Sweeping changes in public health have transformed life over the past century. On average, people live longer, healthier lives than ever before. Even so, this past century's revolution in human health and well-being is incomplete. For people living on less than US$1 per day - and according to the World Bank there are more than 1 billion of them - health services and modern medicines are still out of reach. Moreover, many initiatives to improve the health of people in extreme poverty have been unsuccessful. A forthcoming Population Reference Bureau publication, "Improving the Health of the World's Poorest People," delves into the poor-rich health divide and what can be done to shrink it.
Poverty and health
The Poor-Rich Health Divide
The potential of school-based WASH programming to support children as agents of change in rural Zambian households
Winter J C; Darmstadt G L; Lee S J; Davis J: BMC Public Health 21:1812, 1-13, 2021
Water, sanitation, and hygiene (WASH) interventions frequently assume that students who learn positive WASH behaviours will disseminate this information to their families. School-based programs rely on students to act as “agents of change” to translate impact from school to home. The authors conducted a quasi-experimental, prospective cohort study in 12 schools in rural, southern Zambia to assess this with students in grades 1–4, using in-person interviews with students, their teachers and caregivers. Student knowledge increased significantly, but primarily among students in grade 1. Students reporting sharing messages from the intervention with caregivers rose from 7% to 23%, particularly in students in grade 4. The authors propose that future work should prioritize developing curricula that reflect the variability in needs, capabilities and support in the home and community among primary school students rather than applying a single approach for a wide range of ages and contexts.
The Power of 'Know-Who': Adaptation to Climate Change in a Changing Humanitarian Landscape in Isiolo, Kenya
Mosberg M; Nyukuri E; Naess L: IDS Bulletin 48(4), doi: 10.19088/1968-2017.154, 2016
This article examines adaptation to climate change in view of changing humanitarian approaches in Isiolo County, Kenya. While humanitarian actors are increasingly integrating climate change in their international and national-level strategies, less is known about how this plays out at sub-national levels, which is key to tracking whether and how short-term assistance can support long-term adaptation. The article suggests that increasing attention to resilience and adaptation among humanitarian actors may not lead to reduced vulnerability because resources tend to be captured through existing power structures, directed by who you know and your place in the social hierarchy. In turn, this sustains rather than challenges the marginalisation processes that cause vulnerability to climate shocks and stressors. The article highlights the important role of power and politics both in channelling resources and determining outcomes.
The Problem of Handwashing and Paying for Water in South Africa
Haffajee F, Chopra M, Sanders D: Municipal Services Project, Occasional Paper 13
Water-related diseases are widely recognised as a major threat to public health, especially in the developing world. An estimated 19% of all infectious diseases are related to water, sanitation and hygiene risk factors. In South Africa the provision of basic infrastructure such as water and sanitation has been an important part of the social contract between the government and its constituencies. In 2001 the government became a partner in the Water, Sanitation and Hygiene for All (WASH) campaign, which was designed to attract resources to address the situation of millions of people without access to adequate water supply and sanitation. In Johannesburg, a privately managed parastatal was contracted to deliver water and associated services in the city. As part of their water service delivery and improvement of services, the company opted to deliver services using prepaid water meters and yard taps. But do households respond differently to hygiene and handwashing interventions such as WASH depending on which water and payment systems they have? This paper explores that question.
The problem or the solution? Early fertility and parenthood in the transition to adulthood in Khayelitsha, South Africa
Swartz A; Christopher C; Harrison A: Reproductive Health Matters 16(32), doi: https://doi.org/10.1080/09688080.2018.1537417, 2018
This article draws on ethnographic data collected between 2014 and early 2016 with young adults (17-25 years) in Town Two, Khayelitsha. Participant observation was the primary data collection method. Narratives and experiences of 15 young people are presented here. The authors argue that in addition to immediate fertility desires, young people’s contraceptive decision-making was significantly shaped by gendered ideals and social norms. Young women’s fertility operated as both an aspiration and a threat within partnerships. Some couples partially achieved relationship stability or longevity through having a child. Entering parenthood in the context of a seemingly stable relationship was perceived as a movement towards an accepted, albeit tenuous, form of social adulthood. Although living up to the ideal of good parent was challenging, it was partially achieved by young mothers who provided care and young fathers who provided financially for children. The authors argue that in the absence of other accepted markers of transition to adulthood and within a context of deprivation and exclusion, early fertility, though clearly a public health problem, can become a solution to social circumstances.
The Prospects and Politics of Social Protection Reform in Zambia
Kuss MK: Institute of Development Studies Working Paper 453, April 2015
This paper analyses the prospects for social protection reform in Zambia under the ‘pro-poor’ government of the Patriotic Front (PF). The paper argues that the PF has been changing the development policy arena in ways that may modify domestic political structures providing more rights-based benefits especially for the extreme poor and vulnerable. It further argues that the persistence of the clientelistic dynamics of state-society relations and weak civil society organisations inhibit the expression of demands for formal social protection by poor people. It concludes that because the social protection reform is supply -, rather than demand-driven, its progress depends on the extent to which the government is motivated to sustain the provision of social protection in the long-run.
The scandal of poor peoples diseases
Pambazuka News
People with AIDS all over the world are fortunate to have fellow sufferers in America and Europe, says this New York Times article. "In poor countries as well, it helps that AIDS strikes all social classes. Brazil would never have become the first poor country to guarantee free AIDS treatment to all who need it without the activism of its many homosexual organizations. For every AIDS victim, though, there are many more suffering from diseases that lack this kind of constituency. Today, contracting a serious disease that affects only poor people is the worst luck of all.
The science of agribusiness profits, versus science for healthy, chemical-free, patent-free food
Jehu-Appiah A: Pambazuka News 641, 31 July 2013
The Sixth Africa Agriculture Science Week was held in Accra from 15-20 July 2013. However, the authors of this article express their concern that the current scientific approach to improve agricultural productivity, and food nutrition of small-scale farmers in particular, is being heavily distorted and influenced by well-funded information campaigns of the big agro-chemical companies. These agribusinesses, and their allies aim to increase their profits by selling chemicals and inputs and one of their key objectives is to introduce patented genetically engineered seed into Ghana and other African countries. The authors argue that genetic engineering (GE) is not about science, it is about money. They point out there is very little record of success in developing countries in helping small scale farmers to improve productivity and adapt to climate change. GE seed is also more expensive for farmers than saving seed for the next planting. The authors argue that small scale Ghanaian farmers need research and extension in support of agro-ecological farming, and this includes access to markets, infrastructure, good roads and transportation, and protection from landgrabs.
The social and economic impact of South Africa’s social security system
Economic Policy Research Institute (EPRI), South Africa , 2004
Social grants play a critical role in reducing poverty and promoting development in South Africa. This study evaluates the socio-economic impact of various social grants including child support grants, disability grants and state pensions. The paper further examines their effects on the household, the labour market and the economy. The paper begins by assessing the impact of social assistance on poverty reduction. To evaluate the level of poverty, the authors use different methodological approaches including absolute and relative measures. The second section investigates the effects of social grants on households’ access to health care, schooling, housing, water and electricity. The third section examines the impact of social security on employment and productivity. Finally the paper analyses the impact of this public expenditure on macro-economic indicators including national savings and consumption.
The social and economic impacts of South Africa’s child support grant
Williams MJ: Economic Policy Research Institute Working Paper 40, November 2007
Evidence from this South African study indicates that cash transfers achieve positive education, health and nutrition outcomes. South Africa's child support grant (CSG) is the country's largest social cash transfer programme and is regarded as one of the government's most successful social protection interventions. This study analysed panel data constructed from general household surveys (2002 to 2004), and compared eligible children who received the CSG in 2003 and 2004 with those who did not receive it. It found robust evidence that the CSG is improving nutrition and education outcomes for children. Hunger, as defined by the lack of food in a household, fell among both CSG recipients and non-recipients over the study period, but the reduction was found to be two to three times larger for children receiving the grant. Children under seven years of age who were eligible for the CSG were significantly less likely to be attending school in 2002 than those not receiving the CSG, but after receiving the CSG for two years there was a 6% increase in their pre-school and early grades enrolment by 2004. The study concludes that these effects are likely to be sustained over time among households receiving the CSG, with cumulative improvements in children’s nutrition and educational attainment in the future.