The health, or lack of it, of millions of people in the world is one of the most pressing issues facing humanity, but there is little consensus on what should be done to improve matters. Some argue that, for relatively quick results, biomedical interventions are needed - immunizations against diseases and drugs to treat them. Others argue that, in the long run, these interventions serve little purpose because they do not attack the root causes of ill-health which are related to poverty. The biomedical interventionists often counter this by saying that alleviating poverty in the world might be a laudable goal but it is totally idealistic, even that it is irresponsible to think that it can be achieved while every day so many are dying of disease.

This essay engages in the debate by comparing a materially poor country (Sri Lanka) with the group of countries to which it belongs in the World Bank economic classification (the low income countries). Firstly the health records are compared, and then the poverty and biomedical indicators. The discussion centres on whether poverty or biomedical interventions are responsible for the differences observed in the health records and on the extent to which a low income country like Sri Lanka can address poverty.

The table reveals that Sri Lanka has far better health indicators than the low income countries in general. The under-five mortality rate is over five times lower and the life expectancy significantly higher. Although these indicators are limited in that they fail to capture the essence of the World Health Organization (WHO) definition of health - a state of complete, physical, mental and social well-being - they are regarded as useful proxy measures for the health of a country. Thus, from this data we can conclude that Sri Lanka is significantly healthier than other low income countries.

Being a low income country does not mean that everyone living in Sri Lanka is materially poor. There are no data in Table 3.5 on wealth distribution, but it would be unsurprising if a wide range did not exist between a few who are rich, those who are comfortably off, and those who are materially poor. The extent of the last group of people is often estimated by the headcount index, which is the percentage of the population who have an annual income less than US$370 per head. Examining the headcount indices in the table suggests that Sri Lanka, with 22% of its population having an annual income less than US$370, has a slightly higher level of material poverty than the low income countries in general.

Thus, on the face of it, Sri Lanka is healthier than the low income countries in general but, if anything, has higher levels of poverty. There are many criticisms, however, of headcount index as a measure of poverty.

The first is that setting the line at an absolute figure in US dollars does not account for differences in purchasing power in different parts of the world. A US dollar will buy far more rice in Sri Lanka than it will in the USA, for example. It also does not account for the fact that many people secure their livelihoods by means that do not involve money. Growing food for oneself is an obvious example.

The headcount index, with its arbitrary line set at US$370, can be pretty meaningless, therefore, but there is a deeper criticism. It only measures material poverty, yet Preparing for Development argues that there are other, inter-related dimensions that are as important as the material ones. These include: • physical weakness arising from poor nutrition, sickness or disability
• physical isolation, such as living in marginal areas of a country
• social isolation, such as lacking basic education and skills
• vulnerability to crisis
• powerlessness.

Some of the other indicators in the table give an idea of these wider dimensions of poverty. Access to safe water and to health care are two proxy indicators of the extent of physical isolation and, in both cases, Sri Lanka performs slightly less well than the low income countries in general and the whole of South Asia respectively. A big difference, however, is in adult illiteracy, with only 12% of adult Sri Lankans being illiterate compared with 41 % for the low income countries in general. This suggests that social isolation is far less in Sri Lanka. So, although, the evidence on the physical and social isolation dimensions of poverty is contradictory, where there is a large difference, it is in Sri Lanka's favour.

The other area where the table suggests large differences between Sri Lanka and the low income countries as a whole is in poverty among women. Sri Lanka has over twice the female advantage in life expectancy, a significantly lower fertility rate and a significantly lower female adult illiteracy rate. This evidence suggests that women in Sri Lanka are less poor compared with their counterparts in the other low income countries and this may be an important factor in explaining the health differences.

If a narrow, material view of poverty is taken, therefore, it seems that there is little apparent connection with health, at least as far as the comparison between Sri Lanka and other low income countries of the world is concerned. A wider view of poverty, however, does suggest a connection, although establishing this does not actually address the biomedical argument. It could be that either tackling poverty or biomedical interventions will improve health; it could also be that both are needed.

Leaving aside the fact that biomedical interventions only attack disease and do not necessarily create a state of complete, physical, mental and social well-being, the biomedical evidence in the table is contradictory. A lower percentage of the population is immunized against measles and against diphtheria, polio and tetanus in Sri Lanka than the low income countries in general, although the difference is not great. The percentage of under-five children in Sri Lanka who undergo oral rehydration therapy, however, is twice that for the low income countries in general (76% compared with 38%), which is a large difference. Oral rehydration therapy deals directly with the lifethreatening symptoms (Le. dehydration) of diarrhoea in children, and diarrhoea is itself a direct consequence of poor nutrition and sanitation. It does appear, from the evidence, that this particular intervention has an impact on health.

In conclusion, it seems that lower poverty levels do equate with better health, as long as a broad view of poverty is taken, and reducing poverty among women seems to be especially important. Only the simplest of biomedical interventions (oral rehydration therapy) seems to have a significant impact and, although poor people won't die of measles if they are immunized against it, the chances are that they will die of something else. As to whether tackling poverty to improve health is idealistic, the example of Sri Lanka shows that inroads can be made, despite the country being materially poor overall. It appears that in this country, the high level of literacy, a comparatively better position for women in society and a targeted, simple and cheap biomedical intervention have contributed to health indicators far better than would be expected.

Notes It was only when I attempted to do Activity Thirteen myself that I realized how difficult a task I had set. Also, like everyone else who has to write essays or reports, time is a constant constraint. I wrote the above while the rest of the Open University system was almost screaming for it, so that 'Preparing for Development' could be finished in time. It is by no means 'perfect', therefore, but you should find the following notes useful:
• The introduction establishes what the debate is about and how I intend to engage with the debate.
• The main discussion moves from a comparison of the health indicators, to the poverty indicators and finally compares the biomedical intervention indicators. In other words, the structure is centred on the key content words of the question. Because I am writing an essay rather than a report, I try to link these themes by signposting sentences, so that the argument flows between them.
• I use many individual signposting words and phrases - 'however', 'thus' and 'therefore' being three obvious examples.
• I try to include and analyse contradictory evidence, rather than ignore it. This, I found, was the hardest bit for me, but one of the most crucial.
• I tie things up in a conclusion, using the actual words in the question to help me structure it. Conclusions should explicitly address the question that has been asked. Although your main discussion should not have wandered off the point of the question, the extra detail and discussion that you need there means that it can fee1lost on occasion. The conclusion brings the main question back into the spotlight.
• Finally, I tried to follow the advice that I gave when I set the question. This is hardly surprising as I wrote the advice! Whenever there is advice with a question, however, it usually gives you important clues as to how you are expected to answer it.

On the next page, to conclude, we'll review what skills you have been exercising, and what you've learned in this sample.

  < previous   next > Page 5 of 6

Content last updated: 08/07/2004

Comments