Health and Poverty
"The biggest enemy of health in the developing world is poverty."
-UN Secretary-General Kofi Annan, address to the 2001 World
Poor people are more often sick
than the better off. Their general levels of health
and well-being are lower. They are more exposed to communicable
disease (1) and have
less resistance to it. They are more likely to live
and work in hazardous environments. They have less food
and less access to clean water (2).
Their housing offers less protection from the weather
and is more likely to be overcrowded.
They have less access to health care, and the services they do
have are low in quality and do not respond to their needs. They get
less respect and time from doctors and nurses. They are less likely
to recover completely from illness, and die earlier. In addition,
they are likely to fall even deeper into poverty as a result of working
time lost to ill health and the cost of health care.
Poor people in a 41-country survey
cited illness most frequently as the cause of destitution
and the reason for a slide into poverty (3).
The threat of loss of work time and income is a constant
fear. Many of the near-poor are just a serious illness
away from poverty, and the poor that close to destitution.
Poor people see ill health, disease and poverty as fundamentally
Poorer and less-educated people
are more likely to have physically demanding jobs, yet
they are less physically fit, (5)
and malnutrition undermines their strength.
Reproductive health is a vital component
of overall health (6).
More than one fifth of the burden of disease among women
of reproductive age is connected with sex and reproduction.
In sub-Saharan Africa, the figure is 40 per cent (7).
AIDS is a disease of poverty, and
has thrown many families into poverty. In the 1990s,
AIDS reduced Africa's per capita annual growth by an
estimated 0.8 per cent. Statistical models show a grim
future. Two decades from now in the worst-affected countries,
economies may be 20 to 40 per cent smaller than they
would have been without AIDS (8)
Globally, there is a stark relationship
between poverty and poor health: in the least-developed
countries, life expectancy is just 49 years, and one in ten
children do not reach their first birthday. In high-income countries,
by contrast, the average life span is 77 years, and the
infant mortality rate is six per 1,000 live births.See Sources
BEYOND INCOME: HEALTH AND WELL-BEING
The linkage between health and poverty is fundamental.
"Poor people define poverty in the conventional way-lack
of income-but also as instability, worry, shame, sickness,
humiliation and powerlessness." (9)
The poor recognize multiple dimensions
of health: "Good health is identified as a central component
of a good quality of life. In their descriptions of
well-being, three different types can be identified:
material well-being, often expressed as having 'enough';
bodily well-being, to be strong, healthy and good-looking;
and social well-being, which includes having children
and caring for them, self-respect, security and confidence
in the future, freedom of choice and action, and being
able to help others." (10)
Early childbearing in marriage helps define social well-being,
and is a nearly universal expectation among poor people
in developing countries (over 90 per cent of first births
occur within a year of marriage). It is only later in
life, and not yet in all societies, that spacing and
limiting the number of children overall is recognized
and welcomed as part of social well-being. It will be
some time before this changes. Poor young people, married
or not, have less access to family planning than their
older siblings or the better off. Delaying marriage
and the first birth comes with better education and
social acceptance of wider choices for young women.
The poor often take their partners early in life. Poor young
women are more likely than the better off to be enticed or forced
into their first sexual experience. They (and their families and
communities) are more likely to see having children as a source of
esteem. To poor people, whose needs are immediate, high barriers
to education may make its possible future rewards appear remote.
In communities where family planning has not been fully
accepted, people see births and family size as unchangeable conditions,
within which they make other choices. It is only when
people recognize that they can control the number and spacing of
their children that they begin to see larger families as a drain on
well-being and report larger numbers of children as a cause
Figure 3: Determinants of health-sector outcomes
Biological, cultural, environmental, social and institutional conditions influence health risk and susceptibility among different populations. Describing the
differences in health outcomes among wealthier and poorer subgroups helps to indicate where special efforts are needed.
Click here to enlarge image
Source: World Bank