POVERTY, HEALTH & DEVELOPMENT

Poverty and Health: Academic Perspectives

It is one of the greatest of contemporary social injustices that people who live in the most disadvantaged circumstances have more illnesses, more disability and shorter lives than those who are more affluent.
-- Benzeval, Judge, & Whitehead, 1995, p.xxi, Tackling Inequalities in Health: An Agenda for Action.

Poverty and Health: Mechanisms

Poverty can affect health in a number of ways: income provides the prerequisites for health, such as shelter, food, warmth, and the ability to participate in society; living in poverty can cause stress and anxiety which can damage peoples health; low income limits peoples choices and militates against desirable changes in behaviour.
- Benzeval, Judge, & Whitehead, 1995, p.xxi, Tackling Inequalities in Health: An Agenda for Action.

Better Health Reduces Poverty, And Reduced Poverty Improves Health

Diminished Quality of life POVERTY Reduced Productivity Lowered learning ability Diminished household savings, debts ILLHEALTH

Increased personal and environmental risks

Increased malnutrition
Less access to knowledge, information Diminished ability to access care

Inverse Care Laws

Rich consume more hospital and public health care than the poor (Hart 1971) Immunization coverage strongly correlated with socioeconomic status (Gwatkin et al. 1999) poor with illness dont access care: 2x more likely to self treat; 10x more likely to do nothing (Uganda, HH Survey, 1994/5). poor that access health care risk medical impoverishment (Liu and Hsiao, 1997; WB, Voices of the Poor, 2000)
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Inverse Care in Public Health

2.80% 6.10%

Public Health Service Use, Ghana

bottom quintile top quintile 10.00% 2.50% 3.30% 2.50% 8.40% 5.00% bottom quintile top quintile 0.00% Clinics Hospitals

Poor kids more likely to die before age five

Global Perspectives
The world bank sees health primarily as an essential asset for economic growth Asian development bank sees health as key to human capital African development bank sees health in terms of human capital The European commission sees work on strengthening health as increasing human capital DFID (UK-Aid) sees health as a mediator of economic growth The Bill and Melinda gates foundation focuses its global health program on targeting the diseases that impose the greatest burdens on poorest countries and those conditions that are associated with poverty

Commitments By Government Of Pakistan

Investing in people
No country can expect to progress in a global world economy without an educated and healthy workforce

Health
Improvement in health outcomes are an important determinants of economic growth Focused on increasing public sector health expenditure with keen spotlight on preventive and control programs

Nutrition
8 million children &1/3rd pregnant women malnourished in Pakistan National nutrition program being strengthened

Population planning
Current TFR still highest in Asia 10 year population perspective plan for population developed Renewed emphasis on utilizing the outlets of both health and population welfare ministries for distribution of contraceptives

Issues Related To Poverty Reduction Strategy By Addressing Health

Are The Health Programs Addressing The Poor
Only 1/3rd sick utilize government health services 2/3rd seek private health facilities Both end up paying from their own pockets Data does not significantly identify poor and vulnerable Safety nets yet to be materialized Need to focus on quality and on pro poor

How To Monitor Health Related Targets

Need to have output or intermediate targets as measuring of outcome target may not demonstrate a significant change

FURTHUR READING
POVERTY AND ILL-HEALTH:CHALLENGES, INITIATIVES AND ISSUES IN PAKISTAN Inayat Thaver, Zulfiqar A. Bhutta (http://www.sasnet.lu.se/EASASpapers/PHDZulfiqarBhutta.pdf) DYING FOR CHANGE: Poor peoples experience of health and ill-health. Ann Kern , Jo Ritzen (http://siteresources.worldbank.org/INTPAH/Resources/Publications/Dying-forChange/dyifull2.pdf)

BREAK

The Concept of Development

Meaning of Development-Todaro
Development is not purely an economic phenomenon but rather a multi-dimensional process involving reorganization and reorientation of entire economic AND social system Development is process of improving the quality of all human lives with three equally important aspects. These are:

Todaros Three Objectives of Development

1. Raising peoples living levels, i.e. incomes and consumption, levels of food, medical services, education through relevant growth processes 2. Creating conditions conducive to the growth of peoples self-esteem through the establishment of social, political and economic systems and institutions which promote human dignity and respect 3. Increasing peoples freedom to choose by enlarging the range of their choice variables, e.g. varieties of goods and services

Alternative Interpretations of Development (Mabogunje)

Development as Economic Growth- too often commodity output as opposed to people is emphasized-measures of growth in GNP. Note here the persistence of a dual economy where the export sector contains small number of workers but draws technology as opposed to traditional sector where most people work and is dominated by inefficient technology

Interrelationship
There is a very strong interrelationship between all types of development and between health and development. One of the most significant influences on development is health. Health increases human potentialities of all kinds Good health means improved quality of life and the opportunity to achieve development potential. Ill health may impact on physical, social, emotional and intellectual development Everyone can benefit from better health in the present, and improved health for the young will lead to healthier population in the future

Interrelationship
Our Planet, Our Health. A report by WHO in 1992

Interaction between human activities and physical and biological environment

Credit: C. Corvalan (http://bit.ly/IQGhgE)

Health is a pre-condition as well as an outcome of all three dimensions of sustainable development (environmental, social and economic). Human beings are central to sustainable development and health is across cutting issue to the seven critical themes

Interrelationship
Health and development have reciprocal and synergistic elements attached to their relation Good health is essential for development and the other way round development is essential for good health Development policies can have direct/indirect and intended/ unintended effects on health

5 areas of consideration regarding impact of development policies on health. Weil et al 1990 Macroeconomic Policies Adjustment policies Public expenditure Trade policies Household response Agricultural Policies Irrigation system Pesticide use Land policy Research Nutrition Industrial Policies Industrial development Occupational health control of water/air pollution Waste management Energy Policies Indoor pollution Domestic fuel Fuel Pricing Fuel gathering Industrial pollution Housing Policies
Housing conditions Low income housing Slums clearance Site and services program Public provision of houses

Harvey Lebenstein (1957)

Relative to the poorly nourished workers, those who consume more calories are more productive and at very low levels of intake, better nutrition is associated with increasingly higher productivity Employers have incentive to raise wages above minimum supply price of labor and to exclude those in the poorest health

Health and development

Environmental Development

HEALTH

Political development

Economic Development

Cultural Development

Social Development

DEVELOPMENT FOR HEALTH OR VISE VERSA

HEALTH
Political Development Human Rights Democratic Development Good Governance

Economic Development Appropriate economic policies Efficient resource allocation More equitable access to resources Increasing the productive capacity of the poor

Social Development Improved income distribution Gender equity Investing in basic health & education Emphasizing participation of the beneficiaries

Cultural Diversity Sensitivity to cultural factors Recognition of values conducive to development

What are the desired outcomes of sustainable development?

Clean water & air Fertile soil & good food A livelihood & a healthy economy An optimum population size
Halting global warming

Safety from poverty & disease Social contact & a sense of community Work, rest & celebration Opportunities to learn

FURTHUR READING
Our Planet, Our Health, Our Future http://www.who.int/globalchange/publications/reports/health_rioconventions.pdf
The Impact Of development Policies on Health http://whqlibdoc.who.int/publications/1990/9241561416.pdf Health and Development. David Phillips http://books.google.com.pk/books?hl=en&lr=&id=k2gGZbtygp8C&oi=fnd&pg=PR8&ots= YFirFfOpkr&sig=Wz7ffDLC71bitLGmdsaECxVOy7s#v=onepage&q&f=false Health and 18th amendment. Retaining national functions in devolution. Dr Sania Nishter. http://www.heartfile.org/pdf/HEALTH_18AM_FINAL.pdf