Bridges - the Israeli Palestinian Health Magazine - A World Health Orginization Publication

Health as a Social Goal : Interview with Timothy Evans .

By Shiri Qurian

Can the health sector influence poverty? If so, how? What poli¬cy measures should be avoided in order to reduce poverty?

The health sector has multiple influences on poverty and well-being. The predominant form of financing health care is out-of-pock¬et payments and point of services which is the most regressive form of financing health care. We know that about 100 million people worldwide are impoverished annually due to this form of health care. That’s just looking at direct cost. Indirect costs relate to loss of income due to loss of work and added transport costs.

The converse is also true. When you improve people's health, the welfare and wealth generated is improved. Improving health leads to more wealth. How can you avoid impoverishing? First, is to move towards more progressive health care financing systems and minimizing out-of-pocket payments. Any form of pooling and pre-payment is better than simply allowing for individuals to pay for their health. Second, is to look for ways to minimize the indirect cost of illness such as mechanisms which offset the cost of missed work and access to care (e.g. transport costs and unemployment insurance benefits). There are ways to off put these indirect costs which wouldn't necessarily be covered under health insurance programs. Third, is to prevent people from getting sick. So, health promotion programs are very important in that regard. Eating better, exercising and not being exposed to toxic agents keep us from entering the vicious downward spiral of poor health and wealth.

Wherever there are more compre¬hensive health insurance and univer¬sal access programs, there are fewer impoverishing consequences. Even in countries where there is health insurance, there can still be impov¬erishing expenditures in health. But it decreases the likelihood. A good part of this evidence comes from child health programs which most¬ly are universally accessible and are delivered free at the point of service. We see that impoverishment associ¬ated with the illness of children in those studies is much less likely.