Generally, Poor people don’t have enough
material or financial resource to avail the health facility. When they fall
ill, they avoid going to doctor. They normally go to the doctor only when their
health problems are in unbearable shape. They are unable to buy expensive
medicines or also avoid buying medicine because of not having enough liquid
amounts. This also discourages the pharmaceutical corporation from spending large
financial outlays in the research and development on the poor man’s disease. The
involvement of many organization such as, Bill and Melinda Gates Foundation,
Clinton Foundation, individual initiatives etc, have helped the poor to afford
the medicine against the market price.
The immunity and resistance level
of poor people are generally weak because of consistently malnourished patterns
of dietary habit since their childhood. A large number of poor people also
start working at an early age and with the irregular and malnourished eating
habits that makes them more vulnerable to infectious diseases. Sanitation and
clean water is also a major problem for the poor population in both urban and
rural areas, but the situation in urban areas are quite worse and raise the
question over the citizenship of poor people.
A large number of urban
populations are engaged in the informal economy, where health and social
security is not provided. Even the labor income in this sector is not
regularized or rule of laws are not followed. Since almost every countries either
signatories or rectified the ILO Declaration on child labor, which prevent employing
child below age 13 in commercial establishment an illegal activity, but in most
of developing country, a large number of children are in labor force. Most of
the employment or jobs are in low productivity sector where ‘poor job quality, a lack of job security, low wages and a lack
of access to social security coverage. This situation is often referred to as labor
informality.
Informal workers in urban areas of Latin America accounted for
44.9% of all workers’ (Social Panorama of Latin America, 2008). Mumbai is one the biggest cities in
India. The total population of the city is around 12 million, which is a population of 1.2% of one-sixth of the world's population. Almost
40% of its population lives in slums or other degraded forms of housing and 10
percent of the city population are staying on pavement or homeless. This is
also interesting that the half of the population in Mumbai occupies only 8
percent of the city’s land and this half of the population in Mumbai has almost
‘negligible access to essential services, such as running water, electricity,
ration card, toilets. Mumbai's gigantic restaurant and food service economy is
almost completely dependent on a vast army of child labor’ (Arjun Appadurai 2000). In
almost every big city in the world has similar kind of situation and a large
army of urban poor is another dimension of the policy challenge.
The main issue of contention here
is that who is responsible for this trend and pattern of falling into poverty
almost in every country? How reliable this is to say that economic growth would
lift the all boat? In 1970s, the World Health Organization started a global
effort to achieve “Health for All” by the year 2000 and access to basic health
was affirmed as fundamental human rights by the Declaration of Alma Ata in 1978
(Hall and
Taylor 2002). After 40 years of this declaration, even to access basic health for
majority of people in the world is a distant dream. A significant portion of young age death are
because of disease like diarrhea, measles and malaria and a wide health related
disparities between poor and rich countries and poor and rich people within
countries are growing fast.
A study by Oxfam shows that 45 percent of Cambodian
farmers who become landless have been forced to sell their land because of
illness. The first four most frequent reported diseases of those who lost land
are malaria, dengue fever, tuberculosis and typhoid. All are preventable and
curable diseases. The issue of governance and the accountability of government
machinery in delivering health services to the poor people has been questioned
in several forum but the big issue is that how to build an effective mechanism
involving all the states and non-state actors in addressing the urgency of
health service and health outcome of poor people?
A number of international and bilateral organizations are
involved in improving the health
outcomes of the poor population. A report recognizes that ‘developing countries account
for 84 percent of the global population and 90 percent of the global disease
burden, but only 20 percent of global gross domestic product (GDP) and 12
percent of all health spending. High-income countries spend about a hundred
times more on health on a per capita basis than low-income countries: even
after adjusting for cost of living differences, high-income countries are
spending about 30 times more on health. Worse still, more than half of the
spending in poor countries comes from out-of-pocket payments by consumers of
care—a highly inequitable form of financing because it hits the poor hardest
and denies all individuals the type of financial protection from the costs of
catastrophic illness provided by public and private insurance mechanisms’ (Pablo and George,2006).
