Declining poverty is good for our health
Poverty can be both relative (in Australia) and absolute (in parts of Africa and India). The level of income below which poverty is declared varies, from $US1.25 a day in the world’s 15 poorest countries, according to The Economist (1 June, 2013), to $US63 a day for a family of four in America.
Apart from the compelling concern poverty stimulates in us for the 1.2 billion people who live on less than $US1.25 a day, there is the matter of their health that should make us as health professionals think seriously.
All is not gloom.
Take heart from the progress that has been made this century in lifting people from poverty and in improving maternal and child survival.
To quote The Economist again, the principal aim of the Millennium Development Goals (MDGs), developed by the United Nations in September 2000 – to halve the 1990 level of extreme global poverty by 2015 – was “achieved five years early”.
The MDGs raise an important point. Workable goals are always built on a platform of feasibility. There is no wisdom, even when defining stretch goals, in aspiring to an unattainable level. With poverty, the goals have been realistic. The outcome was foreseeable when the MDGs were set.
Not that the MDGs can claim all the credit. China has been at the forefront of extreme poverty reduction and, more or less independently of the MDGs, has contributed hugely to global progress.
Also remember that the success the world has had in alleviating extreme poverty does not, of course, mean that those rescued from it now enjoy stylish middle-class accommodation, access to vital health services or to education.
Crossing the poverty line is but the first step in community development for many nations, and subsequent steps may be more difficult and complex. That is no reason not to plan to take them, but we should be ready for the hard yards involved.
The MDGs are due to expire in 2015. The United Nations and its agencies, including the World Health Organisation, are considering how the development agenda should be expressed for the next decade and beyond.
Sustainability is a major preoccupation now, alongside poverty, and goal-makers ponder the significance that climate change and capricious global financial systems will have for the health of the world.
The effects of economic growth, including poverty reduction, occur almost independently of the political configuration of the country.
If the rates of economic growth seen currently in developing countries were to continue, The Economist projects they could cut extreme poverty from 16 per cent to 3 per cent by 2030.
Whether the better off nations will allow such growth to continue, given their own economic difficulties, is a serious question.
Economically-challenged countries that are well off close doors to remain safe, decreasing vital trade with less-developed nations.
Whatever trajectory economic development follows, we, as health-interested people, can say that – at least in regard to the reduction of poverty – it is good for people’s health.
Beside economic growth, The Economist draws attention to the extent to which income distribution is important for poverty reduction.
In countries where there are severe inequalities in income, poverty reduction is much diminished, as economic growth feeds the rich.
‘Trickle-down’ effects are not a major force in poverty reduction. Policies that achieve income redistribution in favour of the poor, either directly or through social services, contribute about one-third to poverty reduction.
While the falling rates of extreme poverty are a cause for celebration, now is not the time for disengaging from serious debate about global health and the role that poverty plays. The agenda is changing.
As cities flourish and poverty rates fall, think of the world’s largest migratory wave in history which is bearing hundreds of millions of people from the country to cities in search of prosperity, and what that means for child-bearing and care, for diet, for exercise and myriad health effects, including cardiovascular disease. Consider what it means for environmental sustainability.
Serious thought and debate about poverty, poverty reduction and the future of global health are essential.