In what ways is childhood ill health related to poverty and inequality.

University Degree Subjects allied to Medicine

TMA 07 Alexandria Dyer

There are many definitions and dimensions concerning the ways in which poverty affects childhood. In order to alleviate poverty it must be defined, measured and studied to enable assistance to communities, families and culturally, in order to eradicate poverty. Poverty is an indicator of many other facets in which children live and endure adversity, it therefore becomes a necessary appeal for action.

To the majority of society poverty is defined as not having enough to eat, being homeless, enduring inadequate accommodation, becoming sick, not having the amenities or access to healthcare, not being able to go to school and have the basic rights of education withdrawn. Poverty is not being able to gain a standard education or being unable to read, being unemployed for a variety of reasons or fearing for the future of self and dependents as well as living one day at a time. Poverty is fear of losing a child to illness brought about by unclean water and suitable medical attention, living through environmental natural disasters, poverty is lack of representation and freedom and finally poverty is facing inequalities of gender, race and social economical policies and not overlooking the emotional and psychological stability of such external and internal circumstances.

Poverty and ill-health are issues for the poor and the rich alike, as it is inequalities such as narrowing the health gap in childhood and throughout life, amid socio economic groups and the most deprived areas and the rest of the world that increase the vulnerability of children and their life experiences from the growing demands of social equalities in respect of their ethnicity, gender, religion or language.

There are two views that can be drawn upon to understand childhood poverty they are absolute and relative poverty, these views define more of the causes of poverty such as ill health and explore the relationship between poverty itself and the social inequalities within families, communities and on a global level.

To example this area under discussion I will refer to the examples of Emma, eleven and Steven, fourteen.

“ Being poor is having no money and no house. Poverty means you cant buy new clothes. Tramps and homeless people are the poorest. They get ill because they are out in the cold. People who are starving are the worst of.”

(Changing Childhood, Pg 46)

It is clear from Emma’s definition of her encountered poverty that those who live in absolute poverty do not have access to the resources required to satisfy basic human material needs. It measures the absolute lack of measurable resources. Three quarters of the world's population live in countries suffering from widespread absolute poverty. The former World Bank President once described it as:

"A condition of life so degraded by disease, illiteracy, malnutrition and squalor as to deny its victims basic human necessities.... life at the very margin of physical existence." (UNICEF, 2000)

With such agencies as the World Bank and UNICEF, it has become possible to implement a measurable system of identifying who should be considered on the basis of absolute poverty, therefore a monetary figure is used to identify those on the poverty line.

Life is threatened without food, drink, warmth, shelter, clothing and good health, therefore it is calculated to be US $1 per day per person to suggest the minimum amount that is needed to produce the necessary basics of physical survival. A primary objective of development should be an extensive condition of basic foods, clean water, housing, clothing and health care. (Further examples of absolute poverty are illustrated in reading A, Ending child poverty; Fig 2; Pg 83-84)

Relative poverty is defined in more general terms as to households with an income below 50% of the median in the countries studied. (See reading A, Ending child poverty: Fig 2; Pg 83).

Relative poverty is measured on the basis of low standard of living and low income in comparison to the rest of society. Unlike absolute poverty it does not necessary involve the physical human necessities of shelter, nutrition and health that cannot be accumulated. Instead it creates a social inequality and exclusion for children, families and communities as it suggest the lack of access to many of the goods and services expected by the rest of a contemporary society.

Steven’s example illustrates how he views his situation in holistic comparison of others in his community.

“I live in a ...

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Steven’s example illustrates how he views his situation in holistic comparison of others in his community.

“I live in a housing co-op……The more well off kids call it the Ghetto………..When some of the kids in my class are going to a movie and ask me if I want to come, I have to say no because my mom doesn’t have enough money. That makes me feel deprived…… We cant afford juice and most of the time I feel hungry because there is not a large enough selection of food in our house……. I cant invite my friends for dinner because we can only afford to have soup or one thing lke salad, and the kids usually have soup, salad, and a main course with meat, and dessert.” (Baxter,1993, p.74)

Examples of lack of goods and services make children vulnerable to many more adversities by means of social inequality, measured by methods of comparison to that of others. It not only holds significance to the children’s physical implications, but also takes into consideration the emotional well being and stigma children deal with, in their communities in correlation to the widening gap between the richest and the poorest in society.

One in six of the developed world's children live in relative poverty that is, below the national poverty line in their country according to a new report from UNICEF.

The distinction between absolute and relative poverty are not exclusive to each other and can intensify interrelating concerns. Steven, Kelly and her sisters (Open University 2003) show perfect examples of interrelating issues as the family not only experience absolute poverty of no money to buy food, it goes further to describe the relative personal experiences of social effects experienced by the children. For example not having named clothing and footwear, drawing on the children’s emotion and psychological position.

As poverty cannot be defined in any certain terms, further study needs to be made in accordance to culture definitions in order to study the cultural trends, as this will vary from culture to culture and family to family.

Technique of such studies are the longitudinal studies, which provide research data regarding the different adversities that affect children positions in society as well as indicating the progress made of individuals and cultures. (Examples of these studies are illustrated in Chapter 3; Section 3; Pg 21-25)

Poverty is an issue of neither black nor white, emphasising an undefined area of grey, in which the majority of it’s disadvantaged are represented. As to a conclusive definition of poverty there cannot be one. For example taking the Southern countries in comparison to the North, deprivation is measured differently in accordance to a particular culture, tradition, spiritual and economic source. Families in the United Kingdom may consider poverty as not being able to give children what they desire for a birthday or Christmas etc.(see Chapter 2; Table 1 Necessities and necessities deprivation, Pg 53) Whereas in the South poverty is measured in terms of health and social status, spiritual, psychological emotional and even gender related, it goes further than being based on material poverty alone in which primary concerns are centred on the quality of life.

Gender relates to poverty, in must the same of other adversities. Poverty is generational, it is hard to break the lineage of poverty, if you are born into a poor family it is likely you will continue to be poor without the necessary provisions of healthcare, education and income, but having said this there are divisions of poverty within poverty. For example poverty can be subject to your place within the family first, second, third born or gender. It is evident in certain cultures that boys hold greater esteem to that of girls (see examples Chapter 3; Section 3.4 Pg 114-116 Health inequalities within families) this is due to the economic viability, in terms of the achievability a male child can bring into the family. For instance income, education and first child male status, boys will more likely be better fed than girls. Girls are secondary and devalued in terms of income, education and family, girls become a liability to the income expenditure of families (dowry on marriage can put a family in worst financial situation). Girls become the care givers for the family younger siblings and relations from a very early age, which makes them more vulnerable to ill health because of poor diets and hard work to that of boys therefore intensifying age and gender inequalities in communities.

Poverty and disease are inextricable, this can be illustrated by showing the relationship between poverty and health in many of the developing countries such as Africa, Brazil, India and even some of the richer countries including the United Kingdom. It is clear that the country with the lowest incidence of poverty has the lowest infant mortality rate. The infant mortality rate measures the number of deaths in the first year of life per 1000 live births. The country with the highest incidence of poverty has the highest infant mortality rate. (See Chapter 3, Section 1, Pg 94 for further evaluation of infant mortality).

Most of the illnesses associated with poverty are infectious diseases, such as diarrhoeal illness, malaria, and tuberculosis. All of them are associated with the lack of income, clean water and sanitation, food, and access to medical services and education, which characterise poor countries and communities. The diseases are linked to malnutrition and children are most susceptible to them (see Chapter 3 Fig 1). The environmental, social, and dietary changes produced by industrialisation and urbanisations are leading to higher rates of childhood illnesses such as respiratory and stress illnesses, diarrhoea between both the urban poor and not so poor.

There is in fact a two way relationship between poverty and ill health, with disease further impoverishing the poor. Illness as poverty is culturally defined, in terms of cultural beliefs and spiritual definition in which it prevents people from working, or affects their productivity, lowering their income. The costs of obtaining health care can also be substantial, both in terms of time off from work (medical centres usually in urban areas and is often a long distance from the household) and in terms of money spent on services, it is estimated that between 1990 and 1994, 21% of previously non-poor households in Bangladesh slipped into poverty as a result of health-related causes. (Refer to Chapter 3 Box 2; Open University 2003) Some countries have, however, managed to tackle the diseases of poverty even though they themselves remain at comparatively low levels of development. Some countries (notably some Indian state and China) have levels of life expectancy far above much richer developing countries. There are several reasons for the success of these poor countries in achieving good health at low levels of income. They include high levels of female literacy. Longitude studies have shown that the higher the proportion of educated girls in the population the better health indicators are. Women with better education are more likely to command higher incomes, take on board health education messages, and to demand better health care, all of which can have beneficial outcomes for themselves and their children. (Illustrations of gender inequalities are exampled in Chapter 3 Section 3.3 Pg 73-76) Income inequalities can also be represented as beneficial to those who are improvised, entitling the benefits of growth to be more evenly distributed, the poor will tend to gain more than the rich, reducing poverty (and the ill health associated with poverty) to a greater extent, government commitment to providing health, education, and social security services, and making them available to the poor and higher levels of public participation in political life. This has the effect of making government more responsive to the health and other needs of poor and vulnerable groups. As previously noted, countries in the South such as Bangladesh have made reductions, under extreme difficulty, but it is obvious to see that the World bank has achieved in helping the deduction of child morality by investing in a national obligation of cultural progression. (Refer to Chapter 3; Section 3.2; Pg 108-110)

The poor are disproportionately vulnerable to environmental hazards. Natural disasters like droughts, floods, fires and earthquakes increase poverty and hurt poor people by imposing human and economic costs, including loss of life, injuries, disabilities and displacement, as well as damage to agriculture, livestock, and infrastructure. The destruction of assets can trap poor families into chronic poverty.

Developing countries face the impact of natural disasters: between 1990 and 1998, 94% of the world’s major natural disasters took place in developing countries. Such countries have limited capacity to lessen the adverse effects of natural disasters. Additionally, social factors such as settlements in hazardous areas increase the vulnerability of the poor to disasters. The poor are unable to afford safer housing or better infrastructure, children are more at risk due to contaminated water, poor sanitation, as well as the carers of the children becoming ill or dying. ( See Chapter 1 Section 2 Adversities and Resilience Pg 6-7) Lessening vulnerability of the poor to disasters must focus on prevention, preparation, and mobilisation of resources. Resettlement, infrastructure, and neighbourhood improvement, diverse livelihood options and low cost local initiatives (like agricultural cooperatives, food banks, environmental conservation and reforestation) can reduce vulnerability.

On a collective level, natural resource use is affected by people’s level of income, the composition of their expenditure, and the distribution of income as reflected in inequality and poverty. The poorest countries are to a great degree reliance based subsistence economies, i.e. the rural poor, who form a high percentage of the population, make a living directly from their local environment. According to the World Summit in 1990, 75% of the world's poorest people live in rural areas, most of which make their living in farming or farm labour. Depleting environmental resources, ill defined property rights death of parent, illness of main earner, put a tremendous pressure on children from poor rural households as directly or indirectly children are constrained by their parents state of affairs, who then have to invest much more time and effort in fetching water, collecting fuel wood, cultivating crops, and other activities in order to survive. (Refer to the reading of Lek living in Thailand; Pg 61-62)

It is clear that the poor depend more directly on natural resources for their livelihoods (although the rich actually consume more natural resources). The reliance on natural resources can be categorised across four sections a) Survival of self and dependence, b) Income obtained from natural resource based products, c) Cost saving, for instance, use of medicinal plants and animal dung to use on the ill instead of attending medical centres with expensive Western medicine disciplines and d) Risk improvement, for instance simple dietary needs (living of the land) from the naturally available fruits and nuts and vegetables.

Traditional assumptions have often held poverty to be more a cause of environmental degradation rather than an effect. Indeed, some approaches not only place the blame of environmental degradation on developing countries on rapidly growing human populations, but also tend to emphasise with social eternities i.e. the depleting rain forests of Africa. This increases the social impact that exist between poverty and environment, in which poor people, facing immediate survival needs and with short time horizons, mine the very resources that underpin their daily livelihoods. Additionally, because of a lower threshold opportunity cost, they may endure lower levels of productivity and environmental quality than those who are better off and have access to alternative livelihoods. This can lead to higher resource depletion than would be the case if they had the choice to move on to alternative income generated method.

The global inequalities are manifested not only on a local level but also by means of a political agenda. Taking for example the macro economic factors that impact a whole nation and particularity children of that nation, by this measurement it is clear to identify that the trickle down effect of industrialisation clearly influence the state of poverty that children encounter direct and indirectly for instance the high taxes on goods from countries of the North, where the undeveloped country must retain status in trades to be able to compete with the rest of the world, which in turn filters down to the common people to find work for the minimum amount of wage in a competitive market, which leave children adverse to situations of contributing to the work force hindering their health due to poor working conditions and discontinuing any education they were receiving. A second example, which affects children indirectly for the benefit of the country, can be seen by the implementation of the structural adjustment programme (SAPs). (Refer to Chapter 3 Section 3Social inequalities between countries Pg 64-69)

Although the programme is to stabilise a countries economy and implement an infrastructure of control in the borrowing of funds it is one of the issues that subject children to poverty and illness by forfeiting such necessities as social welfare provisions or healthcare as it holds greater priority for a country to obtain social progression. This in turn allows the World Bank to imply an invisible hand in the provision of these countries without physically intervention in governmental issues as to the running of the county. (Referred reading Chapter 3; Section 3.1; Social inequalities Pg 64-72)

“Adam Smith wrote that a free society operates as if "an invisible hand" based on free trade, directs people's actions in such a way as to serve the interest of the whole society.”)

To conclude it is evident that children are unintended victims of consequence, specifically in terms to childhood illness, the undervalued concerns of social welfare provisions and health care. Childhood mortality, AIDS/HIV related diseases are issues that children of poorer countries face on a day to day basis and probably the most noticed of issues of concern for African and Asia countries on all levels of the family, community and global. The World Bank and structural adjustment programmes do not provide provisions for the children affected, it would appear it creates a greater rift of poverty as to the affordability of health service and education. The children affected will be no closer to social welfare or education for example as they will have to work for longer hours for the family to attain a reasonable income to afford the goods and services social progress aims to achieve and reduce the highly unequal distribution of wealth i.e. the richer families will be able to afford the better healthcare facilities in the urban areas and those in the rural areas will still experience the social inequalities. It stands for reason these are the risks children experience to improve wealth for the very poorest.