COVID-19 and Poverty

That health and illness are close associates of wealth and poverty is well known. This dictum applies to covid-19 both within and among nations.

Gradients for death rates for most diseases provide evidence that the less well-off suffer more of nearly all illnesses and die at younger ages. Interventions that seek to reduce poverty in the name of better health have this association as their foundation.

But while we often think of poverty as leading to illness – a social determinant of health – we can easily overlook the fact that the reverse also operates.

A September 26th leader in The Economist – ‘Failing the poor’ https://www.economist.com/leaders/2020/09/26/covid-19-has-reversed-years-of-gains-in-the-war-on-poverty explores the link between covid-19 and poverty. It quotes a World Bank estimate that the number of extremely poor people who make less than AUD2.7 a day “will rise by 70m-100m this year” because of covid-19.  The UN estimates that the number of people lacking basic shelter and clean water, the article goes on to say, increasing by 240m-490m this year, abolishing hard-won progress of the past decade. The impact of the new wave of poverty on basic health care can be disastrous. Some estimates suggest that vaccination rates for children have been set back two decades.

Here we see an illness – covid-19 – as a ‘social determinant of poverty’ – and then poverty hovering to cause more illness.

The Economist explores how corrupt and brainless actions of some governments – spending unwisely and buying the favour of cronies – can make this dire problem worse.  India has given billions of dollars to subsidise coal mines and Mexico has done likewise for its oil industry while their poorer citizens suffer.  If you want to give aid – and most rich countries are considering how to give less – give it directly to the poor. Funding zombie industries such as fossil fuel because of their political power does not help.

“With a little extra cash in their pockets, recipients can feed their children and [possibly] send them back to school.  They can avoid a fire-sale of assets, such as a motorbike-taxi or a cow, that will help them make a living in the future.”

Brazil, interestingly, according to the article has done well, helping 66m impoverished with cash handouts of AUD155 a month for three months.

These are controversial suggestions and not all agree with them.

It is easy to feel overwhelmed.  But poverty is not something new or unfamiliar.  We cannot as individuals influence the massive international agendas that lead to and support poverty, but we can each do something. Increments will not solve the global problem but can help individuals.

Peter Singer, an eminent Australian ethicist, has led a global debate about poverty for deacdes and what we each might do by way of response.  He has recently published the tenth edition of his book “The Life You Can Save: Acting Now to End World Poverty”, now  available as a free e-book.  As Wikipedia puts it synoptically, Singer advances three premises for his argument:

First premise: Suffering and death from lack of food, shelter and medical care are bad.

Second premise: If it is in your power to prevent something bad from happening, without sacrificing anything nearly as important, it is wrong not to do so.

Third premise: By donating to aid agencies, you can prevent suffering and death from lack of food, shelter and medical care, without sacrificing anything nearly as important.

Conclusion: Therefore, if you do not donate to aid agencies, you are doing something wrong.

Singer argues that it is obvious that an adult ought to save a child from drowning unless that individual is risking something as valuable as the child’s life. Singer points out that as many as 27,000 children die every day from poverty that could be easily and cheaply helped by existing charities.

Singer says that many of his readers enjoy at least one luxury that is less valuable than a child’s life. He says his readers ought to sacrifice such a luxury (e.g. bottled waters) and send proceeds to charity, if they can find a reliable charity.

Perhaps the covid-19 pandemic can encourage us to think and act about the poverty it is creating – at least as it affects individuals – but then give a little to help, while we are stuck at home Zooming and eating too much!

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Stephen Leeder is an Emeritus Professor of public health and community medicine at the University of Sydney.  Steve has 45 years of experience in epidemiological research, medical education reform and in mentoring young investigators. Most of his research has been collaborative and he has always sought ways of ensuring the career development of members of his teams.

Steve is currently Editor-in-Chief of the International Journal of Epidemiology. He held the position of Chair of the Western Sydney Local Health District Board from 2011 until 2016 and was Editor-in-Chief of the Medical Journal of Australia from January 2013 until April 2015.

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