Chronic diseases and health promotion

Part Two. The urgent need for action

Chapter Two. Chronic diseases and poverty

Key messages

Chronic diseases and poverty are interconnected in a vicious cycle. This chapter explains how, in almost all countries, it is the poorest people who are most at risk of developing chronic diseases and dying prematurely from them. Poor people are more vulnerable for several reasons, including greater exposure to risks and decreased access to health services.

  • The chronic disease burden is concentrated among the poor.
  • Poor people are more vulnerable for several reasons, including increased exposure to risks and decreased access to health services.
  • Chronic diseases can cause poverty in individuals and families, and draw them into a downward spiral of worsening disease and poverty.
  • Investment in chronic disease prevention programmes is essential for many low and middle income countries struggling to reduce poverty.

Poverty and worsening of already existing poverty are also caused by chronic diseases. Once again, it is people and families who are already poor who are most likely to suffer, because chronic diseases are likely to ruin a family’s economic prospects.

Poverty can be divided into extreme (when households cannot meet basic needs for survival), moderate (in which basic needs are barely met), and relative poverty (in which household income is less than a proportion of average national income). All of these poverty types adversely affect health. Poverty is found in every country, but unlike moderate and relative poverty, extreme poverty occurs mainly in low income countries.

Wealth enables people to avoid most of the risks of developing chronic disease, and to obtain access to health care. However, even within high income countries, psychosocial factors, for example lack of social support and perceived lack of control, are strongly related to the risk of chronic diseases.

At the same time, in some countries, evidence clearly links growing national income with increases in obesity and high cholesterol levels across the population. Alarmingly, the evidence also reveals that this trend occurs at an earlier stage of socioeconomic development than has been previously assumed. As countries develop economically, some risk factors appear to affect wealthier populations first, although they quickly concentrate among the poor.

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