Poverty-Health & Development Week 11

7/28/2019 Poverty-Health & Development Week 11

1/29

POVERTY, HEALTH &DEVELOPMENT


2/29

Poverty and Health:

Academic Perspectives

It is one of the greatest of contemporary

social injustices that people who live in the

most disadvantaged circumstances have

more illnesses, more disability and shorter

lives than those who are more affluent.

-- Benzeval, Judge, & Whitehead, 1995, p.xxi, Tackling

Inequalities in Health: An Agenda for Action.


3/29

Poverty and Health:

Mechanisms

Poverty can affect health in a number of ways:

income provides the prerequisites for health, such as

shelter, food, warmth, and the ability to participate in

society;

living in poverty can cause stress and anxiety which

can damage peoples health;

low income limits peoples choices and militatesagainst desirable changes in behaviour.

- Benzeval, Judge, & Whitehead, 1995, p.xxi, Tackling Inequalities in

Health: An Agenda for Action.


4/29

Better Health Reduces Poverty, And Reduced

Poverty Improves Health

POVERTY

ILL-

HEALTH

Increased personal

and environmental

risks

Increased

malnutrition

Less access to

knowledge,

information

Diminished ability to

access care

Diminished Quality

of life

Reduced

Productivity

Lowered learning

ability

Diminished

household savings,

debts


5/29


6/29

6

Inverse Care Laws

Rich consume more hospital and public health care

than the poor (Hart 1971)

Immunization coverage strongly correlated with

socioeconomic status (Gwatkin et al. 1999)

poor with illness dont access care: 2x more likely to

self treat; 10x more likely to do nothing (Uganda, HH

Survey, 1994/5

). poor that access health care risk medical

impoverishment (Liu and Hsiao, 1997; WB, Voices of the Poor, 2000)


7/29

7

Inverse Care in Public Health

2.80% 6.10%

bottom qui top quintile

2.50% 3.30%

2.50% 8.40%

0.00%

5.00%

10.00%

Clinics Hospitals

Public Health Service Use, Ghana

bottom quintile

top quintile


8/29

8

Poor kids more likely to die before age five8


9/29


10/29


11/29

Global Perspectives

The world bank sees health primarily as an essential asset for economic growth

Asian development bank sees health as key to human capital

African development bank sees health in terms of human capital

The European commission sees work on strengthening health as increasing human

capital

DFID (UK-Aid) sees health as a mediator of economic growth

The Bill and Melinda gates foundation focuses its global health program on

targeting the diseases that impose the greatest burdens on poorest countries and

those conditions that are associated with poverty


12/29

Commitments By Government OfPakistan

Investing in people

No country can expect to progress in a global world economy without aneducated and healthy workforce

Health Improvement in health outcomes are an important determinants of economic

growth

Focused on increasing public sector health expenditure with keen spotlight onpreventive and control programs

Nutrition 8 million children &1/3rd pregnant women malnourished in Pakistan

National nutrition program being strengthened

Population planning Current TFR still highest in Asia

10 year population perspective plan for population developed

Renewed emphasis on utilizing the outlets of both health and populationwelfare ministries for distribution of contraceptives

I R l t d T P t R d ti St t B


13/29

Issues Related To Poverty Reduction Strategy ByAddressing Health

Are The Health Programs Addressing The Poor

Only 1/3rd sick utilize government health services

2/3rd seek private health facilities

Both end up paying from their own pockets

Data does not significantly identify poor and vulnerable

Safety nets yet to be materialized

Need to focus on quality and on pro poor

How To Monitor Health Related Targets Need to have output or intermediate targets as measuring of

outcome target may not demonstrate a significant change


14/29


15/29

FURTHUR READING

POVERTY AND ILL-HEALTH:CHALLENGES, INITIATIVES AND ISSUES IN PAKISTAN

Inayat Thaver, Zulfiqar A. Bhutta

(http://www.sasnet.lu.se/EASASpapers/PHDZulfiqarBhutta.pdf)

DYING FOR CHANGE: Poor peoples experience of health and ill-health. Ann Kern , Jo

Ritzen (http://siteresources.worldbank.org/INTPAH/Resources/Publications/Dying-for-

Change/dyifull2.pdf)


16/29

BREAK


17/29

The Concept of Development


18/29

Meaning of Development-Todaro

Development is not purely an economic

phenomenon but rather a multi-dimensional

process involving reorganization and

reorientation of entire economic AND socialsystem

Development is process of improving the

quality of all human lives with three equallyimportant aspects. These are:


19/29

Todaros Three Objectives of Development

1. Raising peoples living levels, i.e. incomesand consumption, levels of food, medicalservices, education through relevant growthprocesses

2. Creating conditions conducive to the

growth of peoples self-esteem through theestablishment of social, political and economicsystems and institutions which promotehuman dignity and respect

3. Increasing peoples freedom to choose byenlarging the range of their choice variables,e.g. varieties of goods and services


20/29

Alternative Interpretations of Development

(Mabogunje)

Development as Economic Growth- too often

commodity output as opposed to people is

emphasized-measures of growth in GNP. Note

here the persistence of a dual economy wherethe export sector contains small number of

workers but draws technology as opposed to

traditional sector where most people workand is dominated by inefficient technology


21/29

There is a very strong interrelationship between all types of

development and between health and development.

One of the most significant influences on development is

health.

Health increases human potentialities of all kinds

Good health means improved quality of life and the opportunity

to achieve development potential.

Ill health may impact on physical, social, emotional and

intellectual development

Everyone can benefit from better health in the present, andimproved health for the young will lead to healthier populationin the future

Interrelationship


22/29

Interrelationship Our Planet, Our Health. A report by WHO in 1992

Interaction between human activities and physical and biological environment


23/29

Credit: C. Corvalan (http://bit.ly/IQGhgE)

Health is a pre-condition as well as an outcome of all three dimensions of sustainable

development (environmental, social and economic). Human beings are central to

sustainable development and health is across cutting issue to the seven critical themes


24/29

Interrelationship Health and development have reciprocal and synergistic

elements attached to their relation

Good health is essential for development and the other way round development is essential for

good health

Development policies can have direct/indirect and intended/ unintended effects on health

5 areas of consideration regarding impact of development policies on health. Weil et

al 1990

Housing

PoliciesHousing conditions

Low income

housing

Slums clearance

Site and services

program

Public provision of

houses

Energy Policies

Indoor

pollutionDomestic fuel

Fuel Pricing

Fuel gathering

Industrial

pollution

Industrial

Policies

Industrial

development

Occupational

health

control of

water/air pollution

Waste

management

Agricultural

Policies

Irrigationsystem

Pesticide use

Land policy

Research

Nutrition

Macroeconomic

Policies

Adjustmentpolicies

Public

expenditure

Trade policies

Household

response


25/29

Harvey Lebenstein (1957)

Relative to the poorly nourished workers, those

who consume more calories are more productive

and at very low levels of intake, better nutrition is

associated with increasingly higher productivity

Employers have incentive to raise wages above

minimum supply price of labor and to exclude

those in the poorest health

H l h d d l


26/29

Health and development

Political

developmentEconomic

Development

Cultural

Development

Social

Development

EnvironmentalDevelopment

HEALTH


27/29

HEALTH

DEVELOPMENT FOR HEALTH OR VISE VERSA

Political Development

Human Rights

Democratic

Development

Good Governance

Economic Development

Appropriate economic policies

Efficient resource allocation

More equitable access to

resources

Increasing the productive

capacity of the poor

Social Development

Improved income distributionGender equity

Investing in basic health &

education

Emphasizing participation of

the beneficiaries

Cultural Diversity

Sensitivity to cultural

factors

Recognition of values

conducive to

development


28/29

What are the desired outcomes

of sustainable development?

Clean water & air

Fertile soil &

good foodA livelihood & ahealthy economy

An optimumpopulation size

Safety from poverty& disease

Social contact & asense of community

Work, rest &celebration

Opportunities tolearn

Halting global warming


29/29

FURTHUR READING

Our Planet, Our Health, Our Future

http://www.who.int/globalchange/publications/reports/health_rioconventions.pdf

The Impact Of development Policies on Health

http://whqlibdoc.who.int/publications/1990/9241561416.pdf

Health and Development. David Phillips

http://books.google.com.pk/books?hl=en&lr=&id=k2gGZbtygp8C&oi=fnd&pg=PR8&ots=

YFirFfOpkr&sig=Wz7ffDLC71bitLGmdsaECxVOy7s#v=onepage&q&f=false

Health and 18th amendment. Retaining national functions in devolution. Dr SaniaNishter. http://www.heartfile.org/pdf/HEALTH_18AM_FINAL.pdf

Poverty-Health & Development Week 11

Documents

Transcript of Poverty-Health & Development Week 11