Poverty: A Killer Disease
Imprisoned in himself, locked into his artificial reserve, Omari* demands proofs. He is not satisfied with isolated statements. He has no confidence in half-truths, single stories, and politicians’ empty and unfulfilled promises. He is one of those people who have to be convinced. If we were compelled to hang a label on Omari, we should have to call him a poor man. This label is rightly pegged in a cloistered, withdrawn existence in which he has learned too soon to painfully accept his situation. A deplorable, stranded life that is profoundly moved by trifles. Omari is the crusader of inner life. He takes refuge in silence. Yet, he observes, and he is angry, too.
His anger has a strong contemporary echo. It is the silent scream of all those who toil in abject poverty simply to exist, and perhaps, to survive another day. This is not just any anger. It is the universal fury against poverty in general, and the sustained violations of the rights of a section of people who are poor. As such, it is an anger that is directed at a specific, long-term desire. The desire itself is grounded in self-consciousness that the situation might not change or improve in the foreseeable future after all.
But Omari has a more urgent and pressing thing at the moment: to get treatment to regain his normal health, after being injured at his place of work. The job itself was a precarious construction project, and workers were paid per day after a long day of hard labor. The only problem, however, is that he cannot afford to foot the hospital bill for surgery on his spinal cord, and he risks remaining disabled and poor for the rest of his life. It is the former that concerns him the most. This fact is further aggressed by the experiences of his other former co-workers who had found themselves in a similar situation before, and never got ‘back to their feet’ again. His lack of money and his status as a poor young man refuses the dim, deceiving echo of the ambition of any total recovery from his ordeal. The distant dream might finally grow into a haughty resignation.
There is another looming problem. Omari has to get better, go to work, get paid each day and provide for his family, without which they would have nothing to eat, the children might not go to school, and the cycle of poverty would inevitably continue. If the expression may be allowed, Omari is the lamb to be slaughtered. Having lived under the extreme ambivalence inherent in the lower social class in his own country, Omari has managed to achieve a grasp — unfortunately too harsh and too exhaustive — of the detrimental consequences of being poor. The intertwined relationship between low income and poor health can be summarized in the figure shown below:
Omari’s story foregrounds the plight of many young people who do not have as their purpose the formulation of a healthy outlook of the world; who have no striving toward the productiveness that is characteristic of a young, energetic generation. They are incapable of escaping their fate. Many young people, especially those who had a rough start in life, coming from poor families, have been humiliated in their most legitimate ambitions and stripped of any dignity that was left. The frustration they have suffered affects the very movement of their lives and the rhythm of their existence. At the extreme, their fundamental human rights have been denied. At any rate, these rights have been challenged based on the fact that they are poor.
Poverty can arguably set children on a lifelong trajectory of limited education and work opportunities, reduced productivity, and may also undermine their physical and mental health. Children who live in poverty are more likely to become impoverished adults and have poor children, leading to sustained intergenerational cycles of poverty. A 2017 report by the Kenya National Bureau of Statistics on Child Poverty in Kenya estimated that 45%, a whopping 9.5 million children in Kenya were severely deprived of 3 or more basic needs. Household poverty during childhood affects children in high-income countries too. In the United Kingdom (UK) specifically, a fifth of the population — 14 million people — are poor, and more than 4.3 million children are affected, with over 200,000 children falling into poverty between 2019 and 2020 alone, according to official government statistics. During his visit to the UK in November 2018, Professor Philip Alston, United Nations Special Rapporteur on extreme poverty and human rights, concluded in his report that “poverty in the UK is systemic and tragic”. In 1999, the then UK Prime Minister Tony Blair pledged to end child poverty by March 2020, and even though UK has advanced significantly, these gains are being undone, notably by the current Coronavirus (COVID-19) pandemic.
Professor Margaret Whitehead and colleagues’ editorial on Poverty, Health and COVID-19 published in BMJ is candid about the pandemic’s potential long-term economic impact on poor families, including further loss on future earnings and unemployment. They are articulate about the role of COVID-19 in amplifying the already existing inequalities. They assert that exposure, vulnerabilities, and social and economic consequences of the infection are unequal, and poorer communities living in poor quality housing, having precarious, low-paid jobs, and potentially with pre-existing illnesses, are relatively disproportionately affected. But although the pandemic is caused by a virus, the inequalities it generates have social causes. The Dahlgren and Whitehead ‘rainbow’ above throws light on the wider social determinants of health.
Poverty wields its destructive influence at every stage of human life, from the cradle to the grave. It conspires with the most deadly and painful diseases and health conditions to bring a wretched existence to all those who suffer from it. The poor are not only more likely to suffer, but, in the words of Paul Farmer, an American medical anthropologist, they are also more likely to have their suffering silenced. Understanding poverty is important for more than one reason. Let us have the courage to say it outright: Poverty exhibits an intimate relationship with inequalities. More specifically, the disparities in health in most counties are a result of systemic, avoidable, and unjust social and economic policies and practices that create barriers to opportunity. For instance in Kenya, the enjoyment of health as a public good remains a mirage — a wishful thinking — for poor people given the numerous challenges to access and affordability. The government’s National Health Insurance Fund, whose intention is to enable all Kenyans to access quality and affordable health services, has failed to adequately address the needs of vulnerable populations owing to service provider capitation issues and patients’ financial constraints. The low government investment has meant that poor people are underserved, their health needs not adequately met, hence leading to poor health, low productivity, and high rates of preventable morbidity and mortality. This conclusion brings us back to Omari’s struggles in life. His circumstances have forced him to play the chorus to poverty’s wrath, and he is barred from himself and from the opportunities around him. But let us not be misled: Omari and people like him might not have the will, knowledge, or ability to fight back these unjust and corrupt systems.
The figure shows disparities in life expectancy (LE) in different countries, emphasizing the importance of the geographical location of birth on health. For instance, in 2018, the World Bank approximated LE at birth at 66 years for those born in Kenya, 15 years less than those born in the UK. But even in high-income countries such as the UK, stack health inequalities exist. The Office for National Statistics provides a difference of 8.7 years in LE at birth between those born in more affluent Westminster, and more deprived areas such as Glasgow City. However, from the World Bank report, and from the map above, most Afrikan countries exhibit low LE at birth, with Nigeria, Chad, Sierra Leone, and Central African Republic showing the lowest LE at 54 years.
But when one approaches a problem as important as health inequalities and social injustices in any society, one should be doubly careful; and become aware of the root causes of those inequalities. The problem of poverty includes not only the interrelations of objective historical conditions but also inefficiencies and imminent corruption within the governments of the day. Governments, especially on the Afrikan continent, could ameliorate health inequalities that emanate from unjust systems and policies, and rectify the historical injustices to improve the living conditions of their people. After all, the corrupt people in governments that misappropriate taxpayers’ hard-earned money are in part motivated by their desire to put an end to a feeling of unsatisfaction; but checks and measures must be installed to remove such people from those leadership positions. What any taxpayer would want from their government is a commitment and a plan of action, including the use of legal instruments and structures to effectuate this. Sadly, most governments in Afrika have notably overlooked these proposals and instead went as far as protecting such individuals and/or institutions. It can be argued that what most governments ignore or reject, is that poverty is the root cause of preventable health inequalities, and that intentional developmental effort and progressive anti-poverty policies could completely rapidly transform the lives of the citizenry.
Actually, in the absolute sense, nothing stands in the way of effectuating such proposals. Nothing — except that those living in poverty lack the opportunities to agitate for it. It is estimated that the world’s 62 richest people own the same wealth as the 3.6 billion poorest people. Omari and other poor people across the globe, especially in the low and middle-income world, have become increasingly aware of such sharp disparities in access to high-quality health. The time is right to demand equality in a way that had never before been found necessary. Most people would agree that the equality they seek would have been beneficial before they started asking for it. Afterward, the governments and those in positions of power might prove inadequate to remedy these ills — for every gain in equality would make the remaining differences seem even more intolerable. This sudden realization instantly changes not only what could be understood as a political demand, but also shapes the very means by which its human agency is recognized. Some would also argue that this task, though daunting, is both urgent and feasible. But corrupt and ineffective governments that do not prioritize tackling poverty lack the advantage of being able to accomplish this task. Unfortunately for such governments, certain issues such as this have yet to acquire any meaningful importance in the national agenda.
It is legitimate to say that an enormous task confronts a young person who has begun by carefully examining the objectivity of these prejudices prevailing in societies. The next generation cannot and should not take pleasure in inheriting such unjust societies. Fundamentally, young people should, as the need arises, become aware of the potentials they have forbidden themselves, of the passivity they have paraded in just those situations in which what was needed was to hold oneself to the heart of the world; to interrupt if necessary the rhythm of the world, to upset the chain of command; and most assuredly, to stand up against injustices and malpractices that perpetuate poverty and exacerbate health inequalities and other inequalities that exist in society today. The profound desire is that they will seek to change, to evolve, and to challenge the system. As a first step, there is a need to tackle poverty and economic inequality, promote healthy development in early childhood, and equitably share power and resources, as these are the structural drivers of conditions affecting the daily lives of people like Omari.
Juma Omala was a 2017–2018 fellow. He is the founder of BoldStep Initiative, a community-based organization that aims to equip rural youth with the skills of prevention, management, and transformation of structures at the grassroots levels.
Global Health Corps (GHC) is a leadership development organization building the next generation of health equity leaders around the world. All GHC fellows, partners, and supporters are united in a common belief: health is a human right. There is a role for everyone in the movement for health equity. To learn more, visit our website and connect with us on Twitter/Instagram/Facebook.
