Health at the heart of inter-locking deprivations

Health at the heart of inter-locking deprivations

Health is a fundamental capability that is instrumental in the achievement of other capabilities. The unfair distribution of health capabilities may therefore affect social justice in several ways (Sen, 2002). Based on evidence from South Asia, Osmani and Sen (2003) conclude that gender bias results in high maternal under-nutrition, which leads to intra-uterine growth retardation of the foetus. This leads to a very high prevalence of low birth weights, which in turn contributes to a high prevalence of both child under-nutrition and adult ailments. Thus, women’s deprivation in terms of nutrition and health attainment has serious repercussions for society as a whole.

HEALTH

The occurrence of multiple deprivations is usually complex and intercon- nected; deprivation in one dimension often induces and reinforces deprivation in other aspects of life. Such a continuous inter-play between various capa- bilities produces (and reproduces) the vicious cycle of poverty. As we have argued earlier, health capabilities have both an intrinsic and instrumental role in enhancing human well-being. Deprivation in health can potentially cause deprivations in a number of other dimensions, such as education, employment, subjective well-being and participation in socio-economic spheres. When people are ill, malnourished, have mental disorders or life-debilitating disabilities, their overall capabilities are greatly reduced. Lack of health can therefore be at the heart of inter-locking deprivations.

To elaborate further, let us consider Nussbaum’s list of fundamental capabilities (see Chapter 2) and how health can potentially affect them:

1 life: lack of health reduces life expectancy and therefore people die younger;

2 bodily health: lack of health greatly reduces all aspects of bodily health capability;

3 bodily integrity: people suffering from severe illness and life-debilitating disabilities may face serious problems in their ability to move freely from place to place; there might also be legal restrictions on the free movement of people with severe mental disorders; a lack of reproductive health (such as in the case of HIV/AIDS) may greatly reduce sexual satisfaction; similarly, stigma associated with various infectious and chronic diseases, disabilities and mental disorders may severely limit the opportunities to have sexual satisfaction (e.g. by limiting their opportunities for marriage which in turn may affect their social acceptance within a community);

4 senses, imagination and thought: certain health problems lead to the mental impairment of individuals (e.g. lack of iodine or neural tube defects), which in turn affect their ability to use sense, imagination and thought; lack of health in childhood may also reduce individual chances of acquiring education;

5 emotions: mental and psychological disorders can greatly affect the emotional health of individuals, therefore stunting their emotional development;

6 affiliation: the stigma associated with various diseases (such as HIV/AIDS), disabilities and mental disorders may greatly affect an individual’s sense of self-respect; chronic diseases may also affect one’s professional opportunities and also a person’s sense of self-esteem;

7 play: people with physical and mental disorders may not be able to play and enjoy recreational activities in the ways that healthy people do.

The impact of health on education is one of the main channels affecting overall well-being and individual health. By using longitudinal data of a large sample

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of Filipino children, Glewwe et al (2001) found that well-nourished children perform better in school than under-nourished ones, mainly because their learning productivity per year was higher. Malnutrition not only lowers the learning productivity of school children; it also reduces their intellectual capacities. Iodine deficiency, for example, lowers IQ scores by as much as 10–15 percentage points (UNICEF 2005). In a randomized experiment with 30,000 school children in 75 primary schools in rural Kenya, Miguel and Kremer (2004) noted the adverse affects of worming (intestinal helminths infect one in four individuals worldwide) on education. They demonstrated that deworming results in a 7.5 per cent gain in primary school participation and a 25 per cent reduction in absenteeism, and generates positive externalities for untreated children.

The World Bank’s study Voices of the Poor (Narayan et al, 2000) suggests that death, injury or severe illness in the family is considered to be one of the major causes of poverty in developing countries. The 2005 WHO Report finds

a very close link between chronic diseases and poverty. While acknowledging that poverty is a causal factor of chronic diseases, the report argues that the incidence of chronic diseases also causes poverty. Furthermore, there are huge costs involved in the medical care of individuals suffering from chronic diseases. As the report puts it:

Chronic diseases have an indirect impact on people’s economic status and employment opportunities in the long term. Indirect costs include: reduction in income owing to lost productivity from illness or death; the cost of adult household members caring for those who are ill; reduction in future earnings by the selling of assets to cope with direct costs and unpredictable expendi- tures; and lost opportunities for young members of the household, who leave school in order to care for adults who are ill or to help the household economy (WHO, 2005, p67).

Thus, it is clear that poor health is not just suffering from illness, for those living in contexts of poverty. It pushes individuals and households towards losses in productivity, incomes assets and education – further entrenching the cycle of poverty. Health deprivations thus reinforce deprivations in other dimensions, which in turn reinforce deprivations in health. Box 10.2 describes the way that poor health results in deprivations in many aspects of life, and vice versa, for a household in rural Pakistan.

HEALTH