There is a growing concern within the international development community that policies aimed at reducing the number of people living below the poverty line could leave the most disadvantaged groups behind. In line with these concerns, this dossier looks at different strategies for reaching the very poor within the health sector, and at the institutional challenges associated with scaling up health-related interventions to cover broader segments of the population. It also highlights the fact that there are ways outside the health sector to improve health or reduce the impoverishing impact of disease, and that in some contexts these may benefit the poor most.
Poverty and health
Meeting the health-related needs of the very poor
Eldis
Developing a Nutrition and Health Education Program for Primary Schools in Zambia
Sherman J and Muehlhoff E: Journal of Nutrition Education and Behavior 39(6): 335-342, November 2007
School-based health and nutrition interventions in developing countries aim at improving children’s nutrition and learning ability. In addition to the food and health inputs, children need access to education that is relevant to their lives, of good quality, and effective in its approach. Based on evidence from the Zambia Nutrition Education in Basic Schools (NEBS) project, this article examines whether and to what extent school-based health and nutrition education can contribute directly to improving the health and nutrition behaviors of school children. Initial results suggest that gains in awareness, knowledge and behavior can be achieved among children and their families with an actively implemented classroom program backed by teacher training and parent involvement, even in the absence of school-based nutrition and health services.
Our cities, our health, our future: Acting on social determinants for health equity in urban settings
Kjellstrom T: Report to the WHO Commission on Social Determinants of Health from the Knowledge Network on Urban Settings
Urbanisation can and should be beneficial for health. In general, nations that have high life expectancies and low infant mortality rates are also those where city government leaders and policies address the key social determinants of health. Within developing countries, the best local governance can help produce 75 years or more of life expectancy; with bad urban governance, life expectancy can be as low as 35 years. Better housing and living conditions, access to safe water and good sanitation, efficient waste management systems, safer working environments and neighborhoods, food security, and access to services like education, health, welfare, public transportation and child care are examples of social determinants of health that can be addressed through good urban governance. Failure of governance in today’s cities has resulted in the growth of informal settlements and slums that constitute an unhealthy living and working environment for a billion people. National government institutions need to equip local governments with the mandate, powers, jurisdiction, responsibilities, resources and capacity to undertake “healthy urban governance”. A credible health agenda is one that benefits all people in cities, especially the urban poor who live in informal settlements.
Child Nutritional Status And Household Patterns In South Africa
Bomela N: African Journal of Food, Agriculture, Nutrition and Development 7(5): 1684-5374, 2007
The influence of person-related and household related characteristics on the nutritional status of children were assessed, taking into account variables such as, gender of household head, de jure and de facto household head, relationship of child to household head, size of household, type of toilet facility and type of dwelling. Chronic malnutrition and underweight were significantly pronounced in children from households with de jure household heads.
Food Insufficiency Is Associated with High-Risk Sexual Behavior among Women in Botswana and Swaziland
Weiser SD, Leiter K, Bangsberg DR, Butler LM, Percy-de KorteF, Hlanze Z, Phaladze N, Lacopino V, Heisler M: PLoS Medicine
This paper reports the association between food insufficiency (not having enough food to eat over the previous 12 months) and inconsistent condom use, sex exchange, and other measures of risky sex in a cross-sectional population-based study of 1,255 adults in Botswana and 796 adults in Swaziland using a stratified two-stage probability design. Associations were examined using multivariable logistic regression analyses, clustered by country and stratified by gender. Food insufficiency was reported by 32% of women and 22% of men over the previous 12 months. Among 1,050 women in both countries, after controlling for respondent characteristics including income and education, HIV knowledge, and alcohol use, food insufficiency was signficcantly associated with inconsistent condom use with a nonprimary partner, sex exchange, intergenerational sexual relationships and lack of control in sexual relationships. Associations between food insufficiency and risky sex were much attenuated among men.
Improving Child Survival Through Environmental and Nutritional Interventions
Gakidou E, Oza SB, Fuertes CV, Li AY, Lee DK, Sousa A, Hogan MC, van der Hoorn S, Ezzati M: Journal of the American Medical Association 298(16), 24/31 October 2007
This paper estimates the reduction in child mortality as a result of interventions related to the environmental and nutritional MDGs (improving child nutrition and providing clean water, sanitation, and fuels) and to estimate how the magnitude and distribution of the effects of interventions vary based on the economic status of intervention recipients.
Transport, (im)mobility and spatial poverty traps: issues for rural women and girl children in sub-Saharan Africa
Porter G: Overseas Development Institute, London, 2007
This paper produced for a conference at the Overseas Development Institute (ODI) reflects on the experiences of women and girls with poor accessibility to services and markets, and inadequate transport in rural sub-Saharan Africa. It uses examples from field research to look at the impact of these factors on girl’s education before going to examine access to health services.
Africa: Food production to halve by 2020
Intergovernmental Panel on Climate Change (IPCC), September 2007
Food security in Africa is likely to be "severely compromised" by climate change, with production expected to halve by 2020, according to climate change experts. The projections in a report by the Intergovernmental Panel on Climate Change (IPCC), said about 25 percent of Africa's population - nearly 200 million people - do not have easy access to water; that figure is expected to jump by another 50 million by 2020 and more than double by the 2050s, according to the report. This year drought-affected parts of southern Africa - Zimbabwe, Swaziland and Lesotho - experienced a 40 percent to 60 percent reduction in maize production, for which global warming was partly to blame, noted the World Meteorological Organisation (WMO). But the IPCC report was more cautious. "The contribution of climate to food insecurity in Africa is still not fully understood, particularly the role of other multiple stresses that enhance impacts of droughts and floods and possible future climate change".
Parched city braces for disease outbreak
Integrated Regional Information Network (IRIN), 19 September 2007
Desperate measures being taken by residents of Bulawayo, Zimbabwe's second city, to cushion the effects of acute water shortages are aggravating the health problems of its 1.5 million residents. Stringent water rationing has been introduced in a bid to make the contents of fast dwindling dams last until the onset of the expected rains in November, but the municipal council acknowledges that the poor inflows of water into the southern city's reservoirs has led to an increase in waterborne diseases.
Poverty, mental health and municipal services in South Africa
Swartz L, Breen A, Fisher A, Joska J, Corrigall J, Plaatjies L and McDonald DA: Municipal Services Project, Occasional Paper 12
There have been dramatic changes to municipal services such as water and electricity since the end of apartheid in South Africa, with considerable research having gone into the impacts of commercialisation and cost recovery on low-income households. The research has revealed complex and often negative relationships between the marketisation of services and access and affordability for the poor. It has also been shown to have direct and very negative public health implications, most acutely in low-income township and rural areas.Less obvious, and much less researched, have been the impacts of changes in service delivery on the mental health of low-income residents and household members. What, then, might be the links between poverty, mental health and the shift towards market-oriented reforms in basic services? This paper explores the relationship in the South African context with a detailed, ethnographic case study of ten low-income families in Cape Town coping with a serious mental disorder (schizophrenia).