Keynote address by David Werner to the NGO Forum for Health's Conference on "Breaking the grip of Poverty on Health" Palais des Nations, Geneva, Switzerland, May 15, 2000

I should begin with an apology. I may not be the right person to speak on poverty and health in the North. First, my community health experience has mostly been in the South, mainly rural Mexico. Second, when in the North, I live in Palo Alto, California, heart of the Silicon Valley, the richest industrial complex on earth. Computers, weapons industry, NASA and BIG money!

But even the Silicon Valley has its pockets of poverty. Freeway exits and McDonald's parking lots have clusters of sickly people with signs that say, "Homeless. Will work for food."

And across the tracks from plush Palo Alto lies East Palo Alto--a fringe settlement that a few years ago had the highest murder rate in the nation. Its plague of crime, violence, alcoholism, drug trafficking, and broken families is clearly poverty-related. Fig. 1   Photo of homeless people in the Silicon Valley's "Rolling Hotel."

In the last few years an effort has been made to "clean up" East Palo Alto. Police have been multiplied, substandard housing condemned, and neighborhoods gentrified.

But the clean-up has been a mixed blessing. As the middle class moves in, rents skyrocket. Now low-income workers can't afford to live anywhere in the area.

Recently a disturbing photo appeared in the International Herald Tribune [Feb 21 2000]. It shows a new kind of homeless people in Silicon Valley--persons with full-time jobs who sleep at night on city buses, dubbed "rolling hotels." But why? Because in the Silicon Valley a small apartment rents for $1700 dollars a month. On the minimum wage of $5.75 an hour, who can afford that? There are 20,000 homeless people in the county, a third with full-time jobs!

Poverty can be absolute or relative. Absolute poverty occurs mainly in the South, where 1.3 billion people live on less than US$1 dollar a day and are unable to secure even the bare necessities of life B adequate food, water, shelter and heath care. WHO calls poverty the World's biggest killer. Malnutrition linked to poverty contributes to 55% of the 12 million deaths of children annually.

But even in wealthy consumer societies--and most strikingly in the United States--the deepening poverty affecting the under-class can have a devastating impact, not only on the health of the poor, but also on society as a whole.

As in the rest of the world, the income gap in the US keeps growing. High-paid industrial managers now earn 150 times as much as the average worker, up from 70 times as much 10 years ago. Real wages of low-paid workers have decreased, as has job security.

Why focus on the United States?

In looking at the impact of poverty on health in the North, I will focus first on the United States, for two reasons:

1. The US is the extreme example of socio-political inequity: a very rich nation with a large impoverished underclass. It has the widest income gap in the North. And despite its growing economy, it provides the fewest health and welfare benefits to citizens in need. Hence it has the worst health indicators.

2. The increasingly deregulated "free market" economy in the US, with its reversals of social progress and erosion of democracy, has done more to polarize society than to end poverty. Yet this same economic model is being imposed on the South, at huge human and environmental costs. Far from bringing Health for All, if this paradigm of imbalanced growth continues unchecked, not only are the life-sustaining ecosystems of the planet in danger, but also the health and survival of all humanity, rich and poor alike.

For these reasons, breaking the grip of poverty on health in the South requires coming to grips with the structural causes of poverty and social injustice in the North, especially the United States.

Situational analysis of poverty and poverty-related health problems in the USA

Let us look at some of the facts.Fig. 2.  Human Poverty Index

Human poverty index. As we can see in the following graph, of 17 industrialized countries the US has the highest level of poverty. It also has the widest income disparity and the highest rate of child mortality.

Fig. 3 Under-5 Mortality Rate Deaths by age 5 per 1000 Live Births, 1998Although child mortality in industrialized countries tends to be much lower than in poor countries, some rich countries have substantially more child deaths than others. America takes the lead.

Poverty as a determinant of poor health.

On observing the above graphs, note that poverty and child mortality rates tend to correlate closely. In terms of overall well-being, Sweden is one of the world leaders, with both poverty and child mortality rates at half those of the United States. But why? Sweden has one of the world's most comprehensive public welfare systems, based on strong political commitment to meeting all people's basic needs and assuring a decent quality of life. This commitment is sustained through high progressive taxation.

In the US, poverty rates for vulnerable group--notably children and single-mother households--are worse than in other industrialized countries. This is partly explained by the nation's huge--and growing--income disparity. Today 1 of every 4 American children lives below the poverty line. In the North, this high rate is matched only by the former Soviet Union.

next page

Page 1