Health is determined by genetics, age and the environment. While some factors are beyond individual and societal control, wealth and poverty play crucial roles in the health status of a society.

Poverty undermines a whole range of human capabilities, possibilities and opportunities.

Poverty and health are inseparably linked, although the relationship may be complex. There are several factors involved including low income, poor diet and living conditions, limited access to healthcare, lack of educational opportunities, and the stresses associated with poverty.

When there is limited or no income, there are the inevitable stresses of attempting to obtain the basic needs for survival.

The diet of the poor is likely to be deficient and consists mainly of foods that are not nutritious.

This impacts on breastfeeding and is associated with an increase in heart disease, obesity and cancer.

When basic nutritional requirements are unaffordable, malnutrition and even hunger results. This contributes directly and indirectly to weakened immunity, recurrent infections and premature death.

Infections are common among the malnourished and poor. Poor living conditions, nutritional status, hygiene practices and education; overcrowding; and limited or no access to healthcare increase the likelihood and prevalence of recurrent infections.

There is global evidence of the link between poverty, malnutrition and poor child health.

In fact, poverty is the root cause of increased child morbidity and mortality. Children whose childhood is spent substantially in poverty will have poor health later on in life.

This leads to poor school performance and subsequent inability to secure good work opportunities and support for the family in the next generation.

Poverty leads to increased health dangers. The workplaces of the poor often have more environmental risks for illness and disability.

Amenities like access to clean environments, good sanitation and even access to clean water affect the poor disproportionately.

The housing and living of the poor are often not conducive to the maintenance of health. There may be increased exposure to toxic materials, inadequate sanitation and a dirty physical environment.

The poor are usually less educated, which leads to decreased knowledge about health-promoting activities and when to access healthcare.

Whilst healthcare in the public sector is available at a nominal payment, there are factors that impact on its access to the poor, such as transport costs, forgoing work to keep appointments at the healthcare facility and inability to purchase recommended medicines that are unavailable at public sector facilities.

This leads to delay or forgoing of healthcare until absolutely necessary and/or seeking healthcare when, in many instances, it is too late.

The poor are less likely to receive timely and appropriate healthcare with consequent mortality from an illness they could have been saved from. This leads to an increase in chronic and life-threatening illnesses, and premature mortality.

As a result of the above, the long, tedious and painful spiral of deprivation that maintains poverty continues.Poverty, poor health, illness, child health, malnutrition, wasting, stunting, underweight, South-East Asia,

Urban poverty

The United Nations Children’s Fund (Unicef) Malaysia published its report, “Children without – A study of urban child poverty and deprivation in low-cost flats in Kuala Lumpur” in February 2018.

This was a comprehensive study of child poverty involving 966 heads of households and 2,142 children in 17 different locations in Kuala Lumpur and Petaling Jaya conducted between Aug 20 and Sept 30, 2017.

The measurements included that of income, living standards, education, nutrition and safety.

The report summary stated: “While Kuala Lumpur has an income per capita equal to developed countries, the children residing in its low-cost flats are not doing well… Adjusted for household size, the relative poverty rate of these children is almost 100%.”

The findings in the report in respect of health included:

• More than one in five households felt that the public areas in their community were not clean;

• 12 in 100 children had less than three meals a day;

• 97 of 100 households stated that high food prices prevented the preparation of healthy meals for their children; one in two did not have enough money to buy food in recent months;

• Seven of 100 children lived in absolute poverty; in relative terms and adjusting for household size, almost all of them lived in poverty;

• Of the children under five years, 15 in 100 were underweight; 22 in 100 were stunted; 20 in 100 were wasted; and 23 in 100 were overweight or obese;

• The prevalence of malnutrition increased after the children were weaned off breastfeeding.

It was higher among older children with 23, 22 and 32 in 100 of four-year-olds stunted, underweight and wasted respectively, compared to 15, 5 and 17 in 100 of two-year-olds respectively.

“Malnourishment is a major concern in Malaysia – one in five is stunted and one in 10 is underweight…

“In terms of stunting, Malaysian children perform worse than Ghana, despite Malaysia’s GDP per capita being six times higher.”

Local data were worse than that of some lower-income countries in Asean: “The prevalence of stunting and anaemia have also increased in a decade.

“In the same period, wasting among children has decreased, but it still remains high, as in every 10 children in Malaysia, one is wasting.”

Whilst noting that there are existing social protection programmes, the recommendations in the Unicef report were “providing a universal child care allowance; ensuring proper exclusive breastfeeding for mothers for at least six months; implementing taxes on sugar-sweetened beverages; providing safe social spaces for school-aged children and revisiting poverty indicators, namely the Poverty Line Income (PLI); and using multidimensional indicators that include the nutritional status of children and relative income poverty.”

It is obvious that there is an urgent need for action to ensure that social protection is child-sensitive to improve access to basic services for the poor and marginalised.

Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. The views expressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.