Poverty and Health

Poverty and ill-health are inseparable. (Dying for change, 2001) For centuries poverty has been connected to income, and it still remains in the core of the definition; a good health means the physical and mental well-being of a person, and poverty, when connected to health, is presented as a vicious-cycle of material lack/poverty, insecurity, bad social relations, physical weakness/illness and powerlessness. (Robert Chambers, 2002) Also lack of education, bad living conditions and political instability can be added to this list of root causes which easily leads to poor health. Poor heal causes medical costs, lowers the strength to work and the level of income. People loose their hope. I can only imagine how horrible it must be to see your children suffer because of something as essential and simple as malnutrition - lack of decent food and potable water. I can easily get medical help for the tiniest reasons, I can choose whether I want to have meat or fish for a lunch and I can choose between bottled or tap water, I can choose whether to deliver my child in a hospital or at home, but the poor have not been given any of these choices in their lives, the least of all to take care and to protect their basic needs and to take care of their families. A woman from Vietnam condenses the essence poverty and health:  

“Poor people cannot improve their health status because they live day by day, and if they get sick they are in trouble because they have to borrow money and pay interests.”

(Dying for change, 2001)   

And a man from Togo says: “We are all poor here because we have no school and no health centre… There is nobody who can help, that’s why we are poor here.”

(Dying for change, 2001)

This structure certainly includes also other types of forms then only poverty and good health connected to the income, but also to a more deepened understanding of the social structures such as access to education, the role of gender and ethnicity and whether your voice is at all heard in the society because you are a poor.     

Structural Violence is a term that goes back to 1960’s and it was defined by Johan Galtung to describe social structures that are violent and injure people not only physically but also influences on people's minds. Some of these structures have already been mentioned and described above. They can be economical, political, legal, religious or cultural structures that deny the access of many people to lead a healthy life and to have equal opportunities. Racism is one of the examples f structural violence, whether it is addressd towards an ethnic group or is gender related, it can cause ill-health in many ways. Structural violence is not a clinical disease, but it is a reason that causes clinical diseases. Structural violence is interconnected to many levels of society, it would need the cooperation of multiple fields and policy making together with health professionals in a global level. More medical professionals will also have to be trained to make structural interventions. (Farmer, P., Nizeye, B., Stulac, S. & Keshavjee, S. 2006)          

Structural Interventions are the actions that make it possible address Structural violence.  Some of the interventions that can have a positive impact are vaccinations, improved water and housing quality or training more qualified midwifes. The Structural intervention example that I will present here is the PIH model (Partners in Health) that have been implemented in Rwanda and in Rural Haiti in AIDS and TB care. In the PIH model the clinical and the community barriers are removed, the treatment is made free of change for the HIV/Aids patients and the care is also delivered with in the villages. Each one of the patients is chosen to have an accompagneteur who is trained to deliver drugs and other supportive care to the patient’s home. This has been a way of removing structural violence, to giving quality care and creating jobs in rural regions. The PIH model is a bottom-up model instead of the traditional scale-up model. The challenges in Haiti and Rwanda have been diverse, because of some social and cultural differences. When the program was implemented in Rwanda the country was recovering from war. The mothers with HIV/Aids were presented a medication during the pregnancy, al well as formula-feeding and close follow-up of infants. Also potable water projects were launched. The lessons of the both countries were that this kind of structural interventions increase the agency of the poor, prevent the illnesses and decreases the inequalities. However, the biggest resistance to the PIH model came from the local and global health policy makers. (Farmer, P., Nizeye, B., Stulac, S. & Keshavjee, S. 2006)

The value that these concepts bring to the discussion is that the structural root-reasons of ill-health are recognized, the concept is deepened as it is; an essential problem of the ill-structure of the whole society. These structures do exist and they are part of the whole interconnection of the globalized world. The article also brings up the question that why do they exists? What can we do in order to decrease structural violence and ensure a good health for everybody? The article also shows that many times these changes start from grass root level, from the actions of people who understand the reality of people who live in poverty and powerlessness. That is what the worls needs, more professionals who really understand the reality of the poor. It also shows that the change can be made, it is possible as long an there is good will, knowledge and understanding.  But when do the policy makers understand that and really start acting instead of talking?    

         

Sources:

• Robert Chambers, 2005 in Dying for change. Poor people's experience of health and ill-health. WHO & The World Bank. Complete report. (to the appropriate extent) You can also choose applicable parts in this Dying for change.
• Farmer, P., Nizeye, B., Stulac, S. & Keshavjee, S. 2006. Structural Violence and Clinical Medicine. PLoS Medicine, Vol. 3(10).
• Poverty in Focus 2006. What is poverty? Concepts and measures. Sanchez, P. & Swaminathan, M.S. 2005.
• Hunger in Africa: the link between unhealthy people and unhealthy soils. (pdf) The Lancet, Vol. 365, 442-444.