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Poverty leads to poor health
Reverse Causality (poor health leads to poverty).
HOW DOES POOR HEALTH CONTRIBUTE TO POVERTY?
Poverty has been identified as a menace to Africa’s development. Some scholars have argued that poor health is a major contributing factor to poverty, inter alia, (Sachs, 2002, Sambit, 2009). While this study grasps with the question of how poor health contributes to poverty, this paper will argue that poverty does strongly contribute to poor health and the reverse may be true as well. Firstly, this paper will provide clarity on the poor health-poverty nexus concept and assumptions. Secondly, it will look at the main body in which it will discuss that poverty to a larger extent does lead to poor health and then the reverse causality as poor health can also lead to poverty. This section will use Uganda as a case study because Uganda was a labeled success story with the fight against HIV/AIDS but just like any-other developing country, Uganda has a number of diseases exacerbated and sustained by poverty. This will then take the essay to the final section where it will emerge that health does play a pivotal role in development overtime and so developing countries need to deal with it by reducing poverty levels.
“Health can be looked at as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO, 1946). Human history has witnessed remarkable increases in life expectancy alongside increases in prosperity(Besley & Kudamatsu, 2006).(Preston, 1975)argues that the relationship is nonlinear with increases in income per-capita in low incomes being associated with the largest gains in life expectancy.
The historical writing of(Julia & Kenneth, 1980)noted that 3 billion people of the less developed world suffer from a plethora of infectious diseases and because they tend to flourish at the poverty level, they are an important indicator of a vast state of collective ill health. In Uganda, HIV/AIDS is still a big threat as there are still high prevalence rates, a notable percent increase, from 6.4% in 2004/5 to 7.3% by 2011 (Uganda Aids Commission, 2015).
Falling mortality has usually meant better health for the living so that people are now living better, healthier and longer lives than did their forebears (Cutler et al, 2006).(Murphy & Robert, 2006)measure both the value of mortality decline and benefits of better health for the living, estimating that between 1970 and 2000, the annual value of increased longevity was about half of conventionally measured national income. Worldwide, poverty and poor health are inextricably linked with poverty playing a role of being both a consequence and a cause of poor health thereby taking me to my next section.
Low income, illiteracy, ill-health, gender-inequality and environmental degradation are all aspects of being poor. This is reflected in the MDGs, the international community’s unprecedented agreement on the goals for reducing poverty(World Bank, 2004). Rogot et al, (1992) argues that in 1980, Americans in the bottom 5% of the income distribution had a life expectancy at all ages that was about 25% lower than the corresponding life expectancies of those in the top 5% of the income distribution. Across the swath of history, improvements in income have come hand in hand with improvements in health (Hoyt, 2010).
Lorentzen et al, (2008) notes that in a poor country, where people are unable to afford sanitation and medical care, people die young and where people have a short time because they expect to die young, they have no reason to save and the economy fails to grow because areas that have high adult mortality don’t give the population leverage to use their productive years.
While governments devote about a third of their budgets to health and education, they spend very little on the services the poor people need to improve health and education. Public spending on health and education is typically enjoyed by the non-poor(World Bank, 2004). In Uganda, there is a system of cost sharing where hospitals must charge for treatments, this therefore implies that Ugandans have to pay for health care whenever they fall sick which hurts the poor. As a result, people with illnesses such as malaria will often delay care as long as possible before seeking treatment (fsd, n.d.)thereby leading to deteriorating health conditions.
With quality improvements, comes an increase in the intensity of service use by existing users (Sarah et al, 2006) and this has a negative impact on the health facility use by the poor e.g. in Uganda, the 1992/1993 integrated household survey showed that drugs being costly was rated higher than distance as a reason as to why people may not use a health unit (ibid, 2006). This will then lead to poor health as the poor will either resort to traditional means of curing the diseases or opt to sit the sickness out which will lead to lessening of their conditions.
Presence of a doctor at a health unit had an impact on whether the poor utilized the nearest modern health facility or not(Hutchinson & Mulusa, 1999). Specific to Uganda, this isn’t the case as with poverty, comes low wages that don’t attract doctors e.g. in Katine, out of the 7 doctors the district is meant to have, they have only one with 15 others at Soroti referral hospital, a single doctor handles more than 25000 patients and all this is due to low wages forcing doctors to work in either urban areas or private sector(Malinga, 2009)which reduces on the numbers of poor attending health facilities hence poor health.
With financial constraint comes the inability to give children quality education. The poor access poor education as they have the inability to afford quality education yet an individual’s level of education plays an important role in decision making regarding seeking healthcare (Sarah et al, 2006). A strong relationship has been found between low education and absence of antenatal care in developing countries (ibid, 2006). The likelihood of choosing public-care as the most frequently used option for both rural and urban mothers’ increases as education levels increase noted Wong et al, (1987). In 1997, the Ugandan government introduced Universal Primary Education as an aim to improve on education enrollment but even with this, a higher percentage of the poor at 21.7% compared to 9.5% for the non-poor never enrolled(Rutaremwa & Bemanzi, 2013). This therefore I dare say deprives the poor children of attaining basic education and hence are more prone to health hazards like no antenatal care, traditional unsafe births, early pregnancies etc.
Due to poor nutrition practices, poor sanitation and inadequate preventive healthcare, developing countries especially in Sub-Saharan Africa continue to face a huge burden of disease(World Bank, 2004). Cutler et al, (2006) argues that better fed people resist more bacterial (although not viral) disease better and recover more rapidly and more often. Children who are frequently malnourished often continually suffer from poorly controlled infectious disease (ibid, 2006).(Deaton, 2013)noted that when the bodies of the children are deprived of the nutrients they need to grow, brain development is also unlikely to reach its full potential. In-case of low income, the food available is over stretching to cover the whole day or all of the household’s members(Kanyabire, 2012). In Uganda, impoverished people prefer to stay in crowded small rooms in urban slum areas because it is what they can afford given their limited earnings from the informal sector, hence poor diets as they will not have the leverage of good balanced diets making the poor more prone to malnutrition diseases.
Sachs et al, 2002 notes that malaria contributes to poverty as where malaria prospers most, human societies have not prospered or developed least. In the Abuja declaration of 2005, African heads of state claimed that malaria depressed income growth in Sub-Saharan Africa since the 1960s, so much that GDP in the region today is 40% lower because of malaria (Hoyt, 2009). Malaria and poverty are quite interrelated e.g. as(Weller, 1958)noted, “It has long been recognized that a malarious community is an impoverished community.”(Sachs & Malaney, 2002)note that poverty is concentrated in the tropical and sub-tropical zones, the same geographical boundaries that most closely frame malaria transmission thereby suggesting that malaria and poverty are intimately related e.g. a comparison of income in malarious and non-malarious countries indicates that average GDP in malarious countries in 1995 was US$ 1526 as compared to US$ 8268 in countries without intense malaria. But it should be noted that malaria isn’t in African countries because they are poor. Tropical countries have mosquitoes which spread malaria to both the rich and the poor. However, the rich have better coping strategies as compared to the poor e.g. how else would one explain the situation of Oman, a rich country with an income per-capita of almost $10000 having severe malaria throughout the country (Sachs et al, 2001) than to say they can ably handle the disease because they have the financial ability to do so as opposed to the poverty stricken sub-Saharan Africa hence showing that poverty to a larger extent leads to poor health.
Malaria and other infectious diseases have fatal as well as debilitating effects on the human population in Africa(Bhattacharyya, 2009). It negatively influences productivity, savings and investments in physical and human capital and directly affects economic performance thereby leading to poverty (ibid, 2009).(Randall, 2009)focus on the number of days of labor lost due to malaria in relation to the average daily wage.(Bhattacharyya, 2009)’s study on the factors contributing to African development concludes that malaria matters most as it negatively affects savings. In Uganda, malaria has negative economic effects for the national economy due to lack of production, at the household level causes an immense burden, particularly for the poorest households, by reducing the number of days a patient can work as it accounts for 34% of total expenditure for the poorest sections of the country, creates a heavy burden upon the health system, with malaria accounting for up to 40% of all outpatient visits, 25% of all hospital admissions, and 14% of all hospital deaths(Bauer). Specific to Uganda, another example is that of the sand flea disease (jiggers) which negatively affects economic productivity as it badly disfigures hands and feet therefore making its victims unable to work and attend school. However, Sand flea disease is common in resource-poor communities in South America and sub-Saharan Africa with prevalence figures in some populations of up to 60 percent as noted by Kehr et al, 2007, as these communities have very poor sanitation which necessitates its spread thereby commonly upholding tungiasis as a disease for the poor. This therefore shows that regardless of the fact that poor heath can lead to poverty, poverty to a larger extent does lead to poor health.
All in all, as discussed, poverty to a larger extent does lead to poor health therefore in search of an explanation to development in developing countries, poverty eradication has to be put at forefront as noted by Uganda’s Poverty Eradication Action Plan (PEAP) (2005-2008) which puts improving quality of life, especially for the poor as one of the long term objectives of Uganda. As put by Hoyt, (2010), when people get richer they invest more in their own health and exhort their governments to spend more on public health thereby showing that this is needed for economic development to take place.
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