Digging deeper into the cycle of poverty and disease | 

It seems pretty obvious to most of us regular folks that being poor also increases your risk of being in poor health and that, conversely, illness can make you poor.

And it seems pretty clear that this is even more so for the very poor living in parts of Africa or elsewhere in the developing world where there are few social safety nets, no disability insurance programs, many more deadly and disabling health threats — and your ability to work is basically a matter of survival.

Apparently, it’s not so clear or obvious to many experts and academics.

Matthew Bonds
Tom Paulson

That’s why Matthew Bonds, who lives and works in Rwanda with the organization created by health activist Paul Farmer called Partners in Health, is trying to bring clarity and hard numbers to what many know as the “cycle of poverty and disease.”

“Yeah, my wife keeps asking me why we need to do this, too,” laughed Bonds, who spoke yesterday at the UW’s Institute for Health Metrics and Evaluation.

“But many economists and development experts actually don’t believe this is the case,” he said. “There’s a big debate, at least within the academic community, about the link between health and poverty.”

Economists like Dani Rodrik and Bill Easterly, Bonds said, are among those who argue that improving health contributes little to fighting poverty. Economist Jeffrey Sachs, who is also one of Bonds’ collaborators, is perhaps the leading expert arguing just the opposite — that improving health is critical to fighting poverty in poor countries.

Bonds, who is trained as both an economist and a disease ecologist, is using his organization’s relatively new and massive investment in improving health in Rwanda as a test case for this debate.

Speaking to the brainiac number-crunchers at IHME yesterday, Bonds presented some of his data and preliminary results so far — talking about things like “regression analysis” and dealing with “stochastic” data. I had to stop listening too closely at one point when smoke started coming out my ears.

But what I did understand from Bonds’ presentation is just how difficult it can be to back up our assumptions and preconceptions with evidence. Nobody doubts that there is some correlation, some kind of feedback cycle, that links poverty with disease, he said, but:

“We really don’t know much about the structure of these feedback mechanism and to what extent any intervention can help to break that cycle,” Bonds said.

While it may seem — even to his wife — that this is another one of those pointless nerd efforts documenting the obvious, he says digging deeper into this cycle may provide some important insights and guidance for future efforts if not help resolve the debate over root causes.

  • http://humanosphere.kplu.org Tom Paulson

    Matt Bonds (in an email to me) says:

    I’d add that I don’t think the issues are quite as “academic” as they seem. At issue is what are the relative costs to benefits of providing health care for the poor. The tradition of health economists is to only consider the financial costs for inputs into the health system. This is why Paul Farmer refers to most health economists as “anti health economists.”

    What these models suggest is that there may be a net cost of NOT providing health care, because of the cascading effects of lost productivity over time from disease.

    Here’s a link to a Nature report on these issues:
    http://www.nature.com/news/2009/091209/full/news.2009.1130.html

    Best,
    Matt