Health & Economic Development
This article summarizes statistics and conditions relating to disease, poverty, healthcare, and economic development around the world; it also examines research and opinions about the interrelationship between poverty, diseases, and healthcare systems. The relationship between economic strife and the spread of disease is illustrated through case studies. The article also discusses the efforts of governments and organizations to improve the living conditions and health of poor populations around the world and explores philosophical and economic issues in the field of healthcare and poverty. The main reasons that global efforts are being hindered are examined and suggestions for improving global efforts are offered.
Keywords Commission on Macroeconomics and Health; Female Sex Workers (FSWs); HIV/AIDS; International Covenant on Economic, Social and Cultural Rights (ICESCR); Millennium Development Goals (MDGs); Neoliberalism; Office of the High Commissioner for Human Rights; Realizing Rights: the Ethical Globalization Initiative; UNAIDS; World Health organization (WHO)
Sociology of Health
The Relationship between Poverty
At a 2008 meeting held in New York, health officials from the United Nations presented various statistics on global health and poverty. They projected that there will be 360 million poor people in sub-Saharan Africa by 2015 (Schineller, 2008, p. 5). Because there is a strong correlation between extreme poverty and poor healthcare, these figures also signify that hundreds of millions of people will be affected by diseases and illnesses in the early twenty-first century. Some of the worst diseases, including malaria and AIDS, are concentrated in the poorest countries around the world. According to statistics from UNAIDS (a joint United Nations program), as of 2012 there were approximately 35.3 million men, women, and children living with HIV worldwide. This is up from 29.4 million in 2001. The percentage of people ages fifteen to forty-nine infected with HIV worldwide was estimated at 0.8 percent in 2012.
Dabbagh et al. et al. argue that the relationships among the various causes and effects of poverty and the spread of HIV/AIDS were not well considered in traditional intervention programs. The suggest that HIV interventions have largely ignored "the correlation of poverty, the social dynamics of marginalization, and the lack of political commitment in creating economic reform and sustainable human development" (Dabbagh et al., 2008, p. 51). Dabbagh et al. is not alone in believing that disease intervention often ignores the factors that actually cause the problem. Many other experts have made comparable arguments. Jere-Malanda (2008) observes that healthcare improvement in places experiencing widespread poverty "requires tackling the root causes of poverty." Jere-Malanda lists economic factors as a major cause for widespread poverty; arguing that "crippling foreign debts, unfair trade rules, as well as Western-backed stifling economic policies" all have adverse effects on the state of people's health in countries throughout Africa (Jere-Malanda, 2008, p. 56).
The Continuing Spread of AIDS
A good example of the relationship between poverty and disease can be seen in Africa and Asia. Dabbagh et al. observes that in Thailand — as well as Africa and South East Asia — husbands and fathers are forced to migrate to cities in search of work. However, they frequently have difficulty securing gainful employment, or for other reasons do not give enough economic support to the women and children they have left in the villages, and this in turn causes the migration of their wives and daughters to the cities. Women and young girls often find work, and are often pressured to work, as female sex workers (FSWs) in the cities. In some impoverished rural communities, the sex trade is the most viable option for women to support their families. Dabbagh et al. cites several studies that indicate "rural-urban migration, limited employment opportunities, and increased poverty in rural communities" has caused a dramatic increase in FSWs in China, India, Thailand, and in countries throughout Africa. Because FSWs in developing countries are usually the poor and uneducated, they have few or no other economic opportunities, and they are often exploited by wealthy brothel owners, and by clients who either force them or pay more for not using condoms. The result is a widespread increase in cases of AIDS. Dabbagh et al. also observes that "in some sub-Indian caste cultures, the oldest daughter is expected to economically support her family and often with the family's approval seeks employment in commercial sex”(Dabbagh et al., 2008, p. 53). But there are many other ways in which poverty and dire social circumstances are behind the spread of illness, disease, and death.
Jha (2004) makes additional observations about the interrelationship of poverty, poor health, and global insecurity. Jha points out that an inadequate supply of food, poor sanitary systems, and crowded living conditions all combine with weak healthcare to make poor people around the world highly susceptible to disease. Jha also notes that "HIV/AIDS is on its way to killing several hundred million people in Africa, China, India and elsewhere. Of the annual toll of 5 million babies who die in the first month of life, 98% live in poor countries" (p. 66). Further, 1.5 million people dies of tuberculosis annually and malaria kills another 1 million. All of these deaths can be directly attributed to living in conditions of abject poverty (Jha, 2004).
Most economists have long accepted the idea that poverty causes poor health, but "economists have only recently begun to show that disease leads to poverty" ("The Health of Nations," 2001, ¶ 7). Although there is a reciprocal relationship between poverty and poor health, though the idea that ill-health causes poverty has been to substantiate ("The Health of Nations," 2001). Poverty can lead to increased prevalence of diseases such as AIDS, but other studies are designed to examine the dynamic between healthcare and poverty from the opposite angle. Krishna (2006) carried out a lengthy study and compared their results with many other studies that were carried out in various nations around the globe, and their findings present a clear warning on the dangers of disease coupled with inadequate healthcare systems. Krishna arrives at the conclusion that "in many places, more families are falling into poverty than are being lifted out" (p. 62).
However, Krishna's research leads to a surprising conclusion. The study reports that the biggest reason for families sinking into poverty around the world is because of poor healthcare systems and the debt of paying for family illness or disease: "tracking thousands of households in five separate countries, my colleagues and I found that health and healthcare expenses are the leading cause for people's reversal of fortune" (Krishna, 2006, p. 62). Thus, as Jha (2004) points out, poverty causes ill health, but ill health also causes poverty. This leads Jha to write, "arguably, one of the most effective instruments in the fight against global poverty is the control of major diseases" (p. 66). Disease control allows for better health in a community; it also allows people to earn more income and greatly increase the potential for higher education, which in turn raises personal income even more. Jha writes, "improving health status helps the poor to better withstand economic downturns and protects households from sliding into poverty as a result of catastrophic medical bills" (Jha, 2004, p. 66).
In 2000, the United Nations unveiled the Millennium Development Goals (MDGs), designed to address the problems of global poverty and disease. The basic goals were to:
- End extreme poverty and hunger;
- Achieve universal free primary education;
- Encourage gender equality and empower women;
- Lower the child mortality rate;
- Improve maternal health;
- Fight H.I.V./AIDS, malaria and other diseases;
- Promote environmental sustainability
- Develop a global partnership for development.
Schineller (2008) writes that "these are the eight ambitious yet attainable Millennium Development Goals (MDGs) that 189 U.N. member states agreed in 2000 to try to achieve by the year 2015" (Schineller, 2008, p.5). At that end of the year 2000, the WHO Commission on Macroeconomics and Health brought together a team of more than 100 economists, financiers and public-health specialists to calculate the cost and discuss the best methods for delivering basic healthcare to 2.5 billion poor people ("The Health of Nations," 2001, ¶ 3). The team concluded that, by 2007, it would take an annual investment of approximately $160 billion in health care. The $160 billion would buy various essential medical goods, and various disease prevention items such as insecticide-treated bed-nets to decrease cases of malaria. The money would also pay for setting up local networks of health centers and community services across the countries most lacking in healthcare infrastructure ("The Health of Nations," 2001, ¶ 4).
Efforts to create local networks and health centers indicate that organizations such as the UN or the WHO are approaching health problems with a collective, social approach, which seems the best approach, though this has been problematic. In 1976, the Office of the High Commissioner for Human Rights established the International Covenant on Economic, Social and Cultural Rights (ICESCR), and Article 12 of that international Covenant recognizes "the right of everyone to the enjoyment of the highest attainable standard of physical and mental health". This particular clause has been difficult to enforce upon sovereign nations for various reasons, but Meir (2007) argues that essentially, Article 12 has been used to inadvertently place individual rights in opposition to community or social rights. Meir writes:
…in pressing for the highest attainable standard for each individual, the right to health has been ineffective in compelling states to address burgeoning inequalities in underlying determinants of health, focusing on individual medical treatments at the expense of public health systems (Meir, 2007, p. 545).
Economic growth in China, India, and East Asia resulted in the number of people worldwide living on less that $1 a day being cut by 50 percent in 2008, eight years after the establishment of the MDGs in 2000. Additionally, significant achievements were made in fighting poverty in Brazil and Benin. Other poor countries have experienced varying success in their efforts to implement economic and health policies related to the MDGs.
The Effects of Neoliberalism
Meir's distinction between individual and collective rights actually points out a larger context, what may be predominant sociopolitical and economic paradigms that are at odds with creating the best...
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