I tried to define and discuss poverty as a determinant factor to shape individual’s and communities’ health, and health care. Reviewing literature to support my argument I tried to analyse the consequences of poverty on health and health care. Because of word limitation I could only touch the key issues such as: Diet or nutrition, Housing pattern, Child mortality and Use of health care services.
“Poverty is the main reason why babies are not vaccinated, clean water and sanitations are not provided, curative and other treatments are unavailable and why a mother dies in childbirth.”(WHO 1995).
Poverty is a condition where the basic needs of humanbeings such as food, shelter clothing, couldnot met Poverty are of two type absolute poverty and relative poverty.
Townsend (1979) defines poverty as the lack of resources to obtain the types of diet, to participate in the activities and to have the customary living conditions and amenities, approved in the societies, which they belong. “Their resources are so seriously below those commanded by the average individual or family, that they are, in effect, excluded from ordinary living patterns, customs and activities.” Boyd-Orr (1937) observed the link between poor diet of lower income group and inadequate nutrition affects on the development of children.
“Furthermore, if all infants and children up to age 15 enjoyed the same survival chances as the children from class I and II,then over 3,000 death a year might be prevented.”(Whitehead 1992) Whitehead clearly the influence of poverty in health and health care.The socio-economic status of an individual life style is based on the economic infra structure.Life expectency is high among Ist class people in comparision toIV or V class.
The studies of different social classes revealed that the poor experienced more disease and illness than rich did. Poor people die younger, suffer from most chronic illness and killer disease than rich people, White et al., (1993). The life expectancies of the population in developed nations are higher than developing nations. (WHO, 1995)
We can not deny the influence of other factors such as the natural environment, war, drinking water, sanitation, genetics, climatic conditions, place of residence (rural and urban), and social factors, i.e.; family structure, child rearing practices, and education on health. Study supports the evidence that improved health has more to do with improved nutrition and wealth than with the development of medical science and other factors. (Sagan 1987).
Housing and health
Housing tenure is a powerful indicator of higher mortality and morbidity for both men and women.(Britton et al 1990)
Health and Life style Survey (Blaxter1990) found strong link between housing lacking basic amenities and overcrowded accomodation and poor health, Higher rates of disease and disability amongst every age group,above average levels of illnes and poor psycho-social health. Benzenal and Judge (1990)revealed significant correlation between over crowding, internal structural defect and poor health.
Benzenal and judge (1990) Hyndman, (1990); strachan (1986); Burr (1986); Hunt (1986) Rutter and Quine(1990) revealed significant correlation between over crowding and damp housing and increased levels of morbidity, in particular with asthma, respiratory disease, chest problems, depressions, diarrhoea, vomiting, higher rates of miscarriage and infant mortality. White et al (1993) demonstrated that height; blood pressure, body mass index and cardiovascular disorder vary with social class.Stocking (1987) Thegreatest risk to health fromelectricity is electrocution or fire causedby incorrectly installed or maintained equipment.
The Breadline Britain Survey conducred in 1983 and 1990 provided considerable evidences on the health gap between poor people and the rest of society.The survey found that poor people were 1.6 times more likely to suffer from longstanding illness, 5.4 times more likely to suffer from feeling isolated and 5.5 times more likely to feel depressed.
Homelessness and health
The adverse effects of homelessness on health have been well doccumented . Conway(1998) links the homeless women are twice as likely to have problem and three times as likely to need admissionduring pregnency as other women.. A quarter of babies born to mothers living in bed and breakfast accomodation are of low birth weight,compared with national average of less than 1 in 10. Poor sanitation and overcrowding encourage the spread of infections and diarrhoel illnesses. Good nutrition is almost impossible because of poor facilities for storing and cooking food.
Reasech on the outcome of pregnency amongest homeless and poorly housed women suggest the considerable influence of inadequate or deficient accomodation on health.
Primary care for the homeless
Doctors do not want to take on such problem families.The policies of government need of adrees to register with general practioner
Even if primary care could be arranged for homeless people the difficulties of access to inpatient services would remain.Hospital often hide behind the catchmant area restriction ,and homeless people can end up as no ones resposibility.Discharging homeless people from hospital is also difficult.
Whitehead (1987), Townsend (1979) supports the evidences that poverty creates stress and reduces individual ability, choices and support to solve problem.
The studies on G .P. consultation have shown the difference in G .P. responses to different social group. Higher social class patient received more explanation (time) voluntarily than did lower class patient. (Pendleton and Bochner 1980). Classes I and II patients are more likely to referred to specialist services by their G .P. than classes IV and V patients Blaxter (1984).
Evidences suggest that poverty determines the well-being of the population .It is major contributor to miscarriage, child mortality, cardiovascular disorder, high blood pressure, stress and mental illness; and is also an obstacle to use the health care services.