Health outcomes are not always closely correlated with
income levels. Life expectancy at birth in Viet Nam
(67.8 years), for example, is higher than in Pakistan
(59.6 years) although they have similar levels of GDP
per capita (5). In
many low-income countries, rapid population growth has
contributed to overcrowding, unsafe drinking water and
poor sanitation, ideal conditions for breeding and communicating
infectious diseases. Poor communities typically lack
primary health facilities, essential medicines and vaccinations.
The combination of poor general
health and high prevalence of disease can extend even
to the highest income groups.
Poor health is a cause as well
as an effect of income poverty. It diminishes personal
capacity, lowers productivity and reduces earnings.
The effect of ill health on productivity and earnings
is likely to be greater on the poor. This is because,
among other things, low-paid, less-educated workers
are more likely to do physically demanding and often
unsafe work in which they can easily be replaced (6).
High prevalence of disease in a
country goes hand in hand with poor economic performance.
In countries where a high proportion of the population
is at risk of severe malaria, average income is less
than one fifth that of non-malarial countries (7).
On the other hand, higher life expectancy,
a key indicator of health status, stimulates economic
growth: an analysis of data for 53 countries between
1965 and 1990 found that higher adult survival rates
were responsible for about 8 per cent of total growth.
Research showed how this works: a healthier workforce
and less absenteeism improves productivity; as life
expectancy increases, individuals and firms have an
incentive to invest in human and physical capital; and
as workers have an incentive to save for retirement,
savings rates increase (8).
ILLITERACY AND INADEQUATE SCHOOLING Illiteracy holds
people back even in the most basic day-to-day activities. Inadequate
schooling prevents them taking advantage of new opportunities,
for example, jobs in the emerging knowledge-based industries.
Less-educated people often find it difficult to express themselves
outside their own immediate group either in speech or writing,
so they are held back from moving into the wider society.
Like other dimensions of poverty, education and health outcomes
interact. It is more difficult for illiterate or less-educated
people to obtain information about health care, for example, in
a form they can use. Poor health and lower survival rates reduce
the incentive to invest in children's education.
SOCIAL EXCLUSION AND POWERLESSNESS Poverty in another
form can be seen in social systems that deny some groups of people
the freedom to interact as equal partners in society or assert their
personal interests in the wider community. In many countries,
not all of them authoritarian, this sort of exclusion prevents large
numbers of people from participating in the development process.
The bias may come from caste, ethnicity or religion, or it may serve
the interests of corrupt elites.
GENDER-BASED POVERTY In many societies, material poverty
interacts with gender-based discrimination, so that poor women's
levels of health, education and social participation are even lower
than their male counterparts'. (Chapter 5 has more detail on gender