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5 - Peoples of the MekongHealth-adjusted life expectancy (HALE) is a new statistic introduced by the World Health Organisationin 2001 36 . It is based on data for life expectancy at birth, adjusted, however, to take into account theeffective time spent in poor health during a lifetime. In the LMB, substantially lower HALE ratesindicate that poor health seriously compromises the expectations for healthy, productive years for amajority of the population. The causes are diverse and may include injury or disability due to landminesor unexploded ordinance, particularly in Cambodia and Lao PDR; endemic and chronic diseases thatare common in the region; and the combined effects of strenuous physical labour, inadequate nutritionlevels and lack of access to health services.Figure 4. Health-adjusted life expectancy, 2000Sources: WB 2002a; WHO 2001Children’s health. Health conditions for children in the LMB, particularly in Cambodia and LaoPDR, have been among the poorest in the world. The mortality rate of infants (IMR g ) and underfivechildren (U5MR h ) are related to a number of factors,including low birth weights and diseases such as malaria,diarrhoea and dysentery. In the recent past, civil strife and theremoteness of large portions of the region meant that many peopledid not have adequate access to health services. As recently as1997 in Lao PDR, one-quarter of children born in poor householdsdied before reaching the age of five years. 37The efforts of governments and international and otherorganisations to implement effective programmes to reduce theIMR and U5MR are showing results. In the decade from 1990-2000, the IMR in Cambodia dropped from 122 per 1,000 birthsto 88. In Lao PDR, it declined from 108 to 92. Nonetheless,these rates remain significantly higher than the average IMR of34 deaths per 1,000 live births 38 for developing countries in Asiaand the Pacific. There are also large discrepancies between theIMR rate in urban and rural areas. For example, in the mid-1990s, the IMR in Vientiane Municipality was 72 deaths per1,000 live births, compared with the much higher rate of 138 innearby Xaysomboon Special Region. 39The presence of landmines andunexploded ordnance is acontinuing problem in Cambodia,Lao PDR and Viet NamghInfant mortality rate (IMR) is the number of infants who die before the age of one year per 1,000 live births.Under-five mortality rate (U5MR) is the number of children who die between the ages of one year andfive years, per 1,000 live births.51