Poverty as the 'cause of causes': call for action and research into addressing poverty to improve the health of urban communities: Evidence from Pakistan
Abstract
Background & Purpose The social factors and processes presented in the ‘Socioeconomic Determinants of Health’ model have proven to create health inequities in various settings. Our study whilst exploring access, cost, &... [ view full abstract ]
Background & Purpose
The social factors and processes presented in the ‘Socioeconomic Determinants of Health’ model have proven to create health inequities in various settings. Our study whilst exploring access, cost, & consequences of limited accessibility to mental health services also looked at the dynamics of the structural deficiencies in social and health system and how poverty catalyses the vicious cycle of social and health inequities.
Methods
We conducted a sequential mixed-methods study in the slums of Karachi from July – September 2015 using purposive sampling. We explored the service utilization patterns and costs of accessing mental health services through a cross-sectional survey. We also explored through qualitative methods, the determinants of reduced access including poverty and low socio-economic status and conducted a limited contextual analysis in terms of measures in place to improve the access of poor to services through better economic opportunities.
Results
Out of 115, only 31% earned regularly with two-thirds (67%) earning less than 5000 Pakistan Rupee (PKR) (roughly equivalent to 50 US Dollars a month), that is below the threshold of poverty line. Around 70% considered the consultation, medicines and travel costs to be high which for most, reached to around a total of 1000 (around 10 US Dollars) PKR per visit. The qualitative inquiry identified the interplay of limited economic opportunities, lack of employment & income-generating activities and loss of income as a result of illness and caregiving as further compounding the circumstances of poor. These coupled with social stigma, exclusion and bias towards poor and fragile health and social system fuel the cycle of poverty.
Conclusions
The consistence emergence of poverty as cause of causes of health inequities and poor health outcomes demands research and action to prevent fragmented urban societies of the future in context of rapid migration and urbanization in LMICs.
Authors
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Aftab Akbar Ali Mukhi
(The Aga Khan University)
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Nazila Bano Khalid
(Aga Khan Health Service, Pakistan & Aga Khan Social Welfare Board for Pakistan)
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Tazeen Saeed Ali
(The Aga Khan University)
Topic Areas
IV. Behaviors 4.1 Mobilities and health 4.2 Spatial analysis of substance abuse and treatm , VI. Research and action 6.1 Collaboration; interaction of researchers; stakeholders 6.2 S
Session
EFA-O-09 » Evidence for Action in Policy and Programs (08:00 - Monday, 4th April, TBA)
Paper
Aftab_A_Ali_Mukhi_et_al_-_Poverty_as_the__cause_of_causes_-_call_for_action_and_research_into_addressing_poverty_to_improve_the_health_of_urban_communities-_Evidence_from_Pakistan.docx
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