5. Poverty leads to ill-health
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Poverty is the predominant underlying cause of the huge burden of disease in poorer countries and the disproportionate burden amongst the poor elsewhere.
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Examples of how poverty and the absence of sustainable systems in every sector of socio-economic life ultimately (in a complementary way) undermine health are illustrated in the Table 1 below.
| Table 1: Examples of how poverty undermines health |
- Economic underdevelopment, including through reduced production and raw goods prices, and protective trade and market practices, damage health through a number of paths, including unemployment and low incomes. Countries cannot ensure basic services for their people and individuals are unable to purchase the necessities of health. Long work hours are among the many stresses that undermine the health of workers in poor countries.
- Shortfalls in agricultural production and lack of land reform have a direct effect on food security and hence on malnutrition. In spite of a world surplus of food, hundreds of millions of people go hungry each day. Malnutrition directly causes illness and vulnerability to infection.
- Lack of education, and in particular women’s education, limits the ability of the poor to identify and take appropriate action to improve their own health and indeed to secure their basic needs.
- The oppressed position of women in poverty leads to poorer health in many ways, including a weak position in ensuring safer sex practices.
- People living in informal settlements with poor infrastructure are exposed to the health problems of social instability and communicable disease, including respiratory infections, and to environmental hazards such as air pollution and fire.
- The more than one billion people who are without access to improved water supply and the 2.4 billion without access to improved sanitation are exposed to water-related diseases.
- Lack of general infrastructure, such as good roads and transport, not only impede access to health services, but add to fatalities and injuries from accidents.
- The “digital divide” not only entrenches poverty by holding back development, but also impedes the chances of care in an emergency.
- Governance and institutional weaknesses, although not uniform, influence health both indirectly and directly. Governments are faced with an array of pressures and health services are not necessarily afforded the priority required; nor is what is available necessarily equitably distributed or efficiently managed. The effectiveness of public and infrastructure services, the basis for development and for encouraging investment, may also be weak. This quality of governance impacts on economies and, through this, on health.
- Besides directly causing death and political instability, war and conflict have had catastrophic effects on health, disease control and disability. Not only are health services prone to collapse, resources are diverted away from health-promoting actions and poverty becomes more pervasive as the health impact extends beyond the war zone. Displaced people become victims of the health impacts of even more acute poverty.
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Poverty resulting in ill health is multidimensional and requires broad intersectoral interventions. The importance of these intersectoral factors on health is being recognised ever more acutely in international fora and by international organisations, and are now an important feature in poverty reduction strategies.
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