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*ILLITERACY cuases of POVERTY

*UNEMPLOYMENT cuases of POVERTY

POOR HEALTH AS A CUASE FOR POVERTY

Around one-third of the total number of deaths in the world - which roughly amounts to 18 million people every year, are attributed to the diseases of poverty. This and other such facts about poverty highlight the relationship between poverty and poor health very well. A newly coined term, the 'diseases of poverty' refers to various diseases which are more likely to affect poor people as compared to their affluent counterparts. It also encompasses those diseases which can result in poverty for people. Some of the most prominent examples of diseases which are more likely to affect people below the poverty line include AIDS, malaria, tuberculosis, measles, pneumonia etc. Most of these diseases are attributed to lack of basic health care facilities. On the other hand, those diseases which can result in poverty for the individual include a range of mental illnesses which tend to hinder the ability of a person to work.

Rather than climatic conditions or complex epidemiology, specialists note that the major causes of ill health for people in developing countries relate to poverty and underlying political and social conditions. This direct causal link between poverty and ill health has long been recognised by many civil society organisations that highlight poverty as the "biggest epidemic" facing the global health community, thereby emphasising the importance of economic policy as a health issue.

The WHO's Commission on Social Determinants of Health has also recently acknowledged that the high burden of illness responsible for premature loss of life arises in large part because of the poor and unequal conditions in which people live and work. The appalling living environment for millions of people is, in turn, the consequence of deeper structural conditions - what the Commission calls the 'structural drivers' of global health inequality.

The promotion of social and economic equity, which the WHO and many civil society organisations maintain is central to respecting human rights obligations in health, therefore depends upon "narrowing the gap" between the worst off and best off over time. This process involves "a progressive flattening of the health gradient", says the WHO Commission, by improving the health of all social groups to a level closer to that of the most advantaged. Put simply, the unacceptable discrepancy in living standards between the developed and developing countries, with almost half the world - some 2.5 billion people - living on less than US$2 a day, is a fundamental factor in the global crisis of ill health.

Furthermore, the intellectual property regime and the vast profits that can be secured from patented drugs has skewed the incentives for research and development of drugs away from the needs of the poor in the developing world towards 'lifestyle medicines' that service the desires of the richer members of society.

An unfettered global economic market that disproportionately empowers large corporations, increases wealth inequality both within and between nations, and fails to eradicate poverty and food insecurity is clearly incompatible with public health objectives. The globalised market system has not worked for the poorest people who lack the resources to fulfil the human right to "a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services". Only a new model for development can meet this vision as enshrined in Article 25 of the Universal Declaration of Human Rights, based on a rehabilitation of the public sector and public services, a reinvigorated notion of the government role in providing essential public services, and a transformed economic system that specifically prioritises health and social welfare.

Diseases in the Developing World

Many of the diseases in the developing world should be entirely preventable with modern medical knowledge and an understanding of the structural causes of poverty.

The examples below illustrate some of the diseases that commonly afflict the developing world, and how a fairer sharing of world resources could help to alleviate them.

Bilharzia and Hookworms

Two billion people worldwide suffer from Bilharzia (schistomiasis) and soil-transmitted parasitic worms, mainly hookworms. Over the past few decades, incidents of schistosomiasis and hookworm have increased and continue to spread, especially in African countries such as Ghana, Senegal, Ethiopia and Mali. Estimates suggest that Bilharzia and soil-transmitted parasitic worms account for more than 40 percent of all tropical diseases, excluding malaria.

A fluke or schistosome parasite causes Bilharzia or Schistosomiasis, which spends part of its life cycle in a water snail and develops in humans. Infected people and their livestock, urinating in water where snails are not yet infected often spread the disease to new areas. Several scientists, including Brinkmann, have found a high incidence of schistosomiasis in areas near imposed infrastructure projects such as artificial lakes and irrigation projects

Strong government intervention can play a critical role in addressing these diseases. For example, the Chinese government managed to reduce the number of people infected in its country from 12 to 1.3 million, through an integrated control programme involving the ministries of Public Health, Agriculture and Water Conservancy. The Chinese authorities also realised the importance of health education in the control of the spread of the disease, so health agencies taught local populations how to prevent its transmission, how to treat it and the importance of cooperation with medical workers for diagnostic screening and treatment. Local people provided the labour, money and material for snail control. Improved water supply and sanitation, according to the World Health Organisation, could also help to prevent the spread of Bilharzia or Schistosomiasis.

Just as schistosomiasis has spread over the past few decades in poorer countries, so has the incidence of hookworm. Hookworms live in damp earth and enter people through the soles of their feet, travelling through the bloodstream to the intestines, where they live indefinitely.

Irrigation projects worldwide again appear to contribute to the spread of the disease. According to the World Health Organisation "intensified irrigation, dams and other water related projects contribute importantly to this disease burden". If the principle of sharing was implemented, governments in the North could aid the World Health Organisation to alleviate incidents of schistosomiasis and hookworm. Both schistosomiasis and hookworm are eminently treatable with cheap drugs, meaning that more wealthy governments should provide drugs required to treat all the people suffering from schistosomiasis and hookworm Educational projects should also be put in place in poorer countries to teach people how to prevent the spread of these diseases Adequate sanitation facilities should be provided, to prevent the spread of these diseases People in danger of contracting the diseases should be supplied with footwear, to protect their feet

Filariasis

Lymphatic filariasis (also known as elephantiasis), dracunculiasis, onchocerciasis and malaria, are also spread by water borne parasites. One billion people in 80 countries are at risk of infection by elephantiasis, so called because the legs of people infected with the disease swell up to the size of an elephant. Furthermore, 120 million people globally are infected with this disfiguring disease, which is caused by a parasite that lives in mosquitoes. Doctors can now treat the disease with albendazole, a drug developed by GlaxoSmithKline and Merck. <.p>

Lymphatic filariasis could be adequately treated if governments helped to integrate participatory programmes for the elimination of this disease, both by treating infected people and preventing the spread of the disease through the provision of adequate housing and bed nets.

Malaria

Malaria, caused by the plasmodium parasite, remains endemic in many Third World countries. 1,600 million people are at risk of infection with malaria worldwide, whilst 396 million people (of which 275 million in Africa) suffer from the disease. The World Health Organisation estimates that 1.4-2.8 million people, most of whom are children under five, die from the disease every year.

To control Malaria, both early prevention and direct treatment are important. In the West, many governments have largely eradicated Malaria, where it previously affected millions. Although it may be impossible to eradicate mosquitoes totally, with modern medical knowledge and global financial resources, it could be easily achievable to treat all those people that are infected. In addition, a strong government role in healthcare provision would help to alleviate malaria. By using organised quarantine methods, infected patients could be isolated to remove the threat of contamination to other mosquitoes and humans.

Donors should provide money for integrated malaria control programmes, combining participatory mosquito control with screening and treatment of infected people in all the countries affected. Every source of stagnant water, where mosquitoes can breed, should be removed and natural methods of eradication could be enhanced to eliminate the remaining mosquitoes (harmless biolarvicides developed in Cuba and currently produced in Argentina by Rosenbush laboratories provide one example).

Dracunculiasis

Dracunculiasis is caused by a parasitic worm, the Guinea worm (Drancunculus medinensis), which spends part of its life cycle in a water flea, and develops in the human body. People catch guinea worms from unclean water in the poorest parts of sub-Saharan Africa, especially in Sudan. The worm migrates under the victim's skin causing severe pain, especially when insertion occurs in the joints. It eventually emerges from the feet, making them swell, blister and ulcerate, accompanied by fever, nausea and vomiting. Although no drug treatment is available, the disease should be completely preventable. In the 1970s, there were several million cases. The World Health Organisation made a serious effort to eradicate the disease and there are now 75,223 cases, most of which are in the Sudan.

Through cooperation and an effective sharing of resources, the Guinea worm could be completely eradicated through the implementation of a proposed World Health Organisation programme by:

Case containment in all endemic villages
Community-based surveillance systems in endemic villages
Providing safe water, health education and water filters
Mapping all endemic villages and maintaining data bases
Certifying guinea worm eradication country by country worldwide. River Blindness

Half a million poor people living in Africa have lost their sight due to river blindness, or onchocerciasis, an insect-borne disease caused by the parasite Onchocerca volvulus and transmitted by blackflies that live on the banks of fast flowing water. Adult worms of the parasite live in nodules in a human body where the female worms produce high numbers of larvae called microfiliariae. These worms then break out of the nodules and find their way to the surface of the skin. Eventually they make their way to the eyes, causing blindness. If caught in time the disease can be treated with the drug ivermectin, or mectizan, a drug developed by GlaxoSmithKline and Merck.

Sleeping Sickness

Sleeping sickness is another disease that seriously affects the poor, with at least 50 million people in 36 African countries exposed to the risk of contracting this disease. A parasite, the African trypanosome that lives in the tsetse fly, transmits this disease by biting humans. The parasite lives in the blood of the infected person for a few days, then travels into the brain, where it begins to cause sleep disturbances, eventually killing the infected person.

Leishmaniasis and Chagas Disease

An estimated 200 million poor people in Africa, the Americas and Asia are at risk of infection with the Leishmania parasite. Leishmaniasis is transmitted by phlebotomine sandflies. This disease can either affect the skin, causing sores, or the internal organs, causing Kala Azar, which is fatal if not treated. Drugs used to treat leishmaniasis are based on antimony (a toxic heavy metal), have to be administered by injection under medical supervision and can cause severe side effects. The Leishmania parasite has become increasingly resistant to these drugs.

Taenia solium

The pork tapeworm, Taenia solium, is the most common parasitic infection of the central nervous system. Although the pork tapeworm usually lives in the intestine of the people it infects, the eggs from the tapeworm can hatch out and migrate into the muscles, heart, eyes, brain and spinal cord, where they form cysts, sometimes causing epilepsy. This disease is associated with poverty and affects people in South America, Brazil, Central America, Mexico, China, India, SE Asia and sub-Saharan Africa.

Just as the causes of poverty are often interrelated, so are the effects of poverty. Bad sanitation makes it easier to spread around old and new diseases, and hunger and lack of water make people more vulnerable to them. Impoverished communities often suffer from discrimination and so get caught in cycles of poverty that create long lasting problems and handicaps passed on from one generation to another: not attending school, child labor to help the parents, lack of education on basic hygiene, transmission of diseases, etc

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