• The case for focusing on the very poor

The case for focusing on the very poor

While it is important to target "the poor", inequalities and inequities are not simply about the most deprived members of society. In low-income countries a large minority or even majority of the population live in poverty. In developed countries there are fine inequalities in health status that span the full socioeconomic spectrum. This article provides an overview of the debate around inequity, inequalities, poverty, and health, drawing together current international understandings of the problem.

Although health may not necessarily be a priority to all governments, most governments wish to initiate economic growth. If health facilitates economic growth, then health should become a priority of governments. This causal link is problematic and caution is emphasised. This article suggests that the following strategies may improve health and welfare:

• Priority should be given to economic growth to allow for the accumulation of wealth which is subsequently invested in programmes to tackle ill health and poverty.
• A support led strategy in which investment in social policies may bring about improved health and welfare should be implemented.

In addition, this article explores aetiological mechanisms that drive socioeconomic differences in health. These vary according to disease and context. Moreover, even among those living in absolute poverty, there are differences in the extent to which parents can use resources to influence children's morbidity and mortality.

Finally, this article suggests paying attention to understanding the time scales over which changes in the circumstances of different socio-economic groups could translate into differences in health status. What are the lag periods between exposure and onset of disease? How does this lag time effect policy-making and health-strategy issues? [adapted from author]

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