Health and Wellbeing in the Lives of the Extreme Poor. Shiree Working Paper No. 27

Abstract

Examining the relation between poverty and health is critical to understanding the potential impact of development interventions on people’s overall well-being. In this paper, we trace out some key ideas which together constitute a point of departure for thinking about the significance of health in understanding livelihoods. Health is a universal prerequisite for successful and critical participation in one’s form of life. Our analysis will show the idea of ‘security’ as an objective need that could be added to form a trio of interdependent universal human needs. Thus, health is best seen as a form of security as well as a proxy for it; and security is understood as both an input and outcome of autonomy. Second, the argument linking poor health and poverty is by now irrefutable. Poverty has a very high cost for health. It makes people sick and in some cases, irreversibly so. It also reduces people’s ability to deal with the consequences of ill health because resources tend to be few and entitlements weak. At the same time, to complete a vicious ‘poverty cul de sac’, being able to forge a decent livelihood requires good health. As a result, health is always more precarious, less certain, more insecurely present among the poor. Third, the link between poverty and ill health is particularly germane to the context of Bangladesh. Although Bangladesh has made good progress in key health indicators notably in relation to the MDG 4 target (under-5 mortality rates) and the MDG 5 target (maternal mortality ratio) (Countdown 2012, NIPRT 2012), the country still faces formidable health related challenges. Food insecurity remains a critical and volatile issue in Bangladesh and although the number of people suffering from malnutrition has decreased recently, it remains very high. Ill health therefore is a common occurrence among the poorest in Bangladesh and a major factor associated with movements into poverty