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Poverty and Health

The adverse effects of poverty on health are well documented and continue to be a major public health concern all over the world. Much of the early pioneering work in public health has its roots in the study of the health consequences of poverty. And, although poverty has long been known to cause numerous public health problems, billions of people globally continue to be affected by poverty. This entry examines the extent of poverty, its impact on health, methods for measuring poverty, and strategies for alleviating poverty and addressing the health needs of the poor.

Demographics

The World Bank estimated that in 2001, 2.7 billion people worldwide lived on less than $2 per day and more than a billion subsisted on less than $1 per day. Some regions, such as eastern and southern Asia, have seen reductions in extreme poverty (from a rate of 33% in 1990 to 14% in 2002 in eastern Asia and from 39% in 1990 to 31% in 2002 in southern Asia). Yet the percentage of persons living in extreme poverty has increased in some of the transition economies of southeastern Europe and many of the countries of the former Soviet Union (from 0.4% in both regions in 1990 to 1.8% and 2.5% in 2002, respectively). While Latin America and the Caribbean have seen marginal reductions in poverty rates, more than 47 million people continue to live in poverty in those regions. With more than 300 million people living in extreme poverty, sub-Saharan Africa continues to have the largest regional proportion of extreme poverty in the world.

While poverty is often a great concern for developing nations, poverty continues to affect developed nations as well. In the United States, the Census Bureau reported that in 2005, more than 12% of Americans were living in poverty (37.0 million people). Furthermore, poverty rates in the United States are higher for some racial/ethnic groups than for non-Hispanic whites. Nearly 25% of blacks, 25% of American Indian and Alaska Natives, and nearly 22% of Hispanics lived in poverty in 2005 in the United States, compared with 8.3% of non-Hispanic whites and 10.9% of Asians. Poverty rates vary widely by geographic areas within the country as well. For example, the proportion of persons in poverty for some areas of the United States is in excess of 40%, whereas other areas have poverty ratesoflessthan5%.

Poverty and Health Outcomes

Poverty has been shown to influence many health outcomes, including all-cause mortality, infectious diseases, chronic diseases, and health behaviors. Millions of people die from poverty-related diseases each year. Many of the diseases associated with poverty are infectious, such as tuberculosis, diarrheal illnesses, and malaria. Lack of appropriate health care, malnourishment, and disease are likely responsible for more than half a million childbirth-related deaths in women each year. However, with increased industrialization and globalization in developing nations, social and behavioral changes that lead to chronic diseases such as diabetes, hypertension, circulatory diseases, respiratory diseases, and cancer are being observed at higher rates. While these diseases affect persons of all socioeconomic strata, socioeconomic gradients in disease incidence, prevalence, treatment, and survival have been shown, most often revealing that poorer individuals have poorer health outcomes. Also, many risk factors for poor health outcomes are povertyrelated, such as substandard housing, environmental pollution, and lack of health insurance. While poverty contributes to the development of disease, there is likely a two-way relationship whereby illness also directly influences poverty due to lost wages and productivity, plus prohibitive health care costs for those without health insurance. Furthermore, people living in extreme poverty tend to have more frequent and severe disease complications and make greater demands on the health care system.

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