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The International Poverty and Health Network (IPHN) was created in
December 1997, following a series of conferences organised by the
World Health Organization with the aim of integrating health into
plans to eradicate poverty. The network's formation was a response to
the evidence of the persistent and growing burden of human suffering
due to poverty. We invite others to join the endeavour.
Around 1.3 billion people live in absolute, grinding poverty, on less
than $1 per day.1 This is despite the overall
substantial growth of the world economy, which doubled over the 25
years before 1998 to reach $24 trillion. Of the 4.4 billion people in
developing countries, nearly three-fifths lack access to
sanitation, a third do not have clean water, about a fifth lack access
to healthcare of any kind, and a fifth do not have enough dietary energy
and protein.
Economic disparities both within and between countries have grown.
In about 100 countries, incomes are lower in real terms than they were a
decade ago.2 By 1995, the richest fifth of
the world's population had 82 times the income of the poorest fifth.
The world's 225 richest people have combined wealth equivalent to the
annual income of the poorest 2.5 billion people in the world (nearly
half of the world's population).1 At the same time, the world is
facing a growing scarcity of renewable resources from
deforestation, soil erosion, water depletion, declining fish
stocks, and lost biodiversity. The impact of these problems will be
felt most by poor populations.
Despite overall dramatic increases in life expectancy over the last
century, healthcare professionals should be concerned about
growing inequalities in health and wealth.3 The precipitous decline in
life expectancy in Eastern Europe, particularly in Russia, is a
graphic example of how health may deteriorate as societies face
sudden social and economic change accompanied by growing poverty.
Even among prosperous nations, there are many examples of growing
socioeconomic inequalities in health over the past 20
years.4 Health inequalities in
Britain have recently been declared the worst ever.5
In Australia, socioeconomic inequalities in health are also
significant. For the period 1985-1987, death rates were
consistently highest for those living in the most socioeconomically
disadvantaged areas.6 This pattern was evident for
both males and females and in each of the three age groups studied (0-14
years, 15-24 years, and 25-64 years) and was observed for all-cause
mortality and selected causes of mortality. Despite overall
declines in mortality rates between 1985-1987 and 1995-1997 for most
conditions, the differentials observed in the earlier period were
still evident a decade later. For example, during 1995-1997, infants
and children living in the most disadvantaged areas experienced the
highest mortality rates for perinatal conditions and sudden infant
death syndrome, and for injury and poisoning. Similarly, men and
women aged 25-64 years residing in the most disadvantaged areas
experienced the highest death rates for all-cause mortality, for
specific causes such as circulatory, respiratory and digestive
system diseases, and for selected causes such as coronary heart
disease and stroke, motor vehicle accidents and
pneumonia/bronchitis.
Although deaths of Indigenous Australians contribute
substantially to the higher death rates in the most disadvantaged
areas, they are unlikely to be the sole cause of these differentials,
particularly in the cities. Rates of premature death (deaths before
age 65) are consistently highest for those living in the most
socioeconomically disadvantaged areas of the capital cities and
other major urban centres (population 100 000 or more)
(Box).7 This pattern is evident in
both 1985-1989 and 1992-1995 and for all-cause mortality and
selected causes of mortality. Death rates for males and females, as
well as for most major causes, increase for each quintile of
socioeconomic status of area (from the lowest rates in the highest
socioeconomic status areas to the highest rates in the lowest
socioeconomic status areas). Disturbingly, the gap between the
rates in the most well-off and in the most disadvantaged areas has also
increased.
Internationally, in the 20th century, development has usually been
equated with economic growth, but the link between economic
prosperity and health, a key component of human development, is not
automatic. A recent World Bank study showed that income improvement
contributed only about a fifth of the decline in mortality between
1960 and 1990.8 Education of women and the
generation and use of new knowledge were more significant factors.
Recent work in Canada and elsewhere shows that the early years of child
development are also important contributors to health
inequalities.9
The International Poverty and Health Network is a worldwide network
of people and organisations from health, business, non-government
organisations and government who seek to influence policy to protect
and improve the health of the world's poor, particularly the poorest
in all countries. The network urges that a balance must be struck
between social development and growth in income; between the human
and financial dimensions of poverty; and between redistribution and
market reforms. Our aspiration is to achieve a balance between
biomedical and social approaches; between population-based health
development and a response to individuals; between prevention of
disease, promotion of health, and treatment; and between physical
and mental health.
Over the next few years supporters of the network will strive to reduce
the burden of ill-health due to poverty by:
- engaging in
strategic discussions with the International Monetary Fund, the
World Bank, the World Health Organization and national governments
to ensure that health is put at the centre of development. We urge
health impact assessments of all policies;
- promoting action for health locally, regionally and nationally by
working with sectors such as education, business, agriculture and
transport;
- building the evidence base on effective interventions that reduce
inequalities in health and on how improved health can reduce poverty;
- facilitating exchange among healthcare professionals in North and
South about effective ways of working;
- ensuring that education programs for healthcare professionals
include information on the impact of socioeconomic inequalities on
health and what they can do to reduce these inequalities;
- encouraging healthcare professionals to work with local
communities to improve the health of the poorest; and
- monitoring trends in health inequalities and using the data to
influence policy.
We invite others to join us in this endeavour. Why not you?
Iona Heath
General Practitioner, and Chair Intercollegiate Forum on Poverty
and Health, Royal College of General Practitioners, London, UK
Andy Haines
Professor, Department of Primary Care and Population Sciences
Royal
Free and University College Medical School, London, UK
John Glover
Director, Public Health Information
Development Unit, University of
Adelaide, SA
Diana Hetzel
Senior Researcher, Public Health Information
Development Unit,
University of Adelaide, SA
For more information, please contact the International Poverty and
Health Network (IPHN). Tel: +44 207 539 1570. Fax: +44 207 539 1580.
(Roger Drew) Email: drew.rAThealthlink.org.uk
- United Nations Development Programme. Human
Development Report 1998. New York: Oxford University Press, 1998.
- United Nations Development Programme. Human Development Report
1996-97. New York: Oxford University Press, 1997.
- McCally M, Haines A, Fein O, et al. Poverty and ill health:
physicians can and should make a difference. Ann Intern Med
1998; 129: 726-733.
- Whitehead M, Diderichsen F. International evidence on social
inequalities in health. In: Drever F, Whitehead M, editors. Health
inequalities. Office of National Statistics, London: The
Stationery Office, 1996.
- Yamey G. Study shows growing inequalities in health in Britain.
BMJ 1999; 319: 1453.
- Turrell G, Mathers CD. Socioeconomic health inequalities in
Australia. Med J Aust 2000. In press.
- Glover J, Harris K, Tennant S. A social health atlas of Australia.
Adelaide: Public Health Information Development Unit, University
of Adelaide. In press.
- Wang J, Jamison D, Bos E, et al. Measuring country performance on
health: selected indicators for 115 countries. Washington DC: World
Bank, 1999.
- Mustard JF. Early years of development are important contributors
to health inequalities [letter]. BMJ 1999; 319: 319.
©MJA 2000
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