Poverty+and+Health

=POVERTY ALLEVIATION AND HEALTH:=

**HIV/AIDS Prevention**
__ Introduction __ In a comprehensive effort to end global poverty, the United Nations Millennium Development coalition is dedicated to combating the spread of HIV/AIDS and other diseases. Not only do HIV/AIDS have a devastating impact on the constituency of a country, they are also powerful indicators of health and poverty conditions within the country. In areas where HIV/AIDS is particularly common, it is a result of a myriad of factors that are both explicitly and implicitly linked to the endemic cycle of poverty.   As the map above reflects, combating HIV/AIDS is a global cause. As the map indicates, some regions are more affected by disease than others, but it is truly in the vested interests of all nations to end the suffering presented by this disease. In order to accomplish this goal, a unique blend of medical and educational expertise will be required throughout the direct implementation of programs and services aimed at the treatment of HIV/AIDS, and most importantly, at the prevention of future spread and growth. Funding and support for these locally and nationally based programs will be derived from both national governments and a variety of organizations that are also members of the global partnership aimed at fighting HIV/AIDS. __The Reality of HIV/AIDS in Today’s World: Developing Sustainable Solutions __ Despite recent efforts, the insurmountable tides of poverty and population-growth have resulted in an increase in the number of people living with HIV/AIDS. According to the United Nations Millennium Development Goals Center, an estimated 33 million people worldwide have HIV/AIDS. Every day, nearly 7500 people become infected with HIV and approximately 5500 people die from it. With these troubling numbers, and the trends of HIV/AIDS growth and development, it is obvious that the existing treatment and prevention methods must be adapted to create more lasting and significant change. The question remains though, exactly what will characterize this sustainable change? What types of programs will reduce and prevent the spread of HIV/AIDS? We propose a combination of detailed and case-specific approaches with an emphasis on education to achieve the desired positive impact. These solutions will include programs aimed at:

Prevention: 4. Address the stigmas and stereotypes associated with HIV/AIDS.
 * 1) Accurate educative initiatives for a wide range of populations. These classes should include age-appropriate awareness for younger populations and more substantive information as populations mature.
 * In countries with low literacy rates or poor school attendance, it is crucial that alternative educative measures are not forgotten.[[image:aidseducationaa.jpg width="338" height="255" align="right"]]
 * Adult education will be another component of these initiatives. In effect with corollary a, these courses should be accessible by the majority of adults with audience-specific explanations and presentations.
 * 1) Increased access to sexual contraceptives, with comprehensive guidelines on how to use them properly.
 * 2) Offer HIV testing. In many regions, those that are HIV positive are unaware that they could be transmitting the virus. It is important to offer HIV testing, and guidelines for what to do if the test is both positive and negative.
 * These guidelines should include information ranging from what to do if your spouse tests positive to how to inform potential sexual partners that you are HIV positive. Once again, these guidelines will be rooted in the educational initiatives from the first solution
 * Will foster and reinforce the bonds behind the global partnership to fight HIV/AIDS.
 * This measure will make preventative endeavors more successful because audiences will be more receptive.
 * It will also ensure that in societies where HIV/AIDS is particularly prevalent, and even where it is not, that people living with HIV/AIDS enjoy the same civic standards as uninfected citizens.

UN Secretary-General Ban Ki Moon says: //"Stigma remains the single most important barrier to public action. It is a main reason why too many people are afraid to see a doctor to determine whether they have the disease, or to seek treatment if so. It helps make AIDS the silent killer, because people fear the social disgrace of speaking about it, or taking easily available precautions. Stigma is a chief reason why the AIDS epidemic continues to devastate societies around the world"//

Treatment: nucleoside analogues, nukes || 1987 || NRTIs interfere with the action of an HIV protein called reverse transcriptase, which the virus needs to make new copies of itself. || non-nucleosides, non-nukes || 1997 || NNRTIs also stop HIV from replicating within cells by inhibiting the reverse transcriptase protein. || 2. Increased funding and support for drug development and testing of anti-HIV/AIDS drugs.
 * 1) Expansion of antiretroviral treatment services. Antiretroviral medications are used to control the reproduction of the virus and slow or halt the progression of HIV-related disease. When used in combinations, these medications are termed HIghly Active Antriretroviral Therapy (HAART).
 * Antiretroviral treatment often involves case-specific intensive treatment with a combination of antiretroviral drugs. To guarantee positive results from this treatment, it is important that patients receive the proper long-term access to the drugs that they need.
 * ~ Antiretroviral drug class ||~ Abbreviations ||~ First approved to treat HIV ||~ How they attack HIV ||
 * Nucleoside/Nucleotide Reverse Transcriptase Inhibitors || NRTIs,
 * Non-Nucleoside Reverse Transcriptase Inhibitors || NNRTIs,
 * Protease Inhibitors || PIs || 1995 || PIs inhibit protease, which is another protein involved in the HIV replication process. ||
 * Fusion or Entry Inhibitors ||  || 2003 || Fusion or entry inhibitors prevent HIV from binding to or entering human immune cells. ||
 * Integrase Inhibitors ||  || 2007 || Integrase inhibitors interfere with the integrase enzyme, which HIV needs to insert its genetic material into human cells. ||

3. Offer transportation and wider access to HIV/AIDS treatment.
 * In rural, impoverished areas especially, transportation and access to proper HIV/AIDS treatment is extremely limited. While resources may be available nearby, many people lack the means to reach this treatment.
 * Actively inform citizens about available aid through a combination of literacy and non-literacy based campaigns.

__The Problem: Maternal and Child Mortality__



Maternal Mortality Maternal mortality represents a human rights issue - the discourse of human rights enables the issue to remain a public concern. It is the leading cause of premature death and disability among women of reproductive age in developing countries, and 99% of pregnancy-related deaths occur in developing countries. Maternal mortality remains the greatest disparity between developed and developing countries, and it has not been significantly addressed. One cannot assume that general development measures (such as nutrition and education) will solve the problem of maternal mortality, though they obviously have other important health and social benefits. Nations should receive aid to alleviate maternal mortality if they are not capable of reforming their own health care deficits, and the UN Guidelines for maternal health should serve as standards by which to judge states' compliance with the obligation to reduce maternal mortality. UN Guidelines (in their objectivity) can be used to monitor states' progress in combating maternal morality as a matter of international human rights law. The reduction of maternal mortality requires states to respect, ensure, and protect a woman's right to help, and it also requires states to eliminate cultural, religious, and social discrimination that devalues women's health and well-being.



Approximately 10.8 million children under the age of five die each year, 4 million of them in their first month of life. Respiratory infections, malaria, and neo-natal mortality remain the predominant causes.
 * Child Mortality**

__The Solution__

The following indicators should be used to determine a state's capacity to reduce maternal mortality and associated infant mortality: - Are there enough health facilities providing care for women, including those with obstetric complications? - Are the facilities distributed evenly across the population? - Do pregnant women use the facilities? -Are the facilities poroviding the necessary services at the proper quality?

Improving maternal and child health are two of the eight Millenium Development Goals (MDGs) and the task force made the following recommendations to improve maternal and child health, and they reflect this project's goal to eliminate poverty in an equitable, individualized manner. The goals should be accomplished by integrating local NGOs, the national governments of the countries in question, and UN standards:
 * Maternal and Child Health: Development Goals**

1.) Health Systems: health systems, particularly at the district level, must be strengthened, with priority given to stragegies for reaching the child and maternal health Goals. -Health systems, as social institutions, shold be responsible for reducing poverty and advancing democratic development and human rights. Policies should strengthen the legitimacy of well-governed states and increase equity.

2.) Financing: strengthening health systems will require considerable funding. -Donors and international financial institutions should increase aid and countries should increase allocations to their health sectors without fees for basic services.

3.) Human Resources: The health workforce must be developed according to the goals of the health system with the rights and livelihoods of the workers addressed. -Empower a wide range of health workers (including birth attendants)

4.) Sexual and Reproductive Health and Rights: sexual and reproductive health and rights are essential to meeting all the MDGs, including those on child health and maternal health. -Universal access to reproductive health services that include HIV/AIDS initiataives -Attention to adolescents and abortion

5.) Child Mortality: child health interventions should be scaled up to 100 percent coverage -Child health interventions should be offered within the community and backed up by the health system

6.) Maternal Mortality: maternal mortality strategies should focus on building a functioning primary healthcare system, from first referral-level facilities to the community level -Emergency obstetric care must be accessible for all women, and skilled attendants must be integrated within district health systems

7.) Global Mechanisms: poverty-reduction strategies and funding mechanisms should support and promote actions that strengthen equitable access to quality healthcare and do not undermine it. -Global institutions should commit to long-term investments and accountability for national health programs is essential

8.) Information Systems: information systems are an essential element in building equitable health systems -Indicators of health system functionality must be developed and integrated into policy and budget cycles

The following table displays existing and proposed targets and indicators for the maternal and child health MDGs:
 * ** Goal **

|| ** Target **

|| ** Indicators **

|| Reduce child mortality
 * Goal 4:

||  Reduce by two-thirds, by 2029, the under-five mortality rate, ensuring faster progress among the poor and other marginalized groups.

||  • Under-five mortality rate • Infant mortality rate • Proportion of 1-year-old children immunized against measles • Neonatal mortality rate • Prevalence of underweight children under 5 years of age

|| Improve maternal health
 * Goal 5:

||  Reduce by three-quarters, by 2029, the maternal mortality ratio, ensuring faster progress among the poor and other marginalized groups. Universal access to reproductive health services by 2029 through the primary healthcare system, ensuring faster progress among the poor and other marginalized groups.

||  • Maternal mortality ratio • Proportion of births attended by skilled health personnel • Coverage of emergency obstetric care • Proportion of desire for family planning satisfied • Adolescent fertility rate • Contraceptive prevalence rate • HIV prevalence among 15–24- year-old pregnant women

|| [|Maternal and Child Health MDG Taskforce]

[|United Nations Development Fund for Women]

[|US Aid]

The development and complete utilization of health systems is the essential aspect of reducing infant and maternal mortality. Health systems play an essential role in democratic development, poverty reduction, and fulfillment of human rights. All health systems introduced as part of the MDGs must ensure equitable access because abusive, marginalizing, or discriminatory treatment by the health systems are synonymous with poverty. As a result, they must be considered as a social institution inherent to democratic development.
 * Health Systems and Broader Development**



BSI: GURVISHA AND NAYANS DISCUSSIONS AND COMPILATION OF VIEWS ON POVERTY AND HEALTH

**__ Poverty and health __** Poverty and disease are inextricably linked. Let’s take an example of a developing country, say, Malayasia. The state with the lowest incidence of poverty has the lowest (best) infant mortality rate. The infant mortality rate measures the number of deaths in the first year of life per 1000 live births. The state with the highest incidence of poverty has the highest (worst) infant mortality rate.7 Most of the illnesses associated with poverty are infectious diseases, such as diarrhoeal illness, malaria, and tuberculosis. All of them are associated with the lack of income, clean water and sanitation, food, and access to medical services and education which characterise poor countries and communities. The diseases are linked to undernutrition and children are most susceptible to them. The environmental, social, and dietary changes produced by industrialisation and urbanisation are leading to higher rates of diabetes, hypertension, heart disease, and respiratory illness among both the urban poor and not so poor.8 Health is a major factor that is going to be addressed, both in rural and urban areas. The number of primary healthcare centers in rural areas is abysmally low and NGOs are trying to fill this void to the best of their abilities. With the dreaded HIV/AIDS epidemic hitting India in a big way, a number of steps are being taken to ensure that the outbreak is brought under control, such as through awareness campaigns and free and safe condom and syringe distribution outlets. There is in fact a two way relationship between poverty and ill health, with disease often further impoverishing the poor. Illness prevents people from working, or affects their productivity, lowering their income. The costs of obtaining health care can also be substantial, both in terms of time off from work (clinics are often a long distance from the household) and in terms of money spent on services: it is estimated that between 1990 and 1994, 21% of previously non-poor households in Bangladesh slipped into poverty as a result of health-related causes. //**__ The price of privatization __**// Privatization leads to steep hike in health expenditures, attributable to the increased costs of medical consultations, drugs and devices, medical tests and hospitalization. Everybody involved has to earn; private medical practice is a profession, not just a public service. Because of the pressure to make a profit, many private doctors, hospitals and diagnostic centres promote uncalled-for investigations and treatment in order to recover their initial investment. So services with limited value will be popularized and promoted to many people – whether or not they need it. This is true for the simple ultrasound scanner, endoscopy centre and test laboratory as well as the more costly and sophisticated lithotripsy, CT and MR imaging, balloon angioplasty and transplant. Every test and treatment must be marketed like a commercial consumer product. This is done y individuals as well as big commercial organisations. Newly developed drugs, test kits or instruments are promoted aggressively. All kinds of methods are used to prove that the product at hand is superior to other, and almost indispensable in itself. The strategy succeeds at the cost of rational, ethical practice and patient care. The global picture then is one in which successes in poverty reduction in east Asia have been countered by increasing numbers in poverty in subSaharan Africa, south Asia, Latin America, and the transition economies. Average income levels in subSaharan Africa are now lower than they were at the end of the 1960s.3 The international poverty line gives us a convenient way of taking a snapshot of poverty in different countries and looking at trends over time. However, it is a very blunt instrument for measuring a complex phenomenon. **__ Tackling poverty and disease __** Some countries should be able to manage to tackle the diseases of poverty even though they themselves remain at comparatively low levels of development. Some countries (notably the Indian state of Kerala, China, and Sri Lanka) must have levels of life expectancy far above much richer developing countries, such as South Africa, Brazil, and Gabon. There are several reasons for the success of these poor countries in achieving good health at low levels of per caput income.10 they include: **__ Conclusions __** Health professionals may have a key part to play in eradicating poverty. Firstly, they need to make sure that interventions inside the health sector benefit the poor. Too often government health expenditure is skewed towards urban hospitals which disproportionately serve the rich. Secondly, they need to make sure that in their everyday relationships with patients they treat the poor as well as anyone else. One of the commonest complaints from poor people using health services is that health professionals treat them with disrespect and offer them substandard treatment.11 Training to stamp out this kind of prejudice should be mandatory for health professionals. Finally, health professionals need to promote interdepartmental cooperation and action by governments to promote better education, water, and sanitation and other services which improve the lives of the poor. The diseases of poverty cannot be tackled without concerted economic and political action. This means justice and equality for the poorest people within our societies. You can help make a difference by getting involved.
 * It does not take into account cost of living differentials within countries. $1 will buy different amounts of goods in urban and rural areas. For example, food may cost more in cities.
 * It does not show who lives in permanent and who lives in temporary poverty.
 * It does not consider the distribution of income within the household-gender inequality means that men usually consume most of the household income.
 * It only values goods which are delivered on the market. In many poor countries people grow and rear food and animals for their own consumption, a process which is not captured by measures of income and consumption based on the measurements of the purchase of goods sold as commodities.
 * High levels of female literacy. International research has shown that the higher the proportion of educated girls in the population the better health indicators are. Women with better education are more likely to command higher incomes, take on board health education messages, and to demand better health care, all of which can have beneficial outcomes for themselves and their children.
 * Fewer income inequalities. Where the benefits of growth are more evenly distributed, the poor will tend to gain more than the rich, reducing poverty (and the ill health associated with poverty) to a greater extent.
 * Government commitment to providing health, education, and social security services, and making them available to the poor.
 * Higher levels of public participation in political life. This has the effect of making government more responsive to the health and other needs of poor and vulnerable groups.

Links to other MDGs Eradicating Hunger Achieving Universal Education Empowering Women Poverty and Health Insuring Environmental Sustainability Developing a Global Partnership for Development Basic Costs Demographics