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GEO 3050 Week 8 Sverdlik.docx

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GEOG 3050
Kate Parizeau

Week 8 Ill health and poverty: a literature review on health in informal settlements Alice Sverdlik Introduction  in informal settlements, residents suffer disproportionately from ill- health throughout their life-course o households more likely to experience disease, injury, premature death o ill-health may combine with poverty to create disadvantages o approx. 1 billion people living in slums o poor-quality housing, lack of infrastructure, minimal access to refuse collection, health care, etc.  Urban areas can promote health improvements o medical centres, infrastructure, health personnel, quality provision of water, sanitation, drainage, health care (lower costs) o local officials usually unwilling to provide services to informal settlements  informal settlements o suffer from both communicable and non-communicable diseases - “double burden” o at high risk from extreme weather events due to climate change o promising trends in health research  MDG target 11 - “significant improvements” for only one-tenth of slum dwellers by 2020 - inadequate o improvements needed on wider scale and with holistic understanding of health This review highlights how:  health inequalities begin at birth, reproduced over a lifetime, may be recreated through vulnerabilities to climate change and a “double burden” of disease Poverty and Health Over the Life-Course 1. Infant and childhood conditions  elevated infant and child mortality rates  risks often stem from informal settlements’ inadequate sanitation, water and housing, minimal access to health care, also may be linked to high prevalence of extreme poverty, insecurity and violence  leading causes of under-five mortality were pneumonia, diarrhoea, malaria, AIDS  low-quality indoor air is often associated with overcrowding, inadequate ventilation and solid cooking fuels, such as wood, crop residues, coal, charcoal  In 2000 - cooking with solid fuels is linked to almost 2 million deaths and 38.5 million disability-adjusted lives 1. Adolescence and adulthood  health risks shift over time  leading causes of mortality for those over five were HIV, TB, ivolent injuries, road traffic injuries  2004 Global Burden of Disease data - mortality rates escalated from adolescence to young adulthood  young males usually at greater risk of premature death  negative impacts from indoor air pollution usually affect women, infants and young children more  outdoor air pollution may disproportionately affect low-income communities and workers  low-income adults often have higher risk of occupational injuries  occupational hazards depend on industry or city, are shaped by level of formality, city regulations, gender and age norms  informal workers’ marginality can worsen their ill-health and disrupt livelihood  informal settlements may have high prevalence of HIV/AIDS  other health risks facing adolescents - undernutrition, substance abuse, violence 1. Ageing, poverty and urbanization  often face heightened insecurities, ill-health, heavy family responsibilities  population over 60yrs is increasing  limited number of elderly receive social protection  increased urbanization, and urbanization associated with non- communicable diseases because of changes in diet and exercise  low-income elderly workers can face a greater risk of occupational injury  if ageing is accompanied by impoverishment, care burdens may continue to rise alongside older residents’ ill-health, emotional strain and economic vulnerabilities Illness Over Time: Health, Chronic Poverty and Cohort Studies  low-income households are often decisively shaped by ill-health, injury and premature death  ill-health is a risk for long-term impoverishment o can be a consequence of poverty or a predictive factor  “chronic poverty” o often associated with downward spiral of ill-health, lost assets, heightened vulnerability Health Expenditure, Quality and Access to Care  If a breadwinner is ill, cannot work, need money for living and for drugs and hospital fees, have to borrow money  health expenditures often larger proportion of low-income households’ incomes as compared to wealthier households  Low-income households may adopt coping strategies during health crises o however, savings may become exhausted and children may have to work instead of attending school --> increased vulnerability  “medical poverty trap” o limited options that worsen their deprivation and ill-health o competent medical personnel rarely available in poor communities, low-quality care may cause further health issues o therefore, poverty and ill-health can become entrenched through limited access to services, high levels of expenditure and inadequate care  some governments help break medical poverty trap by offering access to affordable, high-quality care, but many cities still need this  need to improve immunization rates  spending more than 10% income on health care deemed
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