Poverty and Health: Why We Need to Address the Root Cause of Disease?

I was part of a meeting where the late Paul Farmer, a renowned doctor and social justice activist, said that poverty makes you sick. His statement surprised the many people in the auditorium. His words resonated well with what I had witnessed in Haiti, Malawi, Liberia, Rwanda, and other countries. I wondered why scientists and global health professionals don’t talk more about this issue. I wondered if we were addressing the disease's root cause or just treating the symptoms. I realized we have made slow progress in improving population health outcomes and might be overlooking the bigger picture. I recalled the saying: “If we do what we have always done, we will get what we have always gotten.”

Poverty makes you sick. This simple yet powerful statement captures the essence of the complex relationship between poverty and health. Poverty is not only a consequence of poor health but also a cause. Poverty exposes people to various disease risk factors, such as malnutrition, lack of sanitation, environmental pollution, and limited access to health care. Poverty also limits people’s ability to cope with diseases, as they face financial barriers, social stigma, and discrimination. Poverty traps people in a vicious cycle of ill health and deprivation.

Addressing the Burden of Disease Should Not Leave Poverty Aside

Several initiatives have focused on reducing the burden of diseases, especially infectious diseases, that disproportionately affect low- and middle-income countries (LMICs). While these efforts have achieved remarkable results, such as reducing child mortality, increasing immunization coverage, and expanding access to antiretroviral therapy for HIV patients, they have not been able to address the underlying causes of health inequities. The World Bank predicted that 574 million people will still live on less than $2.15 daily in 2030. These people are more vulnerable to diseases and have fewer resources to prevent and treat them.?

It is also important to note that many LMICs face a debt crisis as they struggle to repay their loans to the World Bank and other creditors amid the economic downturn. In its recent report, the World Bank reported that the combined external debt stock of 120 low- and middle-income countries rose to $8.4 trillion at the end of year 2020, an increase of 9.5% from 2019.

While emerging technology is helping to treat complicated diseases, there is a dire need for technological innovations targeting poverty alleviation. Technology can provide affordable, accessible, and reliable solutions to enhance poor people's livelihoods, education, energy production, and water security. Technology can also enable poor people to self-diagnose their poverty level and create customized plans to overcome it with the help of existing community resources. Technology can also foster innovation and entrepreneurship among poor people, allowing them to create value and generate income.

Social Support and Poverty Alleviation Should Be a Core Component of Each Public Health Intervention

It is not enough to focus on specific diseases or interventions to break the cycle of poverty and disease. Instead, a holistic approach is needed to address the social forces or determinants of health, such as income, education, gender, and environment. Social support and poverty alleviation should be a core component of public health interventions, as they can improve health outcomes and reduce health disparities. For example, cash transfers, microfinance, social protection schemes, and universal health coverage can help people afford basic needs, access health services, and cope with shocks. Similarly, investing in education, especially for girls and women, can empower people to make informed choices about their health and well-being.

The late Paul Farmer was a pioneer and a leader in this field. He advocated for a model of care that combines clinical treatment with social support and community empowerment. He challenged the conventional wisdom that complex diseases such as multidrug-resistant tuberculosis or HIV/AIDS could not be treated in resource-poor settings. He showed that with adequate funding, political will, partnership, and solidarity, it is possible to deliver high-quality health care to the poorest and most marginalized people. Partners In Health’s model could guide efforts to end the burden of disease and global health disparities.?

Poverty and Sustainable Development Goals: The Need for Global Commitment

Poverty is not only a human tragedy but also an obstacle to sustainable development. Poverty undermines human dignity, social cohesion, environmental sustainability, and economic growth. Poverty also hampers the achievement of other Sustainable Development Goals (SDGs), such as ending hunger, ensuring quality education, promoting gender equality, reducing inequalities, combating climate change, and building peaceful societies.

The first SDG aims to end poverty in all its forms everywhere by 2030. This ambitious goal requires a global commitment from all stakeholders: governments, civil society organizations, private sector actors, international institutions, donors, and individuals. It also requires a comprehensive strategy that addresses the multiple dimensions of poverty: income poverty, multidimensional poverty (lack of access to essential services), relative poverty (social exclusion), chronic poverty (long-term deprivation), and intergenerational poverty (transmission of disadvantages).

The 2030 Agenda for Sustainable Development recognizes that eradicating poverty is the greatest global challenge and an indispensable requirement for sustainable development. It also acknowledges that no one should be left behind in this endeavor. Therefore, it calls for prioritizing the needs of the poorest and most vulnerable and ensuring that they benefit from the opportunities and resources generated by development.

Closing Eyes to Poverty Does Not Keep Us Immune

Poverty is a global problem that affects us all, directly or indirectly. Poverty is not only a moral issue but also a practical one. Poverty undermines our collective security, prosperity, and well-being. Poverty also violates our common humanity and dignity.

Closing our eyes to poverty or not using poverty in our scientific jargon does not keep us immune. Instead, it defeats and keeps us shortsighted as we address global health disparities. We must face the reality of poverty and its impacts on health and act accordingly. We must follow the example of the late Paul Farmer, who dedicated his life to fighting poverty and disease with compassion and courage. We need to join forces and work together to end poverty and ensure health for all.