Introduction

The poverty endured by the bottom half of humankind poses serious dangers to their health and survival. The poor worldwide face greater environmental hazards than the rest of us: from contaminated water, filth, pollution, worms and insects. They are exposed to greater dangers from people around them: through traffic, crime, communicable disease and the cruelties of the more affluent. They lack means to protect themselves and their families against such hazards through clean water, nutritious food, good hygiene, ample rest, adequate clothing and safe shelter. They lack the means to enforce their legal rights or to press for political reform. They are often obliged by dire need or debt to incur additional health risks: by selling a kidney, for instance, or by accepting hazardous work in prostitution, mining, construction, domestic service, textile and carpet production. They lack financial reserves and access to public sources of medical knowledge and treatments, and therefore face worse odds of recovering from disease.

Mutually reinforcing, these factors ensure that the poor bear a hugely disproportionate burden of disease – especially of communicable, maternal, perinatal and nutritional conditions – and a hugely disproportionate share of premature deaths: 30 per cent of all deaths each year, 18 million, are from poverty-related causes. These much greater burdens of morbidity and premature mortality in turn entail large economic burdens that keep most of the poor trapped in lifelong poverty.