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.
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
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
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
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
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.
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.
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.