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Chapter 5. Our Socially Divided World: Poverty and the Burden of Disease
To be poor often means to be sick. Poverty and ill health are closely linked, and they tend to reinforce each other. Health is closely related to access to safe water, something that 1.1 billion people lack. Waterborne diseases claim more than 3 million lives each year, mostly as a result of dysentery and cholera. These and other waterborne diseases take their heaviest toll among children. Infant mortality in the affluent societies averages 6 per thousand; in the 48 poorest countries, it averages 100 per thousand, or nearly 17 times as high.26
Another reason for the close coupling of ill health and poverty is the lack of sanitation. Some 2.4 billion people live in villages or urban squatter settlements with no sanitary facilities at either the household or community level.27
Many of the world's poor lack knowledge of the basic principles of good hygiene. The poor and uneducated often do not understand the mechanisms of infectious disease transfer and thus cannot take steps to protect themselves. And people with immune systems weakened by hunger are more vulnerable to common infectious diseases. Poverty also means children are often not vaccinated for these routine diseases, even though the cost may be just pennies per child.28
Among the leading infectious diseases, malaria claims more than 1.1 million lives each year, 90 percent of them in Africa. The number who carry this disease and often suffer from it most of their lives is several times greater. Thousands of children die from malaria each day. Economists estimate that reduced worker productivity and other costs associated with malaria are cutting economic growth by a full percentage point in countries with heavily infected populations.29
Nowhere is the evidence that poverty begets disease and disease begets poverty more dramatically illustrated than with the HIV epidemic in Africa, as described earlier. In this case, we are now witnessing the spread of a fatal disease on a scale that is altering the future of a continent. In addition to the continuing handicaps of a lack of infrastructure and trained personnel, Africa must now contend with the adverse economic effects of the epidemic. AIDS has dramatically raised the dependency ratio—the number of young and elderly who depend on productive adults. This, in turn, makes it much more difficult for a society to save. Reduced savings means reduced investment and slower economic growth, or even decline.
The link between poverty and disease is a strong one, but one that has been broken for most of humanity by economic development. The challenge now is to eradicate this link for that remaining minority who do not have access to safe water, vaccines, education, and basic health care.
26. WHO and UNICEF, op. cit. note 3; Peter H. Gleick, Dirty Water: Estimated Deaths from Water-Related Diseases 2000-2020 (Oakland, CA: Pacific Institute, August 2002); PRB, op. cit. note 4.
27. WHO and UNICEF, op. cit. note 3.
28. Hunger as a risk factor for disease in WHO, World Health Report 2002 (Geneva: 2002), and in Majid Ezzati et al., "Selected Major Risk Factors and Global and Regional Burden of Disease," The Lancet, 30 October 2002, pp. 1-14.
29. WHO/UNICEF, The Africa Malaria Report 2003 (New York: 2003); Anne Platt McGinn, "Malaria's Lethal Grip Tightens," in Worldwatch Institute, Vital Signs 2001 (New York: W.W. Norton & Company, 2001), pp. 134-35.
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