Poverty and poor health seem to go hand in hand. Not only are the poor disproportionately affected by infectious and non-infectious diseases alike, but they are also excluded from the very treatments which could save or significantly improve their lives. Lack of treatment, poor nutrition and poor living conditions increase the severity of each individual illness and fuel contagion between individuals. Diseases like polio, tuberculosis and rickets, which are practically unknown in rich areas, are common in poorer areas. Here in India, for example, where an estimated 8.5 million people are living with active tuberculosis disease (30% of the world’s total), 99% of TB patients live below the poverty line.
Countless studies have shown the two-way causal relationship between poverty and poor health. We could cite study after study examining the ways in which poverty causes poor health, and for each of those we could cite another which shows how poor health leads to increased poverty. But instead, we will turn to a few examples which we have seen in our work with people living in the Yerwada slum. Of course, we have changed the names to respect the privacy of those involved.
Radha is 8 years old and is in the first grade. She’s friendly, energetic and intelligent, but education has been a struggle for her. As an orphan, she lives in a one-room house made of corrugated steel with her aunt, uncle and five cousins. Her aunt works long hours in the market selling second-hand clothing, and as the oldest child, Radha does much of the housework – cleaning, washing and looking after her young cousins. When someone falls ill, she must stay out of school to care for them and pick up any slack in the household. Without basic literacy gained in school, she is unlikely to do anything but marry young and follow her aunt into the used clothing market.
Pooja, aged 9, lives in a two-room house with sixteen other people. Her father, who has tested positive for active tuberculosis disease for at least two years, has been on and off treatment because of his alcoholism and thus has developed multi-drug resistant tuberculosis. He has now been consistently treated for three months with all five first-line tuberculosis medications (rifampicin, isoniazid, ethambutol, pyrazinamide and streptomycin) and his health has only deteriorated. Pooja, who tested positive for tuberculosis a few months ago, is waiting to start her treatment until she knows she will not simply be reinfected by her father.
Amit is 3 years old, but is still not walking. He is weak, frequently sick and generally “failing to thrive”. The doctors have said he has rickets and anemia, but his mother is unable to afford the vitamin supplements he needs to grow and develop normally.
What these examples hopefully vividly show is that poverty feeds and in turn is fed by poor health. The individuals and families that we work with on a daily basis are unhealthy because they are poor, and they are poor because they are unhealthy.
The urban setting for our work poses a number of special challenges. Most striking is the overcrowding. Houses are small, usually consisting of one room, and rarely containing more than two. Families are large and extended, including three (and sometimes four) generations, totaling often between fifteen and twenty people. These fifteen people sleep, eat, cook and live in the two rooms, and the entire adult community shares a public toilet constructed (but not regularly maintained) by the municipal government. Consequently, diseases which are spread easily in overcrowded conditions predominate: tuberculosis, scabies and intestinal parasites. Houses are connected to their neighbors, and the seemingly chaotic lanes and staircases provide children with ample opportunities for hide-and-seek, but also lead to a staggering number of accidents caused by falls from the roof.
For all of the above reasons, we believe that health care and health education is more important for the impoverished than for any other group. Our health-related work in the slum is structured along the same lines as our work in our residential program. We believe that it is important to address the deeper causes of disease and poverty, but that building towards a better future should not preclude us from alleviating suffering in the present. As we believe that every individual is deserving of adequate healthcare, no matter what their income, there is no set limit on our services. Rather, we are committed to pursuing treatment for each issue until it is satisfactorily resolved or managed. Our health program also seeks to address many of the other factors – socio-economic exclusion, illiteracy and lack of effective state-sponsored social services – which have led to the poor health outcomes that we see every day. We lead health education and literacy courses (the latter at the explicit request of many of the women we work for), encourage the education of children from the community through our educational outreach program, and work with local health-related governmental programs and non-governmental organizations in order to encourage more effective coordination and delivery of programs.
Our health outreach programs strive to complement our educational outreach and residential programs. In all three, the goal is to ultimately break the cycle of extreme poverty which gives rise to street children who in turn raise more street children. Through a concerted effort by all parts of society, we can eliminate many of the reasons that children are forced out of schools and onto the street and see a day when all children are able to grow to their full potential.
Gopi et al (2005). “Estimation of burden of tuberculosis in India for the year 2000”. Indian Journal of Medicine. 122 (September): 243-8.
UNFPA (2007). State of the World’s Population 2007: Unleashing the Potential of Urban Growth. New York: United Nations Population Fund.
The Global Fund. “Tuberculosis in India”. http://www.theglobalfund.org/en/in_action/india/tb1/