A Response to
Poverty and Health
Introduction
Poverty
and health are closely related issues. It could be said that due
to poverty, there is a negative impact on health as well as access
to effective health services. Sickness and disability trim down
the efficiency of individuals, families and communities. This, in
turn, makes it possible for many to fall into poverty. People’s
health is severely affected by poverty. Many of the factors
associated with poverty, such as malnutrition, make people
vulnerable to illness. The majority of the world’s poor live in
countries where good health care is a privilege of the rich, while
poor people lack access to appropriate treatment and care. As a
result, in poorer countries, life expectancy is significantly
lower overall than in richer countries, infant and child mortality
are higher, and women’s chances of dying in childbirth are
greater.
According to
Stanwell-Smith (2003), while there has been a dramatic improvement
in general health and longevity in the United Kingdom over the
last century, some groups in the society still live in poverty,
with some indications that the gap between rich and poor is
increasing. There are many issues that are linked with poverty
and health. The discussion of poverty and health is however,
without use if there are no policies and enactments that would
enable the prevention of the growing number of those living in
poverty due to unfortunate health. The main concentration of this
concise exposition is the effect of social policies in the
bridging the gap of poverty, as well as specific examples of
policies as response to poverty and health. In order to have a
clear understanding of the effect of social policy in response to
the improvement of health and the lessening of poverty, it is also
a vital step to give a brief overview of the general terms of
poverty and health. Solid evidence demonstrates a correlation
between poverty and ill health. This paper identifies public
policy strategies designed to alleviate the health impacts of
poverty, either by reducing poverty or mitigating its effect on
health. It also reviews strategies shown to be effective.
Poverty,
Deprivation and Social Exclusion
Poverty
is a commonly used and understood concept. However, its
definition is highly challenged. The term ‘poverty’ can be
considered to have a cluster of different overlapping meanings
depending on what subject area or discourse is being examined
(Gordon and Spicker, 1998). For example, poverty, like evolution
or health, is both a scientific and a moral concept. Many of the
problems of measuring poverty arise because the moral and
scientific concepts are often confused. In scientific terms, a
person or household in Britain is ‘poor’ when they have both a low
standard of living and a low income. They are not poor if they
have a low income and a reasonable standard of living or if they
have a low standard of living but a high income. Both low income
and low standard of living can only be accurately measured
relative to the norms of the person’s or household’s society.
Social
exclusion on the other hand, is a discourse, which emerged in
France during the 1970s and has since spread across the rest of
Europe. The Commission of the European Community (now Union)
(Bradshaw et. al., 1998) started to use the concept in the 1980s
and it is now widely applied by both social scientists and
politicians. How to interpret the concept is nevertheless unclear
and the definition of the concept varies among countries,
different school of thoughts and different experts and
researchers. The key text in the genesis of social exclusion does
not actually use the term but seeks to redefine poverty as an
objective condition of relative deprivation where individuals,
families or groups lack the resources for participation in the
customary activities of the society to which they belong. In this
preliminary formulation, poverty is a lack of resources (income,
wealth, housing) and social exclusion a common consequence of
poverty. What constitutes social exclusion is therefore dependent
upon judgments both within and about society in assessing the
accepted necessarily way of life and adequate participation
(Bradshaw et. al., 1998). Notably, the question of participation
goes beyond the levels of consumption afforded to those with
restricted resources. Although social exclusion is sometimes used
only as a substitute for poverty, many researchers have tried to
establish a distinction between poverty and social exclusion.
Sometimes it is disputed that poverty is a tapered concept dealing
with problems that are directly related to financially viable
resources, while social exclusion deals with a broad range of
questions dealing with the individual’s integration in the
society.
Policy Responses
to Poverty
There
are increasing studies that provide important information about
the distribution of disease in society. Such information,
however, are unable to conclude whether the association between
community socioeconomic context and aggregate or individual
measures of health either, one, simply reflects the relationship
between individual socioeconomic position and individual health of
residents, or two, reflects the fact that community socioeconomic
context affects characteristics of the community environment that
can affect the health of all residents.
Impact of
Poverty on Health
In the
European Region, addressing inequities in health has been central
to the work of WHO and features prominently in the targets for
health for all set by Member States. Despite these efforts,
however, there is today acute recognition that poverty itself is a
true evil in all 51 countries in the Region. Such people also
suffer from inadequate housing, insufficient means to guarantee a
nutritious diet and the lack of rewarding and remunerative
employment. As a result, they suffer poor health, have less access
to appropriate health and other related services, and are
marginalized and often even excluded from society. Those living
in the countries of central and Eastern Europe and the newly
independent states, whose economies are in transition, are at
special risk as a result of their poverty, and many cannot now use
the health care system because of an inability to pay. The
under-the-counter payment systems run by health professionals are
also acting as a deterrent to those in need. Key groups at risk
are women, children, and the elderly and those suffering from
mental illness.
Poverty has been
acknowledged as a cause, an allied factor, a mechanism and a
result of ill health. Many people living in poverty are unable to
meet their basic needs of adequate food, water, clothing, shelter
and health care. Several studies have shown that, as a country
becomes better-off, the health of the population increases.
Poverty is a disease that saps people’s energy, dehumanizes them
and creates a sense of helplessness. Illiteracy, ill health,
malnourishment, environmental risks and lack of choices contribute
to the perpetual cycle of poverty and ill health. The unhealthy
environment frequently associated with poverty-stricken
communities is a cause of much ill health, including diarrhea and
upper respiratory infections. These conditions sustain the
poverty and ill health cycle along with a lack of knowledge and
information about disease process and prevention.
Policy
Responses to Poverty
The
United Kingdom is adopting the target of improved health for all
segments of society. Its goal for a comprehensive agenda of
programs is designed to reduce socio-economic inequalities.
Although it will take years to judge how well good intentions
translate into action, the program is impressive. Attempting to
overcome health effects associated with inequality, the current
government has initiated programs to reduce inequality and improve
health. At the beginning of the twenty-first century, your
chances of a healthy life still depend on what job you do, where
you live, and how much your parents earn. It is unfair and
unjust. To achieve its goal, the government has set out a
comprehensive program, including action to eradicate child poverty
by increasing parental incomes, a Surestart program for
preschoolers, improving housing and neighborhoods, raising
employment, increasing the minimum wage, targeting social
exclusion and strengthening programs to reduce smoking and drug
and alcohol abuse. It has instituted targets, such as halving
child poverty by the year 2010; established eight regional Public
Health Observatories that act as information clearinghouses and is
strengthening its evidence base in order to be able know which
interventions work (UK Department of Health, 2001).
The
United Kingdom has already identified poverty as a key government
priority and has set targets to work towards its resolution.
Evidence from the literature indicates that nurses and midwives in
some countries have recognized the important role that poverty
plays in the health of individuals and are making efforts to help
fight its alleviation. The vast majority, however, are unaware of
the link between poverty and health and unlikely to have the
appropriate competences and skills to make an effective
contribution. Yet the professions constitute the largest group of
health sector workers in most countries. They also comprise the
group most likely to be in contact with large sections of the
population who experience poverty and whose circumstances may be
unknown to any other health worker or related agency. In this
regard, they may be a useful source of intelligence especially on
hidden poverty.
Conclusion
The
policies and programs reviewed primarily address people living in
poverty. However, policies and programs that help poor people are
not necessarily closed to others; some are universal or near
universal and aid a broad range of people within a certain
demographic or geographic category. Other interventions are
targeted at poor people. The degree of access to a program
depends on the definition of poverty used to judge eligibility.
If eligibility is based on an absolute concept of poverty,
citizens must meet specific criteria in order to qualify. If a
relative concept based on the notion of inequality is used, then
individuals representing a wider income range will be eligible.
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