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Introduction
The relationship between poverty and ill-health is not a simple one. It is multi-faceted and bidirectional. Ill-health can be a catalyst for poverty spirals and in turn poverty can create and perpetuate poor health status. The relationships also work positively. Good physical and mental health is essential for effective production, reproduction and citizenship, while productive livelihood strategies and risk management are critical to safeguarding individual and household health status (Harpham and Grant 2002, in Hulme and Lawson, forthcoming: 12).
As with poverty, ill-health affects both the individual and household, and may have repercussions for the wider community too. Sudden or prolonged ill-health can precipitate families into an irretrievable downward spiral of welfare losses and even the
breakdown of the household as an economic unit (Pryer et al, 2003: 1). Poor households in developing countries are particularly vulnerable and problems of ill-health can be viewed as inherently part of the experience of poverty. This is exemplified by CPRC
research in Uganda: “I am poor because I have nothing in my house; no husband, no blanket, no cooking utensils. I have to beg for food. I can’t pay fees for my child. Besides, I am always sick” (a Ugandan woman, in Lwanga-Ntale and McClean, 2004:184). This means that ill-health should not (only) be responded to in terms of its medical components but must be seen and therefore treated as part of the wider socio-economic and political response to poverty reduction.
This paper identifies the mediating factors that underpin a spiral or descent into chronic poverty and identifies points at which intervention will most likely make a difference.
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