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The urban environment, poverty and health in developing countries.

The process of urbanization could be described as one of the major global environmental changes directly affecting human health today. Populations particularly affected are in developing countries where rapid urban growth has been accompanied by massive urban poverty. Urban environmental health impacts, particularly the impact on adults of an environment of poverty, are still poorly understood. Definitions of the urban environment tend to be physical, excluding the complex ramifications of a social setting of disadvantage. This paper provides a brief overview of existing knowledge on the links between environment, poverty and health in urban areas of developing countries, with an emphasis on the policy implications implied by research on health differential between groups within cities. The paper argues that urban poverty and inequalities in conditions between groups within cities present a central crisis confronting urban policy in terms of human health and quality of life. The paper suggests that definitions of the urban environment tend to consider only the physical, and not the social complexity of the urban setting. The review concludes that the scale and the complexity of the urban crisis in developing countries demands a real commitment to re-thinking the management of cities to address multiple deprivation. The paper suggests that this challenges urban professionals who continue to act with a bias towards unintegrated single sector solutions despite claims to the contrary.

Developing Countries↗

Poverty area residence and changes in depression and perceived health status: evidence from the Alameda County Study.

BACKGROUND: Previous evidence from the Alameda County Study indicated that residential area has an independent effect on risk for mortality, adjusting for a variety of important individual characteristics. The current research examined the effect of poverty area residence on risk for developing depressive symptoms and decline in perceived health status in a sample of 1737. METHODS: Data were from a longitudinal population-based cohort. Multiple logistic regression analyses were used. RESULTS: Age- and sex-adjusted risk for incident high levels of depressive symptoms in 1974 was higher for poverty area residents (odds ratio [OR] 2.14; confidence interval [CI]: 1.49-3.06). Those reporting excellent/good health in 1965 were at higher risk for having fair/poor health in 1974 if they lived in a poverty area (age- and sex-adjusted OR 3.30; CI: 2.32-4.71). Independent of individual income, education, smoking status, body mass index, and alcohol consumption, poverty area residence remained associated with change in outcome variables. CONCLUSION: These results further support the hypothesis that characteristics of place affect health conditions and health status.

Adult↗

Poverty, birthweight, and infant weight gain in Hertfordshire, 1923-1939.

OBJECTIVE: To investigate the association between poverty, birthweight, and infant weight gain in Hertfordshire, 1923-1939. DESIGN: Cohort study based on the Hertfordshire Health Visitors' Register (HHVR). SETTING: The population of Hertfordshire, and a sub-sample of five Hertfordshire towns-Hoddesdon, Berkhampstead, Hertford, Hitchin, and Bishops Stortford-extracted from the HHVR. SUBJECTS: Some 71 201 live birth entries in the HHVR and a sample of 13,649 live birth entries for the five towns. MEASURE OF POVERTY: Rateable value of birth addresses reflecting market and rental value of housing. MAIN OUTCOME MEASURES: Birthweight, and infant weight gain (z score of weight at one year minus z score of birthweight). RESULTS: In Hertfordshire as a whole there was a reduction in mean birthweight from 7.7 pounds (lbs) in 1923 to 7.4 lbs in 1939. Over the same time period there was an increase in mean infant weight gain, although with a degree of variation within the trend. In the sample of five towns there was no association between rateable value and birthweight, but a significant association between rateable value and both weight at one year, and weight gain during the first year of life. CONCLUSION: In Hertfordshire average birthweight declined, whereas weight gain during the first year of life tended to increase, at a time when, nationally, calorific intake and per capita consumption of a range of nutritional ingredients was rising. Poverty, as measured by rateable value, did not correlate with birthweight but was associated with weight gain during the first year of life. These findings suggest that nutritional poverty had a more significant influence on post-natal weight gain than it did on birthweight.

Birth Weight↗

A history of noma, the "Face of Poverty".

Noma (necrotizing ulcerative stomatitis, stomatitis gangrenosa, or cancrum oris) is a devastating orofacial gangrene that occurs mainly among children. The disease has a global yearly incidence of 140,000 cases and a mortality rate of approximately 90 percent. Patients who survive noma generally suffer from its sequelae, including serious facial disfigurement, trismus, oral incontinence, and speech problems. The medical history of noma indicates that the disease was already known in classical and medieval civilizations in Europe. In the sixteenth and seventeenth centuries, Dutch chirurgeons clearly described noma as a clinical entity and realized that the popular name "water canker" was not sufficient, because this quickly spreading ulceration in the faces of children was different from "cancer." In the eighteenth century, awareness that noma is related to poverty, malnutrition, and preceding diseases such as measles increased in northwestern Europe. In the first half of the nineteenth century, extensive surgical procedures were described for the treatment of the sequelae of noma. At the end of that century, noma gradually disappeared in the Western world because of economic progress, which gave the poorest in society the opportunity to feed their children sufficiently. Only in the twentieth century were effective drugs (sulfonamides and penicillin) against noma developed, as well as adequate surgical treatment for the sequelae of noma. These modes of treatment remain inaccessible for the many present-day victims of noma because of their extreme poverty. The only truly effective approach to the problem of noma throughout the world is prevention, namely, combating the extreme poverty with measures that lead to economic progress. In the meantime, medical doctors in the Western world should not forget their own history and ignore this global health problem; rather, they should face "the face of poverty" with the eyes of mercy and concern suited to their profession.

Child↗

Effects of poverty and maternal depression on early child development.

Researchers have renewed an interest in the harmful consequences of poverty on child development. This study builds on this work by focusing on one mechanism that links material hardship to child outcomes, namely the mediating effect of maternal depression. Using data from the National Maternal and Infant Health Survey, we found that maternal depression and poverty jeopardized the development of very young boys and girls, and to a certain extent, affluence buffered the deleterious consequences of depression. Results also showed that chronic maternal depression had severe implications for both boys and girls, whereas persistent poverty had a strong effect for the development of girls. The measures of poverty and maternal depression used in this study generally had a greater impact on measures of cognitive development than motor development.

Adolescent↗

Duration and developmental timing of poverty and children's cognitive and social development from birth through third grade.

Relations of duration and developmental timing of poverty to children's development from birth to age 9 were examined by comparing children from families who were never poor, poor only during the child's infancy (0-3 years of age), poor only after infancy (4-9 years of age), and chronically poor. Chronically poor families provided lower quality childrearing environments, and children in these families showed lower cognitive performance and more behavior problems than did other children. Any experience of poverty was associated with less favorable family situations and child outcomes than never being poor. Being poor later tended to be more detrimental than early poverty. Mediational analyses indicated that poverty was linked to child outcomes in part through less positive parenting.

Child↗

The concept of poverty.

Although poverty is one of the most familiar and enduring conditions known to humanity, it is an extremely complicated concept to understand. Some researchers view it as a reaction to the stress of being poor, whereas others perceive it as a process of adapting to the condition of poverty. Historical definitions are numerous, but can be classified as relating to either lack of financial income or lower social status. Numerous factors contribute to the concept of poverty, including political, economic, social, and cultural forces. The one that has consistently had the greatest effect on the evolving concept is the passage of time, which encompasses all these forces in a very intricate manner. This author explored the evolution of the concept of poverty to identify relevant themes for consideration in the public health nursing domain.

Culture↗

Tuberculosis and poverty.

OBJECTIVE: To examine whether the historical link between tuberculosis and poverty still exists. DESIGN: Retrospective study examining the notifications of all forms of tuberculosis by council ward over a six year period and correlating this with four indices of poverty; council housing, free school meals, the Townsend overall deprivation index, and the Jarman index. SETTING: The 33 electoral wards of the city of Liverpool. SUBJECTS: 344 residents of Liverpool with tuberculosis. RESULTS: The rate of tuberculosis was correlated with all measures of poverty, the strongest correlation being with the Jarman index (r = 0.73, p < 0.0001). This link was independent of the high rates of tuberculosis seen in ethnic minorities. CONCLUSION: Tuberculosis remains strongly associated with poverty.

Adolescent↗

Disparities in access to care and satisfaction among U.S. children: the roles of race/ethnicity and poverty status.

OBJECTIVES: The study assessed the progress made toward reducing racial and ethnic disparities in access to health care among U.S. children between 1996 and 2000. METHODS: Data are from the Household Component of the 1996 and 2000 Medical Expenditure Panel Survey. Bivariate associations of combinations of race/ethnicity and poverty status groups were examined with four measures of access to health care and a single measure of satisfaction. Logistic regression was used to examine the association of race/ethnicity with access, controlling for sociodemographic factors associated with access to care. To highlight the role of income, we present models with and without controlling for poverty status. RESULTS: Racial and ethnic minority children experience significant deficits in accessing medical care compared with whites. Asians, Hispanics, and blacks were less likely than whites to have a usual source of care, health professional or doctor visit, and dental visit in the past year. Asians were more likely than whites to be dissatisfied with the quality of medical care in 2000 (but not 1996), while blacks and Hispanics were more likely than whites to be dissatisfied with the quality of medical care in 1996 (but not in 2000). Both before and after controlling for health insurance coverage, poverty status, health status, and several other factors associated with access to care, these disparities in access to care persisted between 1996 and 2000. CONCLUSIONS: Continued monitoring of racial and ethnic differences is necessary in light of the persistence of racial/ethnic and socioeconomic disparities in access to care. Given national goals to achieve equity in health care and eliminate racial/ ethnic disparities in health, greater attention needs to be paid to the interplay of race/ethnicity factors and poverty status in influencing access.

Adolescent↗

Poverty and mental illness.

OBJECTIVE: To assess the relationship between poverty and mental illness in order to stimulate debate on future international cooperation programs in mental health. METHOD: Epidemiological data in the international literature addressing the issue of material poverty as a risk factor for the development of mental illness and as a prognostic factor for the outcome of mental illness were reviewed. RESULTS: The international literature reviewed supports the notion that material poverty is a risk factor for a negative outcome among mentally ill people. In addition, preliminary epidemiological data suggest that service-related variables may be determinants of outcome of mental illnesses. In our view, cooperation with developing countries is a great opportunity to evaluate mental health services in a natural setting. CONCLUSIONS: A new generation of programs for international cooperation in mental health is needed, in which knowledge and technology transfer is based on a service-research attitude. Attention should be focused on variables related to the poverty of services that might be linked to the course and outcome of mental illnesses.

Cross-Cultural Comparison↗

Searching for social capital: historical perspectives on health, poverty and culture.

Social capital has been seen as having a positive effect on health, and the concept of social capital has been viewed as of central importance to debates about healthy, sustainable communities. More generally, behaviour and its relationship with health has become much more central to policy-making, as illustrated in the Choosing Health White Paper (2005), and the concept of social capital has been one influence on the concept of social exclusion. Robert Putnam's arguments, both those expressed in Making Democracy Work (1993) and the revised version seen in Bowling Alone (2000) have been taken up by numerous social scientists and policy-makers. But despite the explicitly historical perspective that Putnam employs in Bowling Alone in particular, the history of social capital remains rather neglected in the available literature. This article is concerned with providing a historical perspective on social capital, especially the ways in which social investigators have viewed the relationships between health, poverty and behaviour. The article puts social capital alongside that of 'underclass' concepts such as the culture of poverty thesis, and examines how the latter has been invented and reinvented in the U.K. and the U.S.A. over the last 120 years. It argues that there are important similarities between the culture of poverty and social capital, but also significant differences, and these have implications for current policy initiatives. One way of analysing concepts like social capital and social exclusion more rigorously is by locating them within this longer-term history of social investigation, in which debates about health, poverty, and culture have been of

Community Health Planning↗

Water poverty.

Water poverty has become to the 1990s what fuel poverty was to the 1970s and 1980s. Underlying the growing concern on the issue is, on the one hand, a steep rise in the numbers living on poverty level incomes over the past 15 years and on the other, increasing difficulties among many poorer households in paying for the water that they need. Having briefly outlined current trends in poverty, the article explores these difficulties in relation to the price of and methods of charging for water and sewerage; the options for helping poorer customers; and the consequences of non-payment. It will focus in particular on the implications for health of two controversial issues: compulsory volumetric metering and water disconnections.

England↗

The family as a determinant of stunting in children living in conditions of extreme poverty: a case-control study.

BACKGROUND: Malnutrition in children can be a consequence of unfavourable socioeconomic conditions. However, some families maintain adequate nutritional status in their children despite living in poverty. The aim of this study was to ascertain whether family-related factors are determinants of stunting in young Mexican children living in extreme poverty, and whether these factors differ between rural or urban contexts. METHODS: A case-control study was conducted in one rural and one urban extreme poverty level areas in Mexico. Cases comprised stunted children aged between 6 and 23 months. Controls were well-nourished children. Independent variables were defined in five dimensions: family characteristics; family income; household allocation of resources and family organisation; social networks; and child health care. Information was collected from 108 cases and 139 controls in the rural area and from 198 cases and 211 controls in the urban area. Statistical analysis was carried out separately for each area; unconditional multiple logistic regression analyses were performed to obtain the best explanatory model for stunting. RESULTS: In the rural area, a greater risk of stunting was associated with father's occupation as farmer and the presence of family networks for child care. The greatest protective effect was found in children cared for exclusively by their mothers. In the urban area, risk factors for stunting were father with unstable job, presence of small social networks, low rate of attendance to the Well Child Program activities, breast-feeding longer than six months, and two variables within the family characteristics dimension (longer duration of parents' union and migration from rural to urban area). CONCLUSIONS: This study suggests the influence of the family on the nutritional status of children under two years of age living in extreme poverty areas. Factors associated with stunting were different in rural and urban communities.Therefore, developing and implementing health programs to tackle malnutrition should take into account such differences that are consequence of the social, economic, and cultural contexts in which the family lives.

Agriculture↗

Poverty and impairment in activities of living among elderly Hispanics.

This study employed data from a prior national survey of elderly Hispanics to examine the relationship between poverty and functionally impaired status, i.e., impairment in activities of daily living (IADL). The sample for this study consists of 1,685 Hispanics age 65 and older, representing four ethnic groups: Mexicans, Cubans, Puerto Ricans, and other Hispanics. Ethnic comparisons based on personal characteristics, poverty status and IADL found there were differences among the groups analyzed in terms of marital status, language, religion, age, education, poverty, and IADL. Logistic regression findings revealed that elderly Hispanics who were married, bilingual, and had higher educational achievement were more likely to live above the poverty level than were their counterparts. Findings from an ordinary least squares regression analysis revealed that poor elderly Hispanics had more IADL problems; that men had more IADL problems than women; that IADL problems tended to increase with age; that more educated people had fewer IADL problems; that Cubans had fewer IADL problems than other Hispanics; and that Puerto Ricans had more IADL problems than all other Hispanics. Implications for social work practice are discussed.

Activities of Daily Living↗

The Poverty and Housing Scale: report on a pilot study.

The measurement of beliefs and attitudes on poverty and housing is important to researchers and social workers interested in examining the role that belief structures have on the development of policy and programs in these areas. This article reports pilot study findings of a new scale, The Poverty and Housing Scale (PHS), that measures this concept and evaluates its psychometric properties. Preliminary reliability was in the very good range. Examinations of content and face validity provided support of the instrument as a valid measure of beliefs and attitudes on poverty and housing. The factor analysis emerged a one factor, 13-item scale. Unlike other related scales, the PHS attempts to link the social factor of poverty and housing together. Theoretical and methodological strengths and weaknesses are considered and the implications for social work practice are discussed. The authors provide recommendations for additional testing of the instrument.

Adolescent↗

Family structure, intergenerational mobility, and the reproduction of poverty: evidence for increasing polarization?

A substantial body of research has demonstrated links between poverty and family structure from one generation to the next, but has left open key questions about the implications of these associations for aggregate-level change. To what extent does intergenerational inheritance affect trends in poverty and single parenthood over time and, in particular, trends in the relative economic positions of single-parent and two-parent families? This article examines how patterns of intergenerational inheritance play out in the population over the long run, using data from the National Longitudinal Surveys and a model of population renewal that takes into account intergenerational mobility and differential fertility across groups that are defined by poverty status and family structure. Our results suggest that current rates of intergenerational inheritance have little effect on population change over time. They account for only a small share of the recent historical change in poverty and family structure and play no role in exacerbating existing economic disparities by family structure.

Adolescent↗

Human capital, social capital and social exclusion: impacts on the opportunity of households with youth to leave poverty.

Based on a sample survey, this paper, analyzes the impact of human capital, social capital and social exclusion on the opportunity of Hong Kong families with youth members to leave poverty. Educational attainment of the youth members and adult family members, as well as the quantity and quality of social networks were found to have significant positive impacts, while social exclusion from the labor market of the adult members was found to have significant negative impact on their opportunity to leave poverty. Among all factors, quality of social network is the most influential. The author suggests that in order to help families out of poverty and enable positive development of youth members, poverty alleviation policies or programs should be targeted to help the youth in poor families to build up a quality social network.

Adolescent↗

Do parenting and the home environment, maternal depression, neighborhood, and chronic poverty affect child behavioral problems differently in different racial-ethnic groups?

OBJECTIVE: To determine whether the processes through which parenting practices, maternal depression, neighborhood, and chronic poverty affect child behavioral problems are similar or different in minority and nonminority children in the United States. METHODS: Data from 884 white, 538 black, and 404 Latino families with children who were 6 to 9 years of age in the National Longitudinal Survey of Youth were analyzed. The outcome, child behavioral problems, was measured using the Behavior Problems Index externalizing and internalizing subscales. The effects of chronic poverty, neighborhood, maternal depression, and parenting on the outcome were analyzed using multigroup structural equation modeling. RESULTS: Chronic poverty affected child behavioral problems indirectly through the other variables, and parenting practices had direct effects in each racial/ethnic group. The effects of maternal depression were partially mediated through parenting in the white and Latino samples but were direct and unmediated through parenting practices in the black sample. Neighborhood effects were present in the white and black samples but were not significant for the Latino sample. CONCLUSIONS: Chronic poverty, neighborhood, maternal depression, and parenting practices have effects on child behavioral problems in white, black, and Latino children, but the processes and mechanisms through which they exert their effects differ among the groups. The differences may be related to social stratification mechanisms as well as sociocultural differences in family and childrearing practices.

Black People↗