Poverty is an inveterate consequence and cause of ill health.1 Without financial resources, people cannot pay for basic human needs: food, water, sanitation, housing, and health care services. In addition, poor people often live in poor countries that have limited or deteriorating health care systems and not enough physicians, nurses, and other trained health care workers. Others live in countries with governments that ignore or are too ineffectual to address the health care needs of the poor. Individuals who are poor also lack adequate education to make appropriate decisions about health and prevention of disease and often lack equity and empowerment to attain education, employment, and skills needed to escape the cycle of poverty.
The first of the United Nation's 8 Millennium Development Goals, determined by 189 countries in 2000, is to eradicate extreme poverty and hunger.2 This specific goal is to halve the proportion of people living on less than $1 a day (the World Bank's definition of extreme poverty) and those who suffer from hunger by the year 2015.2-3 This goal cannot be achieved without improving the level of human development—the opportunity to escape poverty through "the choices that come with a sufficient income, an education, good health, and living in a country that is not governed by tyranny"—among the poor.4 Such development requires careful evaluation and study of interventions aimed to address the needs of poor individuals within their unique local conditions and socioeconomic context, with sufficient follow-up to determine whether effects are sustainable.
In 1990, more than 28% of the developing world's population (1.2 billion people) lived in extreme poverty.2-3 By 2002, this proportion had decreased to 19% but still represented more than 1 billion people.2-3 While substantial declines in extreme poverty have been reported for Eastern and Southern Asia between 1990 and 2002 (from a rate of 33% to 14% in Eastern Asia and from 39% to 31% in
Among all regions of the world other measures demonstrate some progress toward achieving the Millennium Development Goals, including declines in the proportion of people with insufficient food and sanitation, increased enrollments in education, increased proportion of women employed, decreases in child mortality rates, increases in measles vaccination rates, and increased proportion of births attended by skilled health care workers.2 Each of these successes will contribute to reducing poverty and promoting human development, but some of this progress has been only marginal and much additional work, aid, funding, and research are needed.2-3,5
Despite huge increases in wealth and prosperity throughout the world in the last several decades, the gap between the wealthy and the poor has widened, with more than 1 billion people still living in extreme poverty.3, 5 The United Nations Human Development Index is a composite of 3 dimensions of human development: living a long and healthy life (measured by life expectancy), being educated (measured by adult literacy and enrollment in primary, secondary, and tertiary schools), and having a decent standard of living (measured by purchasing power parity and income).4 According to the most recent report,
Substantial efforts have been directed at reducing poverty, addressing health needs, and ultimately improving human development during the last few decades.3-5 However, much of the early work begun in the 1960s and 1970s lost support in the mid-1980s following severe economic downturns in many poor countries, the demise of previously state-run approaches to development and the provision of health care, and overall pessimism about the ability to actually reduce poverty and provide health care for all.6 In addition, acts of violence, conflicts, and mass disasters have led to social upheaval and long-term displacement, rendering the most basic health care impossible to deliver. Signs of renewed concern and attention began in the late 1990s with recognition by agencies such as the World Bank of the connection between health, poverty reduction, equity, and economic success as well as increased governmental and private aid and funding of research into poverty and health.6 However, most aid still falls far short of promises and what is needed.5
A vast literature discusses poverty and its associations and effects. A recent search of MEDLINE using the key term "poverty" resulted in more than 22 000 citations, while results in Google Scholar included about 1.3 million articles. However, the MEDLINE citations represent less than 0.002% of the database's 14 million total citations.7 Furthermore, despite the large number of articles, the effectiveness of many interventions to improve health in poor countries remains untested and unproven.8 In fact, compared with costly interventions and therapies that are mostly available to those who can pay for them, relatively few health interventions targeted to serve the poor are evidence-based.8 A systematic review of 286 randomized controlled trials (RCTs) on topics relevant to 35 leading causes of global burden of disease published in 6 leading general medical journals in 1999 found that 124 (43%) of these trials addressed 1 of the 35 leading causes of global burden of disease. Of these, ischemic heart disease, HIV/AIDS, and cerebrovascular disease were the most commonly studied.9 One third of these trials studied 1 of 10 top causes of global burden of disease, but 7 (20%) of the leading causes of global burden of disease were not addressed by any trial.
However, progress is being made in efforts to conduct reliable research on the health needs of the poor and to provide evidence-based solutions. Since 1971, 404 reports of RCTs on interventions related to poverty have been included in MEDLINE, with 57% of these published in the last 6 years. Recent studies have examined a range of interventions, some successful and some not, including strategies to reduce inequalities in access to care; microcredit programs; sustainable health care financing alternatives for the poor; strategies to provide access to essential drugs, vaccines, and therapies; strategies to reduce infant and maternal mortality rates; nutritional interventions; behavioral interventions to improve health and adherence with therapeutic regimens and to prevent disease; educational programs; family planning services; interventions to increase access to clean water and sanitation; and primary care treatments for preventable diseases, chronic diseases, and mental health disorders. The success of microcredit was recognized with this year's award of the Nobel Peace Prize to Muhammad Yunus and Grameen Bank for their "efforts to create economic and social development from below."10
To help disseminate research into interventions that specifically address the needs of the poor, JAMA will publish a theme issue on poverty and human development in October 2007. JAMA is 1 of more than 140 scientific journals participating in plans to simultaneously publish papers on this topic under the coordination of the Council of Science Editors.11 For this theme issue, JAMA will consider manuscripts that report original research of interventions targeted to address poverty, hunger, access to care, and prevention of disease that are based on careful consideration and analysis of local context, evidence, and environments and that are directly targeted to serve the poor. We are also interested in assessments of interventions that are both scalable and sustainable. We are primarily interested in receiving reports of randomized or cluster controlled trials, but we will also consider cohort studies, case-control studies, and other observational studies as well as systematic reviews, meta-analyses, and commentaries. Manuscripts received by May 1, 2007, will have the best chance of consideration for the issue. Please see JAMA's Instructions for Authors for information on preparing and submitting manuscripts.12
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