What do we mean by 'major illness'?: the need for new approaches to research on the impact of ill-health on poverty

What do we mean by 'major illness'?: the need for new approaches to research on the impact of ill-health on poverty

Understanding the links between ill-health and poverty

It is widely recognised that ill-health is one of the most serious challenges that many individuals, households and families have to face. But there is limited knowledge of the complex processes involved in suffering from and coping with multiple and diverse health-related challenges. Support mechanisms are seen primarily in terms of providing assistance in meeting the cost of in-patient treatment but such approaches fail to address the multiple and complex pathways which link ill-health and well-being. It has recently become commonplace for health economists to use the term ‘catastrophic health expenditure’ when referring to situations in which household expenditures on healthcare exceed a given proportion of ‘disposable income’, social support mechanisms. This chapter in the book 'Health and social protection; experiences from Cambodia, China and Lao' by Studies in Health Services Organisation and Policy argues that such indicators, while of considerable interest, should by no means be seen as adequately reflecting the range of issues which need to be addressed in either understanding the links between ill-health and poverty or in designing social support mechanisms.

The paper outlines research in Cambodia, China and Laos which has focused on households affected by a ‘major illness’, defined broadly in terms of risk to household livelihoods. The research investigated the processes set in motion as different types of households coped with different types of health problems. The authors argue that in spite of the attractions of traditional research surveys, there is an urgent need from both academic and policy perspectives to go beyond the kind of information that they can deliver. Continuing to estimate the incidence of predominantly minor, acute, symptomatic illnesses or the proportion of such episodes which result in a visit to a facility described by the respondent as a pharmacy, clinic, health centre or hospital, is simply not sufficient. It does not address existing serious knowledge gaps relating to the impact of ill-health on households or to guide policies intended to mitigate the effects of such impacts.

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