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Health Care
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According to the World Health Organization (WHO), health is defined not just as the absence of disease and infirmity, but rather as a person's state of complete physical, mental and social well-being. This comprehensive definition implies that “health” and “disease” are perceived differently in different cultural and social environments. This makes intercultural and historical comparisons extremely difficult. However, the absence of health in the dramatic sense – for example when it is expressed in high rates of infant and child mortality, or in extreme pain or disability – is perceived as an undesirable state in all cultures and by all social classes equally.
Due to deficiencies in meeting basic needs and the still low average age of people in developing countries, the majority of those who are ill are suffering from infectious diseases and other diseases of poverty – including diarrhea and parasitic diseases caused by a lack of hygiene and clean drinking water, and malnutrition.
One consequence of these infectious diseases and diseases of poverty is high rates of infant, child and maternal mortality, which are the clearest evidence of the gap between the northern and southern hemispheres in the field of health. For example, infant mortality in Switzerland is six cases per 1,000 births, while the figures are 33 per 1,000 in Peru, 79 per 1,000 in Bangladesh and 122 per 1,000 in Somalia. High rates of infant and child mortality have particularly severe and cumulatively negative effects. Because the parents want “surviving offspring” and not just “babies born,” poor societies respond to the high mortality rates with high birth rates. From the individual point of view this is understandable, but from a health-policy perspective it is disastrous. The shorter the intervals between two births, the more frequently a woman gives birth, or the higher her age when she gives birth – the higher the rates of illness or death both for the additional children born and for the mothers.
In practically all developing countries, the lowest 20 percent of income earners have a burden of illness three to four times higher than the top 20 percent of earners in the same societies, measured in terms of infant and child mortality, the numbers of children who are underweight or mentally retarded, and other indicators. Similar differences exist in most industrialized countries as well, although they are not as marked.
But poverty never just means “income poverty,” in terms of a lack of economic development – it always goes hand in hand with a lack of power, which makes it impossible to claim legitimate entitlements from family members, the village community, or the state and its official bodies. Poverty also always means humiliation and exclusion from society, and a disadvantaged status that goes well beyond merely financial aspects. Although the lowest 20 percent of income earners have to bear a disproportionate burden of illness and mortality, they have much less access to vaccination programs, treatment of acute or chronic illnesses, prenatal and postnatal care, and medically trained personnel. When they do manage to obtain access, they tend to be treated in an unfriendly and unprofessional fashion – in addition to receiving a poorer quality of treatment. Instead of being regarded as clients entitled to services and medicines, they are often dismissed as tiresome nuisances.
By contrast, their wealthier compatriots may have easy access to health care services as a result of their political power, or even through corruption. This is particularly repugnant when these services are provided free of charge or are heavily subsidized, so that high-income earners would not be entitled to them legally – and certainly not for reasons of need. Despite the tremendous importance of economic development, overcoming poverty requires an integrated definition of development that is directed toward culturally appropriate enhancements in the quality of life for every segment of society – and this is what matters in terms of achieving sustainable improvements in health.
Courtesy of Novartis Foundation