The impact of ill health on the poor

In Poverty and health sector inequalities, Wagstaff reviews evidence on the relationship between adverse health events and chronic poverty: poverty breeds ill-health and ill-health keeps people poor.

Poor people’s use of health services is constrained by several barriers including lack of information, poor access to social networks, inadequate services, and inability to pay. In an attempt to make savings on treatment, some poor people adopt inappropriate health-seeking behaviours such as choosing a below-standard, unregulated health care provider, self-medication or discontinuation of treatment. These actions worsen the financial and health status of the patient, thus creating a vicious cycle.

To pay for health care some people are forced to adopt ex-post strategies. These are strategies to cope with the financial consequences of ill health including the costs of healthcare and loss of wage and production due to illness. Some people may sell productive assets as a coping mechanism and others become indebted, often at high short-term interest rates. These strategies reduce poor people’s capacity to negotiate their way out of poverty in future.

The final outcome can be catastrophic, both in terms of health and wealth. According to Xu & al in Household catastrophic health expenditure: a multicountry analysis this is especially the case in transition and Latin American countries. If the affected person remains disabled or chronically ill, or the disease recurs, the negative impact is magnified. If many households experience similar problems, a community’s capacity to cope with shocks may be affected.