UNFPAState of World Population 2002
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HOME: STATE OF WORLD POPULATION 2002: Health and Poverty
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Health and Poverty

Reproductive Health and Poverty
Measuring Health Differentials between Rich and Poor
Supporting More Equitable Health Care


"The biggest enemy of health in the developing world is poverty."

-UN Secretary-General Kofi Annan, address to the 2001 World Health Assembly

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 linked (4).

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 of poverty.

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.

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Source: World Bank

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