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This article reviews the extent to which a child is placed at risk because of poverty. It looks especially at behavioral and developmental outcomes that are affected by poverty and suggests interventions to overcome any adverse effects.
In this paper, we study the relation between life expectancy and both average income and measures of income inequality in 1980 and 1990, using the 17 Spanish regions as units of analysis. Average income was measured as average total income per household. The indicators of income inequality used were three measures of relative poverty-the percentage of households with total income less than 25%, 40% and 50% of the average total household income-the Gini index and the Atkinson indices with parameters alpha=1, 1.5 and 2. Pearson and partial correlation coefficients were used to evaluate the association between average income and measures of income inequality and life expectancy. None of the correlation coefficients for the association between life expectancy and average household income was significant for men. The association between life expectancy and average household income in women, adjusted for any of the measures of income inequality, was significant in 1980, although this association decreased or disappeared in 1990 after adjusting for measures of poverty. In both men and women, the partial correlation coefficients between life expectancy and the measures of relative income adjusted for average income were positive in 1980 and negative in 1990, although none of them was significant. The results with regard to women confirm the hypothesis that life expectancy in the developed countries has become more dissociated from average income level and more associated with income inequality. The absence of a relation in men in 1990 may be due to the large impact of premature mortality from AIDS in regions with the highest average total income per household and/or smallest income inequality.
In this paper, we attempt to verify that neighborhood economic structure influences individual health over and above other individual characteristics, and to comparatively evaluate the effects of neighborhood concentrated affluence, concentrated poverty and income inequality in relation to individual health in the USA. We also explore physical environment, health-enhancing services, social hazards (crime) and social resources as mechanisms operating at the neighborhood level that may help to explain the influence of structural economic conditions on health. We use Hierarchical Ordinal Logit Models to examine a rich multi-level data set. Results indicate that affluence exerts significant contextual effects on self-rated health while poverty and income inequality at the neighborhood level are not important structural factors. Moreover, we find that a composite measure of social resources distinguishes itself in both explaining the impact of concentrated affluence and exerting an independent contextual effect on individual health. Physical environment, or the level of physical disorder in the neighborhood, also mediates the effect of affluence on self-rated health, although to a lesser degree than social resources. Our empirical findings suggest that different dimensions of economic structure do not in fact have unique and additive contributions to individual health; the presence of affluent residents is essential to sustain neighborhood social organization which in turn positively affect health.
This paper seeks to establish the strength of association between contemporary tuberculosis (TB) in England and Wales and several potential aetiological factors. It presents an ecological analysis of standardised annual TB mortality rates for the 403 local authority districts between 1982 and 1992, disaggregated by age and sex. Social, demographic and ethnicity measures from the 1981 and 1991 censuses and standardised annual AIDS-related mortality rates for young men are used to calculate Poisson regression models. A strong association was found between all TB mortality groups and overcrowding at the household level. For women, no other measures improved the explanatory power of the models. In multiple regressions, both poverty and AIDS-related mortality explained additional variation in the model for younger men. The link between ethnicity and tuberculosis notifications was not reflected in this analysis of mortality. For all groups no evidence of a positive relationship with ethnicity was found, once overcrowding had been accounted for. The significance of household as opposed to district level crowding suggests that prolonged contact is required for disease transmission. Regression analysis indicates that it is the overcrowding and poverty among ethnic populations that is significant for their tuberculosis mortality. The fact that the relationship between AIDS and TB is confined to the group most typical of AIDS patients provides evidence that AIDS has little influence on the level of tuberculosis mortality in the wider population. Explanations for the observed relationship include preferential certification, migration for treatment and shortcomings in health care provision.
BACKGROUND: Poverty and female gender have been found to be associated with depression and anxiety in developed countries. The rationale behind this paper was to bring together five epidemiological data sets from four low to middle income countries to examine whether key economic and development indicators such as income and poor education, and female gender, were associated with common mental disorders. METHOD: The paper is based on five datasets: three based on primary care attenders in Goa, India; Harare, Zimbabwe and Santiago, Chile; and two based on community samples in Pelotas, Brazil and Olinda, Brazil. All five studies estimated prevalence of common mental disorders along with variables to measure economic deprivation and education. FINDINGS: In all five studies, female gender, low education and poverty were strongly associated with common mental disorders. When income was divided into tertiles, with the lowest tertile as a reference value, there was a significant trend for reduced morbidity for the lower two tertiles. DISCUSSION: These findings have considerable implications since the rapid economic changes in all four societies have been associated with rising income disparity and economic inequality. Examples of population based prevention strategies based on increasing the proportion of those who complete schooling and on high-risk strategies such as providing loan facilities to the impoverished are potential outcomes of these findings. Development agencies who focus on women as a priority group have failed to recognize their unique vulnerability to common mental disorders and need to reorient their priorities accordingly.
It is often said that women live longer than men, but suffer more illnesses throughout their lives. It has also been demonstrated in various studies of women's health that measures of health and health behaviour vary over different geographic scales. Added into this mix is the fact that historically more women than men in relative terms are found on the lower rungs of the socio-economic ladder. What has not been so well-developed is our understanding of the connections among health, gender, poverty and especially location. In 1998, Statistics Canada released the second wave of the National Population Health Survey (NPHS-2). Included with the NPHS-2 public use microdata file are measures of health status, gender, income and location which can be analyzed in the form of logistic regression models. Results are reported which provide a better understanding of the relative roles that gender, poverty and location play in the geography of inequalities.
The short- and long-term effects of poverty and unemployment on alcohol abuse are investigated using structural equation modelling (SEM) to better understand the observed conflicting relationships among them. We studied 795 community residents who provided complete data in both 1989 and 1991 in the Winnipeg Health and Drinking Survey (WHDS), with equal representation of males and females. Results indicate that (a) increased poverty causes increased alcohol use and alcohol problems, and (b) recent unemployment decreases alcohol use while longer unemployment increases it. It is concluded that the effect of unemployment on alcohol abuse changes direction with time and, thus, both cross-sectional and longitudinal data are required to assess any meaningful relationship between them.
This study explored the effects of structural and experiential neighborhood factors and developmental stage on antisocial behavior, among a sample of poor urban adolescents in New York City. Conceptually and empirically distinct profiles of neighborhood experience were derived from the data, based on measures of perceived neighborhood cohesion, poverty-related hassles, and involvement in neighborhood organizations and activities. Both the profiles of neighborhood experience and a measure of census-tract-level neighborhood hazard (poverty and violence) showed relationships to antisocial behavior. Contrary to expectation, higher levels of antisocial behavior were reported among adolescents residing in moderate-structural-risk neighborhoods than those in high-structural-risk neighborhoods. This effect held only for teens in middle (not early) adolescence and was stronger for teens perceiving their neighborhoods as hassling than for those who did not. Implications for future research and preventive intervention are discussed.
Data from a national sample of 878 4-9-year-old children in single-mother families were used to test a structural model of the effect of poverty on children's socioemotional problems. Results show that the effect of poverty is mediated by maternal depression and mothers' use of physical punishment. Maternal depression influence children's socioemotional problems directly, as well as indirectly through physical punishment.
Poverty may be defined narrowly as a lack of income, but is more usefully viewed as a multidimensional concept. I discuss some associations between poverty and health, identify groups with special needs, and describe some aspects of the government's health policy which are relevant to those needs. Finally, I note the importance of ensuring there is a more integrated approach in future.
BACKGROUND: Malnutrition rates in Sierra Leone are among the highest in the world. However, policy-makers do not always recognise the fight against malnutrition as a policy priority to ensure the healthy human capital needed to fight poverty and achieve sustained positive economic growth. OBJECTIVE: The analysis presented here was conducted by an intersectoral and inter-agency group of Sierra Leonean senior policy advisors to quantify some of the potential human and economic benefits of improved policies and programmes to reduce malnutrition. FINDINGS: The analysis revealed that 46% of child deaths in Sierra Leone are attributable to malnutrition, the single greatest cause of child mortality in the country. In the absence of adequate policy and programme action, malnutrition will be the underlying cause of an estimated 74000 child deaths over the next five years. The analysis also revealed that if current levels of iodine deficiency remain unchanged over the next five years, 252000 children could be born with varying degrees of mental retardation as a result of intrauterine iodine deficiency. Finally, the analysis showed that, in the absence of adequate policy and programme action to reduce the unacceptable rates of anaemia in women, the monetary value of agricultural productivity losses associated with anaemia in the female labour force over the next five years will exceed dollars 94.5 million. CONCLUSION: Sustained investment in nutrition in Sierra Leone could bring about enormous human and economic benefits to develop the social sector, revitalise the economy, and attain the poverty reduction goals that Sierra Leone has set forth.
This study examined the relationship between poverty and coping and defense behaviors and the way social support moderates this relationship. One hundred fifty Indian adults responded to scales of income, perceived economic status, coping, defense and social support. In addition, physical quality of living was rated on the basis of observation and a short interview. Results showed that income and physical quality of living were positively associated with perceived economic status. Income, physical quality of living, and perceived economic status were negatively related to coping and defense behaviors. Finally, social support did not moderate the impact of poverty on coping and defense behaviors.
This article describes the findings of a modest qualitative study that deals with the concept of health and involves the women-centered interviewing of six women who live in poverty. The themes uncovered in this study identify the struggle for wholeness in the midst of poverty. The findings validate many of the nursing theorists' definitions of health as wholeness, and challenge care providers to bring an appreciation of this view to their understanding of women's health.
Interviews were carried out with 16 South African Zulu widows. Much of what the widows had to say seemed like what one might hear from widows in economically developed countries, but there were also striking differences. All the widows lived in poverty, and for some their grief seemed much more about the poverty than about the husband's death. Most widows observed a year of traditional ukuzila mourning practices, which made them a threat to others and which is difficult to carry out in the social upheaval of modern South Africa. Widowhood was in some cases a struggle with witchcraft--as cause of the death or as an accusation directed at the widow.
After more than a century of decline, in the mid 1980s tuberculosis began to increase in some developed countries. Health care workers were then forced to look to the developing world, where they found tuberculosis to be out of control, in many countries. It is now appreciated that tuberculosis is not only increasing globally but is likely to do so beyond the next decade for three principal reasons. First, demographically as the expected population increase will be greatest in areas of the world where tuberculosis is most prevalent, particularly middle Africa and South Asia. Secondly, the increase of HIV, which renders the host uniquely susceptible to tuberculosis, is occurring in the same areas of the world and is already causing an increase in tuberculosis case rates of up to tenfold. Thirdly, as more and more people are forced to live in poverty, where poor nutrition and crowded conditions lead to the spread of tuberculosis, the disease risk will be compounded. Sound medical management, particularly the use of the five components of directly observed therapy, will relieve the situation. But until world conditions of poverty and HIV spread are addressed, it is unlikely that tuberculosis can be controlled.
This paper aims to begin to consider the evidence for AIDS as a disease of poverty. It seeks to describe the important influence of the social and economic context of HIV/AIDS and of those behaviours associated with HIV transmission, and argues for a shift in emphasis in the conceptualization of the 'problem of AIDS'. The relationship between poverty and AIDS is explored, particularly in relation to global economic development, urbanization, homelessness and the disintegration of neighbourhoods, migration and systems of labour and production. Examples of socially-driven community-based responses to the prevention and control of the HIV epidemic in diverse cultures are discussed and the need for new outcome measures for assessing community initiatives is proposed.
To study drug use in the context of poverty, it is necessary to undertake a complex analysis of various perspectives to understand the dense interweaving of socioeconomic, political, and cultural factors involved in the problem. The analysis of this social scenario was our starting point in planning holistic actions for the prevention of human immunodeficiency virus/acquired immunodeficiency syndrome and other illnesses related to drug use. Merely copying successful models from developed countries, which are designed for other contexts and populations, would result in insufficient and ineffective actions. The Asociación Civil Cristiana Recuperación Atención de Drogadependientes (ACCRAD), also known as "El Retoño" ("sprout"), is a nongovernmental organization that has been working since 1985 to consolidate a model of analysis and intervention that considers this complex framework and seeks to meet the needs of drug users from the poorest sectors of society. Our research on the use of drugs and its relationship to poverty, together with the documentation of harm-reduction interventions, has been carried out since 1997.
Poverty rates have fallen more slowly over the last three decades among older women living alone than for other groups of elderly persons. The simultaneous increase in the percentage of elderly women living alone has given rise to speculation that these two phenomena are related. Using 1950 and 1980 Census data this relationship was explored. Over the 30-year period, poverty among elderly women fell by 35.9 percentage points. It would have fallen further if women had not changed the types of households in which they lived, but by only an additional 3 percentage points. The effect of changes in household composition, however, was greatest for the oldest of the elderly individuals.