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Poverty is not merely the absence of money but the absence of resources to get the necessities of life. Poverty and health are always in a reciprocal relationship. This relation came to light in 1948 when the WHO defined health as complete physical, mental and social well-being. In 1987, the Alma Ata Declaration opened the discussion on health inequity. This opened the door for thousands of projects, proposals, and publications on this relation. Although the relationship between poverty and infectious diseases was clear, there was inequity in funding. The Global Fund invests US$ 4 billion annually for AIDS, tuberculosis, and Malaria, while other diseases lack funds. That is why they were considered neglected tropical diseases. However, the relationship between health and poverty is not limited to infectious diseases but includes noninfectious problems like malnutrition and injuries. In this chapter, we will assess the association between poverty as a predictor and health as an outcome.
Faculty of Medicine, Family and Community Medicine Department, Jazan University, Jazan, Saudi Arabia
Maged El-Setouhy
Faculty of Medicine, Family and Community Medicine Department, Jazan University, Jazan, Saudi Arabia
*Address all correspondence to: ahmadalqassim1407@gmail.com
1. Introduction
There are several definitions of poverty as a concept based on the context of the topic in which it is placed. During the World Summit on Social Development in Copenhagen in 1995, 117 countries adopted two concepts for poverty absolute and overall [1]. An ambitious global plan was proposed to eliminate absolute poverty and reduce overall poverty. Absolute poverty was defined as “a condition characterized by severe deprivation of basic human needs, including food, safe drinking water, sanitation facilities, health, shelter, education, and information. It depends not only on income but also on access to services.” On the other hand, overall poverty is a “lack of income and productive resources to ensure sustainable livelihoods; hunger and malnutrition; ill health; limited or lack of access to education and other basic services; increased morbidity and mortality from illness; homelessness and inadequate housing; unsafe environments and social discrimination and exclusion. It is also characterized by a lack of participation in decision-making and civil, social, and cultural life. It occurs in all countries: as mass poverty in many developing countries, pockets of poverty amid wealth in developed countries, loss of livelihoods as a result of economic recession, sudden poverty as a result of disaster or conflict, the poverty of low-wage workers, and the utter lack of people who fall outside family support systems, social institutions and safety nets.”.
Every country has its concept of poverty. However, the world bank defined poverty as “Poverty is a pronounced deprivation in well-being.” [2].
Traditional poverty is a lack of essential resources for basic needs such as hygienic food, water, clothing, and shelter. However, access to healthcare, education, and transportation might also be included as indicators of poverty in the modern world. In general, Poverty is a state in which a community or person lacks the Necessary needs for minimal standard of living in that place.
Each country has its own definition of poverty. The poverty line is substantially lower in poorer countries than in richer ones [3]. This means that if we were to only depend on national poverty criteria for a global measure of poverty, the outcome would be a measuring framework in which a person’s place of residence would decide whether or not they were poor. Setting global poverty lines based on national definitions and applying them globally is one solution to this issue. The global Poverty Line was determined in this manner by the United Nations. The global poverty line must be frequently adjusted to account for changes in worldwide price disparities. The new global poverty line was updated to $2.15 starting in the fall of 2022 [4]. Therefore, it is considered extreme poverty for someone to make less than $2.15 daily.
More than 689 million people rely on less than $1.9 per day, while 250 million are under the global poverty line [5]. Two-thirds of the world’s poor people are children and young, while women predominate in most areas [6]. Sub-Saharan Africa sees an increase in the concentration of extreme poverty, and about A little over 40% of the local population makes less than $1.90 each day [7]. Between 2015 and 2018, the Middle East and North Africa experienced a nearly doubling of the extreme poverty rate, from 3.8 to 7.2%, primarily due to the political conflicts in the area [8]. Between 2015 and 2018, the Middle East and North Africa experienced a nearly doubling of the extreme poverty rate, from 3.8 to 7.2%, primarily due to the political conflicts in the area [9]. Around 67% of the world’s poor people are predicted to live in unstable regions by 2030 [9]. In extreme poverty, 70% of adults over 15 either have no formal or minimal education. Around 1.3 billion people reside in 107 developing nations and experience poverty [10].
Globally, poverty and poor health are deeply associated [11]. Disparities in politics, society, and the economy are the underlying causes of poor health among millions worldwide. Poverty is both a cause and a consequence of poor health [12]. Infectious and neglected tropical diseases affect millions of the world’s poorest and most vulnerable individuals annually [13]. Poverty is a crucial contributor to poor health and a barrier to receiving necessary medical care [14]. Financial restrictions prevent poor people from acquiring the necessities for optimal health, such as enough quantity of high-quality food and medical care. However, the relationship is also linked to other aspects of poverty, such as a lack of knowledge about the best ways to promote health or a lack of a voice to ensure that social services are effective for them. Because they lack the knowledge, resources, or access to healthcare that would enable them to prevent and treat disease, marginalized groups and vulnerable individuals frequently suffer the most. Indigenous communities and other marginalized groups may have severe health repercussions due to reduced healthcare use due to cultural and social barriers, which maintain their extreme poverty levels [15]. Robust health systems protect populations from the potentially disastrous effects of out-of-pocket healthcare costs and enhance the entire population’s health status, especially the poor, who are more likely to experience poor health and limited access to healthcare [16]. In general, the poor are disproportionately more likely to have bad health [17].
Globally, the number of people suffering from extreme poverty, poor people living on less than $1.90 a day, decreased from 36% in 1990 to only 10% in 2015 [12]. For nearly 25 years, the number of poor people living on less than $1.90 a day has been steadily declining [18]. Unfortunately, this gradual improvement was halted in 2020 by the effects of the COVID-19 pandemic [19]. The COVID-19 pandemic has swept back decades of progress in the fight against poverty. According to the World Bank, the COVID-19 pandemic pushed between 143 and 163 million people in 2021 into extreme poverty [20]. Some countries have been affected more than others. We find that countries in South Asia and Sub-Saharan Africa have suffered from new waves of high extreme poverty rates, more than previously reported [21]. These large numbers of these “new poor” will be in addition to the already 1.3 billion poor people living in extreme poverty and experiencing exacerbated life difficulties in light of the COVID-19 pandemic [22]. Poverty rates are alarmingly high, especially in developing countries that are the most vulnerable to economic risks since the onset of the COVID-19 pandemic [23]. These devastating effects on developing countries are not just due to health crises but also because of the pandemic’s impact as a devastating social and economic crisis for the foreseeable future [24]. According to the United Nations Development Program, income losses are expected to exceed $220 billion in developing countries [12]. The world’s population without access to social protection is expected to reach an estimated 5% of people [25]. All this will lead to the repercussions of these losses affecting education, human rights, basic food security, and global nutrition. There is a light at the end of the tunnel due to the beginning of the recovery phase from the pandemic starting in 2022 [26]. This might contribute to returning to the right track in achieving sustainable development goals in many countries where poverty rates have risen to record numbers [12]. These record numbers caused mistrust of these countries in the current global sustainable development plans. The need has become urgent and intense to start taking actual steps by developed countries to reduce poverty rates by opening economic cooperation and transferring sufficient expertise to improve the economic environment for these countries.
As described above, poverty and ill health are mutually related as each affects the other. Infectious diseases are mostly related to poverty, so we will only consider them in this chapter. Aiming to integrate health with the plans to eradicate poverty, the World Health Organization developed the International Poverty and Health network in 1997. This network of people and organizations from business, health, governmental and non-governmental organizations worked on developing policies to improve the health of the poor populations worldwide [27].
Three years later, with the support of the Group of eight (G8) (Group of eight, namely the United States, Canada, the United Kingdom, France, Germany, Japan, Italy, and Russia), the global fund was declared to cover three diseases that appear as unstopped in different countries. The Global Fund invests US$ 4 billion annually for AIDS, Tuberculosis, and Malaria, while many other diseases lack funds for eradication or elimination.
That is why they were called neglected tropical diseases, mainly prevalent in the tropical and subtropical regions of Africa, Asia, and the Americas. However, they included a group of infectious diseases that are highly prevalent in these developing countries. These three events and declarations defined the diseases concerning poverty. But unfortunately, the first three Malaria, Tuberculosis, and HIV/AIDS were lucky to get the global fund, while others were neglected as defined.
To make it easy, we divided poverty-related diseases into two main groups those covered by the Global Fund and those considered neglected tropical diseases.
6.1 Diseases covered by the global fund
Replace the entirety of this text with the main body of your chapter. The body is where the author explains experiments, presents and interprets data of one’s research. Authors are free to decide how the main body will be structured. However, you are required to have at least one heading. Please ensure that either British or American English is used consistently in your chapter.
6.1.1 HIV/AIDS
After the death of the first known case of HIV/AIDS in Kinshasa (Belonging to Congo nowadays) in Africa in 1959, the disease spread to many other countries in the world as a global blood-born and sexually transmitted disease pandemic (Figures 1 and 2) (Table 1) [28]. The estimated number of globally infected people now is around 38 million [29]. The virus attacks the immune system with different manifestations of the disease ranging from the carrier state with no manifestations to severe immune-depression states and death. No standard curative treatment is known for the disease [30, 31, 32, 33]. That is why the patients’ early diagnosis, symptomatic treatment, and care help them to live longer. However, primary prevention is considered the cornerstone in preventing the spread of the disease [34, 35, 36].
This would describe the much higher prevalence of deaths from HIV/AIDS in developing countries compared to developed countries and even the higher deaths in the developed countries among poor people who have limited access to healthcare facilities [37, 38, 39, 40, 41, 42]. This fact is evident in maps 1 and 2 quoted from the WHO website 2017, especially compared to the extreme poverty presented earlier (Figure 3), where Africa carries the primary disease burden and deaths from the disease [43].
That is why the global health sector strategies (GHSSs) focus on HIV, viral hepatitis, and sexually transmitted infections for 2022–2030. The GHSSs guide the health sector in implementing strategically focused responses to end AIDS, viral hepatitis B and C, and sexually transmitted infections by 2030. This would be achieved through the synergistic work of different health sectors with the Primary Health Care (PHC) [44].
6.1.2 Malaria
Malaria is a vector-borne parasitic disease transmitted by anopheline mosquitos [45, 46]. The disease is caused mainly by four kinds of malaria parasites that can affect man. They are called Plasmodium (P) falciparum, P. vivax, P. oval, and P. malariae [47]. The estimated number of Malaria cases in 2020 was 241 million in 85 endemic countries. The global Malaria map (Figure 4) is nearly the same as the poverty map presented earlier. Malaria is mainly prevalent in poor countries [48]. Most Malaria cases (around 95%) are present in Africa [49]. Although most developed countries eliminated the disease, developing countries did not [50, 51].
The World Health Organization (WHO) launched the first Global Malaria Eradication Program (GMEP) in 1955 [52]. The program targeted The Americas, Europe, and Asia through spraying DDT and the use of chloroquine [53, 54]. However, most African countries were excluded due to logistical difficulties at that time (most of them were occupied by European countries) [55, 56]. However, in 1969, the WHO suspended this program after developing resistance to the treatment and the insecticides [57]. Malaria re-emerged in Europe in the 1990s, and the WHO launched the Roll Back Malaria program in 1998 using insecticides that impregnated bed nets and new cheap drugs [52, 58, 59, 60]. In 1987 Mosquirix vaccine was created against P. falciparum malaria and hepatitis B after great efforts and funds. The vaccine is now available in Europe for children aged 6 weeks to 17 months, but not yet for poor African children, although Africa carried all the burden of the vaccine’s clinical trials [61, 62, 63]. Although malaria is eradicated in the United States and most of the European countries, it is still highly prevalent in the poor countries of Africa [52].
6.1.3 Tuberculosis
Tuberculosis (TB) is one of the oldest diseases caused by tubercle bacilli. It is a disease in poor people and countries. It is highly prevalent in developing countries, as shown in the map compared with the poverty map [64, 65, 66, 67]. Despite all efforts to eradicate tuberculosis (TB), it remains a threat to global health (Figure 5). In the early 1920s, the BCG vaccine against tuberculosis was available. However, no universal global vaccination program has been adopted, and still, tuberculosis is responsible for millions of deaths [68]. Different lines of treatment were developed to eliminate the disease, as drug resistance developed for some medications used to treat the disease [69, 70]. However, Directly Observed Therapy (DOT) is still effective in many areas but in poor areas where direct observation of the therapy is impossible [71, 72, 73]. The concurrent infection with HIV in poor areas was a decisive factor hindering the disease treatment [74]. Poverty with overcrowding, inadequate housing, poor ventilation, and famines were all contributing factors to the disease’s continued among poor populations.
6.2 Neglected tropical diseases related to poverty
Neglected tropical diseases (NTDs) are affecting more than 1 billion propel. They are mainly diseases of poor populations in the tropical and subtropical areas [75, 76]. They are a group of 20 diseases as mentioned down:
Buruli ulcer
Chagas disease
Dengue and chikungunya
Dracunculiasis
Echinococcosis
Foodborne trematodiases
Human African trypanosomiasis
Leishmaniasis
Leprosy
Lymphatic filariasis
Rabies
Mycetoma, chromoblastomycosis and other deep mycoses
Onchocerciasis
Scabies and other ectoparasitoses
Schistosomiasis
Soil-transmitted helminthiases
Snakebite envenoming
Taeniasis and cysticercosis
Trachoma
Yaws
The NTDs are mainly diseases in developing countries, as shown in the maps of some of the NTDs down if compared to the map of poverty shown earlier in the chapter (Figure 6) [77, 78, 79, 80, 81, 82, 83, 84]. However, due to a lack of funding, the WHO published a 2021 booklet as a road to end the NTDs by 2030 by integrating their prevention and control (Figure 7) [76].
As described above and with comparing the maps of the diseases described it is obvious that fighting poverty should be considered in preventing these diseases (Figure 8). Whatever we would do to prevent these diseases, they will continue affecting poor people till poverty is controlled (Figure 9).
Poverty is the economic condition in which the individual lacks sufficient income to obtain the minimum levels of food, clothing, healthcare, education, and all the needs necessary to secure a decent standard of life. The phenomenon of poverty in all countries of the world is considered an intractable problem. However, in developing countries, the significant increase in poverty rates is the problem. In addition, the COVID-19 pandemic has dramatically affected the increase in poverty rates, especially in developing countries.
Poverty affects health significantly in several directions. Malnutrition is when the poor suffer from the lack of food, and it may not be healthy if available. They also suffer from malnutrition, which makes children starve to death. The inability to access healthcare, as the poor cannot afford the healthcare expenses or buy the medications they need, is a considerable obstacle. Poverty is associated with a higher risk of diseases, epidemics, and early deaths. The relationship between poverty with health remains a deep-rooted relationship, no matter how researchers differ in determining who affects the other. Therefore, developed countries must increase the rates of economic cooperation and support the development of developing countries.
We would like to extend our sincere thanks to international and local organizations such as the United Nations, World Bank, and CDC for making valuable data and information available to researchers and supporting developing countries’ development process.
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Written By
Ahmad Alqassim and Maged El-Setouhy
Submitted: 21 September 2022Reviewed: 21 October 2022Published: 18 November 2022
Open access peer-reviewed chapter
