Social Evils Poverty and Health
Poverty is one of the most important social evils and a major determinant of ill health (1). From time it is known that poor social status is a major determinant of disease and reduces longevity in a big way. The Charaka Samhita recognized that community structure and functioning was an important cause of disease in individuals. The association of individual illness causing community disturbances and poverty and vice versa was noted (2).
Health status is strongly determined by socio-economic positions and a large body of literature from developed ountries demonstrates that most causes of deaths occur at a greater rate in groups with lower socio-economic status (3). Pathways from adverse social circumstances to ill health are then discussed and some suggestions are made for eliminating these social evils. The Global Burden of Diseases Study reported major causes of mortality, disease burden and risk factors in various parts of the world (4). In developing countries, infections of respiratory tract, HIV/AIDS, diarreah, tuberculosis, and malaria have emerged as important causes.
The reliability of mortality ata has been questioned in terms of medical classification of deaths as a large number of deaths are recorded as proof and old age. Globally, the important causes were lower respiratory infections, AIDS, heart disease, and malaria. Indian National Commission on Macroeconomics and Health (9) has reported that communicable diseases, maternal conditions as well as non- communicable diseases which are major causes of disease burden. The Second Global Burden of Diseases Study (4) quantified more than twenty health risk factors that influence health of populations.
Major risk factors identified were childhood and maternal undernutrition leading to childhood and maternal underweight. , iron deficiency, anaemia, vitamin A deficiency and zinc deficiency. There was a difference in risk factors causing disease burden or mortality. Social circumstances and poverty are the major determinants of all these factors. A social problem is defined as a situation confronting a group or a section of society which inflicts injurious consequences that can be handled only properly (11). There are a number of social problems in India (11).
These have been identified as poverty, illiteracy, unemployment, population explosion, communalism, youth unrest, violence against women, crime and criminals, alcoholism, terrorism, corruption, and more recently, overweight/obesity in the urban subjects coupled with changing lifestyles. Multiple efforts to accurately identify social determinants of health have been performed and some efforts have evolved recently. Social determinants of health were enumerated by Marmot and others at the Solid Facts Program of the World Health Organization (12).
The factors identified were social rganization, early life events, life-course social gradient, high unemployment rates, psychological work envoronment, transport, social support, cohesion, food, poverty, and social exclusion. All of these factors are classified as social evils that directly influence health. Because non-communicable diseases are major health issues in Europe and other developed countries, these factors reveal only half the story. For example, illiteracy and low educational status is a major disease risk factor but not part of the WHO agenda as this is not as serious f a problem as it is in Europe (3).
A major development to address various social issues and poverty was the landmark United Nations Millennium Declaration in the year 2000 by various Heads of States and governments. The declaration articulated Millennium Development Goals (MDGs) which include specific targets for social engineering to bring about equitable prosperity and health (13). These specific targets include poverty reduction, increasing primary education, promoting gender equality, and development of a global partnership for an even bigger development.
