By Zubeida Mustafa
POVERTY is the buzzword in development economics and policymaking in Third World countries today. The problem with the strategies that are being mooted to eradicate this blight from people’s life is that planners tend to focus on the monetary aspect of poverty.
It is widely — but erroneously — believed that if a person has a comfortable income to enable him to purchase the good things in life he has pulled himself out of poverty. That is why the emphasis is on employment generation and schemes to enable people to earn a livelihood.
What is often overlooked is that a dent can be made in poverty by addressing other factors as well — not necessarily financial — that will create an impact on the poverty level of a society. It is a pity that no empirical study of its kind has been done to determine what effect interventions in the social sectors will have on poverty. A person’s economic income may be given a boost not by directly doling out cash or jobs to him.
Raising his educational level and improving his health status while providing him positive and inspirational leadership could lift him out of poverty by giving him the incentive and motivation to better his living standards. The basic difference between the poor and the rich is that the former have few choices in life while the latter have far too many. Reducing poverty, in effect, is all about creating choices for everybody.
In an excellent background paper titled, “The poverty-health relationship in Pakistan”, prepared for the Asian Development Bank, Akbar Zaidi, a senior economist and consultant, has correctly pointed out the close nexus between poverty and ill- health. “The poverty health relationship in developing countries is often an interlocking relationship, with each round of poverty having an impact on ill health, and the further deterioration of health having a subsequent impact on the level and nature of poverty at the individual and household level,” he writes.
It is strange, as Zaidi points out, that not much notice has been taken of this interrelationship that is so obvious. Thus it is not surprising that the national health survey of Pakistan found 65 per cent of the extremely poor ill at the time of the survey. Moreover, nearly two-thirds of the deaths in Pakistan are caused by communicable diseases (mainly infectious, viral and malarial). These can be easily controlled by better hygiene and sanitation. It is generally the poor who fall victim to typhoid, diarrhoea, tuberculosis, etc because they are affected more profoundly by the government’s apathy, ineptitude, inefficiency and corruption — all of which are the primary cause for the creation of conditions that lead to these illnesses.
But what needs to be noted is that it is not just health and poverty that are so closely interlinked. Education, water supply, housing, sanitation and environment also have a direct impact on one another as well as on health and poverty. Hence the need for a holistic approach to all these sectors of national life.
One doesn’t even need a survey to be told that the majority of the extremely poor are also illiterate and uneducated. Going further, it is the poverty-stricken that are denied access to potable water supply. The rich go and purchase bottled water. Those living in dismally unhygienic conditions are also the poor.
An empirical study on how the deficiency in one area of life affects the other aspects of people’s life would be instructive and also shake policymakers out of their stupor. It is no revelation that a child who is ill cannot attend school and his high rate of absenteeism makes him likely to drop out and thus become a candidate for illiteracy. This in turn would ensure his lack of awareness of how insanitation and impure water affect health. This vicious cycle would serve to perpetuate his poverty.
Hence it is essential to focus on all aspects of life of the poor if poverty has to be eradicated. Unfortunately, this is not being done. Had there even been an iota of awareness of the linkages between the various social sectors and poverty, the government’s blatant thrust towards the private sector would not have existed. The private sector does not cater to the needs of the poor. The shrinking role of the public sector in education, health, population welfare and housing point to a policy of marginalisation of the poor.
It is time our policymakers were more honest in their poverty eradication policy. Their loud talk about doing away with poverty and their concern for the poor are no more than a subterfuge to win support from the aid givers. Only a fraction of the funds that flow in for the purpose of eliminating poverty actually go to the poor.
Thus the government claims that its poverty reduction strategy consists of five elements: accelerating economic growth, investing in human capital, augmenting targeted interventions, expanding social safety nets and improving governance.
But that doesn’t convince one that the policy is sincerely directed against poverty. Thus investment in human capital by itself is not enough. It must be channelled towards the poor. The Pakistan Economic Survey 2005-06 boasts of poverty related expenditures amounting to Rs378 billion in 2005-06 that include community services, human development, rural development, safety nets and governance. But in the absence of any breakup, one cannot be certain how much of this amount helped the rich. The Economic Survey itself admits that consumption inequality in Pakistan has increased with consumption having increased faster for the top 20 per cent of the population as compared to the growth rate of the bottom 20 per cent. The Gini Coefficient went up from 0.2752 in 2001-02 to 0.2976 in 2004-05. (The higher the figure the greater is the inequality.)
Had the government been focusing on poverty reduction, its education policy would also have been oriented towards establishing schools in the public sector to provide high grade education to the children of those living below the poverty line.
Rather than setting up expensive tertiary hospitals, the government would have focused on preventive medicine such as immunisation, sanitation, environmental protection, clean water supply, safe maternal health and population planning. The fact, however, is, as pointed out by Akbar Zaidi, “The market-driven private, for-profit sector, for the most part, is not involved in preventive measures.” It may be added here that the government has not done enough either.
Emphasis on preventive medicine would automatically reduce the need for interventions of a curative nature which mostly benefit the private sector — be it the physician charging Rs1,500 for a visit and a prescription for high cost medicines or the quack who charges Rs50 for dispensing medicines the contents of which he himself doesn’t know.