1. 3
Health & the Poor
Who gets sick more often?
Who gets treatment faster?
Who can afford treatment more easily?.....

2. 3-1
POVERTY AND HEALTH
What is the “real” cause of T.B ?
People say that a germ called Mycobacterium tuberculosis causes the disease TB. This
germ is very common in India and many of us have this germ inside us. But we see that
out of a hundred people who get infected with the germ, only 10 of them get the TB
disease. We also see that of these people who suffer from TB more than eighty percent
are poor people !
Yet, why do we not say that it is poverty and not a Mycobacterium that causes TB!
Why is it important to say that poverty causes TB?
The question is important because unless we identify the cause correctly, we will not be
able to solve the problem. If we say that a bacterium is the reason for TB, we will only use
medicine to get rid of the bacteria. All our energy and money would go into treating pa-
tients with TB.
But if we accept that poverty causes TB, we as a society would try to do something to
make life better for the poor if we want to control TB.
CASE STUDY : T.B in Britain
Did you know that TB in Britain at one time was as high as that in many parts of India. This was
during during the phase of industrialisation. But in just a hundred years - from 1840 onwards until
1940 - the number of TB cases dropped from lakhs to a few hundred cases all over Britain. It was
no longer a public health problem.
How did Britain do this magic while here in India TB continues to kill millions even today?
Let us look at the rate of TB in Britain over the last
hundred and fifty years.
You will probably say that their
people could afford good and expen-
sive medicines. But then just remem-
ber that the first effective drug against
TB came out only in 1944 and BCG
to prevent TB in children was al-
lowed even later. Even before these
drugs were found Britain had re-
duced TB.
So it was not drugs but increase in
living standards, better housing laws
that were implemented, old age pen-
sions, employment guarantees, food
security etc. that reduced T.B cases.
Even after knowing this our TB programme in India talks mainly about having microscopes
and TB drugs. Why do we not talk of bettering the lives of the poor as a way to control TB?
Unless we do that our poor will continue having TB and not have the means to cure it.
The same is for malaria, diarrhoea and most infectious diseases. The poor are the first to be
hit and the last to get cured. Even in the disease AIDS, from the time it was discovered in
1981, the AIDS epidemic has hit many countries all over the world. But most of the patients
once again are placed in the poorest regions of the world in Africa and South Asia.

3. 3-2
Are only the rich healthy?
It is not true that only people in richer countries can enjoy good health. Usually we measure
health by the number of children who die before the age of one. If this is so we see even Kerala
in India and neighbouring Sri Lanka almost matching the rates found in much “richer” coutries
like the U.S. And they have done this at a much lower cost.
How have they done it?????
Not by buying tablets and having fancy hospitals for their people !
These societies have educated their women and given them a high status. This helps more
money to go into health and education rather then on roads and television. Their good public
health policies that involve people in making their own decision , and these have worked
wonders.
As health workers in villages we often have to work with limited resources and have to choose
who we should first help. At such times, poverty can be a good indicator to help prioritise. We
can choose how best to spend our money.
We know that the poor are more likely to suffer from disease and they they are more likely
to die from it. So, instead of spending the money or time on all equally, we can focus on
helping the poor. In return we are much more likely to help improve the health statistics
also, because the worst health statistics come from the poor.
Buying Tablets alone Cannot Buy you Health
Health in countries like ours has a lot to do with
infections. This is a fact. But it does not mean that
the answer lies in medicines that kill germs.
It has more to do with public policies that ensure
every person gets a minimum living wage,all citi-
zens get clean drinking water, have sanitation, get
immunisation and education, they live in ad-
equately large houses, get a balanced nutritious
diet and get at least minimal medical care free of
cost close to their house. It also depends on tradi-
tions where women enjoy a good status.
Drug companies
say:
Think of this .....
“You poor are Can the malaria mosquito pick out only the poor
hungry.... people to bite and leave out the
Have more rich? No. But still we see that
medicines!” poor people get bitten more
than the rich.
The poor may not have a
house that can keep mosquitoes away. They
may not have mosquito nets. And they may be
forced to go into the forest to cut wood for a
living and get bitten by mosquitoes. So, should
we blame the mosquitoes or should we blame poverty
for causing malaria ??!