Breaking the poor health-poverty link in the 21st century: do health systems help or hinder?

Abstract: It is depressing but true that, at the beginning of the 21st Century, poverty and ill-health are still closely interrelated. This review traces the current pathways from poor health to poverty in low- and middle-income countries, first at the national level, then at the household level. Ill health can have a substantial impact on gross domestic product, holding countries back from economic development, the fruits of which could be used to improve population health. At the household level, people may be pushed into poverty as a result of paying for health care. Households are forced to pay for the direct and indirect costs of health care at precisely the time when their incomes may be lowered by ill health. For this reason, many forego care, or rely on self-care or informal care, which may hasten the decline in their health and reduce their productivity. Sick people face a double jeopardy: their ill-health puts them at greater risk of poverty, and their poverty is likely to damage their health still further. The review goes on to discuss the role of health systems in the generation of poverty, before concluding with pointers as to how health systems can become part of the solution, rather than part of the problem.