When will we become worldly enough to stop calling them "developing countries"? Many of them aren't developing -- they are dying -- and the rich countries of the world are doing less to help them than they were five years ago.

Total foreign assistance to the 2 billion people who live in impoverished countries was $6 billion last year, down from $10 billion in the mid-1990s. That $6 billion comes out to three bucks per person per year. To put that $6 billion in perspective: In May, the House voted for to appropriate $13.1 billion to continue the bombing of Kosovo for up to five more months.

Within the impoverished world, there is a special hell inhabited by 712 million people who live in 42 nations that are are known as "highly indebted poor countries." The combination of extreme poverty and extreme indebtedness has plunged these countries into a desperate downward spiral. Thirty-four of these countries, and 548 million of these people, are in sub-Saharan Africa.

The Center for International Development at Harvard University recently offered this snapshot of conditions in Zambia, which is typical of many of these countries: Twenty percent of the population is HIV-positive. An estimated 9 percent of children younger than 15 have lost a mother or both parents to AIDS. Half of the population is without access to safe drinking water. Thirty percent of the children haven't been vaccinated against anything. Infant mortality is 112 per 1,000 births (compared with 5 per 1,000 in the United States). Life expectancy dropped from 49.1 years in 1990 to 43.1 in 1997. Zambia spends $17 per person per year on health care; the richest nations spend an average of $2,300 per person. Zambia spends 10 percent of its budget on basic social services and a crushing 30 percent on international debt service.

These are staggering and shocking disparities. Do we really think the world's richest nations can continue basking in prosperity while these countries hover on the brink of collapse? In June, the world's seven wealthiest nations agreed to a plan in which more than half the debt owed by about 30 of the poorest countries would be written off if they agreed to spend the savings on education and health programs, especially AIDS prevention. President Clinton hailed the Cologne Initiative as a "historic step." It made the front pages for one day.

Jeffrey Sachs, director of the Harvard center and, perhaps, the world's leading expert on debt relief, says the initiative isn't enough. Sachs, who has advised many poor nations, agrees with public health specialists who have said for some time: When governments fail to meet the basic health and education needs of their people, they destroy the base for future economic growth. They destroy any chance they have to put their people on the road to what Sachs calls "human betterment."

Governments have no chance of meeting those needs when they are spending a third of their budgets on international debt service. Sachs proposes that prosperous countries forgive almost all of the debt, take the International Monetary Fund and the World Bank out of the driver's seat and give the United Nations relief agencies the resources and the clout to put these countries on the path to recovery.

These governments are bankrupt, and they are confronting "incredible social needs," he told me. "That combination means the debt relief has to be vastly more substantial and linked . . . to the government's capacity to meet its responsibilities. . . . Debt relief has to be essentially complete for many if not nearly all of these countries. We need a completely different process for how it should be structured. We give utterly too much focus to what I would call the IMF agenda . . . and far too little regard for the profound public health agenda which really lies at the absolute core of the crisis."

Lifesaving measles vaccines and vitamin supplements aren't going to people who need them because the money isn't there and the delivery system has fallen apart, he said. "A third or more of the children are malnourished or stunted. We are talking about truly urgent situations where there are known public health interventions that simply aren't in operation now. I get letters from people in rural clinics in all of these countries where anti-malarials aren't available, or clean syringes.

"Debt would not be forgiven immediately," he said. "In every one of these countries, there needs to be a strategy. They can stop paying right now, but if they want debt really forgiven, let's get a plan of social action with quantified targets, with approaches suggested by the governments with active support" of the U.N. agencies and nongovernmental organizations.

These countries will continue to receive foreign assistance, which provides leverage to ensure that both the aid and the funds released through debt relief go to public health and education and to meeting the needs of the poorest. The U.N. agencies involved under his plan would need more money, and he knows that's not going to be an easy sell. "In the U.S., we have a mind-boggling antipathy to the U.N. right now, which doesn't serve American interests at all. . . . Most of the agencies have new directors, most are undertaking very serious reforms, and we should be playing an extremely important leadership role in helping them do it."

The deterioration of many of these countries has gotten the attention of policymakers across the political spectrum who understand that a radical approach is needed. Rep. Jim Leach (R-Iowa), chairman of the House Banking Committee, and no bleeding-heart liberal, is sponsoring a bill that would cancel more than 90 percent of the loans owed to the United States. This is the kind of leadership the United States should be taking to help avert a massive human catastrophe.