Poverty and Health Poverty and Income Inequality in India: Social Work Response

Introduction:
Poverty and health is one of the important aspects because it is going hand in hand. As the Commission on Macroeconomics and Health (CMH) of the World Health Organization (WHO) has shown, substantially improved health outcomes are a prerequisite if developing countries are to break out of the circle of poverty. Good health contributes to development through a number of pathways, which partly overlap but in each case add to the total impact:  Higher labour productivity, Higher rates of domestic and foreign investment, Improved human capital, Higher rates of national savings. Demographic changes. Health systems comprise the promotive, preventive, curative and rehabilitative services delivered by health personnel and their support structures (e.g. drug-procurement systems). They include both public- and private-sector services (for-profit and not-forprofit), formal and informal, as well as traditional services, and home- and family-based care. In many developing countries health systems are weak and fragmented, with the result that millions of the world’s poor do not have access to the public health services and personal care they need. In this respect, a major challenge is to address the gender, ethnic and socio-economic biases in health service delivery in order to reach vulnerable groups and groups with special needs. 

​The health of poor people, in particular, is determined by a wide range of factors, including income, education level, food security, environmental conditions, and access to water and sanitation. Economic, trade and fiscal policies are also important determinants of household incomes and nutritional status. They have an impact on inequality and exclusion, whether by gender, ethnicity or socio-economic groups, and these in turn have a major impact on health status. The poor and socially vulnerable from the impoverishing costs of health care. This requires increasing the pooling of risk, cross-subsidy and protection against health shocks, in the context of a comprehensive review of the social protection of the poor. . It includes the provision of quality public health and personal care services, with equitable financing mechanisms. It goes beyond the health sector to encompass policies in areas that affect the health of the poor disproportionately, such as education, nutrition, water and sanitation. Finally, it is concerned with global action on the effects of trade in health services, intellectual property rights, and the funding of health research as they impact on the health of the poor in developing countries. 

Links between poverty and poor health:
The economic and political structures which sustain poverty and discrimination need to be transformed in order for poverty and poor health to be tackled. The majority of the people are suffering from poor health because of their poverty. The politically and economically sound people are accessing all health resources and they are exploiting the health services which are meant for poor. 

Marginalized groups and vulnerable individuals are often worst affected, deprived of the information, money or access to health services that would help them prevent and treat disease. Many people are suffering from ill health because of lack of information and money or access to health due to poverty.

Very poor and vulnerable people may have to make harsh choices – knowingly putting their health at risk because they cannot see their children go hungry, for example. Many poor people are working in foundry, sanitary work, working in dust, chimney cleaning, working in mines, working in unhealthy environment, garbage collecting, leather product making and ect,.

The cultural and social barriers faced by marginalized groups – including indigenous communities – can mean they use health services less, with serious consequences for their health. This perpetuates their disproportionate levels of poverty. Many poor people believe in cultural practiced system of health and they still believe in traditional healer and quakes, because of this they are put their health in untrained health personnel. This is causing very serious effect on health.  

The cost of doctors’ fees, a course of drugs and transport to reach a health centre can be devastating, both for an individual and their relatives who need to care for them or help them reach and pay for treatment. In the worst cases, the burden of illness may mean that families sell their property, take children out of school to earn a living or even start begging. Now a day’s affording health services is very difficult because of spending more money on health facility. In many instance poor people is in debt.

The burden of caring is often taken on by a female relative, who may have to give up her education as a result, or take on waged work to help meet the household’s costs. Missing out on education has long-term implications for a woman’s opportunities later in life and for her own health. Many poor women are deprived from education and good job opportunity and their health because of caretaking of their kith and kin.

Overcrowded and poor living conditions can contribute to the spread of airborne diseases such as tuberculosis and respiratory infections such as pneumonia. Reliance on open fires or traditional stoves can lead to deadly indoor air pollution. A lack of food, clean water and sanitation can also be fatal. In our county many poor people are not having good food and clean water and good health facilities because of their living condition and lack of accessibility and affordability of health care. Concern for the health of the poor is one of the critical issues in development. Poverty cannot be defined solely in terms of low or no income. Lack of access to health services, safe water, adequate nutrition, and education are also essential components of poverty. Poverty and health are closely linked. Poverty is one of the most influential factors in ill health, and ill health can lead to poverty.

Poverty drains family savings. In addition, poor people are more exposed to several risks (poor sanitation, unhealthy food, violence, drug abuse and natural disasters) and less prepared to cope with them. More than 1.5 billion people in the world –most of them children- live in extreme poverty, and 80 percent of them live in developing countries. Poor people have little or no access to qualified health services and education, and do not participate in decisions critical to their day-to-day lives. UNICEF statistics show that 22,000 children die each day because of poverty. People with low income are at greater risk of illness and disability. They are also less informed about the benefits of healthy lifestyles, and have less access to quality health care. It is estimated that one third of deaths worldwide –some 18 million people a year or 50,000 a day- are due to poverty-related causes.Those who live in extreme poverty are five times more likely to die before age five, and two and a half time times more likely to die between 15 and 59 than those in higher income groups. The same dramatic differences can be found with respect to maternal mortality levels and the incidence of preventable diseases.

The impact of poverty on health is largely mediated by nutrition and is expressed throughout the life span. Those living in poverty and suffering from malnutrition have an increased propensity to a host of diseases, a lower learning capacity, and an increased exposure and vulnerability to environmental risks. It is estimated that 165 million children worldwide suffer from malnutrition. However, nutrition and health are only moderately responsive to mere economic growth. Increased income alone cannot guarantee better nutrition and health because of the impact of other factors, notably education, environmental hygiene and access to health care services, which cannot necessarily be obtained with increased income in developing countries.

Education is one f the most powerful weapons to fight against poverty and its effects.

Experiences in several countries have shown the power of education to increase the nutritional levels and the health status of the poor. In that regard, girls’ education is one of the most effective investments countries can make toward development and better health. Those countries that have the greatest gender disparities in access to education, like Afghanistan, India, Ethiopia and Yemen are also among the poorest countries in the world. In urban India, for example, it has been found that the mortality rate among the children of educated women is almost half than that of children of uneducated women. In the Philippines, primary education among mothers has reduced the risks of child mortality by half, and secondary education has reduced that risk by a factor of three.

Several strategies can be used to improve the access of mothers and children to educational opportunities as a way of improving their health status and overcome poverty. At the national level governments -particularly in developing countries- have to establish education as a priority, and provide necessary resources and support. At the international level, lending institutions have to increase the number of debt-reduction plans for those countries willing to provide resources for basic education, particularly in rural areas and at the community level. Since an important goal is to reduce economic inequity to improve the health status of populations, education can provide substantial benefits to people of all ages.

Rural poverty is a multi-dimensional social problem. Its causes are varied. They are as follows:

1. Climatic factors:
Climatic conditions constitute an important cause of poverty. The hot climate of India reduces the capacity of people especially the rural people to work for which production severely suffers. Frequent flood, famine, earthquake and cyclone cause heavy damage to agriculture. Moreover, absence of timely rain, excessive or deficient rain affect severely country’s agricultural production. This may leads health hazard and lack of money for getting health facilities.

2. Demographic factors:
The following demographic factors are accountable for poverty and health in India.

(i) Rapid growth of population:
Rapid growth of population aggravates the poverty of the people. The growth of population exceeds the rate of growth in national income. Population growth not only creates difficulties in the removal of poverty but also lowers the per capita income which tends to increase poverty. The burden of this reduction in per capita income is borne heavily by the poor people. Population growth at a faster rate increases labour supply which tends to lower the wage rate. This rapid growth not only affecting their income it is also declining the health of the poor people.

(ii) Size of family:
Size of the family has significant bearing on rural poverty. The larger the size of family, the lower is the per capita income, and the lower is the standard of living. The persistence of the joint family system has contributed to the health and earning capacity of the rural people. And sometimes it is not allowing the women to seek health facility.

3. Personal causes:
(i) Lack of motivation:
Lack of motivation is an important cause of rural poverty. Some rural people do not have a motive to work hard or even to earn something. This accounts for the poverty of the rural people. This poverty is also cause the health of the poor people in terms of lack of motivation to get good health facilities.

(ii) Idleness:
Most of the rural people are lazy, dull and reluctant to work. Hence they rot in poverty as well as they are indulging in bad habits. This may leads to many health problems.

4. Economic causes:
(i) Low agricultural productivity:
Poverty and real income are very much interrelated. Increase in real income leads to reduction of the magnitude of poverty. So far as agricultural sector is concerned, the farmers even today are following the traditional method of cultivation. Hence there is low agricultural productivity resulting in rural poverty. This poverty is leads to poor health condition of the poor people.

(ii) Unequal distribution of land and other assets:
Land and other forms of assets constitute sources of income for the rural people. But, unfortunately, there has been unequal distribution of land and other assets in our economy. The size-wise distribution of operational holdings indicates a very high degree of concentration in the hands of a few farmers leading to poverty of many in the rural sector. The unequal distribution of land and other assets are very less in the poor people. Even it is their many times they are in the condition of selling because of they are spending money on  health of the family members.

(iii) Decline of village industries:
At present consequent upon industrialization new factories and industries are being set up in rural areas. Village industries fail to compete with them in terms of quality and price. As a result they are closed down. The workers are thrown out of employment and lead a life of poverty. The declines of village industries also cause ill health of the poor people because they are working in hazardous setting of modern industries.

(iv) Immobility of labour:
Immobility of labour also accounts, for rural poverty. Even if higher wages are offered, labourers are not willing to leave their homes. The joint family system makes people lethargic and stay-at-home. The immobility of Labour cause poverty and it may leads not having good amount of money to spend on health of the family members. The rural people are mostly illiterate, ignorant, conservative, superstitious and fatalistic. Poverty is considered as god-given, something pre­ordained. All these factors lead to abysmal poverty and health of the poor people in rural India.

(v) Lack of employment opportunities:
Unemployment is the reflection of poverty. Because of lack of employment opportunities, people remain either unemployed or underemployed. Most of these unemployed and underemployed workers are the small and marginal farmers and the landless agricultural labourers. Because of this poor people are remaining in poverty and it may result in lack of good food, shelter and living condition cause serious health problems.

5. Social causes:
(i) Education:
Education is an agent of social change and egalitarianism. Poverty is also said to be closely related to the levels of schooling and these two have a circular relationship. The earning power is endowed in the individual by investment in education and training. But this investment in people takes away money and lack of human investment contributes to the low earning capacity and lack of health related information of individuals. In this way people are poor because they have little investment in themselves and poor people do not have the funds for human capital investment on health and education.

(ii) Caste system:
Caste system in India has always been responsible for rural poverty. The subordination of the low caste people by the high caste people caused the poverty of the former. Due to rigid caste system, the low caste people could not participate in the game of economic progress and not even able to spend on their own health.

(iii) Joint family system:
The joint family system provides social security to its members. Some people take undue advantage of it. They live upon the income of others. They become idlers. Their normal routine of life consists in eating, sleeping and begetting children. Even they are not having power to spend money on health of their own children. They have to take grant from head of the family. In this way poverty and health problems gets aggravated through joint family system.

(iv) Social customs:
The rural people spend a large percentage of annual earnings on social ceremonies like marriage, death feast etc. As a result, they remain in ill health, debt and poverty.

(v) Growing indebtedness:
In the rural sector most of the rural people depend on borrowings from the money-lenders and land-lords to meet even their consumption expenses. Moneylenders, however, exploit the poor by charging exorbitant rates of interest and by acquiring the mortgaged land in the event of non-payment of loans. Indebted poor farmers cannot make themselves free from the clutches of moneylenders. Their poverty is further accentuated because of indebtedness. Such indebted families continue to remain under the poverty line and ill health for generations because of this debt-trap.

Conclusion:  
The poverty and health is one of the interdependent components. In this article we would to like know about how one component is influencing on other component and what are the reasons are there in the health and poverty. The developing countries like India are often, however, facing substantial problems of poverty and inequality. In health, as in other sectors, the role of development co-operation in these countries is modest financially, but often important in facilitating new approaches and innovations. An example is assistance in improving strategies or strengthening the capacity to direct health resources to poor and vulnerable groups. Mobilizing resources for improving the health of the poor is an investment in economic growth and development and should be a priority for reducing poverty. The lack of resources allocated to health is not the only obstacle to the effective implementation of pro-poor health policies, but it is a major, and inescapable, part of the problem.

References:

1. Constitution of the World Health Organization (1948).
2. Investing In Health To Reduce Poverty Dac Guidelines And Reference Series: Poverty And Health – Isbn 92-64-10018-0 – © Oecd, Who 2003 
3. WHO (2001), Macroeconomics and Health: Investing in Health for Economic Development, Report of the Commission on Macroeconomics and Health, WHO, Geneva.
4. Birdsall, N., A.C. Kelley and S. Sinding (eds.) (2001), Population Matters: Demographic Change, Economic Growth, and Poverty in the Developing World, Oxford University Press, New York. 
5. WHO (2000), The World Health Report 2000: Health Systems: Improving Performance, WHO, Geneva. 
6. DAC Guidelines And Reference Documents: Poverty And Health – Isbn 92-64-10018-0 – © Oecd, Who 2003 Isbn 92-64-10018-0 DAC Guidelines And Reference Documents 
7. Poverty and Health © OECD, WHO 2003 
8. Starfield B. Child health care and social factors: poverty, class, race. Bull N Y Acad Med. 1989 Mar;65(3):299–306. [PMC free article] [Pub Med] 
9. Kuh D, Wadsworth M. Parental height: childhood environment and subsequent adult height in a national birth cohort. Int J Epidemiol. 1989 Sep;18(3):663–668.[Pub Med] 
10. West P, Macintyre S, Annandale E, Hunt K. Social class and health in youth: findings from the west of Scotland twenty-07 study. Soc Sci Med. 1990;30(6):665–673. [Pub Med]
11. Call RL. Effects of poverty on children’s dental health. Pediatrician. 1989;16(3-4):200–206. [Pub Med]
12. Milén A. Role of social class in caries occurrence in primary teeth. Int J Epidemiol. 1987 Jun;16(2):252–256. [Pub Med]
13. Roemer MI. The value of medical care for health promotion. Am J Public Health. 1984 Mar;74(3):243–248. [PMC free article] [Pub Med]
14. McCormick MC. The contribution of low birth weight to infant mortality and childhood morbidity. N Engl J Med. 1985 Jan 10;312(2):82–90. [Pub Med]
15. McGauhey PJ, Starfield B, Alexander C, Ensminger ME. Social environment and vulnerability of low birth weight children: a social-epidemiological perspective. Pediatrics. 1991 Nov;88(5):943–953. [Pub Med]
16. Starfield B, Weiner J, Mumford L, Steinwachs D. Ambulatory care groups: a categorization of diagnoses for research and management. Health Serv Res. 1991 Apr;26(1):53–74. [PMC free article] [Pub Med]
17. Dr. Cesar Chelala is a co-winner of the 1979 Overseas Press Club of America award for the article “Missing or Disappeared in Argentina: The Desperate Search for Thousands of Abducted Victims

B. G. Anantharamu
Assistant Professor, Department of Psychiatric Social Work, Dharwad Institute of Mental Health and Neuro sciences, Dharwad