POVERTY

AND
INEQUALITY
To Raise Awareness on the
Effects of Poverty on Health
Team B
Lisa, Lorenzo, Andrea, Zeeshan, Imran
BACKGROUND
According to the United Nations, nearly half of the world's population
currently lives in poverty, which is defined as to have an income of less than
$2 day. Of those, over 800 million live in extreme poverty, with an income of
less than $1.25 a day (2023). The first goal of the United Nations 2030 Agenda
for Sustainable Development is eradicating poverty for all people.

Poverty is a major cause of both poor physical and mental health, as well as a
barrier for many to access necessary healthcare.

We believe that it is crucial to raise awareness on how poverty effects health,

as there are millions of people around the world limited in their health due to
their income.

This project will address the effects of poverty on health in four countries:
Indonesia, America, Romania, and India, and provide specific courses of
action related to these respective countries.
INDONESIAN
PERSPECTIVE
Lorenzo
Andrea
Indonesian Perspective
Indonesia is on the verge of a nutritional health crisis. According to the
National Statistics Agency, 1.63 million Indonesian were pushed to

poverty, this is significant because the rise took place prior to Indonesia's

mass outbreak.

In Indonesia the cost of maintaining an acceptable standard of living is

used of determine poverty. It comprises cost of necessity, 75% of which

are food related. In the months of September 2019 and March 2020, CIPS

(Center of Indonesian Poverty Studies), noted that price rises for basic

foods. Eggs increased by 11% sugar by 5.53%, and rice by 1.8%. This

indicates that the prices were the main reason of poverty when the

pandemic began. Now the Pandemic has placed more people into poverty

due to unemployment and economic turndown which leads into a record

0f 20.7 million Indonesians living in the poverty line by September 2020.

There are various ways poverty is affecting people's health in Indonesia.

For instance, due to insufficient nutritional intake, children have

experienced stunted growth. People that are suffering from mental health

issues are not able to get proper help due to the expenses.

Lorenzo
Reasons/Attitudes Behind the Cultural Perspective
A study has been done in Serang and Pandeglang, where researchers from the Indonesian Institute of Sciences did a survey of

about 1200 targeted participants, and found that the attitude people have may be contributing to their poverty. The article states,
'Our research found people’s fatalistic attitude had prevented them from being lifted out of poverty. Most of our respondents

believed being poor was God’s fate, and there was nothing they could do.' This clearly shows that the mentality amongst the

targeted participants and potentially others in similar situations living in different areas, is significantly effecting their efforts to

get out of poverty. Researchers have also found this attitude leads to self-denial, most of the respondents believing they're not

actually poor. Poverty in Indonesia is related to the social and cultural tendency of low-income families sharing their limited assets
amongst themselves and relatives. This habit makes them poorer as the family gets bigger. Due to this habit combined with the

negative attitude, the respondents believe that God was helping them via the support from their family and social aids and

therefore have little to no motivation to try and help themselves. The self denial also creates a problem for government efforts to

reduce poverty in the region, due to difficulty identifying poor people who don't want to admit they're poor.

Multiple cities were included in the testing of a health program called JPK-Gakin in 2003. The involvement of two managers from

the health program made the government issue a policy on the division of the community health clinics service area. This provided
an opportunity for the local government to do an evaluation of the performance of the program, comparing several differences in
the type and extent of health services offered by the two of them. Findings from the evaluation show that although the community
health clinics and hospitals pay patient costs for poor families, the amount of people getting referred is quite small. Unfortunately,
there are some limitations that interfere with the access families have to health services. Things like poor socio-economic

conditions, endemic malaria, a low number of health workers and the long distance between people's homes and health services

are some of the limitations.

Andrea
Course of Action
The main goal would be for Health programs to be implemented throughout Indonesia where poorer families can have easier access
to facilities and should not have to worry about the expenses. An article states, "Kompas Research and Development, which

conducted a survey in five cities in DKI Jakarta, found that only 29 percent of poor households in DKI Jakarta have JPK-Gakin. This

means that the majority of DKI's poor do not yet have JPK-Gakin." This is mainly due to worry of expenses and difficulty in
accessing the facilities, as well as most of the patients not being aware of the health programs themselves/not many people getting
referred to them.

While more health programs should be implemented throughout Indonesia, the government should try and find separate solutions
for each region depending on the root cause. For example, in regions where poverty is a cultural problem, local governments can

create programs to empower people to improve their attitude and motivation. The Indonesian Institute of Sciences has stated that,
'Our research suggests the government adopt social and cultural approaches to understand a region’s whole poverty issue.

Understanding poverty should start by identifying the relationship between people and their social environment.' It is important to
understand that the root cause for poverty in each region is different. While distributing money will help with poverty in general,

the government's approach to simply distribute money amongst the poor will not solve poverty problems for all regions.

Discrimination against the patients going to health programs and patients who are able to pay should also be considered when

hiring health workers. According to an article, 'Another problem, as frequently found by SRMI in the field, is the practice of

differential treatment or discrimination between JPK-Gakin beneficiaries and patients who have the ability to pay.' This kind of

treatment from health workers is likely to discourage patients even further from going to health programs, even though patients

may have access to the services provided within a close distance and do not have to worry about the expenses.

Andrea and Lorenzo

AMERICAN
PERSPECTIVE
Lisa
The American Perspective
Poverty has been a major ongoing issue in America. According to the United
States Census (Figure 1), the national poverty rate in America in 2021 was
11.6%, a total of 37.9 million people (2021). In the context of health, Health
Affairs, a healthcare journal, states that the United States has among the
largest income-based health disparities in the world, as poor adults are five
times as likely as those with incomes above 400 percent of the federal
poverty level to report being in poor health (Khullar, Chokshi, 2018).

Poverty in the states has primarily influenced a great deal of physical health
issues, such as increased rates of heart disease, diabetes, stroke, drug

poisoning, alcohol, and suicide. According to Common Wealth Fund, one-

fifth of low-income adults report their health as fair or poor, compared to
only 5 percent of higher-income adults. Additionally, rates of obesity are
also higher among low-income adults with 36%, while higher-income adults
is 28%. Low-income adults are also more likely to smoke, with 25%, which
can cause many physical health issues (Cunningham, 2018). This shows that
there is a strong correlation between the impoverished community and
greater health risks problems in America.

Figure 1.
Additionally, Health Affairs states that compared to Americans living in families that earn more than
The National Poverty Rate in
$100,000 a year, families that earn less than $35,000 a year are four times more likely to report being
nervous and five times as likely to report being sad all or most of the time (Khullar, Chokshi, 2018). This America from 1959 to 2021
illustrates that there are also many ongoing mental health problems that Americans in poverty experience.

In conclusion, it is important to understand that those in America living in low-income situations experience
numerous physical and mental health issues. Even with advanced support efforts during the COVID-19
pandemic, these unhealthy conditions are often not treated, causing a widespread issue in America.
 Reasons/Attitudes Behind the Cultural Perspective
In America, there are many factors that contribute to the inability of those with lower income to receive
medical care and experience unhealthy lifestyles.

One major cause is costly healthcare and insurance, as medical bills and debt can burden those with
lower income, and America does not provide free, universal healthcare to its citizens. According to the
Common Wealth Fund, in 2018, 58% of uninsured adults had incomes below the 200 percent of the
federal poverty level (which is $24,120 for an individual) (2018) (figure 3). This shows that there is an
obvious connection between the level of income and the healthcare insurance coverage of Americans.
With little to no coverage of health costs, those in poverty would be more likely to not seek medical
attention.

A prime example of this issue is Susan Finley, from Grand Junction, Colorado who was laid off from her
job, losing her health insurance coverage. According to Consumers for Quality Care, she struggled to
find a new job, and was eventually found dead in her apartment after avoiding medical treatment for flu-
like symptoms (Sainato, 2020). Finley is one of many struggling Americans that avoid receiving medical
care due to the high costs and a lack of health insurance. Her story demonstrates the disadvantage that
those in poverty have in treating illnesses in America.

Furthermore, Health Affairs states that Americans in poverty face many socioeconomic stressors such
as community violence, vandalism and crime, unstable housing, and food insecurity that leads to poor
mental health (Khullar, Chokshi, 2018). According to the National Survey of Drug Use and Health
(NSDUH), sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA),
9.8 million adults aged 18 or older in the U.S. had a serious mental illness, including 2.5 million adults Figure 3.
living below the poverty line (2016). This shows that impoverished living conditions have a great effect The uninsured rate of Americans
demographics
on the mental health and well-being of Americans.

All in all, the poor health of low-income Americans is not just blamed on a low income, but the outrageous expenses of receiving care, and the quality of life in
impoverished neighborhoods. These key factors greatly effect poverty in America, and it is important to address them in solving this issue as a whole.
 CONSEQUENCES
Poor health caused impoverished areas and low-income situations in America can
ultimately lead to a shorter life expectancy. A study by the National Library of
Medicine shows that between 2001 and 2014, life expectancy increased by 2.34 years
for men and 2.91 years for women in the top 5 % of the income distribution, but for
those in the bottom 5%, it has only increased 0.32 years for men and 0.04 years for
women (2016). This shows that although the rich are experiencing advances in the
average life expectancy, there has been little to no improvement in the lives of those in
poverty. This further enables me to find the relationship between low income and
lower life expectancy.

Furthermore, ill health caused by poverty can greatly effect children. Childhood poverty
is associated with developmental delays, toxic stress, chronic illness, and nutritional
deficits, and those who experience childhood poverty are more likely to experience
poverty in adulthood. According to National Center for Children in Poverty, for adults
who experienced moderate-to-high levels of poverty during childhood, 35-46% are poor
at throughout early and middle adulthood (Wagmiller, Adelman, 2009). This shows that
childhood poverty and poor health can generate cycles of poverty which can lead to
more health issues.

Poor economic and health situations greatly effect the future of low-income
Americans, which is an issue that needs the be highly acknowledged and
promoted, in order to solve this problem.
COURSE OF ACTION
There are different approaches that could be taken to solve this issue, which could include reducing poverty and increasing access to medical
care. According to Health Affairs, a survey from the Robert Wood Johnson Foundation in 2021 found that four in five respondents believed that
the government is responsible for enduring that health care is affordable for everyone (Lowry, Johnson, Hunt, Lee, 2022). This makes it clear
that the U.S. government needs to take action to ensure quality health for all, including for those with low incomes.

To address the issue of poverty, there are many steps that can be taken. For example, the American government could implement/create more
safety net programs to benefit those in need, such as the Coronavirus Aid, Relief and Economic Security (CARES) Act covered unemployment
insurance to lift million out of poverty have proven to be successful (Pathak, Ross, 2021). Especially now that this provision expired at the end
of July 2020, the creating of more safety net programs to not only lift people out of poverty, but to prevent many from falling into it as well..

Another way this issue could be solved is by increasing access to affordable healthcare and health insurance. One way this can be done is for
the government to reduce administrative costs on healthcare facilities. According to Brookings.edu, "administrative costs account for one-
quarter to one-third of total health-care spending in the United States" (Cutler, 2020). This is much greater than the amount necessary for
delivering effective health care. Reducing these excessive burdens will reduce high costs for patients and insurers.

Furthermore, according to the White House Fact Sheet, the Biden-Harris Administration "believes that health care is a right, not a privilege",
and are currently working towards affordable health insurance and reduce health care costs (2021). Showing support to and raising awareness
to the efforts made by the American government would be a large step towards granting quality, affordable health care.
 01

ROMANIAN
PERSPECTIVE
Zeeshan
Romania Perspective 14

Romania has a huge issue with Poverty because according to borgenproject.org, 4.6 million people lived at or below
the poverty line in 2017. Furthermore, borgenproject.org says, "Poverty in Romania concentrates in rural areas,
where about 46% of the population lives which is one of the many issues Romania has currently going on in terms of
Poverty.

It appears that Romania has more issues concerning Poverty as according to United Nations special
Rapporteur on extreme poverty and human rights. He said that, "Many Romanian officials are in a state of
denial about the extent of poverty and discrimination against the extremely poor, and especially Roma", said
Philip Alston, the United Nations special Rapporteur on extreme poverty and human rights. This report of
Romania government officials is concerning as it shows Romania officials are not acknowledging the poverty
in Romania which could make the extent of poverty worse as they are not putting effort of stopping poverty
from rising.

According to brookings.edu. The average citizen of Romania will live on less than or 5.50 dollars a
day which is the highest poverty rate in the EU. Furthermore, 40 percent of romanians don't work
while another 28% work off subsistence agriculture which brings to my point that Romania citizens
don't have much options when they're living in poverty as you either work in agricultural or you
don't work and earn no money.

In conclusion, we should understand that Romania is actually trying to change as according

to borgenproject.org, the European Union and the Romanian government decided to work
together to combat poverty in Romania which is why Romanian government is trying to
reduce Poverty in Romania.
Reasons/Attitudes Behind the Cultural Perspective

In Romania, the elderly face a huge issue to poverty as according to borgenproject.org, the elderly in Romania reached a
record high percentage of 25.1% in 2020, whereas in 2012, it was 14.4%. Furthermore, 24.5% of elderly woman in
Romania are under the poverty line with pension, while elderly men who are under the poverty line with pensions are
18% in 2020 which shows you that elderly poverty is rising which makes the elderly search for work in order to survive.

Another issue Romania has with poverty is it's healthcare system as according to the borgenproject.org, the romanian
government spends only 4% of the country gdp on health care which is the lowest rate in Europe. Moreover, since the
year 2007, 15,700 romanian medical experts from private and public healthcare have left Romania to pursue a better
salary in another country as some specialist earn as much as 350 dollars a month with most romanian doctors resorting
to bribery which makes it hard for people in Romania who are living in poverty to get proper healthcare as the
Romanian doesn't even care in healthcare in the first place.

In conclusion, these are the reason and attitudes behind the cultural perspective and gives you more insight on
poverty in Romania and why we should bring awareness to the issue in Romania.
 01

INDIAN
PERSPECTIVE
Imran
 Indian Perspective
In India, poverty is widely regarded as a major issue that needs to be addressed. It is
estimated that more than 22% of India's population lives below the poverty line, which is
defined as an income of less than INR 32 per day in rural areas and INR 47 per day in urban
areas.
The Indian government has launched several initiatives to reduce poverty, including job
creation programs, financial assistance schemes for the poor, and investment in
education and healthcare. However, despite these efforts, poverty continues to be a
persistent problem in India, and many people still struggle to meet their basic needs for

food, clothing, and shelter.

Poverty in India is often linked to issues such as low levels of education, lack of access to
healthcare, and limited job opportunities. In addition, social and cultural factors, such as
discrimination based on caste, religion, or gender, also play a role in perpetuating poverty
in India.
Overall, there is a growing recognition in India of the need to address poverty, and there
are many initiatives underway to do so. However, much work remains to be done, and
sustained efforts will be required to make a meaningful impact on poverty levels in the
country.
Reasons/Attitudes Behind the Cultural Perspective
In India, poverty is measured based on a methodology devised by the planning commission called the Tendulkar methodology. This
emphasizes measuring poverty in terms of consumption or spending over a certain time period. Further, each state in India has its own
poverty threshold which determines the population living below the poverty line

In India, there are more than 80 million living in poverty.a large share of India’s middle class has been pushed back to living below the
poverty threshold. At the same time, those already living below the poverty threshold have likewise been hit by the downturn pushing
them into absolute or extreme poverty. By contrast, the rich have gotten richer during the pandemic, further exacerbating India’s
existing inequality problem. Since India’s economy started growing post-independence, there has been a correlation between an
increase in inequality relative to wealth and income measured by the Gini coefficient. However, this does not mean that development
has not benefited the country despite increasing inequality.

Since the 1990s, the share of people living below the poverty line has dramatically decreased to almost half. This can directly be
attributed to economic development and a higher GDP.
COURSE OF ACTION
In conclusion, poverty and inequality remain major challenges in India, affecting large sections of
the population. Despite government efforts to address these issues, poverty continues to persist
due to a range of economic, social, and cultural factors. The government must work in partnership
with the private sector, civil society organizations, and communities to develop and implement
effective and sustainable solutions to reduce poverty and inequality in the country. This may
include creating more job opportunities, improving access to education and healthcare, reducing
discrimination based on caste, religion, or gender, and providing financial assistance to the most
vulnerable sections of society. Addressing poverty and inequality is not only a moral imperative
but also essential for promoting social and economic stability and growth in India.
 CONCLUSION
In conclusion, with many differences and similarities, this project discussed thow 4 different countries were facing the issue of the effects of
poverty on health.

For example, Indonesia's poverty, primarily caused by the negative mentalities and indifference of those with low incomes, has become the
source of various nutritional health problems, such as stunted growth, and also serious mental health issues. Although efforts have been made
to improve community health clinics, there have been a disappointing number of patients with limiting obstacles such as poor socio-economic
conditions, and a low number of health workers. To address these health-related issues, our team has suggested for increased accessibility to
health programs, while empowering people to increase motivation and eliminating discrimination can be considered to solve the issue of
poverty in Indonesia.

Our second cultural perspective, America, is also greatly challenged with the issue of poverty, and its effects on well-being. Similar to Indonesia,
health issues caused by poverty not only includes physical illnesses, such as increased rates of heart disease, diabetes, and stroke, but also poor
mental health. We found that this is mainly caused by a restricted access to health care and health insurance due to high costs, and like Indonesia,
poverty and health tie in with various socioeconomic stressors. Furthermore, it was discovered that those in poverty in America have a shorter life
expectancy, and 35-46% of poor children are likely to be in poverty throughout early and middle adulthood. Courses of action that could be
implemented by America is to make healthcare more affordable, and create safety net problems to aid those in poverty.

Lastly, we learned about a connection between rural areas and poverty in the country of Romania, with a lack of awareness of the issue, and
the complex problem of more than 800 million in poverty in India, which can be caused by wealth inequality, limitations in education, job
opportunities, and social and cultural factors, which the government has attempted to resolve, but similar to Indonesia, they have had little
success. Our team suggests a partnership of the government with organizations and communities to tackle the issues of poverty and
inequality, thus granting improved public health.

It is clear that despite varied differences in these 4 cultural perspectives, many similarities could be found in both the causes and possible
courses of action. Poverty is severely challenging ongoing issue that continues to live on today. With the added context of negatively effected
health and restrictions to receiving care, it is clear that action needs to be taken by both governments and communities to relieve the
economic strain that the impoverished population face.
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