Dying for change : poor people's experience of health and ill-health
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Drawing on the accounts from the World banks ‘Voices of the Poor’ this booklet looks at the intimate link between health and poverty and the need for health to be central to attempts at poverty reduction. Three key lessons are: [1] People view and value their health in a holistic sense, as a balance of physical, psychological and community well-being, consistent with the WHO view of health as ‘a state of complete physical, mental and social well-being, not merely the absence of disease or infirmity. [2] People overwhelmingly link disease and ill-health to poverty, while poverty is also seen in terms of instability, worry, shame, sickness, humiliation and powerless-ness. [3] Health is valued not only in its own right, but because it is crucial to economic survival. Other lessons include: the fact that ‘poor people’ are not homogenous and in particular women and men, and the young and old, experience poverty and ill-health quite differently. Gender differences include the fact that men access and are seen as more entitled to formal health care, while women more often draw on traditional and alternative health services or defer their own treatment. Attitudes of health staff often appalling. Humiliating treatment by health personnel who treat people as ‘worse than dogs’ was a common experience and barrier to getting treatment. Access to health facilities, rarely built in poor areas, and often too costly to access are a problem. WHO concludes that "there can be no real progress on poverty reduction, or improvement in health outcomes, unless economic and social inequities are tackled"