Health and Economic Development

This article summarizes statistics and conditions relating to disease, poverty, healthcare, and economic development around the world; it also examines research and opinions about the interrelationship between poverty, diseases, and healthcare systems. The relationship between economic strife and the spread of disease is illustrated through case studies. The article also discusses the efforts of governments and organizations to improve the living conditions and health of poor populations around the world and explores philosophical and economic issues in the field of healthcare and poverty. The main reasons that global efforts are being hindered are examined and suggestions for improving global efforts are offered.

Keywords Commission on Macroeconomics and Health; Female Sex Workers (FSWs); HIV/AIDS; International Covenant on Economic, Social and Cultural Rights (ICESCR); Millennium Development Goals (MDGs); Neoliberalism; Office of the High Commissioner for Human Rights; Realizing Rights: the Ethical Globalization Initiative; UNAIDS; World Health organization (WHO)

Sociology of Health & Medicine < Health & Economic Development

Overview

The Relationship between Poverty & Health

At a 2008 meeting held in New York, health officials from the United Nations presented various statistics on global health and poverty. They projected that there will be 360 million poor people in sub-Saharan Africa by 2015 (Schineller, 2008, p. 5). Because there is a strong correlation between extreme poverty and poor healthcare, these figures also signify that hundreds of millions of people will be affected by diseases and illnesses in the early twenty-first century. Some of the worst diseases, including malaria and AIDS, are concentrated in the poorest countries around the world. According to statistics from UNAIDS (a joint United Nations program), as of 2012 there were approximately 35.3 million men, women, and children living with HIV worldwide. This is up from 29.4 million in 2001. The percentage of people ages fifteen to forty-nine infected with HIV worldwide was estimated at 0.8 percent in 2012.

Dabbagh et al. et al. argue that the relationships among the various causes and effects of poverty and the spread of HIV/AIDS were not well considered in traditional intervention programs. The suggest that HIV interventions have largely ignored "the correlation of poverty, the social dynamics of marginalization, and the lack of political commitment in creating economic reform and sustainable human development" (Dabbagh et al., 2008, p. 51). Dabbagh et al. is not alone in believing that disease intervention often ignores the factors that actually cause the problem. Many other experts have made comparable arguments. Jere-Malanda (2008) observes that healthcare improvement in places experiencing widespread poverty "requires tackling the root causes of poverty." Jere-Malanda lists economic factors as a major cause for widespread poverty; arguing that "crippling foreign debts, unfair trade rules, as well as Western-backed stifling economic policies" all have adverse effects on the state of people's health in countries throughout Africa (Jere-Malanda, 2008, p. 56).

The Continuing Spread of AIDS

A good example of the relationship between poverty and disease can be seen in Africa and Asia. Dabbagh et al. observes that in Thailand — as well as Africa and South East Asia — husbands and fathers are forced to migrate to cities in search of work. However, they frequently have difficulty securing gainful employment, or for other reasons do not give enough economic support to the women and children they have left in the villages, and this in turn causes the migration of their wives and daughters to the cities. Women and young girls often find work, and are often pressured to work, as female sex workers (FSWs) in the cities. In some impoverished rural communities, the sex trade is the most viable option for women to support their families. Dabbagh et al. cites several studies that indicate "rural-urban migration, limited employment opportunities, and increased poverty in rural communities" has caused a dramatic increase in FSWs in China, India, Thailand, and in countries throughout Africa. Because FSWs in developing countries are usually the poor and uneducated, they have few or no other economic opportunities, and they are often exploited by wealthy brothel owners, and by clients who either force them or pay more for not using condoms. The result is a widespread increase in cases of AIDS. Dabbagh et al. also observes that "in some sub-Indian caste cultures, the oldest daughter is expected to economically support her family and often with the family's approval seeks employment in commercial sex”(Dabbagh et al., 2008, p. 53). But there are many other ways in which poverty and dire social circumstances are behind the spread of illness, disease, and death.

Jha (2004) makes additional observations about the interrelationship of poverty, poor health, and global insecurity. Jha points out that an inadequate supply of food, poor sanitary systems, and crowded living conditions all combine with weak healthcare to make poor people around the world highly susceptible to disease. Jha also notes that "HIV/AIDS is on its way to killing several hundred million people in Africa, China, India and elsewhere. Of the annual toll of 5 million babies who die in the first month of life, 98% live in poor countries" (p. 66). Further, 1.5 million people dies of tuberculosis annually and malaria kills another 1 million. All of these deaths can be directly attributed to living in conditions of abject poverty (Jha, 2004).

Increasing Poverty

Most economists have long accepted the idea that poverty causes poor health, but "economists have only recently begun to show that disease leads to poverty" ("The Health of Nations," 2001, ¶ 7). Although there is a reciprocal relationship between poverty and poor health, though the idea that ill-health causes poverty has been to substantiate ("The Health of Nations," 2001). Poverty can lead to increased prevalence of diseases such as AIDS, but other studies are designed to examine the dynamic between healthcare and poverty from the opposite angle. Krishna (2006) carried out a lengthy study and compared their results with many other studies that were carried out in various nations around the globe, and their findings present a clear warning on the dangers of disease coupled with inadequate healthcare systems. Krishna arrives at the conclusion that "in many places, more families are falling into poverty than are being lifted out" (p. 62).

However, Krishna's research leads to a surprising conclusion. The study reports that the biggest reason for families sinking into poverty around the world is because of poor healthcare systems and the debt of paying for family illness or disease: "tracking thousands of households in five separate countries, my colleagues and I found that health and healthcare expenses are the leading cause for people's reversal of fortune" (Krishna, 2006, p. 62). Thus, as Jha (2004) points out, poverty causes ill health, but ill health also causes poverty. This leads Jha to write, "arguably, one of the most effective instruments in the fight against global poverty is the control of major diseases" (p. 66). Disease control allows for better health in a community; it also allows people to earn more income and greatly increase the potential for higher education, which in turn raises personal income even more. Jha writes, "improving health status helps the poor to better withstand economic downturns and protects households from sliding into poverty as a result of catastrophic medical bills" (Jha, 2004, p. 66).

Further Insights

Global Efforts

In 2000, the United Nations unveiled the Millennium Development Goals (MDGs), designed to address the problems of global poverty and disease. The basic goals were to:

• End extreme poverty and hunger;
• Achieve universal free primary education;
• Encourage gender equality and empower women;
• Lower the child mortality rate;
• Improve maternal health;
• Fight H.I.V./AIDS, malaria and other diseases;
• Promote environmental sustainability
• Develop a global partnership for development.

Schineller (2008) writes that "these are the eight ambitious yet attainable Millennium Development Goals (MDGs) that 189 U.N. member states agreed in 2000 to try to achieve by the year 2015" (Schineller, 2008, p.5). At that end of the year 2000, the WHO Commission on Macroeconomics and Health brought together a team of more than 100 economists, financiers and public-health specialists to calculate the cost and discuss the best methods for delivering basic healthcare to 2.5 billion poor people ("The Health of Nations," 2001, ¶ 3). The team concluded that, by 2007, it would take an annual investment of approximately $160 billion in health care. The $160 billion would buy various essential medical goods, and various disease prevention items such as insecticide-treated bed-nets to decrease cases of malaria. The money would also pay for setting up local networks of health centers and community services across the countries most lacking in healthcare infrastructure ("The Health of Nations," 2001, ¶ 4).

Efforts to create local networks and health centers indicate that organizations such as the UN or the WHO are approaching health problems with a collective, social approach, which seems the best approach, though this has been problematic. In 1976, the Office of the High Commissioner for Human Rights established the International Covenant on Economic, Social and Cultural Rights (ICESCR), and Article 12 of that international Covenant recognizes "the right of everyone to the enjoyment of the highest attainable standard of physical and mental health". This particular clause has been difficult to enforce upon sovereign nations for various reasons, but Meir (2007) argues that essentially, Article 12 has been used to inadvertently place individual rights in opposition to community or social rights. Meir writes:

Economic growth in China, India, and East Asia resulted in the number of people worldwide living on less that $1 a day being cut by 50 percent in 2008, eight years after the establishment of the MDGs in 2000. Additionally, significant achievements were made in fighting poverty in Brazil and Benin. Other poor countries have experienced varying success in their efforts to implement economic and health policies related to the MDGs.

The Effects of Neoliberalism

Meir's distinction between individual and collective rights actually points out a larger context, what may be predominant sociopolitical and economic paradigms that are at odds with creating the best healthcare system for an entire society. Individual rights may not be the same as rights for all, or may not achieve the same end. Meir uses this argument to point out that a social concept of healthcare for all could be hindered by a neoliberal capitalist concept of an unfettered market economy that is essentially based on profit margins from each consumer. Meir argues that the neoliberal free market paradigm "undermines the supply of public goods, crippling public health systems and diminishing their ability to prevent disease and promote health" (2007, p. 547). He also observes that, since this economic model has been the force behind globalization, "tension persists between the philosophy of neoliberalism, emphasizing the self-interest of market-based economics, and the philosophy of social justice that sees collective responsibility and benefit as the prime social goal" (Meir, 2007, p. 547). This may be especially true in the "emerging markets" of developing countries.

We should clearly recognize the difference between a market economy's consumer-based preference for healthcare, and what Meir refers to as a "social medicine vision of public health". Meir argues that a social medicine approach protects entire societies by bridging many disciplines and agencies so as to "address the collective causes of health and disease". Meir concludes that a social medicine approach to health seeks "not just the highest attainable standard of health for each individual, but the widest distribution of health benefits throughout society" (Meir, 2007, p. 547). The argument implies that, if healthcare is left up to market forces, then most likely the rich will have good healthcare while the poor — a group that is apparently increasing around the world — will continue to face all the worst health threats without receiving adequate healthcare.

Ethics & Global Healthcare

If we were to examine the reasons that Mary Robinson (the first female President of Ireland, serving from 1990 to 1997, and the United Nations High Commissioner for Human Rights, from 1997 to 2002) resigned as High Commissioner, we would find a frustrating quagmire of politics preventing effective delivery of improvements to the poor of the world (Burkeman, 2002). Upon stepping down, Ms. Robinson immediately founded and headed up the organization Realizing Rights: the Ethical Globalization Initiative. In a recent interview, she was asked why ethics need to be applied to healthcare, and she replied,

It may be that Meir is correct, and the neoliberal free market economy, which is pushing globalization, is indeed ignoring the poor since they do not have money from which business can profit. Robinson's "holistic approach" thus indicates an emphasis on the "social medicine vision of public health" that Meir proposes as superior in addressing widespread disease and poverty. Meir also makes the observation that "globalization's societal impacts to public health implicate collective responses to health dilemmas" (p. 551). Since societies are fundamentally part of the problem that creates health pandemics like HIV/AIDS, it makes sense to use "a societal-level analysis and action." Meir writes that, "such a societal framework for health necessitates a collective right to public health, obligating states to address the systematic and social conditions that underlie disease" (Meir, 2007, p. 551).

A Holistic Approach

Indeed, if we look at countries where the battle against AIDS is succeeding, there is a holistic social approach for preventing and treating entire communities. For example, in Cambodia well-organized efforts by the Cambodian Ministry of Health with non-governmental organizations targeting FSWs has succeeded in decreasing HIV infections. According to Dabbagh et al. (2008), "research results indicate that the increase in consistent condom use among FSWs with clients from 53.4% in 1998 to 91.7 % in 2003 is the main cause for the reductions" (p. 54). Before the government implemented a nationwide program, men were transmitting the infections to their wives, partners, and children (through maternal transmission) at an alarming rate, but a well-organized public health initiative caused a dramatic reduction in the incidence of HIV infections (Dabbagh et al., 2008, p. 54). This indicates that government has an important role in organizing national efforts at improving disease prevention and healthcare, a role that business and the private sector are neither interested nor well equipped to tackle.

Still, Dabbagh et al. also recognizes that interventions focused on only increasing condom use are not viable solutions for the long term because such programs "neglect the multidimensional aspects of poverty and behavior." However, a more encompassing solution is again something that a free market may not create on its own, meaning government initiatives and policies could remove the underlying causes as well. Dabbagh et al. argues that there is "a lack of political will and commitment in supporting initiatives created to improve and sustain human development." They conclude that, in poor countries around the world, social programs need to be developed to focus on improving the economic conditions and welfare of the population in general and women in particular since such programs would decrease behaviors that are driven by economics. Some of these solutions, such as increasing educational opportunities, are often ignored because they are indirect in their relationship to solving problems of health and poverty, but they are actually the better long-term solutions (Dabbagh et al., 2008, p. 55).

Issues

Obstructions to Progress

Schineller (2008) points out "three key factors" that are hindering the progress of improving health among the world's poorest: warfare, economic downturn, and the food crisis. Wars break up societies and are also very costly. Jeffrey D. Sachs, head of the U.N. Millennium Project, explained in an interview that "the U.S. military spends $1.9 billion every single day. Over five years, $1.5 billion dollars could provide mosquito net coverage to prevent malaria in all of Africa" (cited in Schineller. 2008, p. 5). Of course, wars in Africa also disrupt societies and cause more poverty and disease, meaning war obstructs progress in more than one way.

Economic downturns also obstruct progress. Wealthier countries cannot contribute to poorer countries when economic turmoil is causing middle-class citizens to lose their homes and/or jobs. Furthermore, there are quite enough American citizens who are either facing poverty from illness-related debt, or they are one illness away from losing their economic security. Globally, rising costs also relate to the third obstruction that Schineller lists, the alarming rise in the price of food all over the world. The rising cost of food in recent years "threatens to undo the gains achieved so far in fighting hunger and malnutrition" (Schineller, 2008, p. 5).

Schineller points out yet another factor that seems no less a hindrance than what he calls the "three key factors," and that is the problem of unstable and corrupt governments. Governments need to "integrate the goals into their national development planning and ensure that funds go to the intended recipients." The author notes that, in many African countries, crises such as starvation are compounded by corrupt governments that in effect prey on their citizens rather than help them (Schineller, 2008, p. 5). However, as pointed out in the article The Health of Nations, even well intentioned governments in some poor countries may lack the ability, for various reasons, to initiate a well-organized and well-implemented healthcare program ("The Health of Nations," 2001, ¶ 11). That is probably why the U.N. has recently decided to work more on establishing a network of local healthcare centers in some of these countries that lack healthcare infrastructure.

Creating a Workable System

The last goal of the Millenium Project is to "develop a global partnership for development." This may be the most critical part to attaining the other goals, and is the focus of work that Mary Robinson and others are working on through various foundations. Branston, Rubini, Sugden and Wilson (2006) suggest that a new economic model that he calls a "Health Industry Model" needs to be seriously contemplated so as to incorporate all the elements that comprise a successful national healthcare system. Branston's argument is that a health industry "is in a sense like any other industrial sector and that therefore needs analysing as such." Branston et al. then breaks down the basic components as such: "the providers of healthcare; financing bodies; and the manufacturers of healthcare products." Between these basic components are:

When creating a workable healthcare system, Branston et al. argues that there are other important considerations that may be unique to each society, and that any healthcare system should allow people, as a community, "to participate fully in the democratic economic development of the locality" (p. 306). The system should identify specific objectives that allow economic development in each specific locality. The system should also analyze and work at the most effective objectives of economic development that might help the locality, and these objectives should be determined democratically rather than allowing the decisions to be made according to corporate objectives or other interests that may not be best for the entire community. Branston gives examples that some of these objectives "might include job satisfaction, success in international trade and the promotion of high-technology industry" (Branston, 2006, p. 306). The main point seems to be that a society should approach healthcare with Meir's "social medicine vision," but it should take into account all components of a healthcare system, and try to benefit both business and society.

Business, Politics & Healthcare

Businesses can contribute much to solving healthcare problems, if they are incorporated into the larger system. For example, the South African mining company Anglo American, has interfaced with the healthcare system to provide employees with HIV-AIDS treatment. The company estimated "that 23 percent of its workforce in Southern Africa was HIV positive, adding US$5 to US$6 an ounce to its cost of gold production and US$3 an ounce to its cost of platinum production" (Branston, 2006, p. 311). The management realized that providing treatment to its employees would create an economic benefit to the company by extending the lives of infected employees (Branston, 2006). This is why Schineller believes that the solution to global healthcare will require "partnership among national leaders, corporations and private individuals." (Schineller, 2008, p. 5).

In June 2012, the United Nations Conference on Sustainable Development was held in Rio de Janerio, Brazil. The conference put in place initiatives to formulate the Sustainable Development Goals (SDGs)—the series of policy initiatives aimed at alleviating poverty and disease worldwide that will take the place of the MDGs in 2015.

Terms & Concepts

Commission on Macroeconomics and Health (CMH): A special commission that operates within the World Health Organization. Launched by WHO Director-General Dr. Gro Harlem Brundtland and chaired by Professor Jeffrey Sachs, the commission is charged with identifying any links between macroeconomic issues and health as well as estimating the costs of healthcare policies and programs.

Female Sex Workers (FSWs): Women who engage in prostitution. FSWs in poor countries often come from rural areas, are uneducated, and are at high risk of HIV/AIDS infection.

HIV/AIDS: The human immunodeficiency virus (HIV) is a virus transmitted through direct contact of a mucous membrane or bloodstream with a bodily fluid containing the virus, such a blood, semen, vaginal fluid, preseminal fluid, or breast milk. It weakens the body's immune system and comprises its ability to fight off certain types of infections and cancers that are rarely found in people with healthy immune systems. Acquired immune deficiency syndrome (AIDS) is the last stage of HIV infection. People with AIDS have severely compromised immune systems and display these "opportunistic" infections.

International Covenant on Economic, Social and Cultural Rights (ICESCR): A multilateral treaty adopted by the United Nations General Assembly. It has been in force since 1976 and commits participating state and non-state parties to seeking to secure economic, social, and cultural rights for people everywhere. The UN Committee on Economic, Social and Cultural Rights oversees the covenant.

Millennium Development Goals (MDGs): Adopted in 2000, the millennium development goals are eight international development goals that 189 United Nations member states have pledged to achieve by 2015. The goals include: ending extreme poverty and hunger, lowering child mortality rates, fighting epidemics like HIV/AIDS, and creating a global partnership for development.

Neoliberalism: Is a label referring to the recent reemergence of economic liberalism among political and economic scholars and policy-makers. Its supporters and proponents are influenced by neoclassical theories of economics and libertarian political philosophies and usually describe themselves simply as "economic liberals."

Office of the High Commissioner for Human Rights: Established in 1993, the Office of the High Commissioner for Human Rights is a United Nations agency that seeks to foster and uphold the human rights affirmed by the Universal Declaration of Human Rights of 1948 and protected by international law. Directed by the High Commissioner for Human Rights, the office oversees human rights activities in UN member states as well as the Human Rights Council in Geneva, Switzerland.

Sustainable Development Goals (SDGs) Initiated at the 2012 United Nations Conference of Sustainable Development in Rio de Janeiro, Brazil, the SDGs are a series of health and economic goals that will take the place of the Millennium Development Goals (MDGs) in 2015.

UNAIDS: A joint United Nations program designed to prevent the spread of HIV/AIDS, and improve treatment of those who have contracted the disease. UNAIDS asserts that the HIV/AIDS is an epidemic and "global emergency." It was created to meet the Millennium Development Goal of reversing the spread of HIV/AIDS by 2015.

World Health Organization (WHO): The agency responsible for overseeing the United Nations' health initiatives. It directs and coordinates health research, standards, policy, and technical support.

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Dabbagh, L., Torabi M. & Heiftje, K. (2008). The impact of rural migration, poverty, and weakened global economies on the continued rise in HIV transmission rates. Health Education Monograph Series, 25, 51-57. Retrieved September 13, 2008 from EBSCO online database Education Research Complete: http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=32818731&site=ehost-live

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Jere-Malanda, R. (2008). Confronting Africa's health crisis. New African; 471: 56-60. Retrieved September 14, 2008 from EBSCO online database Academic Search Premier: http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=31216782&site=ehost-live

Jha, P., Stirling B. & Slutsky A. (2004). Weapons of mass salvation: Canada's role in improving the health of the global poor. CMAJ: Canadian Medical Association Journal, 170 , 66-67. Retrieved September 14, 2008 from EBSCO online database Academic Search Premier: http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=11786895&site=ehost-live

Krishna, A. (2006). Reversal of fortune. Foreign Policy, 154: 62-63. Retrieved September 14, 2008 from EBSCO online database Academic Search Premier: http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=20878445&site=ehost-live

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Ovie Ejumudo, K. (2013). Managing the Development / Environment Dilemma The Global Challenge. Journal Of Development Alternatives & Area Studies, 32(1/2), 5-24. Retrieved November 15, 2013 from EBSCO online database SocINDEX with Full Text:http://search.ebscohost.com/login.aspx?direct=true&db=sih&AN=88992520&site=ehost-live

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Suggested Reading

Ford, O. (2008). IBM says hope for healthcare lies in EHRs and prevention. Medical Device Daily, 12, 1-9. Retrieved September 14, 2008 from EBSCO online database Academic Search Complete: http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=32671438&site=ehost-live

Jere-Malanda, R. (2008). How China is speaking in figures. New African, 471: 22. Retrieved September 14, 2008 from EBSCO online database Academic Search Premier: http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=31216782&site=ehost-live

Milakovich, M. (2008). Globalization and public administration. Public Administration, 5: 10-15. Retrieved September 12, 2008 from EBSCO online database Business Source Complete: http://search.ebscohost.com/login.aspx?direct=true&db=bth&AN=32767057&site=ehost-live

Okunade, A. (2005). Analysis and implications of the determinants of healthcare expenditure in African countries. Health Care Management Science, 8, 267-276. Retrieved September 14, 2008 from EBSCO online database Business Source Premier: http://search.ebscohost.com/login.aspx?direct=true&db=buh&AN=19169031&site=ehost-live

Opinion. (2006). Beijing Review, 49, 4. Retrieved September 12, 2008 from EBSCO online database Academic Search Premier: http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=22941840&site=ehost-live

Stage fright: The risks and benefits of moving forward. (2006). Pharmaceutical Technology; 30: 86-89. Retrieved September 14, 2008 from EBSCO online database Business Source Premier: http://search.ebscohost.com/login.aspx?direct=true&db=buh&AN=22533678&site=ehost-live

Venkatesh, R. & Jayachandran, S. (2008). Globalization and industry competitiveness in healthcare services and marketing. ICFAI Journal of Marketing Management, 7: 15-24. Retrieved September 14, 2008 from EBSCO online database Business Source Complete: http://search.ebscohost.com/login.aspx?direct=true&db=bth&AN=31198231&site=ehost-live

Wild, R. (2006). Global healthcare. Financial Planning, 36, 101-104. Retrieved September 14, 2008 from EBSCO online database Business Source Premier: http://search.ebscohost.com/login.aspx?direct=true&db=buh&AN=23005063&site=ehost-live

Wilkins, K., & Enghel, F. (2013). The privatization of development through global communication industries: Living Proof?. Media, Culture & Society, 35, 165-181. doi:10.1177/0163443712468606 Retrieved November 15, 2013 from EBSCO online database SocINDEX with Full Text:http://search.ebscohost.com/login.aspx?direct=true&db=sih&AN=86050362&site=ehost-live