Poverty, hunger, COVID, and my research

Hi friends,

Happy summer time - or as we say here in Texas - it’s just plain ole’ hot. If you live in the West you are also experiencing hot too! Dear Colorado peeps, please send down better weather.

I wanted to give a bit of an update on my work and the COVID situation in Africa. Many of you know I work in global health for children who need surgical care, with the biggest work in Somaliland in the horn of Africa. Somaliland is the 4th poorest country in the world with a GDP of $348 per year - y’all, that’s $348 for families. Many of these families are already poor or nomadic.

The pandemic is estimated to double the number at risk of starvation (120 to 256 million), push an additional 42-66 million children into extreme poverty and increase wasting by 50%, with the poorest countries impacted the most. In the United States, food insecurity has doubled from 10% of all US households to 23%, with children being 1.5 times more likely to bear this burden. Similar to what is seen in settings outside of the US, poorer and/or rural communities are more likely to experience hunger due to COVID-19, as they make up 87% of counties with the highest rates of food insecurity.

So, what does this mean to families already at risk of poverty?

That’s where I want to introduce you to the term of poverty trajectory.

We know that poverty is not a one-time event, but rather a trajectory impacted by macro-economic factors, such as a country’s healthcare infrastructure and gross domestic product, and micro-economic factors, such as household’s income and socio-demographic conditions. Globally, 3.4 billion people live below the poverty line (<$3.20/per day). Although we have seen strong declines in poverty over the past twenty years, poverty in the poorest communities have remained relatively the same. Simply getting people over a static poverty line is not the goal. Keeping families over that line and creating ladders to move forward away from the poverty line is. Do you see the sinking-into-poverty in the next figure? Some families get stuck in poverty and others can get out of the acute situation. But which ones? If we can figure that out, we can help families not get stuck if they are already in poverty or at the edge of a descent.

In other words, for some families already at the poverty threshold risk (see the dotted vertical line above) it will just take one event to push them into poverty - one kid gets sick, one drought, one job loss, etc. We see that here in the States too but we definitely see it globally in the poorest countries.

WHICH BRINGS ME TO MY WORK…

My research team (comprised of 12 Somali data collectors and led by an in-country Somali team that is fantastic!) looked at 900 families in Somaliland to see which ones descended into poverty and stayed there and which ones got out - and what was different between the two. You want to know what made the difference?

Families with a child who needed surgery were more likely to descend into poverty and never come out than families without a child who needed surgery - this was even after adjusting for other factors that could affect poverty (like family size, household income, etc). Here’s the figure showing the statistics of all families and then separated out by families with and without children needing surgical care.

What does this mean???

This means one major way to protect families from getting in poverty is by protecting their children - providing surgical care when needed in a timely and safe manner.

Geography matters too. We found that the majority of kids in our study were hours (HOURS) away from reaching surgical care in the capitol city of Hargeisa (where the specialized surgical care is) if they needed it. If they could afford the transportation, could someone take them?

That’s the next step for us - how do we do that? We advocate, we give, we do more research, we educate ourselves. I’ll keep you posted on some next-steps work we are doing to bring care closer to the children of this great country.

I hope this post reminds us that the interplay of poverty, hunger, and COVID affects us differently - depending on where we are in the world. Vaccines are finally reaching Somaliland but not quick enough. There’s more work to do. For many families, the choice between food, health, and poverty is a real and everyday situation.

***If you want to read the full sciencey-manuscript from this study, go here.***

Love thy neighbor,

FNE

Source: The person who championed the poverty trajectory work is Dr. Anirudh Krishna. You can see his work (including the figure source) here.