Voices of the Poor Speak about Health

A new World Bank book, Voices Of The Poor, summarizes poverty from the perspective of the poor, drawing from input from 60,000 poor people in 60 countries. It chronicles the daily struggles and aspirations of the poor, and how their lives are shaped by common hardships such as hunger, powerlessness, social isolation, state corruption, gender inequality, and the rudeness of local officials. 

Key findings are that poverty is not just a lack of income but also constant hunger, powerlessness, humiliation and fear of illness with exorbitant health care costs. Other common themes are the ineffectiveness of the state in reaching the poor, corruption and distrust of government, and breakdown of family and social bonds that provided some security in spite of poverty.

Of the fifteen causes of a downward slide into poverty that were encountered during the study, illness was the most frequently cited, ahead even of employment loss, which was in second place. 

Deepa Nayaran, the chief author, suggests five actions:
 

1. An increased concern for protecting the poor against the financial shocks of ill health, i.e. more affordable protection against catastrophic illness.

2. A stronger emphasis on health infrastructure, such as water and sanitation, where the poor reside.

3. Improvement of the behavior of public health care providers who often treat the poor rudely. 

4. Greater attention to domestic, gender-based violence, which affects women especially.

5.  Recognition of the psychological impact of AIDS, i.e. the social stigma and shame, in addition to its physical impact.

To order “Voices of the Poor,” go to
www.worldbank.org/html/extpb/voices.htm