Dying for Change

The World Bank study Voices of the Poor, which gathered the views of more than 60,000 poor people across the globe, looks broadly at poverty, its determinants and consequences. Health and ill-health emerged as central concerns of those consulted, prompting WHO and the World Bank to collaborate on a separate publication that would highlight the relationship between poverty and poor health from the perspective of poor people.

Dying for Change is the result. It aims to illuminate from a human, qualitative perspective what many quantitative studies have already recorded: how poverty creates ill-health, and how ill-health leads to poverty. It also highlights the link between good health and economic survival. Poor people everywhere say how much they value good health. A fit, strong body is an asset that allows poor adults to work and poor children to learn. A sick, weak body is a liability, both to individuals and those who must support them. 

In particular, poor families are concerned about the health of their breadwinner – when he or she dies, or needs expensive medical treatment, the costs can be devastating. The family may be thrown into a cycle of poverty from which it cannot escape. 

One of the strongest messages to emerge from the study is that poor people are angry and frustrated at their exclusion. They understand why they are ill and why they are poor, and often have ideas about what can be done. But the majority are ignored and marginalized by those with power, including health service authorities. In 2000 world leaders issued the Millennium Declaration, pledging to halve the numbers of people living in extreme poverty by 2015. If we are to succeed in this task, we must include, involve and listen to poor people and their representatives. The poor have long recognized the link between good health and development.  But until recently, this has been neglected in mainstream development thinking.

The full text and sections of the report may be downloaded in PDF format below. 

Read the complete report:

• English: Dying for Change: Poor People (95kb)
• French: Un Enjeu Vital: Les Pauvres Face à la Santé et à la Maladie (2.9MB)

Read the complete report (with pictures) (13MB) or download it by section:

• Foreword and Content  (1.5MB)
• Introduction  (59KB)
• Part I: Health, Ill-health and poverty (134KB)
  1. Poor places kill: The social and economic determinants of ill-health  (2MB)
  2. No right to speak: Age, gender and health  (1.7MB)
  3. Health is number one: ill-health and its consequences  (2.6MB)
  4. Worse than dogs: Poor people  (1.6MB)
• Part II: Reflections and implications (106KB)
  Participation  (1.3MB) Improving health of the poor, Conclusion, and References (971KB)

All files are in PDF format and may be viewed with the free Acrobat Reader

For more information, please email empowerment@worldbank.org.