 1.661 1.920 297 493 30.486 573 132 3.312 618 586 406 560 241 518 891 2.278 499 209 1.824 343 413 56.849 2.286 3.000 982 214 235 2.431 836 1.358 2.007 2.346 477 676 4.024 892 240 2.754 542 866 501 537 267 460 257 2.504 845 333 1.490 658 348 34.366 (a) I dati si riferiscono alle iscrizioni che vengono effettuate, nel corso dell'anno di riferimento, presso il Casellario Centrale Giudiziale e risentono, pertanto, del volume di attività svolto. Fonte: Istat Tab. 49 - Condannati per distretto di Corte di Appello - Totale - Anni 1995-2001 (v.a.) Torino Milano Brescia Trento Bolzano (Sez.) Venezia Trieste Genova Bologna Firenze Perugia Ancona Roma L'Aquila Campobasso Napoli Salerno Bari Lecce Taranto (Sez.) Potenza Catanzaro Reggio di Calabria Palermo Messina Caltanissetta Catania Cagliari Sassari (Sez.) Italia 1995 1996 1997 1998 1999 2000 2001 20.605 19.096 6.762 3.966 18.989 6.711 9.868 18.872 19.657 3.186 6.734 24.044 7.634 2.502 24.747 3.990 11.732 5.450 5.364 2.227 4.178 2.464 9.652 4.085 2.250 9.922 5.760 2.113 262.560 21.885 23.001 9.236 1.949 1.905 17.294 7.909 10.822 13.834 15.630 2.751 5.741 19.420 6.977 1.587 17.912 4.076 10.501 7.458 3.772 2.543 3.010 2.795 11.470 2.578 1.518 10.466 5.293 2.089 245.422 28.178 26.010 6.945 1.867 2.432 15.504 6.409 12.150 15.367 15.045 3.278 5.929 22.327 7.264 1.757 36.216 6.373 11.217 5.250 7.197 2.660 7.015 2.893 17.163 2.983 1.545 15.489 4.748 1.769 292.980 26.959 30.827 9.548 1.754 2.137 17.736 7.088 10.275 15.409 15.937 2.967 6.363 27.775 7.075 1.938 35.074 7.005 11.987 6.382 4.971 2.785 6.998 2.117 16.804 2.726 1.728 11.765 4.971 3.565 302.666 23.188 19.842 7.238 1.436 2.152 13.493 5.999 8.929 14.556 13.928 2.567 4.934 46.350 6.771 1.389 32.203 5.392 9.840 4.962 5.915 2.254 5.071 2.294 13.364 1.799 2.416 11.290 6.003 3.085 278.660 14.783 16.880 5.572 1.252 1.320 10.353 3.999 7.888 11.726 10.903 1.855 3.266 132.988 3.436 917 20.046 3.947 6.599 4.043 4.340 1.832 3.621 3.686 13.255 3.003 1.456 9.986 2.679 2.669 308.300 16.735 25.691 7.017 1.527 1.965 16.104 5.561 10.527 14.454 14.803 3.014 4.664 25.762 5.507 1.482 18.320 3.762 8.533 5.333 4.543 1.940 3.434 1.890 13.622 4.053 2.056 8.856 5.559 2.460 239.174 (a) I dati si riferiscono alle iscrizioni che vengono effettuate, nel corso dell'anno di riferimento, presso il Casellario Centrale Giudiziale e risentono, pertanto, del volume di attività svolto. Fonte: Istat 11873_2002 7. Study D2: Poverty, Informal Sector, Health and Labour BIBLIOGRAFIA ESSENZIALE GENERALE - Censis, 36° Rapporto sulla situazione sociale del Paese 2002, Franco Angeli - Istat, Annuario Statistico Italiano 2002 - Istat, Italia in cifre 2002 - Istat, Rapporto annuale sulla situazione del Paese 2002 SALUTE - Bucci R. Loiudice M.T., Il dibattito sulla qualità in ambito sanitario, Collana I quaderni di Mecosan - Censis, 36° Rapporto sulla situazione sociale del Paese 2002, Franco Angeli - Geddes M., Berlinguer G. (a cura di), La salute in Italia. Rapporto 1997, Roma, Ediesse, 1997 - Mapelli V., Il sistema sanitario italiano, Bologna, Il Mulino, 1999 - Ministero della Salute, Relazione sullo stato sanitario del Paese 2001 – 2002 - Presidenza del Consiglio dei Ministri - Dipartimento per l’informazione e l’editoria, Medicina e Migrazioni - Traumi e Problemi di Salute Fisica e Mentale in Immigrati e Rifugiati,1992 - WHO, The World Health Report 2002 POVERTÀ - Beckerman W., Stime della povertà in Italia nel 1975, Rivista Internazionale di Scienze Sociali, n. 2, 1980 - Censis, 36° Rapporto sulla situazione sociale del Paese 2002, Franco Angeli 288 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour - P. Calza Bini, D. Maddaloni, La politica del lavoro e la cittadinanza sociale in un’epoca di transizione: alcune riflessioni, IRiDiSS Research Paper, 2000 - A.Ciocia, The New Italian Pension System Model, Paper presentato al Seminar of the European Network for Research on Supplementary Pensions (ENRSP), Roma, 17-18 dicembre 1998 - D. Maddaloni, Economia della partecipazione e configurazioni occupazionali flessibili. Alcune osservazioni con riferimento all’esperienza italiana, IRiDiSS-CNR Research Paper, 1998 - M. Falivene, Innovazione tecnologica e processo lavorativo. Il caso del telelavoro, IRiDiSS-CNR Research Paper, 1998 - G. Ponzini, Alcune note a proposito del dibattito sulla bioetica, Relazione presentata al Convegno “Etica e comunità”, Chieti, 22-23 aprile 1989 - G. Ponzini, Towards a New Social Contract?, IRiDiSS Cnr, Research Paper, 1997 - S. Turcio, La qualità dei servizi in un processo di mutamento sociale, intervento presentato al seminario internazionale “Change in Health Policy: A European Perspective”, Consiglio Nazionale delle Ricerche, Roma 16 e 17 dicembre 1996 - Disuguaglianza e stato sociale. Riflessioni sulla crisi del welfare italiano, a cura di E. Bartocci, Donzelli, Roma, 1996 - Commissione Gorrieri di indagine sulla povertà, Primo rapporto e studi base, Presidenza del Consiglio dei Ministri, Roma, 1985 - Istat, Anziani in Italia, Il Mulino, Bologna, 1997 - Pace D., Pisani S., Le condizioni economiche degli anziani, VII Rapporto Cer-Spi, La Terza, Bari, 1998 - Presidenza del Consiglio dei Ministri, Terzo rapporto sulla povertà in Italia, Istituto Poligrafico e Zecca dello Stato, Roma, 1993 - Rizzi D., Poverty in Italy: 1984, Ricerche Economiche, XLIII, 3, 1989 289 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour - Rossi N. (a cura di), Competizione e giustizia sociale:1994-1995, Terzo rapporto CNEL sulla distribuzione e redistribuzione del reddito in Italia, Il Mulino, Bologna - Sarpellon G., La povertà in Italia, Franco Angeli, Milano, 1982 CRIMINALITÀ - AA. VV., Rapporti degli ispettori europei sullo stato delle carceri in Italia che vale anche da manuale da istruzioni per carcerieri, carcerati e cittadini in libertà provvisoria, Palermo, Sellerio, 1995 - Campelli E., Faccioli F., Giordano V., Pitch T., Donne in carcere. Ricerca sulla detenzione femminile in Italia, Feltrinelli, Milano 1992 - Censis, Cultura dello sviluppo, cultura della legalità - Programma integrato per il Mezzogiorno, Roma, Gangemi, 1997 - Censis-Cds, Contro e dentro - Criminalità, istituzioni, società, Milano, Franco Angeli, 1992 - Centorrino M., La Spina A. e Signorino G., Il nodo gordiano Criminalità mafiosa e sviluppo nel Mezzogiorno, Bari, Laterza, 1999 - Chinnici G., Santino U., La violenza programmata, Milano, Franco Angeli, 1989 - Commissione Parlamentare Antimafia, Economia e criminalità, Forum del 14-15 Maggio 1993, Camera dei Deputati - Giovani Imprenditori Confindustria, Sviluppo, criminalità e corruzione in Quale impresa, n. XIV, 1994 - Lupo S., Storia della mafia, Roma, Donzelli, 1993 - Occhiogrosso F., Introduzione a Mastropasqua I., I minori e la giustizia. Operatori e servizi dell’area penale, Liguori, Napoli 1997 290 FONDAZIONE CENSIS TURKEY Selahattin Bekmez, Ph.D. - Cem Mehmet Baydur, Ph.D. İbrahim Tokatlıoğlu, Ph.D. - Fatih Türe, Ph.D. Necla Ayaş - Bayram Coskun 11873_2002 1. Study D2: Poverty, Informal Sector, Health and Labour COUNTRY PROFILE This chapter intends to introduce a brief recapitulation of social, economic and geographical caracteristics of Turkey. 1.1. Population Turkey is the most densely populated country in the Middle East. According to the 2000 census, the population of Turkey amounted to 67.8 million. 33.6 million of the population are female and 34.2 million are male. While the annual average population increase was 24.9 %o in the 1980-85 period and 21.7 %o in the 1985-90 period , this figure dropped to 18.3 %o in the 19902000 period. This rate is expected to drop to 14.5 %o in the 2000-2005 period. Since the 1960’s, Turkey has been considered to be among the countries which registered the greatest progress in urbanization. Thi 2000 census indicated that 44 million people live in provinces and administrative centers, and 23.7 million people live in districts and villages. Of the 81 provinces in the country , three most densely populated are Istanbul with a population of 10 million, Ankara with a population of 4 million, and Izmir with a population of 3.4 million. Turkey is a country with a young population. The 0-14 age group comprise 30% of Turkey’s population, the 15-64 age group 64.4% and the 65+ age group 5.6% of the population. When these figures are compared with those of European Union (EU) countries it is observed that the 0-14 age group in the EU countries, with a mere 17.2% is approximately half of that of Turkey. Conversely, the 65+age group in EU countries is almost thee-fold of that in Turkey with 15.7%. 292 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour Table 1: Developments in Demographic Indicators1 Demographic Indicators Unit 1997 2001 20052 Total Population (Midyear) Total Population Growth Rate Approximate Birth Rate Approximate Mortality Rate Total Fertility Rate Average Age for Child Bearing Infant Mortality Rate Life Expectancy at Birth 1000 persons 63.7 67.8 71.7 Per thousand 16.4 14.6 13.1 Per thousand Per thousand 21.6 6.5 20.2 6.5 19.0 6.5 No. of Children Year 2.5 26.8 2.3 26.3 2.2 26.0 Per thousand Year 40 68.2 33.9 69.1 28.8 70.3 According to 2000 general census 88 people live in 1 kilometre square. Thus it can be said that country is not crowded. Basic problem of the population is high growth rates. While Turkey’s population was one of the rapid growing in the world in last fifty years, now this rate shows a decreasing tendency in the last decade. Other dimension of the population composition related to birth ant mortality rates. These rate reflects health conditions and family planning in the country. Although birth rates are decreasing they are stil high. Birth rates are decreasing because of exploitation of better education and increasing participation fo the woman to the employment and production. 1 2 State Statistical Institute Projection 293 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour Table 2 : Proportion of Population by Age Group Demographic Indicators Unit 1997 2000 2005 0-14 Age Group Percentage 31.7 30.0 28.3 15-64 Age Group Percentage 63.1 64.4 65.8 65 + Age Group Percentage 5.1 5.6 5.9 Age composition is important in education programs, demographic investments, social activities and to determine social needs. Produvticity and needs of the people changes in age groups. Migration Turkey has growing and dynamic structure, and migration is an important social and economic factor. The reasons of the migration are; poverty, low life standarts in rural areas, labor demand in urban centres. It must be added that the war in eastern and south-eastern part of the country until midnienties was the cause of strong movement ou the people in this areas. In recent years this movement from rural areas to urban centres turned to opposite: in a slow pace the pouple returning to their original settlements. In the last 30 years, the population in the western and southern regions has increased, while it has decreased in the central, northern and eastern regions.The changes in the regional distribution of population in Turkey resulted from migration from the eastern and northern regions to the western and southern metropolises. External migration began in 1960’s first to Europe and than to the world. So called “Guest worker” from Turkey continued and today about 3.6 million Turks are working and living in Europe, Australia, USA, Asia and Africa. This migration movement abroad slowed after 1990’s. Better economic possibilities in Turkey, restrictions of receiving countries are the main reasons of slowing external migration from Turkey. 294 FONDAZIONE CENSIS Table 3: Turkish Citizen Working and Living Abroad Countries European countries Germany France Holland Austria Belgium Sweden Great britain Danmark Italy Finland Spain Switzerland Norway Luxemburg Lichtenstein Total Middle-East and North Africa Saudi Arabia Libia Quveyt Irak Israel Jordan Total Other countries Union of independent states. Russian federation Turkik republics Australia Usa Canada Japan Rest of the world Grand total Turkish Citizen LIVING abroad 1995 1999 Turkish Citizen WORKING abroad 1995 1999 1.965.577 268.000 264.763 150.000 85.303 35.948 51.390 34.967 15.000 1.800 848 78.615 10.000 2.962.211 2.110.223 287.343 *279.786 138.860 73.818 35.943 66.000 38.055 8.500 2.000 904 79.478 10.000 220 809 3.131.939 742.566 102.900 84.500 51.297 26.764 24.800 15.746 14.445 5.000 1.400 500 35.828 6.000 1.111.746 740.530 78.965 *48.000 54.711 26.855 5.300 37.600 13.639 32.944 6.000 60 339 1.044.943 130.000 6.236 3.500 4.114 1.591 145.441 120.000 3.000 3.500 5.000 1.600 133.100 120.000 5.802 3.300 4.114 200 133.416 115.000 2.600 3.300 200 121.100 1995 40.000 1999 1995 40.000 1999 13.000 26.300 49.342 85.505 18.130 1.729 31.000 - 10.514 13.381 12.890 1.729 1.648 3.170 7.324 1.504 3.368.675 3.462.215 1.323.486 1.206.061 49.375 135.000 35.000 * Double passport holders included Source:Ministry of Social Security and Employment 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour Migration to Turkey mainly from neighboring countries continuing. In 1989-1990 345 thousand people came to Turkey during the Iran-Iraq war and the population flow of Turkish origin from Bulgaria were the main sources. Turkey became in recent years one of the main routes of illegal migration from Asia and Africa to Europe. Now after the normalization of the conditions in southern and south-eastern part of the country the flow of illegal migrants slowed drastically. Interior Ministry is now better equipped and well trained specialists are in the scene against the illegal migration. Ethnic, Religion compositions and Spoken Language3 Turkish is the language of %90 of the population of Turkey. The Caucasian and several Kurdish dialects, Greek, Ladino and Armenian are among the other 70 languages and dialects spoken in the country. The Turkish spoken in Turkey is an agglutinative language similar to other Ural-Altaic languages and is the modern form of Ottoman Turkish . Turkish is the seventh most spoken and widespread language among the approximately 4000 languages spoken in the world today. More than 200 million people speak Turkish. There are no exact data on religious composition of the country. Researchs about ethnic structure and spoken language shows %94 of the population is moslem and other % 6 is christians mainly belonging the Greek, Armenian, Assyrian churches and jewish. Education In Turkey, education is carried out under the supervision and control of the state.According the Constitution, everyone has the right to receive an education. After 1997 compulsory education increased from five to eight years. Investments in school building and equipment increased steadily afterwards. 296 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour In the 2001-2002 scholastic year, a total of 18.6 million students, composed of 289 thousend preschool students, 10.5 million primary school students, 2.8 million secondary/middle-high school students, 1.7 million higher education students and 3.2 million non-formal education students, were educated in 60.057 formal and non-formal educational institutions. Table : 4 – Composition of Education 1995-1996 Level of Education Pre-school education Primary school Secondary school Collage Technical schoolUniversity and other higher schools Number of Students (‘000) Rate of Schoolarization (%) 1999-2000 Number of Students (‘000) Rate of Schoolarization (%) 2000-2005 (1) Number of Students (‘000) Rate of Schoolarization (%) 199 9.564 2.223 1.277 946 7,7 89,8 55,0 31,6 23,4 252 10.053 2.444 1.506 938 9,8 97,6 59,4 36,6 22,8 690 10.328 2.886 1.539 1.346 25,0 100,0 75,0 40,0 35,0 1.226 23,8 1.492 27,8 2.002 37,3 (*) Graduate Students included. (1) Projection Source : State Planning Organization Literacy rate gradually increasing. During the tumultouse years from mideighties to mid-nienties educational institutionals were main targets of terror. This had an negative impact on the rate of literacy. According the General Census of 2000 literacy rate is %87.30 and continuing to decrease. 1.2. Economy and labor Prior to 1980, Turkey followed an economic policy based on the substitution of import. Instead of importing her goal was to manufacture products in the country which would meet the domestic demand. Domestic 297 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour production and producers were protected by customs tariffs, import restrictions for manufactured goods, and other equally efective taxes. But on January 24, 1980 a comprehensive Stability Program with the objective of providing radical economic reforms was introduced. Thus, Turkey abondoned the planned economic development model and adopted an industrialization model concentrating on, and giving priority to export industries. Since then the process of implementing the Free Market Economy continuing. The foreign exchange regime was liberalized to a great extent as of 1984.Today, Turkey is one of the laeding countries in terms of liberal foreign exchange regimes in the world. According to World Data Bank daka, Turkey was in sixteenth place among 127 countries with her 2.9% increase in the annual average per capita GNP between 1980-1991. The GNP achieved an average increase of 5.3% per annum between 19801990, 3.2% between 1995-1997, and an average of 7.9% between 19951997, which is above woryd average. However, from August 1998 until mid-1999, the Turkish economy which felt the negative impact of the Russian crises in every sector, and especially in exports, was also hard pressed by the tax reform and the tight monatery and fiscal policies embraced withen the context of the disinflation program. With the delaying of some of the liabilities in the Tax Law and the government package to support the small and medium- size producers and exporters in the middle of 1999, the economic indicators showed signs of picking up; but with the earthquake disaster Turkey suffered yet another schock. Even though in 2001 the economy shrunk by 9.4%, as of March 2002, industrial production rose by 18.8% and there were indicators that the situation was picking up. 298 FONDAZIONE CENSIS Table 5: Real GNP by Main Kind of Economic Activity (Billion TL) Year Agriculture Industry 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 13.746 13.663 14.249 14.129(1) 14.358(1) 14.640(1) 15.395(1) 14.509(1) 16.176(2) 15.369(2) 15.962(2) 14.923(2) 21.873 22.504 23.911 26.260 24.775 27.766 29.743 32.337 33.494 31.814 33.738 31.207 Construction Services 6.271 6.144 5.857 6.141 6.415 6.560 5.739 5.991 5.662 48.973 48.720 52.163 44.307 42.615 45.803 48.949 67.988 54.454 47.329 56.540 53.179 GDP 84.592 84.887 90.323 96.591 91.321 97.888 104.927 111.249 116.114 110.646 118.789 109.885 (1) Turkish economy statistics and analysis August 1997, State Institue Of Statistic Prime Ministry Republic Of Turkey (2) Turkish economy statistics and analysis January-march 2003, State Institue Of Statistic Prime Ministry Republic Of Turkey Table 6: National Per capita incomes, Unemployment, Inflation Rates Per Capita GNP(Dolar) 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2175 2666 2774 3091 2192 2759 2928 3079 3255 2879 2948 2160 2584 Unemployment Rates 8.0 8.1 8.3 8.8 8.4 7.5 6.5 6.7 6.8 7.7 6.6 8.5 10.6 IMF (World Economics Outloc) DİE 2002, DİE 1996. Inflation Rates(%) 66.1 70.1 66.4 106.3 88.1 80.3 85.8 84.6 64.9 54.9 54.4 45.0 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour Unemployment rate in 2001was about 8.5% (1,902,000 people). In terms of gender, 8.8% of males and 7.9% of females in Turkey were unemployed in 2001. In cities the total unemployment rate is 11.5%, 10.3% for men and 16.8% for women. In rural areas, this reta is a total of 4.8%, with 6.5% for men and 1.6% for women. In 2001, the rate of unemployment among educated youth was 25.8%. Foreign Trade Turkey eliminated all trade barriers on imports of industrial goods from members of the European Union (EU) with the Customs Union established with the EU as of the 1st of January 1996 and also the EU’s Common Customs Tariff has started to be applied in trade with other countries. As a result , the balance of foreign trade yielded a deficit of 20 billon dollars in 1996. In 1997, exports increased by 13% reaching 26.2 billion dollars and imports insreased by 11.3% amounting to 48.6 billion dollars. As of the end of 2001, imports decraesed to 40 billion dollars and exports reached 30 billion dollars. An important structural change occurred in Turkey’s exports in the 1980s. The share of agricultural products in total exports, which was at a high level of 75% in 1970 and 57% in 1980, was 7.2% in 2001. On the other hand, the share of industrial products in exports, which was 18% in 1970 and 36% in 1980, insreased rapidly and reached 91.6% in 2001. 300 FONDAZIONE CENSIS Table :7 İmport-Export Values (million dolar) Export(Fob) 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 12.959 13.593 14.715 15.345 18.106 21.636 23.224 26.261 26.973 26.588 27.775 31.340 35.753 İmport(Cif) 22.302 21.047 22.871 29.428 23.270 35.709 43.627 48.559 45.992 39.773 54.012 39.748 51.203 Foreign Trade Balance -9.343 -7.454 -8.156 -14.080 -5.164 -14.073 -20.403 -22.298 -18.949 -13.185 -26.237 -8.408 -15.450 Export/ımport 30.581 64.6 64.3 52.1 77.8 60.6 53.2 54.1 58.7 66.8 51.4 78.8 69.8 DİE 2001, T.C. Maliye Bakanlığı, 1996 Yıllık Ekonomik Rapor. (State Statistical Institute 2001 and Ministry of Fiunance Report) 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour 1.3. Geography and territorial characteristics Geography and territorial patterns of Turkey composite of geographical surface, geographical distribution of population, principle Natural Resources, climate characteristics and environmental Issues. Geographical Surface The Republic of Turkey spans two continents. The seas which surround the country on three sides are the Black Sea, the Aegean and the Mediterranean. Turkey has borders with Georgia, Armenia, Nakhicevan (Azerbaidjan) and Iran to the east, Bulgaria, and Greece to the west and Iraq and Syria to the south. Turkey has an area of 814,578 km square. 3% of the area of Turkey is located in Thrace in Europe, and the remaining 97%, which is referred to as Anatolia, is located in Asia. The legth of the land borders of the country is 2,875 km. and the length of the coastline is 8,333 km. Turkey has a width of app. 550 km. and a length of app. 1,500 km. Turkey has seven geographical regions: The Black Sea, the Marmara, the Aegean, the Mediterranean, the Central, East and Southeast Anatolia Regions. The Regions are not definiteve demarcations, but markers of gradually changing geographical and climatic features. Principle Natural Resources Turkey has large and varied mineral deposits and resources.Turkey holds 28th place in terms of total production among 132 countries in the world who are involved in mining activities and 10th place in terms of the type of minerals produced. Today 53 different metals and minerals are being produced in the mining sector. While the public sector predominates in the production of mineral fuels ano metallic ores, the private sector has concentrated on industrial minerals. 302 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour Some of the most important minerals produced in Turkey are as follows: Coal :reserves around 1.3 billion tons, and 72% of it is coke. Lignite: there are lignite deposits in almost every region of the country.Total reserves are 8.3 billion tons; annual production is around 65-70 million tons. Crude oil and natural gas : Turkey is a net importer of crude oil and natural gas. Petroleum reserves are about one billion barrels and 14 billion metric cubes of exploitable natural gas reserves are in the country. 2,5 million tons of crude oil were produced in 2001. Again in 2001 311,5 million metric cubes of natural gas were produced. Iron ore is extracted from various regions in Turkey. The annal production is over 6 million tons. Chromium ore and other important minerals: Turkey is one of the leading countries in the production and export of chromium ore. With its 40 million tons of reserves, Turkey places fourth in the world. In recent years marble production has also been increasing gradually, along with copper, boron, aluminium,lead, mercury, sulfur, emery and meerschaum. Climate Characteristics Turkey is located along a moderate climate belt. In spite ou this, there are differences in climate from region to region, the reason being that mountains are parallel to the coast and there is diversification in the surface morpholdgy. The coastal regions have a moderate maritime climate, while the central regions, surrounded by mountains, have a continental climate. The Mediterranean region experiences hot and arid summers, while in the winter it is mild and rainy.The Mediterranean climate also manifest itself in the Aegean region and in the south of the Marmara region. A more moderate and rainy climate predominates in the Black Sea region. In the interior regions, the summers are hot and slightly rainy and a steppe climate is observed in the winter which is cold and snowy. In the Eastern Anatolia region, the summers are cool and the winters are very cold and there is snow. In the Southeastern Anatolia region, the summers are hot and arid, and winters not very cold. 303 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour Environmental Issues Turkey faced environmental issues more late for being late to industrialization. Rapid urbanization and industrialization caused at the same time envirenmental problems like weather pollution, water pollution, land degredation, coastal pollution, exhausting natural and cultural resources, forest degredation, decreasing bio diversity and solid waste problems in the metropolitan and urban areas. Environmental policies becam than one of the important issues in the country. Even a Ministry of Environment was established. In the harmonization process with the EU which began with the Helsinki Summit of 1999, preparatory studies aimed at intensifying cooperation with the EU on environmental issues gained momentum. A national plan is being prepared for the harmonization of environmental regulations. Regulations concerning motor vehicles and chemical substances have already been made to conform. References (1) Aslan Eren, Türkiye’nin Ekonomik Yapısı ve Güncel Sorunları, Muğla. Muğla Üniversitesi Yayını, 2002 (2) Kemal Görmez, Çevre Sorunları ve Türkiye, Ankara: Gazi Kitabevi, 1997. (3) Orhan Türkdoğan, Etnik Sosyoloji, İstanbul: Timaş Yayınları, 1999 (4) Peter Alford Andrews Türkiye’de Etnik Gruplar, çev. Mustafa Küpüşoğlu, Ant Yayınları, 1993. (5) Rıdvan Karluk, Türkiye Ekonomisi, İstanbul. Beta Yayınları, 1995. (6) Türkiye Ekonomi Kurumu, Türkiye Ekonomisi Sektörel Analiz, Ankara: İmaj Yayınları, 2001. (7) Turkish economy statistics and analysis January-march 2003, State Institue Of Statistic Prime Ministry Republic Of Turkey. 304 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour (8) Turkish economy statistics and analysis January-march 2003, State Institue Of Statistic Prime Ministry Republic Of Turkey. (9) Statiatical Year Book Of Turkey 2001, State Institue Of Statistic Prime Ministry Republic Of Turkey. (10) Statiatical Year Book Of Turkey 1997, State Institue Of Statistic Prime Ministry Republic Of Turkey. (11) TC. Maliye Bakanlığı, 2001 Yıllık Ekonomik Rapor. (12) TC. Maliye Bakanlığı, 1996 Yıllık Ekonomik Rapor. (13) Turkey 2002, Directorate General of Press and Information of the Prime Ministry. 305 FONDAZIONE CENSIS 11873_2002 2. Study D2: Poverty, Informal Sector, Health and Labour HEALTH According to the Turkish constitution, everybody has right to live in a healthy and nutrious environment and the government has to provide physical and physiological health services for the public (no:56). For that reason, providing a healthy environment, and financing the health services are a constitutional responsibility of the government. The law accepted in 1930 called “General Law of Health” ensures that government should increase the living conditions of the public, solve the problems related to public health and provide a better environment for the future generations (no: 1). The responsibility of public health is belong to the ministry of health. Ministry of health has all the authority concerning public health, and a healthy environment. One of the main objective of this organization is to create “a healthy individual and healthy society, an improved health system, a protection for diseases, and a planned health system”. The headquarters of the ministry is in the capital, Ankara, and it has sub-offices in all 81 cities of Turkey. In additon to the “General Law of Public Health” and “Ministry of Health foundation Law” there are more than 30 laws concerning health issues in Turkey. Also, there are considerable amount of governmental decisions regardin health problems. The definition of health in Turkey generally is taken from the World Heatlh Organization. Within this context, Nusret Fisek (1983:1) has defined the heatlh as “health is not only to have a body without any physical desease, but also it is mentally and socially the case of goodness.” However, in practice health is considered as a goodness in terms of physical body (Medicana: 379-380). The main indicators in Health Sector in Turkey and some projections for 2005 as follow: 306 FONDAZIONE CENSIS Table 1: Existing Status and Objectives of VII.Plan at Health Indicators Criterions Bed Capacity (*) (2001) Population per Bed (2001) Bed Occupancy Rate (%) (2001) Health Manpower (2001) Number of Physicians Population per Physician Number of Dentists Population per Dentist Number of Pharmacist Population per Pharmacist Number of Sanitarian and Health Population per Sanitarian Number of Nurses Population per Nurse Number of Midwives Population per Midwife Existing Status Targets of 2005 at VIII.Plan 175.190 392 60,2 200.000 351 75 85.117 797 16.002 4.237 23.266 2.914 46.528 1.457 71.612 947 41.590 1.630 89.000 789 16.000 4.389 77.100 910 - (*) Ministry of National Defense is included Source: http://www.saglik.gov.tr/extras/istatistikler/apk2001/002.htm 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour The big amount of hospitals in Turkey operate under the directions of Ministry of Heath. However, there are small number of hospitals operate under the directions of Ministry of Labor, universities, municipals and other public institutions. The distribution of hospitals in terms of organizations as follows: Figure 1: Distribution of Hospitals in terms of Organizations, 2002 Source: http://www.saglik.gov.tr/extras/istatistikler/ytkiy2002/elektronikkitap/grafik1.htm As shown in Figure 1, following the Ministry of Health, as a public institutions the Social Insurance Institute (SSK) has the most of the hospitals. Individuals who are working under coverage of Labor Low can benefit from these hospitals. However, in 2003, the existing government made possible for those people to use other public and private hospitals as well. With this application, the burden of SSK hospitals has substially lessened. 308 FONDAZIONE CENSIS Table 2: Number of Doctors an number of persons per doctor Years Population (1000) Number of Doctors People per doctor 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 53715 54893 56473 57326 58584 58869 61183 61444 62697 62610 64786 65819 66834 68610 69749 42502 46708 50639 53264 56985 61050 65832 69349 70947 73659 77344 81988 85117 88456 93586 1276 1270 1115 1076 1028 980 929 886 883 850 872 838 785 776 745 Soruce: http://www.saglik.gov.tr/extras/istatistikler/ytkiy2002/elektronikkitap/tablo4.htm 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour Due to an increse in education expenses in last decades, the number of people per doctor has decreased. As can be seen in Table 2, in the last 14 years this decrease continued. While this number in 1988 was 1276, it decreased to 745 in 2002. This improvement has been reached inspite of a 24% increase in population. An increase in the health expenses in last years created an increase in heatlh expenditure per person as well. Health expenditure per person has increase by 38% in last ten years (tab. 3). Even though there is an improvement in health expenditures in Turkey, it still is too low when it comes to compare with the OECD countries. This huge differences has been shown in Tabloe 4 below. However, the same increasing trend cannot be seen in Ministry of Health’s share from the general budget. In last ten years, the Ministry of Health’s share from general budget fluctuates between 4.5% and 2.5%. The decrease in health expenditure in last years is a result of economic crisis experienced during last years (tab. 5). Table 6 and 7 show the data for some contagious illnesses. According to 2001 data the AIDS incidents experienced is 1325. The number of men with AIDS is more than the number of women with AIDS. According to 1999 data total number of cancer detected in Turkey is 25,942. Medicine and medicine related imports show an incresing trend in terms of years. In 1990, import of medicine and medicine related row materials is about $470 million. This number reached to $1.5 million in 2001 (tab. 8). The evaluation of mother-baby health issues in Turkey shows that the rate of giving birth with the help of a specialist increases rapidly. The amount of giving birth at home has decreased more than 50% in the period between 1999 and 2001 (tab. 9). 310 FONDAZIONE CENSIS Table 3: Heath Expenditures per year Years Total Health Expenditure GDP (%) 1991 1992 1993 3.7 3.9 4.4 63.5 66.2 68.2 97.8 107.7 130.1 182.4 207.0 247.1 1994 1995 1996 1997 1998 4.0 3.9 3.7 3.6 4.0 64.7 64.3 64.0 63.0 63.0 85.2 106.5 111.4 119.8 139.9 161.9 234.3 251.1 259.1 279.1 1999 2000 4.1 4.3 79.9 80.0 116.4 135.3 220.0 250.0 Public ( % ) Per person Hearlth Per person Health Expenditure ( $ ) expenses $/SAGP) Source: http://www.saglik.gov.tr/extras/istatistikler/ytkiy2002/elektronikkitap/tablo10.htm Table 4: Heath Expenditures of Selected OECD Countries, 2000 Country Canada Czeck Republic Frans Germany Greese Italy Japan Mexico Portuqual Spain Turkey England U.S.A Heath Expenditure The share of Private Public in GDP Expenditures (%) (%) 72,0 91,4 76,0 75,1 55,5 73,7 76,7 46,4 71,2 69,9 71,1 81,0 44,3 28,0 8,6 24,0 24,9 44,5 26,3 23,3 53,6 28,8 30,1 28,9 19,0 55,7 The rate of Heath Expenditures in GDP (%) 9,1 7,2 9,5 10,6 8,3 8,1 7,8 5,4 8,2 7,7 5,0 7,3 13,0 Source: http://www.saglik.gov.tr/extras/istatistikler/ytkiy2002/elektronikkitap/tablo24.htm Table: 5 Ratio of Budget of Ministry of Health To Budget State (Thousand TL) Years Budget of State 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 207.545.328.000 398.710.000.000 823.396.387.000 1.335.978.053.000 3.558.506.822.000 6.344.685.500.000 14.753.000.000.000 23.570.000.000.000 46.843.000.000.000 48.060.000.000.000 97.831.000.000.000 Budget of Minis. of Health Ratio of Budget of Minis.of Health To Budget of State 9.783.005.000 18.184.911.000 30.639.327.000 49.417.951.000 98.064.401.000 204.499.276.000 390.891.701.000 663.123.501.000 1.059.825.001.000 1.280.660.000.000 2.345.447.691.000 4,71 4,56 3,72 3,70 2,76 3,22 2,65 2,81 2,26 2,66 2,40 Table 6: Distribution of AIDSCases Cases and Carriers By Age Group and Sex Age Group Total 0 1–4 5–9 10 - 12 13 - 14 15 - 19 20 -24 25 - 29 30 - 34 35 - 39 40 - 49 50 - 59 60 + Unknown Total 1.325 7 6 10 4 2 37 189 219 255 157 169 91 46 133 Male Female 919 6 2 3 3 1 13 88 150 203 128 131 62 33 96 406 1 4 7 1 1 24 101 69 52 29 38 29 13 37 Source: http://www.saglik.gov.tr/extras/istatistikler/apk2001/073.htm Table 7: Distribution of Cancer Cases with respect to Age and Sex, 1999 Age Groups Total 0–4 5–9 10 - 14 15 - 19 20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69 70 - 74 75 + Number 25.942 342 313 266 353 408 507 739 1240 1767 2400 2810 3139 3284 3872 2701 1801 Incidence 39.41 5,17 5,54 4,00 5,22 6,26 8,79 14,46 25,77 44,.46 73,78 111,02 158,46 184,49 241,4 260,46 209,91 Number 16.023 205 189 154 180 215 244 346 576 916 1.349 1.720 2.019 2.254 2.718 1.805 1.133 Male Incidence 48,30 6,08 5,65 4,52 5,21 6,48 8,31 13,35 23,45 88,5 81,66 135,97 211,64 269,94 352,07 394,97 303,75 Number Female Incidence 5.051 137 124 112 173 193 263 393 664 851 1.051 1.090 1.120 1.030 1.154 896 668 30,38 4,21 3,87 3,44 5,23 6,16 9,57 15,75 29,14 45,46 68,42 90,08 110,56 109,34 141,6 167,79 144,28 Source: http://www.saglik.gov.tr/extras/istatistikler/apk2001/089.htm Table 8: Imports of drug and drug raw material by years in Turkey (USA $) Years 1990 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 Total 470.114.087 522.394.938 510.532.307 489.174.620 729.565.587 978.504.000 981.953.471 1.180.592.194 1.242.129.545 1.511.000.000 1.491.579.320 Raw Material Manufactured Drug 386.257.785 425.530.447 400.532.307 371.174.620 565.785.587 716.755.000 667.728.360 769.378.609 808.003.771 828.000.000 831.857.360 83.856.302 96.864.491 110.000.000 118.000.000 163.780.000 261.749.000 314.225.111 411.213.585 434.125.774 683.000.000 659.721.960 Source: http://www.saglik.gov.tr/extras/istatistikler/apk2001/107.htm Table 9: Maternal and Child Health Services of Health Centers Investigation of Pregnant and Child Years 1990 1994 1995 1996 1997 1998 1999 2000 2001 Pregnant 2.380.544 2.944.022 2.667.850 2.759.365 2.626.591 2.146.736 2.376.280 2.261.896 2.535.632 Infant 0-11 Months 4.886.821 5.116.693 5.109.084 4.995.731 4.877.703 4.064.790 4.573.632 4.363.537 4.726.729 Child 1-6 Ages 6.503.311 5.650.572 5.996.169 6.010.649 6.032.435 4.899.265 5.500.351 5.368.475 5.726.902 Total 508.634 542.994 577.703 589.159 586.108 505.725 578.065 557.315 602.219 Birth With the Help of Health Personnel 428.257 474.786 511.214 533.519 536.593 469.981 542.334 525.163 567.792 Source: http://www.saglik.gov.tr/extras/istatistikler/apk2001/071.htm Table 10: Data regarding General Health, Fertility and Nutrition Indicators The rate of contraception use The rate of births with the assist of Health Personnal Fertiliy rate of women in the age betwee 15-19 Persons who know how to use contraceptions The rate of children that has taken measles shot The rate of underweight childeren Source: www.die.gov.tr 1991 (%) 1998 (%) 62.6 75.9 56 99.1 77.9 9.5 63.9 80.6 60 98.9 78.5 8.3 By Herself 80.377 68.208 66.489 55.640 49.515 35.744 35.731 32.152 34.427 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour Table 10 indicates that the rate of underweight children has decreased, immunization rate for some illnesses has increased, and the use of contraceptives has increased. In addition to above given data there is a resarch conducted by Osman Gazi University in 2002 (Aksam Newspaper, August 12, 2002). - In Turkey, 20.2% of the population is not covered by the social security - 2.7% of all babies die for several reasons. - 25% of all drugs wasted. - Import of drugs 10 times more than that of export. - Only 1.2% of people give blood.. - Annual drug expenditure is 2.5 billion and annual drug consumption per person is $38. - The rate of people who has no healthy water is 26.5%. - One third of 27 million children cannot receive appropriate nutritions. Even though this research gives a pecimistic view, the official numbers show an increase in health quality in Turkey. However, some people in Turkey still cannot receive health protection, while some people are not happy with their protection. Unfortunately, in most cases a health service covering every part of Turkey cannot be given as it is planned. Especially, data for rural and urban areas and data for east and west differ a lot. For that reason, we cannot mention a standard health quality all over the country. There are more than one reason for this. The reasons can be summarized as follow (Ministry of Health, YKP, Special Council for Health, 2001, pp:4). The whole authority in the health services belongs to the Ministry of Health in Turkey. For that reason, it is widely open to political misuse. Decisions are made according to political views of the government and thus, a long run policies sometimes may not be possible to implement. Projections do not imply the actual data in most cases due to political decisions. The coordination cannot be reached among critical institutions for public health. These institutions become a political arena for the parties in power, and 315 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour expected coordination and services cannot be provided to the public. Some problems experienced in Turkey regarding health services are following: - Health sector cannot be organized adequately due to spread structure of institutions. The main reasons for this disorganization can be stated as follow: misuse of human resources, political views, erroneous definitions of duties, and lack of inspections in health sector. Another reason for disorganization is that lack of information due to problems in the flow of information among institutions. - The share of health in GDP is not enough. Lack of building, resoruces and other tools used in health servises are them main reasons of hardship in health. İn other words, most of the problems in health sector is due to financial problems. Turkey is one of candidate countries for full membership to the European Union. As analyzed from this point of view, Turkey has not yet reached to the level of EU countries (Isik, 2001, pp: 106-107). However, efforts in this area is notable in last five years. In addition to that, health institutions belong to NGO in last years has increased. Also, people who have no health securities, if they are eligible, can get health services free of charge from the Ministry of Health. According to 2001 data 1.3 million people receive free health services in Turkey. But after the parlamentary elections last year Turkey has now a “one party government”. It seems that some of the notorious problems in the health sector are going to be solved. Reorganization of the sector is already underway. Health Reform activities can be summarized as : the initiation of the application of General Health Insurence as soon as possible; to separate the service supplier from the financing organization; to give autonomy to hospitals to help them provide high quality and efficient services; to adopt the Family Medicine model in primary health services; to help the Ministry of Health acquire a new structure and to harmonize Turkish health regulations with EU norms. The information and statistics in Turkey is collected and stored by the Ministry of Health and State Institute for Statistics. The web addresses of these institutions are: - T.R. Ministry of Health: www.saglik.gov.tr 316 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour - State Institute for Statistics: www.die.gov.tr References - Aksam Newspaper, August 12, 2002 - Fisek, Nusret , Introduction to Public Health, Hacettepe University press, Ankara 1983 - Isik, Nilufer Avci, The relations of Turkey-EU and the Health, Minsitry of Health , EU coordination department, Ankara, 2001. - Medicana General Health Ansiklopedia, Milliyet press, Vol:12, 1993 - VIII. Five year Development Plan: Efficiency in the Health Services, The special commission for Health Report, State Planning Organization, Press No: 2561, Ankara, 2001. - http://www.saglik.gov.tr - http://www.die.gov.tr 317 FONDAZIONE CENSIS 11873_2002 3. Study D2: Poverty, Informal Sector, Health and Labour POVERTY 3.1. Definitions There are various definitions of poverty in literature, but three of which are being used in Turkey. These definitions are: i) half of median income ii) minimum food need to be purchased, and iii) basic needs approach. Definition according to “Minimum Calorie need to be taken” approach (minimum food basket): The poverty calculations are made based on proposed calorie per person for all population in the country. People who receive lower calories than propesed calorie are considered as poor (absolute poverty definition). Definition accordign to “minimum food need to be purchased” approacah: In order for a person to continue his/her life there are some basic needs such as nutrition, cloth, housing, education and health services that need to be purchased. İt shows the border for poverty calculations made by using these above mentioned criteria (absolute povery definition). Definition accordign to “median or avarege income” approach: This definiton uses average income created by whole society, takes half of this median income, and considers those people who receive less than that as poor (relative poverty definition). State Planning Organization uses median income approach, but some organizations suhc as Turk-Is labor Union use basic needs definition for their calculations. 3.2. Policy and Legislation One of the most efficient ways to prevent povery is to provide minimum needs for live by providing social benefits for those considered as poor. Given the main reason for poverty is lack of human capital, social benefits 318 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour such as education and health become the most efficient tool for preventiong poverty. Government is the most active player in social benefits in Turkey. In other words, payments for social benefits are paid by governments budget from an item called “social transfer payments.” However, these payments cannot be thought as enough given the magnitude of poverty in Turkey. Usually the poor has no social security for themselves and their families. Only those people who work with daily and/or monthly salery have social security. The reminder of the population has no socail security at all. Table 1: Distribution of the poor in terms of Social Security Institutions (%) (2001) 1 Ssk Emekli sandiği Bağ-kur Private Non-registere Total 2,17% 0,00% 2,53% 0,00% 95,31% 100% 2 20 PERCENTILE 3 4 4,96% 0,41% 3,72% 0,00% 90,91% 100% 7,75% 0,39% 4,26% 0,39% 87,21% 100% 16,10% 1,50% 6,37% 0,00% 76,03% 100% Total 5 16,31% 1,77% 9,22% 0,71% 71,99% 100% 9,58% 0,83% 5,28% 0,23% 84,09% 100% Source: Authors’ calculations from 2001 Household Labor Survey As can be seen from Table 1, most of the poor are not covered by any social security benefits. This means that government does not provide enough social security benefits for its workers. It is going to be meaningful to see the development of transfer policies with respect to years. 319 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour Table 2: Percentage rates of transfer payments in General Budget 1980 1985 1990 1994 1999 2000 Health Education 4.4 2.8 4.7 3.5 2.4 2.3 16.1 12.3 18.8 13.4 11.8 9.4 Domestic Debt interest payments 2 5 14 26 35 28 Total Transfers/Budget 36.6 40.6 36.6 53.2 61.8 65.5 Source: Derdiyok, Turkmen, “Debt Policies after 1980” XVI.Turkish Public Finance Symposium, May 28-31 2001. Antalya, Financial Policies after 1980 in Turkey As can be seen from Table 2, between 1980 and 1999, the rate of interest payments for domestic debts in general budget shows an increase, while the rate of expenditures for education and health decreases. This numbers show that Turkish officials use their choices in favor of those who receive capital income. In addition, the poor gets poorer every year due to unsatisfactory transfer payments of the government. 320 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour Figure 1: Percentage shares in Total Transfers 67.5 70 63.2 60 53.8 50 52.9 52.1 43.1 55.8 58.2 57.7 51.3 41.9 40 30 20 10.4 10 7.1 16.3 14.2 13.5 15.7 12.4 5.3 5.4 5.4 6.2 00 20 99 19 98 19 97 19 96 19 95 19 94 19 93 19 92 19 91 19 19 90 0 Socail Transfers Interest Payments for Domesti Debts Source: Derdiyok, Turkmen, “Debt Policies after 1980” XVI.Turkish Public Finance Symposium, May 28-31 2001. Antalya, Financial Policies after 1980 in Turkey When transfer payments in domestic national product is investigated, it can be seen that while interest payments show a very sharp increase, security payments show relatively very small increases. The share of social transfers in total transfers was 12% in 2000. However, the same rate for domestic interest payments was 67.5%. Bu tablolar göstermektedir ki kamunun bozuk gelir dağılımını düzeltmek ve yoksullukla mücadele etmekte önemli bir politika aracı olan transfer ödemelerinin yapısı bu amacı gerçekleştirmekten uzaktır. Transfer ödemelerinin yapısı, piyasa başarısızlığını gidermekten uzak ve hükümet başarısızlığıyla sorunu derinleştirecek niteliktedir. All the Tables mentioned above show that public sectors tranfer payments are far away from providing equity in income distribution. The structure of 321 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour transfer payments has lack of ability in providing a justice in income distribution, and it deepens the problem if we add the unorganized goverments. 3.3. Sources For definations and data of poverty in Turkey www.die.gov.tr For definations and policy and legislation issues www.dpt.gov.tr Different defination of poverty from Non-goverment organisations and data www.turkis.org.tr www.denizfeneri.com.tr 3.4. Data Human Development Report (2001) Human Poverty Index Rank: 22 Human Poverty Index Value: 12.4 Probability at birth of not surviving to age 60: 8.0 Adult illiteracy rate: 14.5 % of population not using improved drinking water sources: 18 Underweight children under age-five: 8 322 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour Population below income poverty line ($2 per day): 10.3 Long-term unemployment (as % of labour force):2.5 Table 3: Poverty Indecise Nutrition Poverty Basic Needs 1994 Poverty Income Poverty Nutrition Poverty Basic Needs 2001 Poverty Income Poverty Number of Head Indecies Yoksulluk Açığı Endeksi Average Poverty Poor Trashhold Sen Index income(TL) (TL) 0,07 0,37 0,039 490993 782899 0,31 0,33 0,46 0,218 818137 1520386 0,34 0,18 0,69 0,144 446219 1461220 0,22 0,08 0,25 0,048 27000000 36090420 0,31 0,41 0,45 0,260 47500000 86198920 0,33 0,18 0,73 0,140 23900000 86939760 0,24 Gini coefficient Soruce: SIS, 1994 and Authros’ calculations from 2001 household Labor Survey Income distribution for all categories worsened under the criteria mentioned above for years 1994 and 2001. While the Gini Coefficient for whole Turkey was 0.46 in 1994, Gini Coefficient in 2001 increased to 0.49. if the Gini coefficient for the poor is investigated we see an equity in income distribution among the poor. However, this equity tends to worsen with the economic crises experienced in recent years. 323 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour Table 4: Expenditure Distribution for the Poor Household (%) First 20th percentile 1994 2001 Health Education Others Total 3,65 0,31 96,04 100 4,68 0,18 95,13 100 Second 20th percentile 1994 2001 3,37 0,11 96,52 100 2,25 0,07 97,69 100 Third 20th percentile 1994 2001 2,75 0,26 96,98 100 1,83 0,09 98,09 100 Fourth 20th percentile 1994 2001 1,92 0,25 97,83 100 2,08 0,23 97,70 100 Sorce: SIS, 1994 and Authros’ calculations from 2001 household Labor Survey It can be easily seen form Table 4 that there is a great diffusion in human capital after economic crises. The share for education in total income is the highest in the fifth 20th percentile. However, this share is not even equal to 1% in total. The share of education for all 20th percentile worsened from 1994 to 2001. This shows the greatness of the problem that the Turkish economy facing and the stickiness, and intergenerational distribution of the poverty. 324 FONDAZIONE CENSIS Fifth 20th percentile 1994 2001 2,02 0,23 97,75 100 2,64 0,21 97,15 100 11873_2002 4. 4.1. Study D2: Poverty, Informal Sector, Health and Labour CRIME Definitions In theory and in law, it is quite difficult to agree on a common definition of crime. For example; according to the positivist school, in the law order an action that requires a punishment in the end is a crime. This definition is not wrong but incomplete. To be more clear, it is a definition that is related to how itiis done, not to the essence. As the law order may change according to place and time, actions that are planned as normative actions are accepted ‘crime’. With respect to this point, the definition is true just in shape. Crime is the action that destroys the morality and as a result ,cannot be tolerated by the government. This definition is also incomplete. Because there are some actions that do not destroy morality, yet, are accepted as crime. For example; political crimes are not accepted as moral crimes. Or vice versa: Some actions are morally corrupted but are not accepted as ‘crime’ . For example: adultry. The most reasonable way to find a common definition is to head off with the elements of crime. In Turkish Crime law – the main source of crime law in Turkey – there is no definition of crime but there are elements of it. According to it, there are three basic elements of crime : 1. The physical element 2. The spiritual element 3. The element of being against law. There are three levels in the physical element: 1. action 2. result 3. cause and effect relationship To be more clear: An active or passive human action, a change that is felt in the outer world as a result of this action and the cause and effect relationship between the action and the mentioned change form the physical element. On the other hand, the spiritual element is a concept that implies personal responsibility. It means that the person who does the action, which forms the physical element, does it on purpose. In other words; a person 325 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour deliberately and willingly does something that is “forbidden” by law or vice versa: deliberately and willingly does not do the thing that he is supposed to “do” by law. The universal principal of the crime law: ‘there cannot be a crime and a punishment without law.’ necessarily brings the the element of being against law. A law that puts crime and punishment has to determine the action, which is called ‘ crime’ and its prohibited result. This situation in the law is called ‘the type’. An action that is fitting to the type is a crime. As a result of the principal of legality, crime and punishment cannot be created by anything except for the law. An action might be condemned or morally blamed but if it is not fitting to the type, then it is impossible to talk about crime and punishment. With the reference to the mentioned elements of crime, we can describe it as the following: “A faulty action that is fitting to the type and against law”. This definition is very commonly accepted by official and non- official authorities in Turkey. 4.2. Policy and legislation According to the second article of the Constitution; “ Turkish Republic is a ... democratic, secular and social law state”. The inevitable and obligatory result of being a law state is to bind those who rule and those who are being ruled equally and to guarantee and develop human rights and freedom at the highest level. The fifth article of the Constitution says that “The fundamental aims and duties of the state are ... to strive for the removal of political, social and economic obstacles which restrict the fundamental rights and freedoms of the individual in a manner incompatible with the principles of justice and of the social state governed by the rule of law; and to provide the conditions required for the development of the individual’s material and spiritual existence”. Philosophically liberal state stands for it. When it is analysed through the perspective of crime and punishment concepts, these principles in the Constitution and the texts of the acts that regulate the mentioned area should be parallel. More clearly, the acts that 326 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour regulate the area of crime and punishment should equally protect the essential rights and freedom of both the victim and the guilty in the sense of justice. But up to recent years, it is difficult to say that primarily the Turkish Punishment Law and other acts that regulate the crime and punishment area have been applied in the way mentioned above. For example; in punishment acts, the area of crimes that are committed against the State has been thoıght very wide and to express the ideas that are against the official ideology were accepted as crime. So the freedom of expressing your opinion- one of the basic human rights- was dramatically restricted. From this perspective, up to the end of 1990s , Turkey reflected itself as an authoritarian state rather than a state that is respectful to human rights. In December 1999, Turkey, which had been trying to be a member of the European Union (EU) since 1960s, got the status of being a candidate country to it. Apart from political, economic, and social rules, naturally there are legal rules to be a member of the EU. These rules are called Copenhagen Criteria and to carry them out is the pre-condition of the membership. For this reason, since the beginning of 2002 to make its law regulations concordant with the EU regulations, Turkey have prepared seven adaptation packets including changes in some acts. Again for the same reason,there have been significant changes in crime acts. For example; Death Penalty has been abolished, and the area of political crimes – icluding the crime of expressing opinion- has been restricted. In short, The Turkish Grand National Assembly has enthusiastically been working to make Turkish Law Regulations concordant with the EU. Also the governments in recent years have been very careful and extremely sensitive about the matter and are trying to make it the general policy of the country. Apart from the process of integration with the EU, the studies that have been carried out since the mid 1980s to update the Turkish Crime Law – the basic source of crime law in Turkey - are due to be completed. In Turkey the basic rules that regulate the crime and punishment area are in the Constitution and in the Turkish Crime Law. In the Constitution the principles at the highest level about this subject are arranged in the 37th and 38th articles: 327 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour “No one may be tried by any judicial authority other than the legally designated court. Extraordinary tribunals with jurisdiction that would in effect remove a person from the jurisdiction of his legally designated court shall not be established (art. 37)” “No one shall be punished for any act which does not constitute a criminal offence under the law in force at the time committed; no one shall be given a heavier penalty for an offence other than the penalty applicable at the time when the offence was committed. The provisions of the above paragraph shall also apply to the statute of limitations on offences and penalties and one the results of conviction. Penalties, and security measures in lieu of penalties, shall be prescribed only by law. No one shall be held guilty until proven guilty in a court of law. No one shall be compelled to make a statement that would incriminate himself or his legal next of kin, or to present such incriminating evidence. Criminal responsibility shall be personal. General confiscation shall not be imposed as a penalty. The death penalty shall not be imposed excluding the cases in time of war, imminent threat of war and terrorist crimes. Findings obtained through illegal methods shall not be considered as evidence. No one shall be deprived of his liberty merely on the ground of inability to fulfil a contractual obligation. No citizen shall be extradited to a foreign country on account of an offence (art. 38)”. There are basic three parts in the Turkish Crime Law that was accepted in 1926. The first part, which was titled as ‘ Genaral Judgements’ contains the basic rules that are valid for all crimes. For example; the application rules of crime acts, types of punishments, the situations that decrease, abolish or increase the crime and punishment, prescription, the principle of legality can be counted among them. The second part, which is titled as’ Crimes’ regulate the more serious crimes that necessitate life imprisonment, heavy imprisonment and heavy fine. The third part, which is titled as ‘ Offenses’ regulate the petty crimes that necessitate lenient imprisonment and light fine. Apart from the Turkish Crime Law, there are some special acts to regulate the crime and punishment area. The Act For Struggling Against Terrorism, The Act of Forests, The Act of Traffic and The Act of Fire Arms can be counted among these special acts. 328 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour 4.3. Sources In Turkey, the basic sources of official statistics and non- official information sources about crime and punishment are the following: 4.3.1. Official sources www.adli-sicil.gov.tr/istatist.htm www.adalet.gov.tr/cte/istatistikler.htm www.die.gov.tr www.egm.gov.tr 4.3.2. Non-official sources www.idealhukuk.com www.hukukcu.com www.hukukrehberi.net www.turkhukuksitesi.com www.hukuk.gen.tr www.kriminoloji.com www.e-akademi.org 4.4. Data In Turkey the number of majors and juveniles in prisons and reformatories can be indicated as the following: 329 FONDAZIONE CENSIS TABLE I – Convicts Received Into Prison by Type of Crime, 1990-2000 Againts Government Administration (Debt, Bribery, Misuse of Duty) Againts Public Decency and Family Order (Rape, Crime About Family) Againts Individual (Homicide, Assault, Insult and Swear) Againts Property (Theft, Surindle, Robbery) 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 550 469 452 519 559 574 583 690 822 905 888 3222 2681 2336 2303 2123 2197 2282 2359 2348 2323 2071 5723 5879 5290 5453 6684 6770 6832 6999 7475 7471 7293 8276 8369 9509 8407 9071 9640 10230 11139 12315 12498 13861 Source: Statistical Yearbook of Turkey, State Institute Statistics Prime Ministry Republic of Turkey, publication number: 2690, Ankara, 2001, p.187 TABLE II - Sentenced Juveniles Received Into Reformatory by Type of Crime, 1990-1999 Homicide Theft Rape Sodomy Battery Robbery Other 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 70 161 68 56 16 73 21 86 115 63 56 11 69 10 77 170 46 66 11 69 16 84 153 44 73 13 110 17 133 213 41 72 12 115 39 140 239 49 53 19 138 33 123 280 54 70 14 112 38 157 231 64 60 16 77 25 142 309 59 50 15 102 29 118 215 42 23 10 120 57 Source: Judicial Statistics 1999, State Institute Statistics Prime Ministry Republic of Turkey, publication number: 2450, Ankara, 1999, p.6 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour 4.5. Phenomenology After talking about the basic policies and information about the area of crime and punishment in Turkey, it will be right to make its critical analysis. Clearly to analyse the general character of the Turkish crime law and to summarise the basic structure of the crime act will help us understand the matter better. When we functionally look at the history of crime law, it is possible to say that there are three different concepts of crime law. These are the oppressive crime law, the preferential crime law, and the crime law that is in favor of freedom. The Oppressive Crime Law is the crime law of monarchic systems.This type of crime law, which is also seen in totalitarian regimes in modern times, is a means of excessive political powers. The fundemental aim is to preserve the political power and to eliminate the ideas that are contrary to the idea that is accepted the unique truth by the state. The area of crime and the discretionary power of judges are wide. As the guilty person is regarded as an aggressive brutal man who attacks on the physical and spiritual possessions of others, he is very severely punished. Among his punishments, death penalty, torture, cutting off an organ and imprisonment in dungeon can be counted. Preferential Crime Law developed after the French Revolution. With the revolution, a shift from the mınarchic system to the liberal state, naturally brought a change in the social structure.The priviliged classes that depended on the base of blood and religion lost their authority and new social classes that depended on wealth replaced them.Thus, the preferential crime law emerged and developed during the time of the liberal state and functioned as the protector of the rich classes and their priviliges. Moreover, it defended these priviliged classes against the poor who were regarded as ‘ dangerous classes ‘ . When opposing social rights are in conflict, this crime law protected the rights of the more powerful, no matter how much disadvantegous it was for the less powerful and it guaranteed the freedom not among the non-equals but among the equals. 332 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour On the other hand, the crime law that is in favor of freedom is the last milestone on the way of the development of crime law. Its most important characteristic is its being equal to all classes without being in favor of any of them. More clearly, this crime law is not a means of restrictions of human rights. On the contrary, it is a means of protecting them equally against the private and especially judicial ( state-oriented) attacks. In 1926, The Turkish Crime law was prepared and accepted as a product of a liberal- conservative ideology. But this law lost its this characteristic on account of the modifications that took place in 1936. As a result of it, it was transformed into an oppressive and preferential crime law. Moreover, in the following years, on the pretext of solving the problems caused by the frequent, extra-ordinary situations that the society underwent, its oppressive and preferential characteristics were increased by the new modifications and reforms. By the process of adaptation to the EU, it is inevitable to re-arrange the present turkish Crime Law in order to make it more liberal and respectful to freedom. Anyway, the draft crime law is under discussion. Non Governmental Organizations, Universities, Lawyears Associations, Producer Organizations etc. are taking part vividly to the discussions. Government itself shows a democratic position, in favor of a modern criminal law. Opposition is also in the same path. Time will show us what will change in this structure on account of the adaptation process to the EU. Literature ALACAKAPTAN, Uğur, Elements of Crime, Ankara, 1970. DÖNMEZER, Sulhi, Criminology, 8th edit., İstanbul, 1994. DÖNMEZER, Sulhi-ERMAN, Sahir, Theoretical and Practical Criminal Law, 10th edit., İstanbul, 1987. ERDURAK, Y. Güngör, Turkish Punishment Law by Doctrine, Ankara, 1984. 333 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour EREM, Faruk, Turkish Criminal Law (General Rules), 12nd edit., Ankara, 1984. ERMAN, Sahir-ÖZEK, Çetin, Turkish Criminal Law (Special Rules), İstanbul, 1992. ÖNDER, Ayhan, Punishment Law (General Rules, General Theory of Crime), İstanbul, 1989. ÖZGEN, Eralp, Crime and Crime Judgemental Law, Eskişehir, 1988. TOROSLU, Nevzat, Punishmental Law, Ankara, 1988. 334 FONDAZIONE CENSIS 11873_2002 5. Study D2: Poverty, Informal Sector, Health and Labour TRENDS AND CORRELATIONS This chapter of the research analyzes the relationship among health, poverty, crime, and other socioeconomic factors. We initially provided brief explanations, definitions, and appropriate data and data sources, then, gave the rates of interrelations among those factors mentioned above. As it is the case in the whole world, Turkish health organizations spent considerable efforts to prevent diseases that risk public health. Especially in last two decades these efforts reached to its maximum. The idea of improved health system in Turkey is not new. It actually started just after the foundation of modern Turkish Republic. For instance, in 1947 the first of “Ten year domestic health plan” had been published. This plan emphasized the importance of health services in small villages and provided solutions to this problem. In this plan, a health specialist and a midwife for each 10 villages, and one hospital for each 40 villages had been aimed. In 1954, another master plan has been prepared, but unfortunately, this plan did not become as successful as expected. After 1960’s, centrally planned Turkish economy came into effect. As a result of centrally planned services, enough consideration has been given to health services. The services have reached to densely populated areas as well as small villages. Also, the quality of health services aimed to be increased during these years. Last two decades were golden years of the Turkish health system, even though there still are some unsolved issues. Within these years, non-optional public and private insurance programs have been introduced. Social welfare programs have been introduced, and free health system called “green card” application provided for those who have below average income level. Table 1 below shows some indicators of Turkish economy in the last two decades regarding education, crime, income level, unemployment rate, and health services. 335 FONDAZIONE CENSIS Table 1: Health, Education, Crime, and Economic Indicators of Turkey Years 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 Number of beds in hospitals 99117 97765 96138 99396 100496 103918 107152 111135 113010 116061 120738 123706 126611 131874 134665 136072 139919 144984 148987 139388 131748 Number of students per School (high schood) 480 458 462 443 445 478 489 500 486 478 462 450 474 490 498 541 547 504 445 505 578 Number of Per capita income persons convicted ($) 31518 36920 36520 32955 27929 29443 34931 39657 45821 41028 44826 53912 54400 53618 60742 63103 61120 62946 69077 83466 98969 1539 1570 1375 1264 1204 1330 1462 1636 1684 1959 2682 2621 2708 3004 2184 2759 2928 3079 3255 2879 2965 Number of unemployed persons 1255 1290 1200 1275 1388 1490 1530 1637 1709 1611 1663 1729 1725 1774 1607 1416 1463 1527 1773 1720 1840 Source: State Institue of Statistics, Annual Report for Turkish Statistics, 2000-2001 and, www.tcmb.gov.tr 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour Providing all the data for last two decades from a single source was not possible. Most of data are not quite organized, and for more recent years. For that reason, we collected the date from different source, and showed extra efforts to eliminate inconsistencies. Improvements in the health sector are represented by the number of beds in hospitals and the improvements in education are represented by the number of schools and the number of students per school. The main logic behind this is because only 5% of all students can have chance to go to higher education institutions. Correlation Coefficients The primary aim in this chapter is to find interrelations among crime, income and other socio-economic factors. The easiest way to know these relations is to find the correlation coefficients of mentioned variables. A correlation coefficient measures the value of interrelations between two variables. If this coefficient receives a value between 0 and 1, we call it a positive correlation, and if it receives a value between –1 and 0, we call it a negative correlation. Actually, correlation coefficient receiving exactly the value of zero implies that there is no relationship whatsoever between two variables. In other words, a correlation coefficient is always between the value of –1 and 1, and it gives only the magnitude of the relations, not reasons of the relations. The following table has been prepared with this logic. Table 2 - The correlation coefficients for people convicted and some economic indicators Number of persons imprisoned No of persons imprisoned Kişi Başına Düşen Gelir İşsizlik Eğitim 1 .823** .628** .653** Per capita income .823** 1 .650** .436* Unemployment .628** .650** 1 0.258 Education .653** .436* 0.258 1 ** % 1 337 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour There is a positive correlation between per capita income and the number of people imprisoned. In other words, $1 increase in per capita income results a 0.82 increase in the number of people imprisoned. This result is of course, contradicts with expectations, since people expect that if per capita income increases, the imprisonment level should decrease. However, number tells a different story for Turkey. The reason for that is because, even though total income level increases, the distribution of income has some problems. If the distribution of income works against most of the population, and the structure of economy makes the rich even richer while making the poor ever poorer, the number of people imprisoned expected to increase. Per capita income increased from $1500 to $2900 in last twenty years. Increase in per capita income is 93.3%, while increase in the number of people imprisoned is 200% in last twenty years. Table 3 and 4 below show inadequate income distribution for 1987 and 1994. Table 3: Income distribution Results for 1987 and 1994 Income groups 1987 1994 1.%20 2.%20 3.%20 4.%20 5.%20 Gini Katsayısı 5,2 9,6 14 21,2 50 0,43 4,9 8,6 12,6 19 54,9 0,49 Source: SIS, Household income and consumption expenses Survey results, 1987, p:63 and 1997, p:79 As can be seen from Table 3, the comparison of both 20% shares and Gini coefficients for 1980 and 1990 show that inequity in income distribution increases over time. As Gini coefficient gets close to one, the inequity in income distribution increases. If we look at the fifth 20% of the population, they receive 50% of all income in 1987, and almost 55% of all income in 1994. This means that the remaining 80% of the population receives the rest of the income, and thus, they are poor. According to our point of view, the main reason of positive correlation between income level and the rate of crime is because of inequity in income distribution. Fortunately, event 338 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour though it is not enough, decreases in Gini coefficient in some extent has been experience in last year. Table 4: Share of the Biggest 500 Industry workers from Value Added (%) Years 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 Wage 42 49 37 34 25 23 23 29 32 39 29 27 20 16 16 18 Sources: ISO.500 Biggest Industry Survey, August, 1998, İstanbul, pp: 42. If Table 4 is used to calculate correlation coefficient for income and crime rates, above mentioned inconsistencies can be eliminated. The correlation results have been shown in Table 5. Table 5 - Correlation between Income distribution and the number of people imprisoned Number of people imprisoned Share of workers from total income Number of people imprisoned Share of workers from total income 1 -0.780** -0.780** 1 With use of this information above, we can also use regression method to estimate if the coefficient is reliable. The results obtained can be reported as follow: PI = 69014 – 575.75 * PVA (1) Where PI stands for persons imprisoned, and PVA stands for share of workers from income 339 FONDAZIONE CENSIS 11873_2002 Study D2: Poverty, Informal Sector, Health and Labour T Statistics: (13.72) (-2.92) P value: (000) R2: 0.68, F: 8.57, (0.04) P value: (000) In words, above statistical terms indicate that if the share of workers from income increases by 1%, persons imprisoned decreases by 57%. This rate looks a little high, but it could be the case in economic terms. A positive correlation between the number of unemployed and the number of people imprisoned also strengthen empirical results above. A regression analysis between these two variables are shown below: PI = 4450 + 30.88 * U, where U stands for unemployed people (-2) (2) T Statistics: P Value: (2.52) (-2,18) (0,03) (0.06) R2: 0.40, F: 4,78, P value: (0.06) In equation (2), a high level of autocorrelation between these two variables has been detected. Thus, we took the first differences. Also, we used Schwarz information criterion to know the lag value of unemployment. Our test showed that the effect of unemployment on people imprisoned is can be seen with lag of two periods. Equation (2) also can be interpreted as equation (1). 340 FONDAZIONE CENSIS 11873_2002 6. Study D2: Poverty, Informal Sector, Health and Labour BIBLIOGRAPHY Kaynak: Devlet İstatistik Enstitüsü, Türkiye İstatistik Yıllığı, 2000-2001 DİE, Hane Halkı Gelir ve Tüketim Harcamaları Anketi Gelir Dağılımı 1987 DİE, Hane Halkı Gelir ve Tüketim Harcamaları Anketi Gelir Dağılımı,1998 İSO.500 Büyük Sanayi Kuruluşu Anketi, Ağostos 1998, İstanbul, s.42. www.tcmb.gov.tr/veri dağıtım sistemi) Akyüz Ferhat, 1980 Sonrası Dönemde Türkiye’deki Gelir Dağılımı ve Dengesizliği ve Yoksulluğun Boyutlarını Etkileyen Faktörlerin İncelenmesi,Muğla Ün. Sos. Bil. Ens. Yayınlanmaış Yüksek Lisans Tezi, 2002 Bulutay Tuncer, Timur S., Ersel Hasan, Türkiye’de Gelir Dağılımı, SBF Yayını, Ankara 1971 Süleyman Özmucur, “Yeni Milli Gelir Serisi ve Gelirin Fonksiyonel Dağılımı:1968-1984” ODTÜ Gelişim Dergisi, Sayı 23, 1994 Tusiad, www.tusiad.org.tr 341 FONDAZIONE CENSIS