Friday, November 29, 2013

Thinking about Poverty Differently: Healthcare

The book I'm reading (Poor Economics) delves into components that make up individual's private lives and analyze the decisions individuals makes and how the help or reinforce the poverty trap. The chapter I just read analyzed the decision making process of impoverished individuals in making health related decisions and then analyzed the underlying reasons for the overarching decision making powers they discovered.

One of the main theories of poverty is that health problems can keep individuals, families, and communities trapped in poverty. For example, workers living in an unhealthy and unsanitary environment could miss many workdays due to illness, children could be too sick to attend school or be sick too often to do well in school, and mothers living in these environments could give birth to sickly babies. Each of these instances could result in future poverty.

With this framework of poverty, it seems relatively easy to fix impoverished communities: a push to turn these environments into healthy environments is all that's needed to break out of the poverty trap. Many of the main illness that keep communities trapped in poverty are malaria and diarrhea, which could easily be prevented in communities through bed nets, chlorinated water, and ORS (a mixture of salt, sugar, potassium chloride, and an antacid to be mixed in water and drunk in order to prevent diarrhea). Many of these things are provided to and available to impoverished communities, yet not used. This leads us to ask deeper questions of why these easily fixed health ailments continue to persist and keep families trapped in poverty.

Since the poor don't seem to be willing to sacrifice much money or time to pursue these effective and relatively easy accessible preventative health measures despite their potentially large health benefits, you begin to wonder if the poor simply do not care about their health and the health of their families. Studies show that this is not the case, and that health is actually one of the primary concerns of most poor families and communities. In fact, these studies shoes that poor countries feel more worry, tension, and anxiety about their healthcare than is seen in the US. The average extremely poor household spends up to 6% of its monthly budget on health, and more than 1/4 of these households visit a health practitioner about once a month. When faced with a serious health issue, poor households cut spending, sell assets, or borrow from local moneylenders at extremely high rates.

The issue is therefore not how much the poor care about their health, or how much they are spending on their health, but on what they are spending their health on. Usually the poor's money is spent on expensive cures rather than cheap prevention. Most people also choose to not go to the free public health centers for preventative measures or for treatments for simple remedies, but opt for more expensive private doctors.

One of the issues is that many of these private doctors have no official health qualifications. Not having a degree doesn't necessarily means these private doctors are incompetent, as they could very well be very well versed in the practice of medicine. The issue is that health care audits by the World Bank have shown that many of these doctors aren't following recommended medical practice in asking appropriate questions about symptoms and giving appropriate treatments for diseases. There was also a clear pattern that doctors tended to under-diagnose and over-medicate.

Another issue is that most of the poor feel the medication has to be injected to be beneficial. This leads to more health issues of unsterilized needles, the increased likelihood of the emergence of drug-resistant strains of bacteria, and damage from overused steroids. This brings us back to the crucial question: why do the poor not exercise their right to obtain cheap and easy preventative health measures in favor of spending a lot of money on things that don't help and actually hurt?

Some blame governments and health employee absenteeism for the lack of use of preventative measures. If people are not there to distribute these preventative measures, how can they be used?

Or, do people not favor these preventative methods because they are too cheap? Rational economics tells us that sunk costs don;t matter, but we all know as irrational human beings that sunk costs do create biases in how much we value and use products we purchase. Maybe if these measures were priced higher, people would value them more and be more willing to use them.

The authors summarize the chapter in what I feel a very effective way. The poor seem to be trapped by the same kinds of problems that afflict the rest of us: lack of information, weak beliefs, and procrastination to name a few. It is true that we are privileged in that we are somewhat better educated and informed than the poor, but the difference is much smaller than you think because in the end we know much less than we imagine.

Our real advantage in not letting health issues trap us into poverty comes from the many things we take as a given. We live in houses where clean water gets piped in and we don't have to remember to add Chlorin to the water supply every morning. Our houses take care of disposing the sewage without us knowing how. Our doctors's qualifications are regulated so we can generally trust them to do the best they can. We have a mostly trustworthy government-regulated public health system that also does the best it can to guide our health decisions. We have no choice but to have children immunized, for without recommended immunizations they cannot enter schools. Most importantly, we do not wonder where our next meal is coming from, so we rarely need to draw upon our limited capabilities of self-control and decisiveness, while the poor are constantly required to do so to stave off potentially deadly disease. We should recognize no one, neither us in rich countries or those in poor countries, could possibly contain the wisdom, patience, or knowledge to be fully responsible to make the right decisions about something as complicated as healthcare.

Once again, fixing poverty is not as simple as it seems. Asking someone to make the proactive commitments of preventive healthcare decisions is equivalent to asking all of us to fully honor our new years resolutions year after year without fail, or to exercise every day in order to prevent heart disease down the road. As humans we tend to let the present rule, and put off costs until tomorrow. Poverty cannot be solved with the mere provision of preventative health measures of infusion of money.

No comments:

Post a Comment