Reducing the impact of poverty on health and human development: Scientific approaches
Annals of the New York Academy of Sciences
Volume 1136, June 2008
Stephen G. Kaler and Owen M. Rennert
National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
".....In summarizing the general condition of poverty, one observer concisely described it as "a form of exile, of being cut off from the larger society."1 Efforts to define poverty more specifically perhaps risk incompleteness, since the causes underlying human destitution are so diverse and interrelated. This volume is an attempt to collate major dimensions of poverty and their impact on human development. In conjunction with the Council of Science Editors Global Theme Issue,2 we recruited established and emerging experts within nine topical areas, illness and disease, maternal health, health disparities, health care services, nutrition, education, housing, social and economic determinants, and engineering and technology. We asked them to provide their scientific perspectives on the causes and solutions relevant to human poverty. Twenty-five U.S. and foreign universities, as well as thirteen national or international organizations are represented.
This collection focuses on the United States, as an example of a developed country in which poverty disrupts many lives,1 and provides an international context as well, through studies of developing countries in which the scale and impact of poverty are often more graphic and apparent. Thus, China, India, Nicaragua, Peru, Russia, and the countries of Africa are represented here, in addition to the United States. We hope the entire volume provides a better understanding of poverty, as it has for us, and that it may spur others to apply the rigor of science to understand, to reduce, and to ultimately eliminate poverty in our nation and around the world.
The opening section is devoted to diseases of poverty, including chronic as well as acute infectious disorders. While not exhaustive in scope-measles, lower respiratory infections, and diarrheal illnesses are covered only by review of recent literature-the connections between neglected diseases and suboptimal development are abundantly evident. One worker remarked with regard to his disease of interest, "It's tied in with grinding poverty; where you find it maps almost perfectly with the poorest of the poor."3
Many whose contributions are in Part I are active participants and leaders in efforts to directly reduce the human toll of these conditions. Their cautious hopefulness in the face of difficult odds indicates the progress their work is engendering. In Part II, maternal health is specifically addressed, and the critical need for support of mothers in avoiding the cycle of poverty is delineated. Indeed, this theme recurs throughout many other sections of this book. In Part III, health disparities in U.S. urban and Native American communities are formally addressed, whereas international health disparities are conveyed throughout most of the book. Access to health care and the problems of the uninsured are the subjects of Part IV. Basic human needs for food, education, and shelter are addressed in Parts V to VII, with papers from experts involved in the intimate connections between these topics and the experience of poverty. Part VIII considers social and economic determinants of human development, in both national and international contexts. Finally, Part IX discusses engineering and technological aspects of human development, which are especially critical for sustaining progress in poverty reduction in the developing world.
While these nine sections provide a framework for the book, the boundaries between them are admittedly artificial. The answer to the question of why someone is poor will vary among individuals but invariably involves one or more of the issues addressed here.
One author who supports preferential options for the poor has written, "Unless the poor are accorded some right to health care, water, food, and education, their lives will inevitably be short, desperate and unfree."4 Poverty touches numerous aspects of human life simultaneously, and concerted efforts must be sustained in multiple arenas to secure meaningful gains. That is truly the message of this volume.."
Table of Contents
Part I. Diseases of Poverty
Treating Multidrug-Resistant Tuberculosis in Tomsk, Russia. Developing Programs That Address the Linkage between Poverty and Disease
Expanding Global HIV Treatment. Case Studies from the Field
Poverty and Human Immunodeficiency Virus in Children. A View from the Western Cape, South Africa
Diseases of Poverty with High Mortality in Infants and Children. Malaria, Measles, Lower Respiratory Infections, and Diarrheal Illnesses
Malaria and Poverty
Hookworm and Poverty
Dracunculiasis, Onchocerciasis, Schistosomiasis, and Trachoma
Eliminating Lymphatic Filariasis. A View from the Field
Intersectoral Approaches to Neglected Diseases
Chronic Diseases in Developing Countries. Health and Economic Burdens
Part II. Maternal Health and Poverty
Poverty, Maternal Health, and Adverse Pregnancy Outcomes
Supporting the Mental Health of Mothers Raising Children in Poverty. How Do We Target Them for Intervention Studies?
Poverty, Gender Inequities, and Women's Risk of Human Immunodeficiency Virus/AIDS
Part III. Health Disparities and Poverty
Poverty and Elimination of Urban Health Disparities. Challenge and Opportunity
Poverty and Health Disparities for American Indian and Alaska Native Children. Current Knowledge and Future Prospects
Part IV. Health Care Services and Human Development
Trends in Private Insurance, Medicaid/State Children's Health Insurance Program, and the Healthcare Safety Net. Implications for Vulnerable Populations and Health Disparities
Health Insurance and Access to Health Care in the United States
Poverty and Access to Health Care in Developing Countries
Part V. Human Nutrition and Poverty
Poverty. The Double Burden of Malnutrition in Mothers and the Intergenerational Impact
Latent Effects of Prenatal Malnutrition on Adult Health. The Example of Schizophrenia
Food Security, Poverty, and Human Development in the United States
Diet and Health Outcomes in Vulnerable Populations
Agriculture in Africa: Strategies to Improve and Sustain Smallholder Production Systems
Building an Alliance for a Green Revolution in Africa
Part VI. Education and Human Development
The Effect of Poverty on Child Development and Educational Outcomes
Long-Term Effects of Head Start on Low-Income Children
Education for All. An Imperative for Reducing Poverty
Part VII. Housing and Human Development
Housing and Health. Intersection of Poverty and Environmental Exposures
Social and Economic Aspects of Immigration
Improving the Health and Lives of People Living in Slums
Part VIII. Social and Economic Determinants of Human Development
Role of Income and Family Influence on Child Outcomes
Psychological Costs of Growing Up Poor
Mandated Empowerment. Handing Antipoverty Policy Back to the Poor?
The Chinese Social Benefit System in Transition. Reforms and Impacts on Income Inequality
Part IX. Engineering and Technological Determinants of Human Development
Poverty, Energy, and Resource Use in Developing Countries. Focus on Africa
Sustainable Transfer of Biotechnology to Developing Countries. Fighting Poverty by Bringing Scientific Tools to Developing-country Partners
Delivery of Agricultural Technology to Resource-poor Farmers in Africa