pdf
PDF of original paper (4pages; 200K)

Resources > Overseas > 2002

The cost of caring

Health and poverty in the two-thirds world - 2002

“The poor you will always have among you.” 1

Jesus’ comment to Judas was not just a statement of fact, but also an indictment of humanity. Poverty is as real and horrifying in our day as it was in the first century, but the scale has grown beyond all imagining.

Consider these few stark facts:

  • The growth of the world economy doubled in the twenty five years before 1998 Yet around 1.3 billion people live in grinding poverty (income < US$1 per day)
  • The developing world population is 4.4 billion
  • Significant proportions of this population lack - Sanitation (3/5) - Clean water (1/3) - Health care (1/5) - Enough dietary energy and protein (1/5)2

Economic disparities both within and between countries have grown over the past decade, and incomes are lower in real terms in about 100 countries. According to the International Poverty and Health Network (IPHN), the link between economic growth and health is not automatic. Poverty is multidimensional. Improving the average health of a nation may widen inequalities, with the rich getting healthier, and the poor becoming increasingly unhealthy3.

Increasing national income has a measurable impact on basic health indicators such as longevity and under-five’s mortality. If a nation is wealthy as a whole, it should be able to afford better health infrastructures, so more people can access adequate healthcare, thus reducing the risks of serious illness for the elderly and very young. If people are wealthier they can afford to pay for healthcare (either directly or indirectly through taxation) so they can more readily stay healthy. More fundamentally, they can afford to eat well and can afford better housing and sanitation, reducing their risks of becoming ill in the first place.

In practice, increases in national wealth often tend to primarily benefit the health of those who are already wealthy. New wealth tends to congregate around those already ‘better-off’, while healthcare services, as they improve, become more costly - both factors tending to disadvantage the poor4.

However, health also affects wealth. As overall health improves so the ability to earn a living improves and the drain on incomes from medical bills is reduced. This also affects the wealth of the nation as a whole because the drain caused by an overburdened health system and a large unproductive population is reduced. A recent report5 suggests that if the basic health inequalities in the poorest nations of the world were met, over $186 billion per annum could be added to the global economy and the resultant economic uplift could take many nations out of poverty. More significantly, eight million lives would be saved each year.

Christian responses

"Heal those who are sick and say 'the Kingdom of God has come near to you'"6.

“Learn to do good, seek justice, rescue the oppressed, reprove the ruthless, defend the orphan, plead for the widow” (emphases mine)7

“I have become all things to all people, so that I might by any means save some” 8

Healthcare has historically been a key part of Christian Mission to the poor9. Jesus sent out the first disciples with the commission to preach and heal10. When confronted by John’s disciples asking if He was the Messiah, Jesus replied ‘The blind can see, the lame can walk, lepers are made clean, the deaf can hear, the dead are raised and the Gospel is reached to the poor’11. When, in Luke 4: 16-21, Jesus stood up in the synagogue in Nazareth, and read from Isaiah 61: 1-2, he proclaimed (among other things) recovery of sight to the blind, and care and freedom for the poor and oppressed. In short, healing, care for the poor, the sick and the weak and the proclamation of the Good News have always gone hand in hand. Seeing people saved from spiritual death is the crucial first step in a mission God has called us to that is also about bringing physical wholeness and restored human social relationships.

This ‘wholistic’ approach to mission was very much a part of the life of the early church. Examples abound of the early church caring for the sick as they travelled across the known world - both in miraculous healings and the more ‘mundane’ areas of care for the chronically ill and dying. For example, during the bubonic plague epidemic of AD 256 in Alexandria, while the rest of the city fled the Christians stayed behind to care for the sick and dying, many of them paying the cost for their compassion with their own lives. 12 Our modern words ‘hospice’ and ‘hospital’ share the same route as ‘hospitality’, recognising that the early church took people into their own homes to care for them (many of whom were suffering from plague, leprosy and other diseases that would usually have left them outside the bounds of normal society). Yet today, global changes are impacting health as never before, and the issues being faced by those caring for the sick are far more complicated than even a generation ago13.

For example one mission leader recently told me that his organisation’s work in Africa was now so impacted by AIDS that they were having to refocus on HIV prevention and care, even though their primary emphasis has always been on church planting and training church leadership. HIV/AIDS is always most common wherever there is poverty.

One challenge is not just to provide care for the sick, but also to confront the economic environment that leaves a third of the world’s population living on less than a dollar a day and nearly 20% with no access to healthcare. The Jubilee Debt Campaign (in which many Christian individuals and churches have been involved) is still fighting to see the debts of the poorest nations cancelled. The Access to Essential Medicines Campaign is fighting for access to life saving treatments (especially for AIDS and HIV) for the poorest people in the world and to encourage drug companies to invest in developing more effective treatments for common illnesses in the developing world.

Meanwhile, Christians are at the forefront of tackling the problems being faced by people here and now. A recent report14 has shown that in Uganda there has been a drastic reduction in the rate of HIV infection, largely due to the impact of churches and Christian agencies educating people to change their sexual behaviours. Meanwhile Hospice Africa and Mildmay International have pioneered an effective Christian response to the needs of those already living and dying with AIDS, cancer and other terminal illnesses.

The costs of maintaining Christian hospitals in developing nations are growing all the time, forcing many to shut down or increase the charges that they must make on patients, making it harder and harder to give care to the poorest and most needy. In many situations, Christian hospitals are the only ones providing care for remote, impoverished communities.

Working in such situations is hard for health professionals. Maybe as many as 95% of all doctors in some African countries leave to work in wealthier nations within a year or two of qualifying. Many nurses are now leaving their own countries short of skilled care to come and work in the West (Britain alone has recruited a vast number of nurses from countries such as Malawi and the Philippines in recent years). Christian doctors, nurses and other health professionals from the West play an important part in keeping the health service of some nations functioning.

The challenge for us is are we prepared to support those who are paying the cost of caring for the most needy and vulnerable in the world? Are we prepared to tackle the issues of poverty in health inequality at source?

Prayer Points

  1. For those working in developing nations with poor resources and in situations of desperate need – for strength, the resources that they need and a continued renewal of their vision and calling.
  2. For the governments of the wealthy nations to act justly towards the poor in terms of aid, debt relief and access to life saving treatments.
  3. For the many Christian student health practitioners from the UK who spend time in Christian hospitals and healthcare projects in developing nations in the summer breaks or as an elective placement in their training: That they would be challenged to respond to the needs and God’s calling on their lives, whether to serve in the UK, overseas, or both.
  4. For the safety of health professionals working in the war torn areas of the world – in Northwest India and Southwest Pakistan, Afghanistan, Sudan, Somalia, Congo, etc.

Steve Fouch (Director, MMA Healthserve)

End Notes

  1. John 12 v8
  2. ‘WHO Bulletin Spotlights Serious Inequalities in Health’ – Press Release WHO/6 26 January 2000
  3. Haines A, Heath I, & Smith R (2000) ‘Joining together to combat poverty’ – BMJ; 320: 1-2.
  4. Haines, Health & Smith – Ibid.
  5. ‘Investing in Health for Economic Development’ – Report of the Commission for Macroeconomics and Health, December 2001.
  6. Luke 10 v9
  7. Isaiah 1 v17
  8. I Corinthians 9, v22b
  9. Davey, T F (1985) Introduction to ‘Heralds of Health’, Edited by Stanley G Browne, pp 1 – 11. CMF/IVP ISBN 0-906747-17-1
  10. Luke 9 v1-2
  11. Luke 7 v22
  12. Davey, T F (1985) Introduction to ‘Heralds of Health’, - Ibid
  13. Clegg, D (2002) ‘The Impact Of Globalisation On Global Health’ – unpublished.
  14. Green, Edward C. (2002) ‘The Impact of Religious Organizations in Promoting HIV/AIDS Prevention’, Synergy Project and Harvard School of Public Health (available at on-line at www.ccih.org)

Resources

Jubilee Debt Campaign PO Box 36620 London SE1 0WJ Tel: 020 7922 1111 Fax: 020 7922 1122 Email: assistant@jubileedebtcampaign.org.uk (General enquiries and materials requests) www.jubileedebtcampaign.org.uk www.jubileeplus.org

Hospice Africa 16 Arden Close Ainsdale Southport PR8 2RR UK Tel / Fax: 01704 573 170 Email: hospaf@connectfree.co.uk

Access To Essential Medicines Campaign Médecins sans Frontières (MSF) Nathan FORD MSF 124-132 Clerkenwell Road, London EC1R 5DJ UK Telephone 020 7427 2215 Email: nathan_ford@london.msf.org www.accessmed-msf.org

Mildmay International 1 Nelson Mews, Southend-on-Sea, Essex SS1 1AL, Telephone 01702 394450 Fax 01702 394454 Email bloisg@globalnet.co.uk www.mildmay.org.uk

news