Poverty and disease are stuck in an ongoing, vicious relationship. One goes a long way towards intensifying the other with studies demonstrating that infection rates of certain diseases are highest in regions where poverty is rife.
According to the World Bank, an estimated 1.2 billion live in extreme poverty (defined as those who live on less than 1,25 USD per day) worldwide. Running parallel to statistics about global poverty are statistics about infectious diseases. Terms such as “neglected tropical diseases” and “infectious diseases of poverty” are employed to define a number of infectious diseases more commonly found in areas where poverty is high. This list includes widely recognised diseases such as HIV/AIDS, malaria and tuberculosis as well as lesser-known ailments such as dengue, chagas disease and foodborne trematode infections.
The relationship between poverty and diseases is emphatically intertwined however we paint with too broad a brush when we generalise that infection rates go down as poverty declines. This trend is not a given and spikes in infection rates do occur when disastrous events take place such as natural disasters or the outbreak of conflict.
The Chicken and the Egg
A common train of thought is that poverty is a driving force behind poor health and disease. While certainly not disputable, that fact reflects only one side of the argument and does not take into account the nuanced links between poverty and health. The fact of the matter is that the relationship between poverty and health is inextricably linked, presenting a chicken-an-egg situation where one seemingly exists, in part, because of the other.
The Global Report for Research on Infectious Diseases of Poverty (put together by the European Commission, the World Health Organization and TDR) offers a clear rationale of this relationship “Poverty creates conditions that favour the spread of infectious diseases and prevents affected populations from obtaining adequate access to prevention and care. Ultimately, these diseases...disproportionately affect people living in poor or marginalised communities. Social, economic and biological factors interact to drive a vicious cycle of poverty and disease from which, for many people, there is no escape.“
In short, poverty is instrumental in cultivating conditions that allow disease to spread. In turn, infectious diseases exacerbate certain factors that contribute to poverty. In many parts of the world, healthcare is not free nor is it cheap, placing huge financial stress on families who may already live under the poverty line. Potential job losses and/or time off work due to illness or injury add to monetary burdens and have an adverse affect on economic development while children who lose their parents to infectious diseases face an increased risk of being exploited.
One study released in late 2012 highlights the interdependent nature of poverty and disease, analysing the negative impact of infectious and parasitic diseases on economic development.
The study also adds a third factor into this argument, taking into account the role that biodiversity plays in this area by noting that a lack of proper maintenance of natural flora and fauna led to an increase in cases of infectious diseases. Writing in the Public Library of Science Biology, the study’s authors state “Our model indicates that vector-borne and parasitic diseases (VBPDs) have systematically affected economic development. Importantly, we show that the burden of VBPDs is, in turn, determined by underlying ecological conditions. In particular, the model predicts that the burden of disease will rise as biodiversity falls.”
Furthermore, the study outlined that maintaining healthy biodiversity and thriving natural environment could help reduce the impact of parasitic and infectious diseases.
The Big Three: HIV/AIDS, Malaria and Tuberculosis
The three diseases mostly commonly linked to poverty—HIV/AIDS, Malaria and Tuberculosis—are the cause of six million deaths globally per year.
More than 40 million people across the globe are infected with HIV/AIDS. Over 90 percent of people living with HIV/AIDS are located in developing countries. Despite this, the link between HIV/AIDS and poverty is not as clear as with other diseases. One study found that in sub-Saharan Africa, wealthier people might be more at risk of infection than poorer people due, in part, to increased wealth leading to higher rates of mobility.
For a thorough anaylsis of HIV/AIDS throughout the world, head to the World Health Organization’s dedicated website.
Malaria is attributable to one million deaths globally per year and predominantly affects people in the world's poorer regions. India, Nigeria and Congo account for 40 percent of the world’s malaria cases while 90 percent of malaria deaths occur on the African continent. According to UNICEF "malaria is truly a disease of poverty — afflicting primarily the poor who tend to live in malaria-prone rural areas in poorly-constructed dwellings that offer few, if any, barriers against mosquitoes". The Center for Disease Control in the US estimates that around 12 billion USD is spent per year diagnosing and treating malaria while the Malaria Foundation states that economic loss due to malaria is around 1.3 percent per year in highly affected countries.
Tuberculosis results in around two million deaths per year, 98 percent of which occur in developing countries. People infected with HIV are incredibly susceptible to contracting tuberculosis (which is an airborne disease) due to the weakening of the immune system through the virus. Tuberculosis (TB) is one of the leading causes of death among HIV infected people in the developing world, accounting for about 13 percent of HIV-related deaths. There are cures available though recently there has been an increase in the number of people contracting drug-resistant forms of TB.
The three aforementioned diseases are widely recognised and receive a higher portion of funding to develop ways to tackle them however there are a string of lesser known diseases which also have a devastating impact upon impoverished populations. Diseases such as dengue fever, cysticercosis, toxocariasis, leishmaniasis and murine typhus are common in tropical areas while cases of Chagas disease are also being increasingly reported among the warmer, poorer southern states of the USA.
Diseases such as measles, other respiratory infections and diarrhoea are also strongly linked to poverty.
The Universal Healthcare Mandate and the Right to Safe Living Conditions
One contributing factor to the spread of disease is a lack of across-the-board healthcare. Factors such as socio-economic status and geographic location can impede upon a person’s ability to access healthcare. The UN Universal Declaration of Human Rights (1948) stipulates the right for everyone to have access to medical care when in need. As stated in Article 25 of the aforementioned treaty:
Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.
In the words of the World Health Organization, the right to health does not mean the right to be healthy. Rather, it means the right to live in an area where the State ensures sanitary, secure and beneficial living conditions designed to keep inhabitants as healthy as possible for as long as possible. According to the Global Report for Research on Infectious Diseases of Poverty, poverty-related circumstances such as “lack of food, shelter, security and social protection make people more vulnerable to infections, while affected populations are often unable to obtain even the most basic means of prevention and care.“ As such, the right to health mandate means ensuring access to clean drinking water, secure housing, sanitary disposal of waste and, of course, access to healthcare.
Key to bringing down rates of infectious diseases and lifting people out of poverty is education (UNESCO's handbook "Poverty and Education" provides good insight into the relationship between the two). Recognising the intrinsic link between health and economic development, the United Nations has specifically included tackling HIV/AIDS, malaria and other infectious diseases as one of its eight Millenium Development Goals.
Author: Anna Rees / RESET editorial. Last update January 2015
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