Wider determinants of health include community empowerment and anti-poverty measures. There are different perspectives on health: as a right, consumption good, or investment. Health as a right involves government responsibility to ensure access and equity. As a consumption good, health is a personal objective not requiring special government responsibilities. As an investment, health affects workforce productivity. Development encompasses improving standards of living and expanding economic and social opportunities. It differs from economic growth, which is a quantitative increase, by transforming society for better well-being. Health plays a key role in development by increasing productivity.

1. Health and development
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2. DETERMINANTS OF HEALTH
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3. • Wider primary health care concepts suggests that
broader interventions, including community
empowerment and anti-poverty measures, are
necessary to promote health.
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4. Different perspectives on health
1. Health as a right
• Health is viewed by some as a right analogous to justice or
political freedom.
• Indeed the WHO constitution states that ‘…the enjoyment
of the highest attainable standard of health is one of the
fundamental rights of every human being without
distinction of race, religion, political belief, economic or
social condition’ .
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5. Health as a right…
• In part, this involves ensuring access to health care.
• The government is seen as having a responsibility to
ensure this, comparable with its role in ensuring equal
justice.
• According to such a view a government will be
particularly concerned with issues of equity in health
and health care.
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6. 2. Health as consumption good
• For others health is seen as an important
individual objective
• that is not comparable with justice, but rather
with material aspects of life.
• Such a view often refers to health as
consumption good.
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7. Health as consumption good…
• The government here has no special responsibilities
in the promotion of health, but leaves decisions as to its
comparative importance to individual consumers.
• The role of the state under such a view might be
limited to ensuring that the health care provided is of
an adequate quality (such as ensuring professional
standards in the same way that it would monitor the
quality of any good or service, such as food).
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8. 3. Health as an investment
• Health largely affects the productive ability of
the workforce.
• Illness may affect overall production, either
through absenteeism or by lowering
productivity through its debilitating effects.
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9. Small Group Discussion
• What is development?
• How does development differ from economic
growth?
• How can development be measured?
• What role does health play in development?
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10. Development
• The modern view of development perceives it
as both a physical reality and state of mind in
which society has, through some combination
of social, economic and institutional processes,
secured the means for obtaining a better life.
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11. • Development in all societies must consist of at
least the following three objectives:
I. To increase the availability, distribution and
accessibility of life-sustaining goods
II. To raise standards of living
III. To expand the range of economic and social
opportunities and services to individuals
and communities
 by freeing them from servitude and dependence on
other people and communities and from ignorance
and human misery.
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12. Growth and development
Growth
• It is a process of becoming:
– larger or
– longer or
– more numerous or
– more important; mostly a
physical change.
Quantitative change
Development
• is a process in which
something transforms
(mostly positive) in to a
different stage or improves,
it may be physical, mental,
social or psychological.
• Development encompasses
the total well-being of the
individual and community
in health and other aspects.
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13. Economic development
• Refers to a raise in per-capita income and
fundamental changes in the structure of the
economy characterized by:-
1.Rising share of industry, along with
the failing share of agriculture in GNP, and
increasing percentage of people who live in cities rather
than the countryside
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14. 2.Passing through periods of accelerating, then
decelerating population growth, during which the
age structure of the country changes dramatically
3.Changes in consumption patterns as people no
longer spend all their income on necessities but
instead move on to consume durables and eventually
to leisure-time products and services.
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15. 4.Meeting the needs of the present without
compromising the ability of future generations to
meets their own needs (sustainability)
5.Participation (mainly) by the citizens of the
country in the process as well as the benefit
While economic development and modern economic
growth involve much more than a rise in per capita
income, there can be no development without
economic growth
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16. Gross National Product (GNP)
• Is the sum of the value of finished goods and
services produced by a society during a given year
and excludes intermediate goods and counts only
income earned by citizens.
• Intermediate goods are goods that are ones used up
to produce other goods. GNP therefore includes
bread, but not wheat; cars but not steel.
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17. • GNP can be measured using:
Consumption
Gross domestic investment
Government spending
Net exports
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18. Gross Domestic Product (GDP)
• Is similar to GNP except that it count all
income produced within the borders of a
country,
– including income earned by foreigner residents,
– but excludes income earned by citizens of the
country who are residents of abroad.
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19. What is poverty?
• Poverty also called penury.
– is deprivation of common necessities that
determine the quality of life, including food,
clothing, shelter and safe drinking water,
and may also include the deprivation of
opportunities to learn, to obtain better
employment to escape poverty, and/or to
enjoy the respect of fellow citizens.
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20. Poverty Definitions…
• The state of having little or no money and few
or no material possessions
• The state of living on less than $2.50 a day,
(World Bank.)
• Poverty can also represent a lack of
opportunity and empowerment, and bad
quality of life in general.
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21.  Many writers assert that there are two main types of poverty.
These are absolute poverty and relative poverty.
Absolute poverty
• With absolute poverty people generally do not have what
they need. They are short of basic foodstuff, shelter,
clothing and adequate or sufficient health care.
• People in absolute poverty are unlikely to gain long-term
benefit from health services until their poverty is relieved.
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Types of Poverty

22. RELATIVE POVERTY
• On the other hand just like beauty lies in the eyes
of the beholder, poverty may be viewed to be a
subjective term and what is poverty to someone
may not be poverty to someone else.
• What is poverty under relative terms is viewed as
being what some people lack in relation to other
people.
• Under relative poverty measures, a mean level of
income may be established under which a person
may be considered to be living in poverty. Any
one living above that level may be considered not
to be living in poverty.
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23. Poverty
Generational vs Situational
Generational poverty: families who have lived in
poverty for at least two generations.
Situational Poverty: families that have fallen into
poverty because of a traumatic event such as illness
or divorce, unemployment, etc.
(Dr. Ruby Payne)
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24. Culture of Poverty
• The culture of poverty concept is a social theory explaining
the cycle of poverty.
• Based on the concept that the poor have a unique value
system, the culture of poverty theory suggests the poor remain
in poverty because of their adaptations to the burdens of
poverty.
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25. Human Development Index
UN measuring tool
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26. HDI
• The first Human Development Report (1990) introduced a new
way of measuring development by combining indicators of :
 life expectancy,
 educational attainment and
 income into a composite human development index, the HDI
• The breakthrough for the HDI was the creation of a single
statistic which was to serve as a frame of reference for both
social and economic development.
• The HDI sets a minimum and a maximum for each dimension,
called goalposts, and then shows where each country stands in
relation to these goalposts, expressed as a value between 0 and
1.
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27. Indicators of Economic Development
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28. Growth versus Development
• Economic growth may be one aspect of economic development
but is not the same
• Economic growth:
– A measure of the value of output of goods and
services within a time period
• Economic Development:
– A measure of the welfare of humans in a society
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29. Economic Growth
• Using measures of
economic growth can
give distorted pictures
of the level of income
in a country – the
income distribution is
not taken into account.
• A small proportion of
the population can own
a large amount of the
wealth in a country.
The level of human
welfare for the majority
could therefore be very
limited.
But this could be just around the corner!
Copyright: chinagrove, http://www.sxc.hu
This might be a common picture……
Copyright: unseenob, http://www.sxc.hu

30. Growth
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31. Economic Growth
• Using measures of economic performance in terms of the value
of income, expenditure and output
• GDP
– The value of output produced within a country
during a time period
• GNP
– The value of output produced within a country plus
net property income from abroad
• GDP/GNP per head/per capita
– Takes account of the size of the population
• Real GDP/GNP
– Accounts for differences in price levels in different
countries
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32. Economic Growth
• High economic growth fuelled through capital spending can
hide a number of underlying economic problems – how is the
income and wealth distributed? Who is doing the spending and
will it ‘trickle down’ to the poor?
Shopping Mall in Saudi Arabia
Copyright : Christo Pacheco, http://www.sxc.hu
Dubai Skyline
Copyright: zchizzerz, http://www.sxc.hu

33. National Income – Problems with using
GDP/GNP
• Reliability of data?
– How accurate is the data that is collected?
• Distribution of income?
– How is the income distributed – does a small
proportion of the population earn a high
percentage of the income or is income more
evenly spread?
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34. National Income – Problems with using
GDP/GNP
• Quality of life?
– Can changes in economic growth measure
changes in the quality of life?
– Does additional earnings power bring with it
additional stress, increases in working hours,
increased health and family problems?
• Impact of exchange rate?
– Difference in exchange rates can distort the
comparisons – need to express in one currency,
but which one and at what value?
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35. National Income – Problems with using GDP/GNP
• Black/informal economy?
• Some economic activity not
recorded – subsistence farming
and barter activity, for example
• Some economic activity is carried
out illegally – building work ‘cash
in hand’, drug dealing, etc.
• Work of the non-paid may not be
considered but may contribute to
welfare – charity work,
housework, etc.
It might not be pleasant, but what he finds among the refuse could be all
he has.
Title: Sierra Leone Liberia. Copyright: Photolibrary Group

36. Development
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37. Human Development Index
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38. Other Measures?
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39. Contributing Factors to Poverty
• Family Destruction and Weakness
• Education Deprivation
• Lack of Jobs – Under and Unemployment
• Lack of Community/Economic Development
• Lack of Income and Wealth Creation
• Lack of Minority Businesses/Venture Capital
• Health Status and Care - Disparities
• Disproportionate Representation - Criminal Justice System
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40. • Unemployment
• Inadequate system of social protection in which
war related beneficiaries have better protection
than civil beneficiaries
• Low pensions
• Violations of human rights: displaced persons and
refugees returning to their prewar homes suffer
from discrimination in sense of public services
and employment.
MAIN CAUSES OF POVERTY
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41. • To ensure equitable development of the
country:
– Plans for establishing of a national fiscal council
could be a good instrument for creating policies
for harmonized development of the country
– Future distribution of international aid between
the entities should consider higher poverty rates
BASIC ELEMENTS OF POVERTY REDUCTION PROGRAM
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42. • Implementation of fiscal reforms will lead to:
– Incremental of public revenues, and accordingly
incremental of revenues for programs for poverty
reduction
– Reduction of corruption which especially hurts
the poor
BASIC ELEMENTS OF POVERTY REDUCTION PROGRAM
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43. • Reorganization of social protection system
which will:
– Provide greater funds for civil beneficiaries
– Harmonize level of social protection within the
country
– Establish the children protection fund
BASIC ELEMENTS OF POVERTY REDUCTION PROGRAM:
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44. • Remove all forms of ethnic discrimination:
– related to this, it is especially important to
implement decision of Constitutional Court on
constitutive status of all ethnic groups within the
country. This would provide proportional
employment for all ethnic groups within public
administration
BASIC ELEMENTS OF POVERTY REDUCTION PROGRAM
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45. • Faster growth of private sector will contribute to growth of
employment, which will especially benefit the poor
• It will be especially important to strengthen government
capacities for analyzing the poverty and monitoring
instruments
• Partnership of government and civil society in poverty
reduction will be enhanced
BASIC ELEMENTS OF POVERTY REDUCTION PROGRAM
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46. How to achieve accelerated and shared growth?
By addressing causes of slow and unequal
growth:
– Reduce vulnerability
– Foster productivity growth
– Improve public service delivery
– Address regional and spatial inequalities, and
– Addressing the needs of marginalized groups
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47. II. Raising Productivity
Most of the poor are in
working families
• Key causes:
– Employment in
unproductive and
uncompetitive
sectors
– Low human
capital
– High dependency
(one employed)
Measures:
• Improve investment climate to bring
more capital
• Strengthen competitiveness through
enforcing financial discipline and
encouraging growth of new firms
• Improve efficiency of public
investment and bring in private capital
to upkeep infrastructure
• Training programs, carefully
sequenced (differentiated) minimum
wage increases
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48. III. Improving access to and quality of public services
• Inherited good network and
partially reversed trend for
eroding access, but limited
capacity to achieve progress
everywhere, hence no
decisive progress
• Key causes:
– Fiscal constraints
– System inefficiencies
– Poor governance and
accountability
Measures:
• Protect social spending; when
reforms are implemented - major
reallocation in favor of these
sectors; where appropriate strive
for financial self-sustainability
• Reform health and education to
focus on quality, deeply restructure
networks by focusing on adequate
upkeep of viable elements
• Improve governance and increase
accountability
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49. IV. Addressing regional and spatial inequality
• Increasing regional
disparities and increasing
concentration of poor in
poor regions
• Key causes:
– Impoverished regions
– Poor agricultural
policies
– Constraints on
mobility
Measures:
• Infrastructure investment in lagging
regions
• Remove constraints (including
indirect) on agricultural and rural
development
• Improve mobility, housing and
social services
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