Blogs posted for BMJ, Public health issues in Asia

The disease of poverty is a doctor’s business everywhere

“If you miss the poor, you’ve missed the point,” said Dr. Margaret Mungherera in her recent inaugural speech as incoming president of the World Medical Association. She urged doctors around the world to advocate on behalf of the poor. If any delegates from the Hong Kong Medical Association, a WMA member, were present I do hope they were listening.

One fifth of Hong Kong’s population lives below the official poverty line. This was set for the first time in September 2013, at 50% of median monthly household income before tax and welfare transfers.

Hong Kong has one of the highest per capita GDPs in Asia and ranks 11th globally, yet its Gini coefficient, a measure of income inequality, indicates it has the worst income disparity in the developed world. The announcement of the poverty line and that there are 1.3 million people living below it has been big news in Hong Kong, but it hasn’t generated the sense of righteous outrage that such a statistic should.

The toxic effects of poverty on health have been widely documented. Poor housing, food insecurity, inadequate access to health care, the physical and psychological stress of coping with the daily indignities that poverty imposes: these are all well known to be associated with higher rates of all the major non-communicable diseases. The health impact on children of growing up in poverty is particularly deleterious.

Since Hong Kong’s poverty line has been announced, the social welfare sector has been very vocal and highly visible in the media, asking what action will follow. But despite the well-established links between poverty and ill-health, any organized response from the local medical community has been conspicuous by its absence.

Unless they are only treating the well-to-do and middle class patients, the medical professionals who treat Hong Kong’s sick, the doctors and dentists who routinely screen all Hong Kong children through government health clinics, must see the health effects of poverty every day, but their professional associations are saying little or nothing about it.

There are ways to tackle poverty. Toronto family physician Dr Gary Bloch treats poverty itself as a disease, for example. Physicians in some parts of the US routinely screen for poverty along with other health risk factors. On a national scale there are many societies that have successfully narrowed the inequality gap. None will say they have a perfect solution, or achieved what they have by making easy choices, but unlike Hong Kong, neither do these developed countries have people living in 20ft2 cage homes, one in five children living in poverty, and one in three elderly people struggling to survive without a pension. Nor do they have the economic and social burden of the health consequences of allowing such a shameful state of affairs to exist.

The World Medical Association may have been speaking more to developing countries in its call to doctors to advocate for the poor. Dr. Mungherera noted that almost half of the world’s population survives on less than a dollar a day, but she also pointed out that there are poor people everywhere. “As physicians, we have been given the privilege to do something about it,” she said. “And we can do so as individual physicians, but we can do even better through organized medicine, as national medical associations and as the World Medical Association.”

Hong Kong’s income disparity may be an extreme example, but how societies like Hong Kong tackle poverty holds lessons for middle-income countries climbing up the development ladder. These countries are already facing the dual burden of infectious and non-communicable diseases, but the latter are not just the diseases of affluence. They will also have to find ways to deal with the diseases of urban poverty. I hope they do a better job than Hong Kong and have a medical community more willing to stand up and be counted in the fight.

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