Bitter Pills:Medicines & The Third World Poor | Page 16

THE UNDERLYING CAUSES

The poor suffer disproportionately from ill health. (21) This is as true of the
prevalence of disease in the world's poorest countries, as in rich industralised
nations. In Britain, for example, the 1980 Black Committee Report, Inequalities
in Health, showed that the poorest suffer more illness and are more likely to die
in infancy than the affluent. (22) In other words, poverty is one major cause of
ill-health. As the Indian Council of Social Science Research (ICSSR) and Indian
Council of Medical Research (ICMR) state in their 1981 report, Health for all:
an alternative strategy, " 'Poverty', itself is an extremely tenacious disease. It
must be directly attacked to improve the health status of the people." (231
But, as the ICSSR/ICMR report points out, in India, a country that is modernising
and industrialising fast, "... although there is some evidence to show that the
percentage of people below the poverty line may have declined, there is no doubt
that their absolute numbers have increased substantially". (24) It is OXFAM's
experience that, in many developing countries, the distribution of wealth is
becoming more concentrated in the hands of a small minority, whilst the mass
of the poor sink deeper into the poverty trap. l25)
Poverty means different things in different societies, but above all it means
powerlessness. In the words of Dr. Klouda, OXFAM's medical adviser in
Tanzania,' 'The existence of the poor has almost no effect on the national goals,
and the poor have no power or voice to influence village thinking, let alone national
thinking. The nation rewards those who actively contribute to its success." l2("
Powerlessness means that the poor have only a limited ability to improve their
health by obtaining more food, or changing their physical environment. As a result,
they are trapped in semi-permanent hunger and squalid living conditions.
Powerlessness means, for example, that the growing minority of relatively wellpaid factory workers, many in the Third World's new free trade zones, are in
no position to protect their health by demanding safer working conditions. There
is chronic unemployment and underemployment in both urban and rural areas,
and in most countries wages are extremely low in relation to the cost of basic
necessities. Inflation, particularly rising food prices, has a direct impact on
nutrition, because the poor have to spend a very high proportion of their income
on food. (:7> For example, a doctor reports that in Ghana in 1979, at a time of
rapid inflation, a labourer's basic daily wage "would have just covered the cost
of carbohydrate for two adults and two children, with no allowance for protein,
rent, clothes or other essentials". (281
Many poor families have so little purchasing power that their health has been
endangered by the growth of the money economy. In Tanzania, for example, a
detailed study of the nutritional status of people in the Southern Highlands in
1977 found that the highest nutritional levels were in families that had stayed
outside the money economy and still depended on subsistence farming. (291
Commenting on this study, Dr. Klouda points out that "money introduces a new
method of obtaining status or acceptance". U0) Moreover, the pressures of