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PubMed2002

Prevalence of household food poverty in South Africa: results from a large, nationally representative survey.

OBJECTIVES: Household food insecurity is a major determinant of undernutrition, yet there is little information on its prevalence in the South African population. This paper assesses household food insecurity in South Africa using a quantitative and objective measure, known as food poverty, and provides prevalence estimates by geographic area and socio-economic condition. DESIGN: Secondary data analysis combining two sources: Statistics South Africa's household-based 1995 Income and Expenditure Survey; and the University of Port Elizabeth's Household Subsistence Level series, a nationally-conducted, market-based survey. SETTING: South Africa. SUBJECTS: A nationally representative sample of the entire country - stratified by race, province, and urban and non-urban areas - consisting of 28 704 households. RESULTS: A household is defined to be in food poverty when monthly food spending is less than the cost of a nutritionally adequate very low-cost diet. The prevalence of food poverty in South Africa in 1995 was 43%. Food poverty rates were highest among households headed by Africans, followed by coloureds, Indians and whites. Higher food poverty rates were found with decreasing income, increasing household size, and among households in rural areas or those headed by females. CONCLUSIONS: The widespread nature of household food insecurity in South Africa is documented here. Prevalence rates by geographic and socio-economic breakdown provide the means for targeting of nutritional interventions and for monitoring progress in this field. The corroboration of these findings with both internal validation measures and external sources suggests that food poverty is a useful, objective measure of household food insecurity.

Adult↗
PubMed1999

Ethics and allocation of health resources--the influence of poverty on health.

Poverty and health are examined from the global and Nordic perspectives. The data from global social policy research, Nordic comparisons and equity in health research provide a basis for the discussion. At the global level the consequences of poverty are growing and the resultant problems posed are becoming increasingly evident. Poverty and sickness are interwoven; poverty aggravates mental problems, a situation regarding which we have seen steady deterioration. Research suggests that social cohesion, the factor that creates social capital and empowerment in societies, is a major factor that promotes health and the economy. Structural measures to combat poverty would require a global social policy: global redistribution, global regulation and global provision. However, the international community is not yet fully prepared for this discussion. At the Nordic level, Finland is a laboratory in which the viability of the welfare state has been tested in the worst recession ever to hit an OECD country. On the whole, it seems that income disparity has not grown during the recession and that services have functioned moderately well despite budget cuts. However, during that period the correlation between unemployment and sickness became apparent, and the challenges to healthcare more evident. We must make headway in untangling these relationships, because the tendency towards greater income disparity is growing in the post-recession boom. At the social welfare and health service level even the Nordic welfare states are not in full command of the means to alleviate poverty and its related health problems. Has the time come to dispel our Nordic arrogance and look at how the present services may in fact be generating inequity?

Ethics, Medical↗
PubMedDate not supplied

Poverty, prenatal care, and infant health in Puerto Rico.

Using data from a survey administered to a representative sample of mothers who gave birth in Puerto Rico in 1994-95, we investigate whether prenatal care and infant health outcomes are associated with family poverty and neighborhood poverty. The results show that infant health outcomes are unrelated to both family poverty and neighborhood poverty, despite the association of family poverty with the adequacy of prenatal care and the content of prenatal care. However, the poverty paradigm does receive some support using measures of participation in government programs that serve the low-income population. Women who rely on the government to fund their medical care are more likely than women who rely on private health insurance to have an infant death. They are also less likely to receive the highest levels of prenatal care. Nonetheless, targeted government programs can have an ameliorative impact. The analysis shows that participants in the Women, Infants, and Children (WIC) program are more likely than non-participants to receive superior levels of prenatal care and are less likely to have negative infant health outcomes.

Female↗
PubMed1996

Effects of poverty on home environment: an analysis of three-year outcome data for low birth weight premature infants.

Investigated the relationship between poverty and parenting in a sample of low birth weight (< or = 2,500 grams) premature (LBWPT) infants (gestation < or = 37 weeks) who were control subjects in the Infant Health and Development Program. When classified using federal poverty levels, poor families scored lower on the HOME inventory (used to measure the caregiving environment) than nonpoor families. A regression model including poverty, race, site, and representative environmental, maternal, and child variables accounted for 60% of variance in total HOME scores. Poverty and maternal IQ had significant and independent effects on HOME scores, whereas maternal distress accounted for little of the variance. In a LBWPT sample, our results find a strong relationship between parenting and poverty, suggest a modest role for maternal psychological distress in this relationship, and indicate that the influence of poverty likely extends beyond commonly measured environmental, maternal, and child factors.

Child, Preschool↗
PubMed2005

Race/ethnicity, poverty status, and renal transplant outcomes.

BACKGROUND: There are known racial disparities in renal graft survival. Data are lacking comparing associations of race/ethnicity and socioeconomic status with graft failure and functional status after transplantation. Our goal was to test if African-American and Hispanic race/ethnicity and poverty are associated with worse outcomes following renal transplantation. METHODS: We performed a retrospective cohort study using a nationwide registry (United Network for Organ Sharing). We studied 4,471 adults who received renal transplants in 1990. Outcomes were graft failure and functional status over 10 years. RESULTS: Cumulative incidence of graft failure was higher among African-Americans and Hispanics than whites (77% vs. 64% vs. 60 %; P<0.001) and among transplant recipients living in the poorest areas (70% vs. 58% in the richest; P<0.001). African-American and Hispanic race/ethnicity were independently predictive of graft failure (RR 1.8, 95% CI 1.6-1.9; RR 1.3, 95% CI 1.2-1.6, respectively) in multivariate analyses but poverty status was not (RR 1.0, 95% CI 0.9-1.1). Days with impaired functional status were higher for African-Americans compared to whites (RR 1.6, 95% CI 1.3-1.9) but not independent of poverty. Poverty was independently associated with impaired functional status (RR 1.3, 95% CI 1.0-1.6). CONCLUSIONS: African-Americans and Hispanics had higher rates of graft failure compared to whites after adjustment for poverty and other covariates whereas poverty, but not race/ethnicity, was related to functional status following renal transplantation. National datasets should include individual-level measures of socioeconomic status in order to improve evaluation of social and environmental causes of disparities in renal transplant outcomes.

Adult↗
PubMed2006

Effect of area poverty rate on cancer screening across US communities.

STUDY OBJECTIVE: To analyse the contextual effect of area poverty rate on never having been screened for breast, cervical, and colorectal cancer by (1) describing the extent of the variation in screening behaviours among 98 US metropolitan areas; (2) determining if the variation in lack of screening can be explained by differences in the characteristics of the persons who resided in these areas; and (3) determining if living in a metropolitan area with a higher poverty rate increased the likelihood of never having been screened for cancer over and above individual characteristics. DESIGN: Cross sectional survey using data from the 2002 Behavioral Risk Factor Surveillance System. Multilevel logistic regression included both individual level factors as well as area poverty rate. SETTING: Ninety eight areas across the USA. PARTICIPANTS: Over 118 000 persons residing in 98 areas; a sample aimed at estimating 48.3% of the US population age 18 or older. MAIN RESULTS: After adjustment for individual level factors, increasing area level poverty rate (per 5%) remained associated with never having had a mammogram (odds ratio (OR) = 1.28, 95% confidence interval (CI): 1.03 to 1.37); clinical breast examination (OR = 1.28, 95% CI: 1.11 to 1.48), colonoscopy/sigmoidoscopy (OR = 1.10, 95% CI: 1.01 to 1.19), and a faecal occult blood test (OR = 1.19, 95% CI: 1.12 to 1.27). Poverty rate was not independently associated with never having had a Pap smear (OR = 1.12; 95% CI: 0.90 to 1.41). The size of the variance among metropolitan or micropolitan statistical areas (MMSAs) varied by type of screening test, with intraclass correlation coefficients ranging from 4.9% (never having had a Pap smear) to 1.2% (never having had a colonoscopy/sigmoidoscopy). CONCLUSIONS: Area poverty rate was independently associated with never having been screened for breast and colorectal cancer, but not cervical cancer. The size of the variance among MMSAs was modest at best.

Adolescent↗
PubMedDate not supplied

Breaking the poor health-poverty link in the 21st Century: do health systems help or hinder?

It is depressing but true that, at the beginning of the 21st Century, poverty and ill-health are still closely interrelated. This review traces the current pathways from poor health to poverty in low- and middle-income countries, first at the national level, then at the household level. Ill health can have a substantial impact on gross domestic product, holding countries back from economic development, the fruits of which could be used to improve population health. At the household level, people may be pushed into poverty as a result of paying for health care. Households are forced to pay for the direct and indirect costs of health care at precisely the time when their incomes may be lowered by ill health. For this reason, many forego care, or rely on self-care or informal care, which may hasten the decline in their health and reduce their productivity. Sick people face a double jeopardy: their ill-health puts them at greater risk of poverty, and their poverty is likely to damage their health still further. The review goes on to discuss the role of health systems in the generation of poverty, before concluding with pointers as to how health systems can become part of the solution, rather than part of the problem.

Cost of Illness↗
PubMed2001

Growth in indigenous and nonindigenous Chilean schoolchildren from 3 poverty strata.

OBJECTIVES: This study sought to determine whether the short stature of Mapuche children, an indigenous group in Chile, reflects poverty or genetic heritage and whether the international reference population, derived from studies of US children of mostly European origin, is appropriate for assessing growth failure in indigenous peoples of the Americas. METHODS: The study assessed 768 schoolchildren of Mapuche and non-Mapuche ancestry, aged 6 to 9 years, living under conditions of extreme, medium, and low poverty. RESULTS: Growth retardation was strongly related to poverty in both ethnic groups. Within poverty levels, there were no significant differences in stature between ethnic groups, and in low-poverty areas in Santiago, the capital city, mean stature was only slightly less than in the reference population. CONCLUSIONS: Poverty, not ancestry, explains the short stature of Mapuche children, and use of the international reference to assess growth in this population is appropriate.

Body Height↗
PubMed2001

Neighborhood poverty and the resurgence of tuberculosis in New York City, 1984-1992.

OBJECTIVES: The resurgence of tuberculosis (TB) in NewYork City has been attributed to AIDS and immigration; however, the role of poverty in the epidemic is unclear. We assessed the relation between neighborhood poverty and TB at the height of the epidemic and longitudinally from 1984 through 1992. METHODS: Census block groups were used as proxies for neighborhoods. For each neighborhood, we calculated TB and AIDS incidence in 1984 and 1992 with data from the Bureaus of Tuberculosis Control and AIDS Surveillance and obtained poverty rates from the census. RESULTS: For 1992, 3,343 TB cases were mapped to 5,482 neighborhoods, yielding a mean incidence of 46.5 per 100,000. Neighborhood poverty was associated with TB (relative risk = 1.33; 95% confidence interval = 1.30, 1.36 per 10% increase in poverty). This association persisted after adjustment for AIDS, proportion foreign born, and race/ethnicity. Neighborhoods with declining income from 1980 to 1990 had larger increases in TB incidence than did neighborhoods with increasing income. CONCLUSIONS: Leading up to and at the height of the TB epidemic in New York City, neighborhood poverty was strongly associated with TB incidence. Public health interventions should target impoverished areas.

Adult↗
PubMed1992

The persistence of poverty under welfare states and the prospects for its abolition.

This article examines the relationship between poverty and the welfare state and attempts to answer the question as to why poverty has persisted under all welfare states. Several major reasons for the persistence of poverty are advanced, and the author argues that the main factor underlying the failure to abolish poverty is the conflict between economic policy and social policy. The challenge to welfare states from the New Right is examined--particularly the contention that welfare states themselves create poverty and dependence--in the light of evidence of the impact of the Thatcher government's policies in Britain. Finally, the author proposes an alternative approach to the abolition of poverty, one that is based on the integration of economic and social policy.

Employment↗
PubMed2006

Living in poverty and its effects on health.

Poverty has been identified as the greatest threat to health. Generally speaking, poor people are sick more often than wealthier people, and poor people die younger due to poorer economic, social, political and physical conditions. The article explains the difference between relative poverty and absolute poverty, before going on to explore various reasons why people living in relative poverty are more susceptible to ill health than their wealthier counterparts. The article delves into how poverty contributes to ill health by the effects of low income and poor health behaviours, with cigarette smoking being identified as the health behaviour with the largest negative impact on people living in relative poverty.

Health Behavior↗
PubMed1999

The effects of poverty and ageing on the increase in tuberculosis.

Among the causes of the current increase in tuberculosis worldwide are poverty and ageing. It has been widely accepted that tuberculosis and poverty have been closely linked since the scientific study of the disease began. The decline of tuberculosis in developed countries before the arrival of specific chemotherapy was largely attributed to improvement in social conditions. With the rapidly increasing world population and the wider disparity of income, more and more people are falling into poverty, whichever way it is defined. Studies in the developed world show that the close association between tuberculosis and poverty remains. Some workers in the field even suggest that tuberculosis cannot be controlled until the issue of global poverty has been addressed. This may be too pessimistic. It may be possible to define accurately which aspects of poverty are most closely associated with tuberculosis and to deal with those specifically. Within developed countries longevity is increasing. The population now in their seventies, or older, even in developed countries, will have been alive when the disease was highly prevalent in the communities in which they lived. The majority will, therefore, have acquired infection, and in a substantial minority of these infection may reactivate to cause disease as the ageing process weakens host immunity. In the indigenous Caucasian population of Western Europe, rates of disease are highest in elderly males. Previous research showed that beyond the age of forty, the incidence of disease declined with increasing age. The higher rates in the elderly were a result of the residue of higher rates from birth cohorts born earlier. Data presented in this article suggest that this pattern may be altering such that the incidence of disease actually increases after a certain age is reached. This could have important repercussions for disease incidence in the emerging economies of the Pacific Rim, where longevity is increasing most rapidly.

Adolescent↗
PubMedDate not supplied

Providing health care to human beings trapped in the poverty culture.

The culture of poverty impacts everything patients in this socioeconomic group think and do. If what poor patients say does not sit well with the way we think, that doesn't mean they are wrong. Physicians have to adjust their mental model and think in different cultural terms. The author recently completed his thirtieth year of a career dedicated to providing health care to people living in poverty. He shares seven concepts important in building a mental model that will enable physicians to successfully provide health care to this patient population: (1) Poverty is the number one health problem; (2) we see same diseases as everyone else; (3) patients are trapped in the poverty culture; (4) patients' behavior is often manipulative; (5) compliance is a unique challenge; (6) patients have limited resources; and (7) the ultimate contributors to poverty are unwanted adolescent pregnancy and substance abuse. These concepts can help physicians to be more effective in providing health care to patients living in poverty. They can help them understand what is happening, so that their experience might be fulfilling rather than demoralizing.

Adolescent↗
PubMedDate not supplied

Public support for poverty-related policies.

OBJECTIVE: This research examined how public perceptions of the relationship between poverty and health predict support for poverty-related policies. METHODS: A random sample of 1,203 Albertans were interviewed by telephone to determine their perceptions of the relationship between poverty and health (myth, drift, behavioural, structural), and their support for government spending in six poverty-related policy areas: nutrition programs, housing, child care, increased welfare allowance, wage subsidies, and recreation programs. RESULTS: The greatest support was for child care programs, with the least support for increased welfare allowance. The degree of support for all policies except wage subsidies and recreation programs differed by the explanation chosen of the relationship between poverty and health. Those who chose a structural explanation were more likely to support government spending than those who chose a behavioural explanation. INTERPRETATION: Beliefs about the relationship between poverty and health influence support for policies. Public health professionals have a role in increasing public awareness of the structural factors that influence health.

Alberta↗
PubMed2003

Poverty, equity, human rights and health.

Those concerned with poverty and health have sometimes viewed equity and human rights as abstract concepts with little practical application, and links between health, equity and human rights have not been examined systematically. Examination of the concepts of poverty, equity, and human rights in relation to health and to each other demonstrates that they are closely linked conceptually and operationally and that each provides valuable, unique guidance for health institutions' work. Equity and human rights perspectives can contribute concretely to health institutions' efforts to tackle poverty and health, and focusing on poverty is essential to operationalizing those commitments. Both equity and human rights principles dictate the necessity to strive for equal opportunity for health for groups of people who have suffered marginalization or discrimination. Health institutions can deal with poverty and health within a framework encompassing equity and human rights concerns in five general ways: (1) institutionalizing the systematic and routine application of equity and human rights perspectives to all health sector actions; (2) strengthening and extending the public health functions, other than health care, that create the conditions necessary for health; (3) implementing equitable health care financing, which should help reduce poverty while increasing access for the poor; (4) ensuring that health services respond effectively to the major causes of preventable ill-health among the poor and disadvantaged; and (5) monitoring, advocating and taking action to address the potential health equity and human rights implications of policies in all sectors affecting health, not only the health sector.

Health Services Accessibility↗
PubMed2004

[Poverty, social exclusion, social capital and health].

Social capital is the social structure which facilitates the actions of individuals, stimulates production and allows for success. Poverty maintains basic needs unmet (food, health, autonomy) over time and unvoluntarily. Social exclusion does not allow individuals to participate in society. The following dimensions are assessed: financial poverty, social inclusion, employment, health and education. Social participation, work integration, empowerment, self-esteem, and personal achievement should be promoted. In Europe 15% of people is exposed to poverty; in Spain corresponding figures are 13.4%, while for the elderly reached 21%. Extreme poverty affects 6.2% population and severe poverty 14.2%. Women and those living in Andalusia, Canary Islands and Extremadura are particularly affected, health inequality are for elderly, immigration, gender, social class, and should be reduced 10% for 2010. The Gini indez measures the income distribution; in the European Union (EU) it is 0.29 while in Spain is 0.33. Poverty and health are inversely correlated, health care expenditure in Spain is 7.5% og GDP. Life expectancy in U.E. is 75.5 years for men and 81.6 years for women, while in Spain it is 78 and 83.1 respectively. Infant mortality in EU is 4.5/1000, 4.1 per thousand in Spain. Lastly, the number of children per women in EU is 1.47 and in Spain 1.3.

European Union↗
PubMed1991

Structural change and the aggregate poverty rate.

This paper measures the extent to which recent increases in the aggregate poverty rate are attributable to the changing distribution of employment across industries. We decompose the total poverty rate change over the 1976-1983 period into components attributable to changes in employment shares and changes in the incidence of poverty within industries. Our results show that the poverty rate increase resulted primarily from the decline in employment rates in general and from increases in the incidence of poverty within all industries, rather than from the shift of employment opportunities between sectors. The growth of service sector employment in particular has not contributed to the increased incidence of poverty in the United States.

Employment↗
PubMedDate not supplied

[Poverty in Mexico. I. Methodology and evolution].

This article is the first of two parts of a research report on the evolution and magnitude of poverty in Mexico. Herein are presented the methodologies used in both parts and the evolution of poverty. The Poverty Line methodology (PL), in its Standard Basket of Essential Satisfiers version, is succinctly explained. Two problems on the definition of normative requirements are emphasized: the foundations of such requirements and the access route by which needs are to be met (private consumption or public transfers). Identification of six household welfare sources allows for criticism of PL and Unsatisfied Basic Needs methodologies which the Integrated Poverty Measurement Method (IPMM) brings together. IPMM is used to estimate the magnitude of poverty in 1989. The results are presented in the second part of this report. Results analyzed in the last section of this article show that while poverty in Mexico decreased steadily from 77.5% in 1963 to 48.5% in 1981, it increased since 1982, reaching 66% in 1992.

Humans↗