Editorial: Iatrogenic poverty

Poverty and illness are intertwined. It is a well-documented fact that poverty leads to ill-health. In every society, morbidity and mortality are higher among the poor (Wagstaff 2002). Determinants of lower health status include nutrition, environment, education, lifestyle and access to health care. Less is known about how illness itself can lead to poverty in developing countries. There are two major pathways. The first is through the death or disability of a household income earner. This reduces future income generation and may jeopardize household consumption. After a household has depleted its wealth it may have less capacity to invest in the education of their children. This transmits poverty to the next generation. The second is through the treatment itself, or more exactly its cost. The chain of events is as follows: when someone falls ill, the household faces several different costs (opportunity cost of care giving, transportation, treatment), and to cope with them, it follows diverse strategies. Sometimes the costs are limited, and the household is able to buffer them by making a short-term adjustment (such as consuming precautionary saving, calling on assistance from informal support networks, temporarily reducing its consumption of other goods). Yet, sometimes, the costs are at, or increase to, a level where these coping mechanisms are not sufficient anymore. The household then adopts the riskier strategies of selling or mortgaging its productive assets (Ensor & Bich San 1996; Bloom & Lucas 2000; Meessen & Criel 2003). Some households recover from the financial shock, but others do not (Wilkes et al. 1997). The next time when they have to deal with an illness, a crop failure or another problem, they may be tipped into poverty. Chambers (1983) has called this process a poverty ratchet.