Tuesday, February 19, 2008

The poverty-health conundrum

Economists, development aid agencies and national statistics bureaus define poverty according to income and wealth. But simply put, poverty is the absence of opportunity and choices. Poverty is a day by day, hand to mouth existence that defies planning, saving and investment.

In the 1960s, many developmental economists believed in the "vicious cycle of poverty" theory, which argued poverty in the developing world prevented accumulation of domestic savings. Low savings resulted in low domestic investment and low investment was seen as the main impediment to rapid economic growth

Poverty is a constellation of difficulties that amplify one another: not just poor soils but low crop yields, hunger and malnutrition, not just low just unemployment and low wages but also low education and lack of skills, insufficient savings and lack of assets, not just lack of access to health services but lack of clean water and poor sanitation for households and whole communities.

Kenya’s first President Jomo Kenyatta declared “War on Poverty, disease and illiteracy” 45 years ago. But progress stalled immediately thereafter: corruption and ethnic patronage produced political disciples and civil servants baptized in the spirit of “what have you done for yourself?”

Today we see little islands of prosperity in a vast ocean of poverty and misery. We have elected to explain regional disparities using unhelpful and patronizing ethnic stereotypes that obstruct honest and dispassionate public discourse and concerted action.

Living in or near poverty is a form of socio-economic exclusion from the larger society. The disparities in income and livelihood outcomes are much greater than it was 45 years ago, because incomes have risen in real terms while the official poverty line has not.

Poverty is essentially the absence of basic services (especially health and education), opportunity and growth. We must begin to see the poor not as lazy but as undercapitalized and unsupported entrepreneurs. They are in large part victims of what Paul Farmer, a physician-anthropologist at Harvard Medical School, calls structural violence, which determines the nature and distribution of extreme suffering.

Proponents of aid believe that the poor cannot create wealth. Proponents of aid believe that the poor cannot create wealth. Hence the need, they argue, to give aid. Opponents of argue that bureaucratic approaches of aid planners have never ended poverty and never will.

We need to step away from the straightforward absolutes on both ends of the aid dispute, and instead seek to better understand why and where aid works or does not work. This is the essential starting point for figuring out how to make it work even better.

A coalition of local entrepreneurs, NGOs, multinational companies, foundations, aid agencies, and governments can create a market-oriented ecosystem, providing poor people with skills, technology, information, credit, infrastructure, and markets necessary for sustainable development.

An evolutionary perspective can help to clarify the meaning of sustainable development. Sustainability can be viewed as the capacity to differentiate, select and maintain adaptive capability. Development is the process of providing services, creating growth and maintaining opportunity. Hence Sustainable development is the goal of fostering adaptive capabilities, creating growth and maintaining opportunities.

Alleviating poverty through wealth creation is essentially an evolutionary process. It proceeds through differentiation of local solutions, selection according to a criterion of fitness, and amplification or scaling up of successful practices and innovations to the next level. Hence creating growth and maintaining opportunity. In this context, fitness can be viewed as value-adding economic transformations and transactions that produce goods and services that meet the needs of the poor.

The poor are encumbered by an inordinate burden of disease. There is no room in a free market for the poor. Market-Based Medicine can cater to the needs of the chronically ill who often suffer from endemic diseases such as malaria, acute lower respiratory tract infections, diarrheal diseases, measles, tuberculosis and HIV/AIDS.

The notion of poverty traps greatly limits the potential of pure market solutions to tackle poverty. The poorest populations in Kenya rely disproportionately on the natural resource base, ecological capital, on which agricultural productivity depends. A distressingly large proportion of the poor suffer chronic rather than transitory poverty.

The poor are trapped in a state of perpetual hunger, malnutrition, chronic illness, vulnerability due to poor asset endowments and market failures, especially for capital, that preclude their efficient investment in or use of productive assets.

Securing population health transition process, consisting of falling death rates from infectious diseases especially in infancy and early childhood, resulting in a greater proportion surviving to old age has been associated invariably, with the processes of economic, social and technological change, and improvements in environmental quality.

Children often suffer disproportionately from the burden of poverty. For instance, mortality in children under 5 years in urban slums is 2·5-fold higher than in other urban districts and 1·5-fold higher than the national average.

Poor children, wasted by hunger and malnutrition, crippled by disease, trapped in failing schools, have limited chances of receiving a solid education, gaining a decent wage employment, and providing a better future for their own children are severely compromised.

The first UN Millennium Development Goal is to eradicate extreme poverty and hunger, and the second is to ensure that all children complete primary schooling. Improving early child development is clearly an important step to reaching these goals.

The sole quantitative environmental target in the Millennium Development Goals is the call to “reduce by half the proportion of people without sustainable access to safe drinking water.” A key rationale for this goal is the impact of poor quality water on human health, particularly on diarrheal disease, which kills 2 million poor children.

Early childhood development is affected by psychosocial, biological and genetic factors. However, poverty and its attendant problems such as malnutrition constitute significant risk factors.

Millions of children under the age of 5 years in developing countries are exposed to multiple risks, including poverty, malnutrition, poor health, and unsanitary home environments, which detrimentally affect their cognitive and social emotional development.

National statistics on young children’s cognitive or social emotional development are not available in Kenya like in most sub-Saharan African countries. This information dearth contributes to the invisibility of the problem of impaired cognitive development in early childhood.

According to neuroscientists, a majority of children growing up in very poor families with low social status experience unhealthy levels of stress hormones, which impair their neural development. Such disadvantaged children are likely to do poorly in school and subsequently have low incomes, high fertility, and provide poor care for their children, thus contributing to the intergenerational transmission of poverty.

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