WORLD HEALTH ORGANIZATION
ORGANISATION MONDIALE DE LA SANTE
REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU REGIONAL DU PACIFIQUE OCCIDENTAL
REGIONAL COMMITTEE Fifty-first session Manila 18–22 September 2000 Provisional agenda item 16
WPR/RC51/10 31 July 2000 ORIGINAL: ENGLISH
MINISTERIAL ROUND TABLE: HEALTH AND POVERTY
The topic for discussion at the ministerial round table is “Health and Poverty”. This document is intended to raise some of the major issues related to poverty and health for the information of participants.
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1. INTRODUCTION
About 1300 million people (20% of the world’s population) live in absolute poverty, with an income of less than US$ 1 per day. These people have been excluded from many of the benefits of economic development and 20th century advances in human health. WHO’s work already benefits the poor in many ways, through the Roll Back Malaria initiative, directly observed treatment, short-course (DOTS) to combat tuberculosis, and the implementation of essential drug policies, among others. Promoting equity has also been a cornerstone of the Health for All approach for over 20 years. Nevertheless, WHO is now paying increasing attention to poverty and health issues, attempting to approach health as a means of combating absolute poverty. At the same time, the international development community has begun to give top priority to poverty reduction. Health is increasingly being seen as a crucially important asset of poor people. From this perspective, protecting and improving health are recognized as central to poverty eradication and human development. Recent developments have included the following: The overarching international development goal set at the World Summit for Social Development (WSSD) at Copenhagen in 1995 was to halve the number of people living in absolute poverty by 2015. A series of concrete targets has been set in pursuance of this goal, many of them focusing on health, including child and maternal health and access to primary and reproductive health care. At the recently concluded follow-up special session of the UN General Assembly— convened in Geneva in June 2000 to take stock of progress five years after the WSSD— participants emphasized that health is central to development. Commitment 6 of the Final Document recognizes universal and equitable access to high-quality health services as essential to poverty reduction and recommends several measures to achieve this. Other agencies also recognize poverty reduction as an overarching objective. The World Bank’s World Development Report for 2000 focuses on the topic of poverty. As a
component of their poverty reduction strategies, the World Bank and the IMF are requiring countries to prepare poverty reduction strategy papers in order to qualify for financial and
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technical support. The Asian Development Bank recently adopted poverty reduction as its primary goal. Recent WHO initiatives include the following: In May 1999, a meeting entitled World Health Opportunity: Developing Health, Reducing Poverty (“the London Meeting”), called by WHO and hosted by the UK Department for International Development (DFID), brought together ministers and senior officials to discuss how investing in health benefits development. At a follow-up meeting, Partnership in Health and Poverty: Towards a Common Agenda, held in Geneva in June 2000,
participants agreed to take actions to: address health conditions that create and perpetuate poverty; make health systems more responsive to the needs of the poor; bring health concerns more directly into poverty reduction strategies; and mobilize additional resources to ensure these results. WHO Headquarters has established a Task Force on Health and Poverty Reduction. A question and answer paper “Poverty and health” was discussed at the 105th Session of the Executive Board in January 2000.
2. HEALTH AND POVERTY
Links between poverty and health
Poverty is known to be strongly correlated with ill-health. For example, those living in absolute poverty are five times more likely to die before reaching the age of five, and two and a half times more likely to die between the ages of 15 and 59, than those in higher income groups. HIV/AIDS, malaria, tuberculosis, diarrhoeal diseases, malnutrition and maternal mortality all disproportionately affect the poor, often rendering them destitute. In the same way, the positive effects of increasing per capita income on health are well documented in development literature. Higher income is known to give greater access to goods and services that promote good health— such as better nutrition, access to safe water and sanitation, and access to good quality health services.
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Recently, however, evidence has been mounting that good health can also promote household incomes and national economic growth. Research suggests that health status— as measured by life expectancy— is a significant predictor of economic growth. It is estimated that a gain of five years in life expectancy can enhance the rate of economic growth by between 0.3 and 0.5% per year. Healthier populations tend to have higher labour productivity, due to their greater mental and physical capabilities. They also have stronger incentives to invest in their human capital (education and skills) and physical capital (savings and investments). Conversely, a higher burden of disease can impede economic growth. The significance of these findings is clear: moving from a vicious to a virtuous circle requires investments in improving and protecting the health of the poor.
3. DISCUSSION POINTS
When considering the relationship between health and poverty, participants at the ministerial round table may like to consider the challenges that face the Region and some of the policy options that are available to respond to them. Policy challenges Total government expenditure on health is too low in many developing countries. Within countries, the distribution is often highly skewed in favour of the better-off. For example, most health personnel are found in urban areas, while the majority of the poor live in rural areas. Financial allocations favour hospital-based curative services, while the poor need accessible and affordable primary health care. In practice, the delivery of services is often profoundly anti-poor. There is rarely a focus on risk factors that are the root cause of the ill-health of the poor. The cost of services is often unaffordable for the poor. In addition, they can ill-afford the opportunity costs— in lost time and income of obtaining services. Studies show that in many health facilities, the poor may be treated with less respect and dignity than others. Unregulated market intervention is also anti-poor. Most developing countries are witnessing
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an expanding role for the private sector in health care. However, public intervention is necessary to achieve universal access where adequate social safety nets have not been put in place. Policy options To halve the number of people in extreme poverty by 2015, health policy development and systems implementation must be more effective in achieving greater equality of health outcomes and greater equity in health financing between the rich and the poor. The following are some ways in which health policy-makers and decision-makers can ensure this: Redirect resources to focus on cost-effective methods to prevent and treat diseases and conditions that disproportionately affect the poor. These “pro-poor” interventions include the Expanded Programme on Immunization, the Integrated Management of Childhood Illness, the Integrated Management of Pregnancy and Childbirth, and targeted interventions for HIV/AIDS, tuberculosis and malaria. Target the poor and vulnerable by directing funds, staff and supplies to areas where the poor live, work and learn. Achieve more equitable health financing by designing systems to protect the poor from out-ofpocket costs, particularly at the time of illness, by: increasing the level of pre-payment for health care by general taxation, mandated social health insurance contributions or voluntary initiatives; subsidizing the poor and lower-income groups by ensuring that the rich are not able to “opt out” of contributing to a pool for basic health care. Ensure that the key functions of the health system— raising and pooling funds, purchasing health services and providing care— work in harmony to achieve overall health system goals by: Overseeing all components of the health system, both public and private. This implies a fundamental shift in focus of health ministries from direct provision of all health services to broad oversight, advocacy, strategic purchasing, setting rules for financing and delivery by all providers and assessing overall performance.
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Lobbying financing agencies, especially Ministries of Finance, to protect budgetary allocations for essential health services by emphasizing the positive relationship between investments in health and poverty reduction. Engaging in cross-sectoral advocacy to influence policy on the wider determinants of the health of the poor. For example, the Ministry of Health can become an advocate for better nutrition by participating in policy discussions relating to access to land, crop subsidies and other agricultural issues. Similarly, health ministries can support efforts to promote girls’ education or better distribution of incomes, since evidence strongly links these efforts to better health outcomes.
3. CONDUCT OF THE MINISTERIAL ROUND TABLE
The ministerial round table has the following objectives: to raise awareness among health policy-makers and decision-makers in the Region about poverty and health links, current policy challenges related to poverty and health, and various options to promote pro-poor health policies in the Region; to encourage sharing of experiences and opinions on these issues, based on the current situation in countries throughout the Region; to identify, in general terms, WHO’s role in this area. Ministers attending the session, or their representatives, may participate in the round table discussions and each Member State is invited to nominate one participant. The round table is expected to last approximately two hours. A moderator will introduce the topic and raise issues for discussion. Thereafter the floor will be open to participants for discussion and sharing of country-level experiences.