Intersectoral health programs that directly combine poverty reduction strategies with health promotion strategies are increasingly common in developing countries. To address the medical, social, and psychological problems stemming from poverty, practitioners collaborated with a charitable organization, Citizens Advice Bureau, to create a “one-stop shop.” 1 Patients were referred to advisors on premise who assisted them in claiming a variety of benefits such as disability allowances, elder care supplements, and unemployment benefits available in the welfare system. For instance, general physicians in the economically distressed seaside town of Blackpool, England, found that many of their patients were afflicted with sleeplessness, depression, and substance abuse problems related to indebtedness and financial insecurity. Recently, several programs have innovatively addressed the nexus between health and poverty by coupling medical care with interventions that directly confront the socioeconomic influences on health. We take this occasion to suggest that primary care physicians may be able to contribute to initiatives that harness useful synergies between economic development, poverty reduction, and health promotion. This month, 208 scientific journals are publishing thematic articles on poverty and human development. Recently, the examples of Costa Rica, Sri Lanka, and the Indian state of Kerala show that major health improvements in poor economies can be accomplished if societies remain committed to equitable and astute social investments. Population health improved dramatically because clean drinking water, better sanitation and hygiene, improved nutrition, female education, higher wages, and labor legislation transformed hitherto squalid living and exploitative work conditions. This approach is hardly surprising-the biggest strides in improving life expectancy and health status in the USA and Britain were made at the end of the nineteenth century before effective medical interventions such as safe surgeries, penicillin, dialysis, and hospital intensive care units were available. In 1976, the Declaration of the International Conference on Primary Health Care in Alma Ata recognized that robust population health could only be attained when a comprehensive and universally accessible primary health service coordinated its actions with related sectors of national and community development, especially agriculture, animal husbandry, food, industry, education, housing, public works, and communications. The most remarkably sophisticated health care delivery systems cannot confront the diseases of poverty in isolation. For instance, the poor die 5–10 years before the rich in Finland, The Netherlands, and UK-all wealthy nations with a satisfactory health care infrastructure. Even in developed nations, a socioeconomic gradient in disease, health outcomes, health services utilization, and life-expectancy is apparent. Infectious diseases kill more than 11 million people a year, virtually all of whom reside in low- and middle-income countries. Out of the current world population of about 6 billion, approximately 3 billion people live below the poverty line on less than $2 per day, and an estimated 1.2 billion individuals live on less than $1 per day. The WHO estimates that diseases associated with poverty account for 45% of the disease burden in the poorest countries. In developing countries, poverty makes people more vulnerable to disease. The intuitions of this prominent Prussian biomedical scientist and vociferous proponent of social medicine of the nineteenth century have been indisputably confirmed in the modern public health literature. Virchow’s Report on the Typhus Epidemic in Upper Silesia emphasized that the ignorance and apathy of the poor were not moral failings but an inevitable consequence of centuries of systematic exploitation and persistent deprivation. Appalled by the callous indifference of the Prussian bureaucracy and public health authorities during the simultaneous famine and typhus epidemic that ravaged Silesia in 1847, Rudolf Virchow concluded that the ills of the poor could not be cured solely by medicines and doctors but by ensuring full education, freedom, and prosperity of the entire population.
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