The intersecting epidemics of poor health and poverty have been identified as significant global issues for over a decade by the World Health Organization (WHO, 1999), organizations and researchers (DFID, 1999; World Bank, 1999; Wagstaff, 2002), and are included as main targets of the United Nations Millennium Development Goals (Goal 1: Eradicate Extreme Poverty & Hunger; Goal 4: Reduce Child Mortality; Goal 5: Improve Maternal Health) (United Nations, 2011). Kofi Annan, addressing the World Health Assembly in 2001 succinctly stated, “The biggest enemy of health in the developing world is poverty” (United Nations, 2001). Poor health and lack of access to health services is both a cause and consequence of poverty, as reported by the World Bank in a 1999 survey of more than 60,000 people in developing nations (World Bank, 1999). Health is a primary concern for people living in poverty and they describe maintaining health, preventing diseases, and acquring medical care as major daily struggles (Dying for Change, 2002). Social factors have long been recognized as leading contributors to health inequalities (Marmot, 2004), but taking action to eradicate poverty and ill-health is a complex task requiring integrated and innovative approaches.
The health statistics of poor nations strongly demonstrate the connection between poverty and health. The same percentage of people living in poverty (46%) are not meeting their daily food needs (Kenya Integrated Household Budget Survey, 2006). Maternal and child health statistics are commonly used as indicators for overall progress of national health. In Kenya, 17% of children under 5 are malnourished, the mortality rate is 84 per per 1,000 live births (DFID, 2009), only 23% of children with malaria symptoms are receiving treatment (World Development Indicators Database, 2010), and the maternal mortality rate is 530 per 100,000 births (World Development Indicators Database, 2010).Throughout Kenya, 46% of the 38 million population is living in poverty (World Bank, 2009), and the average per capita income is $770 (DFID, 2009). Nationwide poverty is severely affecting public health, preventing families from accessing adequate nutrition, engaging in preventative health behaviors and accessing life saving testing and treatment.
Not only is Kenya affected by the infectious diseases that have plagued the nation for decades – malaria, tuberculosis, HIV/AIDS- which account for 69% of deaths throughout Africa, but non-communicable diseases such as hypertension, diabetes and cancer, are increasing at an alarming rate and currently account for 22% of deaths across the continent (WHO, 2011). With the combination of infectious and chronic diseases affecting a significant proportion of the population, it is necessary for health programs to not only address multiple health issues simultaneously through horizontal integration, but they must also tackle the root cause of all ill-health – poverty.