Linkages between health and social protection

Within the health sector both equity and efficiency arguments are being used to justify a focus on the very poor. Some argue that health policies aimed only at achieving Millennium Development Goals (MDGs) relating to child health and maternal mortality may not benefit the poorest.

In How much would poor people gain from faster progress towards the Millennium Development Goals for health?  Gwatkin suggests that many countries are likely to improve their health indicators because of gains by better-off groups. This raises important questions about health equity and social justice, and is contrary to a rights-based approach to development.

Others argue that progress towards reducing the overall burden of disease will be slowed if the very poor are not reached, and that this will compromise efficiency objectives.

Two other concerns within the health sector have focused attention on health and the very poor:

• Health policy has become aligned with the MDGs and their primary focus on treatment and cure. This has shifted attention away from care and support for the chronically ill or disabled, many of whom are among the poorest.
• The high costs of treatment, particularly those associated with in-patient hospital care and on-going management of chronic illness, are recognised as potentially catastrophic for households. Meessen et al. argue that this is a cause of “iatrogenic poverty”.

The shift towards poverty reduction as the overarching goal of international development aid has brought the issue of social protection to the fore. The social protection agenda emphasises the need to understand individuals, households’ and communities’ vulnerability to, and coping strategies in relation to risk or “shocks”. Thinking is informed by a growing body of work on the dynamics of poverty, and more recently, new conceptual work on chronic poverty.

The high costs associated with purchasing medical care are recognised as potentially one of the most significant shocks faced by individuals or households, and a contributing factor to worsening poverty. It is also recognised that other types of shock (e.g. natural disasters, civil war, economic shocks) leave individuals susceptible to ill-health.

Health and social protection: meeting the needs of the very poor analyses the shared agenda between health and social protection and the case for joined up thinking between the two sectors.