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 Eldis 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.
Poverty and health
Meeting the health-related needs of the very poor
Eldis Dossier
Is the water and sanitation MDG achievable?
The seventh Millennium Development Goal (MDGs) commits the international community to halving, by 2015, the proportion of people without sustainable access to safe drinking water. The baseline set for most of the MDG targets, including that on water and sanitation, is 1990. As 2002 is the last year for which comprehensive data is available it can be considered the halfway mark towards achieving the 2015 MDG deadline. Based on 2002 data, is the world on course for achieving this goal? A report prepared by the World Health Organization/UNICEF Joint Monitoring Programme (JMP) presents a report on progress made towards fulfilling the MDG commitment. Encouragingly, with 83 percent coverage, the world is set to meet the drinking water MDG. This progress is tempered, however, by slow progress in sub-Saharan Africa.
Relating mortality rates to the poverty trap
National Bureau of Economic Research (NBER), 2005
The authors of this paper present the argument that development occurs only if people make provision for the future. If they see no future, there is no growth. Using development indicators as their data for their research, they examine a basic determinant affecting decision horizons: the risk of premature death. The paper suggests that the causal relationship between mortality and poverty is bi-directional:
- on the one hand, in a poor country, unable to afford sanitation and medical care, people die young;
- on the other hand, where people have a short time horizon because they expect to die young, they have less reason to save and the economy fails to grow.
Study attributes AIDS to food insecurity in Mozambique
Mozambique's Food and Nutritional Security Technical Secretariat (SETSAN) says the country could face severe food insecurity as a result of HIV/AIDS. In a report released on Monday in the capital Maputo, at a symposium on the relation between hunger and absolute poverty, SETSAN warned that the agricultural sector might lose 20 percent of its workforce to AIDS-related illnesses by 2010.
How much would poor people gain from faster progress towards the Millennium Development Goals for health?
This article, published in The Lancet, explores what further progress towards the health objectives set out in the United Nations Millennium Development Goals (MDGs) will mean for the poor. The author notes that, unlike the MDGs overall, these health objectives do not focus specifically on poor people. “Rather, they call for improvements in national averages that can be achieved through gains in both advantaged and disadvantaged groups. As a result, any reduction in society-wide average rates of death or illness can provide a wide range of outcomes for poor people.”
The politics of staying poor: exploring the political space for poverty reduction in Uganda
World Development, Volume 33, Issue 6
Despite claims that Uganda’s recent success in poverty reduction has been significantly related to “getting the politics right,” there are concerns that the poorest may not have benefited from this form of poverty reduction or the types of politics that have helped shape it. Employing the analytical framework of political space reveals that although some of the poorest groups are represented within the political system, political discourse reveals a strong bias toward the “economically active,” leaving the poorest excluded from poverty programs. Significantly, there is an increasing divergence between the regime’s political project of “modernization” and the international poverty agenda, with important implications for the poorest.
Understanding the linkages between HIV/AIDS and agriculture
The agricultural sector has been seriously affected by the HIV/AIDS crisis. In parts of eastern and southern Africa, HIV prevalence rates exceed 15 percent. The disease has contributed to a loss of assets, loss of land, and, in some cases, labour shortages. As a result, crop production has declined for many farm households and rural inequality appears to have increased. Agricultural policies need to take account of these changes. Agricultural growth built on policies sensitive to the impacts of HIV/AIDS is essential if poverty caused by the disease is to be reduced.
Land tenure, poverty and food security
Concerns over the food security situation in sub-Saharan Africa are reflected in the Millennium Development Goal (MDG) to reduce the number of food insecure by half by 2015. Given that land plays an important role in the livelihoods of the majority of Africans, food security and poverty reduction cannot be achieved unless issues of access to land, security of tenure and the capacity to use land productively and in a sustainable manner are addressed. Recognizing the importance of a better understanding of these linkages, the Economic Commission for Africa (ECA) undertook a study in 2002/2003 on the Impacts of Land Tenure on Food Security and Sustainable Development.
Social Determinants of Health: The Solid Facts
World Health Organisation
Even in the most affluent countries, people who are less well off have substantially shorter life expectancies and more illnesses than the rich. Not only are these differences in health an important social injustice, they have also drawn scientific attention to some of the most powerful determinants of health standards in modern societies. They have led in particular to a growing understanding of the remarkable sensitivity of health to the social environment and to what have become known as the social determinants of health. This publication outlines the most important parts of this new knowledge as it relates to areas of public policy.
The link between unhealthy people and unhealthy soils
Pedro A Sanchez, M S Swaminathan, Lancet 2005; 365: 442–44
"Malnutrition is the biggest risk factor for illness worldwide. Various dimensions of malnutrition (eg, underweight, zinc deficiency, iron deficiency, vitamin A deficiency) account for seven of the 13 leading risk factors associated with the global burden of diseases. For both children and adults, malnutrition reduces the body's natural defences against a vast range of diseases. The death rate from diseases such as lower respiratory infection, malaria, and measles, which account for a large proportion of children's deaths, are much higher in children who are underweight or have specific nutrient deficiencies than in those who are not. Undernourished people infected with HIV/AIDS develop the full symptoms of the disease more quickly than people who are well fed. Yet one of the earliest side-effects of AIDS is reduced consumption of food in affected households."