Chronic diseases and health promotion

Part Two. The urgent need for action

Chapter Two. Chronic diseases and poverty

From chronic diseases to poverty

The previous section illustrated that the poor are more likely both to develop chronic diseases and to suffer more from the negative consequences of chronic disease. This section describes how chronic diseases cause poverty and draw individuals and their families into a downward spiral of worsening disease and impoverishment.

The cycle of poverty

An important cause of poverty in low and middle income countries is the death or severe illness of a family's primary income earner. Out of 125 case studies summarized in the World Bank's publication Voices of the poor crying out for change, illness, injury or death was the most common trigger of households' impoverishment. In Bangladesh, for example, of those households that moved into the status "always poor", all reported death or severe disabling diseases as one of the main causes.

Chronic diseases inflict an enormous direct and indirect economic burden on the poor, and push many people and their families into poverty. Existing knowledge underestimates the implications of chronic diseases for poverty and the potential that chronic disease prevention and health promotion have for alleviating poverty in low and middle income countries.

Spotlight: Barriers to treatment in Jamaica

In Jamaica 59% of people with chronic diseases experienced financial difficulties because of their illness, and a high proportion of people admitting such difficulties avoided some medical treatment as a result.

Spotlight: Medical expenses in India

People in India with diabetes spend a significant portion of their annual income on medical care. The poorest people – those who can least afford the cost – spend the greatest proportion of their income on medical care. On average, they spend 25% of their annual income on private care, compared with 4% in high income groups.