Health and Poverty Reduction - Essay Example

Health and poverty reduction Apart from many challenges faced by the country in its efforts at poverty reduction, Pakistan also faces problems of poor health and nutrition among its population. Studies have shown that there is a direct link between poverty and ill health. Results from these studies at a micro level shows that “there is a very clear and very robust relationship between individual income and individual health. That is, poverty leads to lower health status” (Phipps, 2003). In other words, countries where poverty is rampant faces a double challenge, one being costs associated with poverty reduction, and the other being additional spending on improving the basic health and nutrition of its people. Pakistan is now facing a similar situation. Moreover, apart from the traditional causes of poor health, of which poverty is one reason, the steps taken towards modernity and industrializations are adding to the problems in this area. It is to the credit of Pakistan that there has been rapid industrialization over the years. But the problems associated with it pose new health issues too. One of the fallouts of industrialization in the country has been the rapid growth of cities which in turn has resulted in a shift of rural population to urban areas. According to Pappas, “the traditional health challenges of poverty, nutrition, and sanitation have remained for many in the country and have been compounded by increases in environmental and occupational problems associated with the rapid growth of cities and industries” (Pappas, 2008). Overcrowded living conditions, pollution, and other stress factors are now contributing to increased incidence of what is generally called lifestyle diseases. The new disease that is rising even among the poor includes cardiovascular diseases, diabetes, and cancer. Heavy rise in traffic has also resulted in hike of casualties from road accidents also. It is clear from what has been mentioned above that the link between poverty and health issues are a hindrance in the poverty reductions strategies and policies of a nation. This is because money spent on poverty reduction programs is only one of the issues that concern the population. Unless additional spending is done for improvement of basic health and sanitation in the country, most of the efforts for poverty reduction will remain ineffective. Focusing on improving health alone is also not feasible or practical. Even if a concerted effort is made through funding and social work for the improvement of health, unless the poverty issue is also addressed, efforts in this area will be wasted. This is because poverty will again bring down the quality of health and nutrition in the population. There is also a theory that advances in modern medicine and its resultant specializations have in fact negatively affected public health. This theory formed from the result of an influential study was first introduced in a book titled ‘Healing the schism: Epidemiology, Medicine and Public Health’ by Kerr White. The book is an “eloquent plea for the healing of the separation of epidemiology, medicine and public health. It traces the historical development of these subjects and describes how their tragic separation has occurred on both sides of the Atlantic” (Waters, 1993). This situation exists in Pakistan also according to Pappas et al mentioned above. This means that very little of advanced and specialized medicine is affordable to the poorer sections of the population. It is quite a serious concern since lifestyle diseases are on the rise in the country. In many cases, such diseases require advanced treatment which is not a part of public health policies. Unless there is a policy change that integrates health improvement policies with poverty reduction and community development programs, the situation will remain the same. Any improvement in health will be curtailed by poverty. It can be argued that a strong drive to reduce poverty will bring about better living standards and as a result improved health. But other issues like incidence of lifestyle diseases still remain. The high cost of treating such diseases will ultimately drain the resources of a family, bringing them back under the poverty line once again. This is a vicious circle and one issue cannot be effectively tackled unless the other one is also taken up in a serious way. The only option is to take both health and poverty issues together. But this creates additional problems for the government due to increased funding for both programs. The situation with primary health care itself is an area of concern in Pakistan. As Muhamud states: “In Pakistan there is a vast gap between the desired public health vision and the current health status indicators, attributable mainly to inadequate funding and inability to deliver a comprehensive package of essential primary health care (PHC) interventions to the poorer segments of society” (Mohamud). The situation at the time of writing the report from which the above quote was taken was so bad that children could not be saved from easily preventable method like oral rehydration to combat the effects of diarrhea. But the report adds that the situation is beginning to improve with programs like the Basic Development Needs (BDN) imitative introduced by the government in conjunction and help of the World Health Organization As suggested above regarding an integrated approach, the BDN initiative too follows a similar strategy. The initiative is in line with Millennium Development Goals, the poverty reduction policies, and the Devolution plan. It is to the credit of the government that an integrated approach linking and poverty reduction is taken. The main area of difference with regard to the BDN initiative is that the local community is also involved in this process. This area was thought to be the sole responsibility of the Health Department, but has changed perceptions since the introduction of this initiative. Some of the steps seen in this initiative are mentioned here. In the villages where this was implemented, village development committees have been set up to oversee the implementation of the whole program. Individuals referred to as cluster representatives have been appointed and are in charge of a fixed number of households. Since women cannot be attended by male volunteers unless it is a qualified physician, Lady Health Workers and village based women volunteers are also appointed. This is primarily targeted at the basic health needs of women and they use the facilities provided by local health centers at the grassroots level. The following table illustrates areas of similarities between the objectives of the BDN initiatives and the Millennium Development Goals in the country. Millennium Development Goals BDN Interventions Goal 1 Eradicate extreme poverty and hunger Promoting Small Scale Micro-credit income generating interventions targeting poorer households. Goal 2 Achieve universal primary education Supporting the development of public sector and/or community managed co-financed primary education and literacy activities with focus on girls’ enrolment. Goal 3 Promote gender equality and empower women Establishing women vocational training centers that promote participatory skills, teach home health care, impart handicraft skills to create income-generating opportunities and the launching of female literacy activities Goal 4 Reduce child mortality Promoting a home health care PHC package of essential interventions i.e. Immunizations against vaccine preventable diseases, nutrition education through growth monitoring, and management of diarrhoea, ARI, reproductive health etc. Goal 5 Improve maternal health Implementation of Home Health Care through community based LHWs and women health volunteers at the village level, TT immunization, antenatal, peri-natal and postnatal care, nutritional counselling, management of anaemia and child spacing and referral for emergency obstetric care. Goal 6 Combat HIV/AIDS, malaria and other diseases Health promotion for awareness creation through community based advocacy with improved tuberculosis case detection and management through DOTS, Malaria control through the promotion of impregnated mosquito bed nets, early diagnosis and standard prompt treatment, and prevention and management of other common locally endemic diseases Goal7 Ensure environmental sustainability (safe water supply) Provision of safe drinking water through installation of deep wells or hand pumps and capturing and storage of spring water for community use, construction of overhead tanks, and water supply pipes managed and maintained by the community and promotion of construction of household latrines. Goal 8 Develop a Global Partnership for Development Building community partnerships promoted by local village organizations i.e. village development committees, community based elected representatives, Citizen Community Boards (CCBs) and supported by national and international Non-Governmental Organiza-tions (NGOs), UN agencies, and district and provincial governments, and health departments and Ministry of Health. Source: Mohamud The challenges are many, but the initial results are encouraging. The country can develop its integrated approach by more such initiatives like the BDN which will go a long way in eradication of poverty and bringing about vast improvements in the overall health and nutritional standards of its population. The report of the WHO indicates that the country has a long way to go with regard to poverty alleviation and health. The life expectancy is only 62 and 63 of men and women respectively. Child mortality (of children dying before 15 years of age) is 97 per 1000 births. The biggest concern is that the government spending on public health comes to only 2% of GDP (World Health Organization: Pakistan). One of the effective ways to improve the health sector in Pakistan is to ensure private sector participation: “In the majority of most poor and middle-income countries - even the most aid dependant - the biggest source of finance in the health sector is out of pocket expenditure (OOP). This finance is mainly spent in the private sector” (Private Sector Participation in Health). Effective private sector participation that includes corporate, health personnel and private hospitals, charities and even individuals can also help in the integrated development of health and reduction in poverty. Some initiatives like the Aga Khan Foundation (and University) do exist. More efforts in the area will augment of efforts of the government and the community. Research question: Challenges to health and education in Pakistan with special reference to attainment of targets set by the Millennium Development Goals of the United Nations and the policies of the Government of Pakistan. Limitations: The study uses only secondary and not primary data. Although utmost care has been taken to source data from reputed journals, government sources, and non-profit organizations (like the WHO and UN), bias or inaccuracies may inadvertently creep in. Any fault in the data has not been verified with primary investigation. The data made available has not been with regard to 2008. In most instances, the data has been more than two years old. But this is not seen as major drawback since demographics in a region will not usually undergo any rapid change within such a short time. Bibliography Mohamud, Khalif Bile. [Online]. The Basic Development Needs Integrated Approach: Working together for Health and Poverty Reduction in underprivileged rural and urban settings. Global forum for Health. Last Accessed 23 March 2009 at: http://www.globalforumhealth.org/Forum8/Forum8-CDROM/Posters/Khalif Bile M F8-479.doc Pappas G, Glasser JH, Akhter M & Nayanil PB (2008). [online]. Healing the Schism: Medicine and Public Health in Pakistan. Education for Health, 21 (1). Last Accessed 23 March 2009 at: http://www.educationforhealth.net/publishedarticles/article_print_173.pdf Phipps, Shelley (June 2003). The Impact of Poverty on Health: A Scan of Research. [online]. Literature. Canadian Institute for Health Information. Last Accessed 23 March 2009 at: http://dsp-psd.communication.gc.ca/Collection/H118-11-2003-1E.pdf Private Sector Participation in Health (November 2004). [online]. Institute for Health Sector Development, London, United Kingdom. Last Accessed 23 March 2009 at: http://www.hlspinstitute.org/files/project/15043/PSPhealth3.pdf Waters, W E (1993). [online]. Healing the Schism: Epidemiology, Medicine, and the Public’s Health. J Epidemiol Community Health. Last Accessed 23 March 2009 at: http://jech.bmj.com/cgi/reprint/47/4/338-a.pdf World Health Organization: Pakistan (2009). WHO. Last Accessed 23 March 2009 at: http://www.who.int/countries/pak/en/ Read More