Poor Health

Rather than climatic conditions or complex epidemiology, specialists note that the major causes of ill health for people in developing countries relate to poverty and underlying political and social conditions. This direct causal link between poverty and ill health has long been recognised by many civil society organisations that highlight poverty as the "biggest epidemic" facing the global health community, thereby emphasising the importance of economic policy as a health issue. The WHO's Commission on Social Determinants of Health has also recently acknowledged that the high burden of illness responsible for premature loss of life arises in large part because of the poor and unequal conditions in which people live and work.

According to the most recent World Bank development indicators, 1.4 billion people were living on less than US$1.25 a day in 2005. A further 2.5 billion people were living on less than US$2 dollars a day, meaning that at least 45 percent of the world's population exist in a state of absolute or relative poverty, including half of the world's children. In contrast, the world's 497 billionaires (approximately 0.000008% of the world's population) have an estimated wealth of US$3.5 trillion (over 7 percent of world GDP).

While people in the West can expect to live until their late 70s, people living in poor countries, such as Burkina Faso or Chad, are unlikely to live beyond 46 or 47 years of age. In Africa, half the population lives on less than US$1.25 a day with little or no access to safe water. According to the UN, 12 million people die of preventable diseases every year, often caused by water-born parasitic diseases like dysentery, insect-born parasitic diseases such as malaria, or from other factors related to wider economic and social problems such as malnutrition and lack of medical care. But why does poverty mean that people are more likely to suffer from ill health or serious illness? In simple terms, poverty often means people lack access to medical services. Even where healthcare is available, poor people cannot afford to pay for it or it is prohibitively expensive. As the World Health Statistics 2009 reveal, people in the poorest countries paid 85 percent ‘out of pocket' for their healthcare costs in 2006. More than 60 percent of medication in low-income countries is only available through the private sector, where the cost is more than six times the international market price. The poorest people suffering from the worst health outcomes due to poverty, in other words, are forced to pay the highest proportionate costs for healthcare. The privatisation of health and other essential services resulted in health insurance schemes flourishing alongside a mix of public and private options for healthcare, often producing a two-tiered health system in low- and middle-income countries as a result of packages designed by the World Bank - meaning one for the rich who could afford choice, and a deficient version for the poor. The public sector, far from being supported by unregulated privatised health services, was increasingly eroded. And the international trend towards a privatised world has effectively redefined the concept of health from an inalienable human right, to a commodity to be bought and sold on the market.

The lack of access to clean water and sanitation is also part of a state of poverty that has both direct and indirect health consequences for the poor. An estimated 2.6 billion people - about 40 percent of humanity - lack adequate sanitation, and over 1 billion lack access to adequate water sources. Consequently, 5,000 children die each day because of a lack of safe, clean water. For millions of others, the daily grind of searching for and collecting water remains an aspect of poverty that transcends the notion of ‘basic' needs. In northern Ghana, for example, girls can spend up to five hours a day fetching water, whereas women may have to wait for hours at a standpipe in a city each day. Medically, the ingestion of contaminated water can lead to a variety of preventable illnesses, such as cholera, typhoid and dysentery. There were 131,943 cases of cholera infection alone in 2005, resulting in the death of 2,272 people across 52 countries - most of them in Africa. Once the cause of death for thousands in Europe during the nineteenth century before its spread was understood, the disease has since been eliminated from most Western countries. Cholera, like most waterborne diseases, is completely preventable and could be eliminated through the provision of clean water and adequate sanitation. According to the WHO, however, it is spreading again in many developing countries, especially across South America and Africa. Aid agencies estimate that the return of Cholera to Zimbabwe during 2008 killed 4,000 people and inflected close to 100,000 others.

This strong intellectual property regime, pushed by the US, EU and Japan at the WTO on behalf of their pharmaceutical companies, has also limited access to medicine for the poorest in the developing world. Under TRIPS agreements, governments grant patents to give a company monopoly power to manufacture and sell a medicine free of competition from any other manufacturer in that particular country, usually for a period of ten years. Such an imposed monopoly significantly increases the price of essential drugs, such as antiretroviral medicine for HIV/AIDS, as well as legally restricts the ability to produce ‘copy-cat' drugs that provide a lifeline for many of the world's poor. Furthermore, the intellectual property regime and the vast profits that can be secured from patented drugs has skewed the incentives for research and development of drugs away from the needs of the poor in the developing world towards ‘lifestyle medicines' that service the desires of the richer members of society. Many of the diseases in the developing world should be entirely preventable with modern medical knowledge and an understanding of the structural causes of poverty.

It is clear that the crisis of global health is intimately related to the crisis of global poverty. However, whilst the direct causes of ill health in the developing world can be attributed to a lack of resources and poverty, if we delve deeper, we can state that a major source of poverty itself is the current structure of the global economic system. Improving global health is impossible without addressing the wider political and economic cause of poverty - capitalism

Adapted from here