Poor and in Poor Health

At the time of Gwatkin’s publication, the World Bank had set the world poverty line at about $1.00 USD a day. This defined line contained about ¼ of the world’s population in this category–no small number. On a smaller scale we have what is called “relative poverty”. This concept essentially sets an income amount to live decently or it uses an arbitrary reference point to a country’s per capita income. For example, the paper mentions that in the U.K., more than one-quarter of the population lives on less than ½ the country’s average per capita income. How exactly does this all relate to health? Historically, health hasn’t truly been a front runner in determining conditions of poverty. Instead, health care and health services were considered “social service suggestions” that would help improve lives of the poor. This concept makes health seem like a concept only available to those who are rich enough to afford it or poor enough to have a group come establish (hopefully) a way to provide health care cheaply.

When speaking on the inequalities present in health availability and quality, the traditional view is to look at income or economic status to determine health state. What this basically implies is that quality of health can be generalized based on income alone; if you’re rich, your health is fine, if you’re very poor, your health is terrible. This has an “over-smoothing” effect on real world numbers by simply averaging out to get a sort of middle ground view. Clearly, the economic dimension is not the only important factor in determining health inequality. Gwatkin cites several other factors, including: gender, ethnicity, education, and occupation—some of which we discussed in class. One could argue that it is a travesty to allow for the existence of poverty, and this is a social justice issue in and of itself. The complete eradication of poverty is an enormous undertaking, and so we must focus on what can be done here and now. What Gwatkin says is that if we work to improve the quality of life for the poor, we may actually see a trickle up of benefits from this development of more efficient health care and health services.
As we know, though, there are many different approaches to solving the same problem. Differences in the approach to health of the poor versus reduction of inequality versus health equity shouldn’t be allowed to cloud what is generally held to be the one common goal—health for all. The current focus has been on trying to improve health system efficiency to improve health for everyone. Gwatkin feels this is in conflict with what most people would want which is the idea that reform needs to come in the way of equitable systems that reach the poor rather than large systems to reach everyone. The takeaway can really be simplified into the fact that no one CHOOSES poverty, and the cyclic nature of it makes it very hard to exercise any free agency over our health. By addressing the structural roadblocks faced by the poor, we can begin opening those pathways to a healthier life.

Below is the link to the paper used for this post. I highly recommend reading it, despite how “dated” it is. It’s a pretty quick read, and it’s bee translated into Spanish if you feel like really testing yourself. 🙂

Gwatkin 2000 WHO paper


Kaylin Brodzki


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