Theme Issue on Poverty and Human Development
Authors: Annette Flanagin, Margaret A. Winker
Journal: JAMA (2006)

POVERTY IS AN INVETERATE CONSEQUENCE AND CAUSE of ill health. Without financial resources, people cannot pay for basic human needs: food, water, sanitation, housing, and health care services. In addition, poor people often live in poor countries that have limited or deteriorating health care systems and not enough physicians, nurses, and other trained health care workers. Others live in countries with governments that ignore or are too ineffectual to address the health care needs of the poor. Individuals who arepooralso lackadequateeducationtomakeappropriatedecisions about health and prevention of disease and often lack equity and empowerment to attain education, employment, and skills needed to escape the cycle of poverty. The first of the United Nation’s 8 Millennium Development Goals, determined by 189 countries in 2000, is to eradicate extreme poverty and hunger. This specific goal is to halve the proportion of people living on less than $1 a day (the World Bank’s definition of extreme poverty) and those who suffer from hunger by the year 2015. This goal cannot be achieved without improving the level of human development—the opportunity to escape poverty through “the choices that come with a sufficient income, an education, good health, and living in a country that is not governed by tyranny”—among the poor. Such development requires careful evaluation and study of interventions aimed to address the needs of poor individuals within their unique local conditions and socioeconomic context, with sufficient follow-up to determine whether effects are sustainable. In 1990, more than 28% of the developing world’s population (1.2 billion people) lived in extreme poverty. By 2002, this proportion had decreased to 19% but still represented more than 1 billion people. While substantial declines in extreme poverty have been reported for Eastern and Southern Asia between 1990 and 2002 (from a rate of 33% to 14% in Eastern Asia and from 39% to 31% in Southern Asia), progress in other regions has been mixed or marginal at best. Limited reductions in poverty rates have been seen in Latin America and the Caribbean (from 11% to 9%), but this region now still has more than 47 million people living in poverty. Rates of poverty in Western Asia and Northern Africa have remained almost unchanged since 1990 (approximately 2%) and have increased in the transition economies of Southeastern Europe and many of the countries of the former Soviet Union (from 0.4% in both regions to 1.8% and 2.5%, respectively). In sub-Saharan Africa, which has the largest regional proportion of extreme poverty in the world, the poverty rate declined only marginally from 1990 to 2002 (from 44.6% to 44.0%), and the number of people living in extreme poverty has increased to 303 million. Among all regions of the world other measures demonstrate some progress toward achieving the Millennium DevelopmentGoals, includingdeclines in theproportionofpeople with insufficient food and sanitation, increased enrollments in education, increased proportion of women employed, decreases in child mortality rates, increases in measles vaccination rates, and increased proportion of births attended by skilled health care workers. Each of these successes will contribute to reducing poverty and promoting human development, but some of this progress has been only marginal and much additional work, aid, funding, and research are needed. Despite huge increases in wealth and prosperity throughout the world in the last several decades, the gap between the wealthy and the poor has widened, with more than 1 billion people still living in extreme poverty. The United Nations Human Development Index is a composite of 3 dimensions of human development: living a long and healthy life (measured by life expectancy), being educated (measured by adult literacy and enrollment in primary, secondary, and tertiary schools), and having a decent standard of living (measured by purchasing power parity and income). According to the most recent report, Norway has the highest level of human development, and Niger the lowest. Individuals in Norway are nearly 50 times wealthier and live almost twice as long as those in Niger and have nearly universal enrollment in education, compared with 21% in Niger. People in the 31 coun-