Poverty Trends and Voices of The Poor-May2001

Poverty Trends and Voices of the Poor
Fourth edition May 2001
Poverty Reduction and Economic Management Human Development Development Economics The World Bank Group
Poverty Reduction and Economic Management/ Human Development/ Development Economics
The World Bank Group
Poverty Trends and Voices of the Poor

May 2001
Abbreviations and Acronyms ...................................................................................................................... 2 Introduction................................................................................................................................................... 3 Income Poverty ............................................................................................................................................. 5 The latest global numbers .......................................................................................................................... 5 Recent regional trends................................................................................................................................ 9 East Asia and the Pacific ..................................................................................................................... 10 South Asia ........................................................................................................................................... 10 Sub-Saharan Africa ............................................................................................................................. 11 Latin America and the Caribbean........................................................................................................ 12 Eastern Europe and Central Asia......................................................................................................... 13 Middle East and North Africa ............................................................................................................. 14 Prospects for poverty reduction ............................................................................................................... 14 Income growth..................................................................................................................................... 15 Consumption trends............................................................................................................................. 15 Distribution ......................................................................................................................................... 16 Scenarios ............................................................................................................................................. 17 Trends in inequality ................................................................................................................................. 24 Social Indicators.......................................................................................................................................... 26 Population ................................................................................................................................................ 26 Health....................................................................................................................................................... 27 Life expectancy ................................................................................................................................... 27 Infant, child, and maternal mortality ................................................................................................... 27 Malnutrition......................................................................................................................................... 29 Health status and health care services for the poor.............................................................................. 30 The problems of AIDS and malaria..................................................................................................... 32 Education ................................................................................................................................................. 34 Primary enrollments ............................................................................................................................ 34 Education of girls ................................................................................................................................ 35 Education for the poor......................................................................................................................... 37 The Environment...................................................................................................................................... 38 Water and sanitation............................................................................................................................ 38 What the Poor Say ...................................................................................................................................... 40 The Good Life and the Bad Life .............................................................................................................. 40 What Makes the Good Life ...................................................................................................................... 41 1. Material Wellbeing.......................................................................................................................... 41 2. Physical Wellbeing.......................................................................................................................... 42 3. Security ........................................................................................................................................... 42 4. Freedom of Choice and Action........................................................................................................ 43 5. Social Wellbeing ............................................................................................................................. 44 Trends and Traps...................................................................................................................................... 44 Four Problems with the System ............................................................................................................... 46 1. Corruption ....................................................................................................................................... 47 2. Violence, Civil Conflict and Public Safety ..................................................................................... 48 3. Powerlessness.................................................................................................................................. 51 4. Insecure Livelihood......................................................................................................................... 53 References.................................................................................................................................................... 55
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Abbreviations and Acronyms GDP GEP HIV IDG NGO OECD PPP WDI Gross Domestic Product Global Economic Prospects Human Immunodeficiency Virus International Development Goals Non-Governmental Organization Organisation for Economic Cooperation and Development Purchasing Power Parity World Development Indicators
This document was prepared by Simone Cecchini, Deepa Narayan and Giovanna Prennushi. The global numbers on poverty were prepared by Shaohua Chen and Martin Ravallion, with inputs in particular from Yonas Biru and members of the World Bank's Poverty Reduction Board. The sections reporting on Voices of the Poor is based on reviews of this work prepared by Deepa Narayan, Robert Chambers, Meera Kaul Shah, Patti Petesch, Raj Patel, Kai Schafft, Anne Rademacher, Sarah Koch-Schulte and Karen Brock. Other inputs were provided by many people, including in particular Deon Filmer, Davidson Gwatkins, Amy J. Heyman, Masako Hiraga, Christine F. Kessides, Sulekha Patel, Eric Swanson and Adam Wagstaff. It is a joint product of the World Bank's Poverty Reduction and Economic Management and Human Development Networks and the Development Economics Vice Presidency.
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Introduction Poverty is like heat; you cannot see it; you can only feel it; so to know poverty you have to go through it. Adaboya, Ghana. Poverty is a multidimensional phenomenon, encompassing inability to satisfy basic needs, lack of control over resources, lack of education and skills, poor health, malnutrition, lack of shelter, poor access to water and sanitation, vulnerability to shocks, violence and crime, lack of political freedom and voice. So when we want to look at what happens to poverty, we look at a number of indicatorsthis is the approach taken also by the OECD and others in defining the indicators to track the International Development Goals1and listen to the voices of the poor. This note contains new information on income poverty and social indicators by region and country, which show how living conditions have deteriorated substantially over the last decade for many Africans; it also reports on and on the findings of the study on Voices of the Poor. The poor are the true poverty experts. In preparing its World Development Report 2000/01: Attacking Poverty, the World Bank wanted to make sure the voices of the poortheir experiences, priorities, and recommendationswould be taken into account. The result was Voices of the Poor which gathers the voices of 60,000 poor men and women from 60 countries. The study consists of two parts and was carried out in partnership with research institutes and NGOs. First, a review was conducted of 81 participatory poverty studies conducted in the mid to late 1990's covering 40,000 poor people in 50 countries around the world. The second was a series of new studies in 23 countries covering 20,000 poor men and women. The results emerging from both the new estimates and the Voices of the Poor study are strikingly similar. The numbers show little progress in reducing income poverty over the last decadeimpressive gains were made in East Asia before the crisis hit, but have been partly reversed, and little if any progress took place elsewhereand a large majority of poor people said they are worse off now, have fewer economic opportunities, and live with greater insecurity than in the past. Poor people describe repeatedly and in distressing detail what has only been glimpsed before, the psychological experience and impact of poverty. Trends in social indicators show that, while there has been steady progress in average indicators of health and education, there are areas of worsening, and in all areas the income poor are systematically worse off than the non-poor. Poor peoples experiences with government institutions are largely negative, even when government programs were
1
See Development Assistance Committee of the OECD (1996), Shaping the 21st Century, Washington, D.C.: World Bank. Available at www.oecd/org/dac. The IDG indicators are available at www.oecd/org/dac/Indicators. The Development Goals website, at www.developmentgoals.org, tracks progress towards the IDGs. Another approach is to construct indices, such as the UNDPs Human Development Index. See United Nations Development Programme (2000), Human Development Report 2000, New York, N.Y.: UNDP; available at www.undp.org/hdro/hdr2000.htm.
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rated as important. Corruption, rudeness and poor quality services seemed to be the norm, whether in health care or in programs of social support. But the poor still greatly value government programs, and feel governments have important roles to play in their lives. The presence of NGOs in the various countries is uneven, but where they are at work their contributions are generally appreciated. The poor find their own local networks and institutions to be the most dependable. Gender relations are in troubled transition, with violence against women frequent.
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Income Poverty The latest global numbers Extreme poverty declined only slowly in developing countries during the 1990s: the share of the population living on less than $1 a day fell from 28 percent in 1987 to 23 percent in 1998, and the number of poor people remained roughly constant, as the population increased. The share and number of people living on less than $2 per daya more relevant threshold for middle-income economies such as those of East Asia and Latin Americashowed roughly similar trends (see tables 1 and 2). It should be emphasized that these historical estimates are subject to some uncertainty. Up-to-date survey and price data are not available for all countries, and the quality of household surveys can vary considerably between countries and over time. Some country surveys yield income measures of living standards, while others yield consumption measures, and these two sources are likely to give different poverty estimates for the same underlying population.2 Further, the international measure of poverty used here is subject to error because of the difficulties involved in estimating PPP exchange rates. Despite these weaknesses, the estimates provide a fairly reliable view of poverty trends at the aggregate level, due to the substantial increases in the coverage of household surveys and in data accuracy over the past few years.
The estimates of global poverty given here are based on consumption, and income data are adjusted accordingly.
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Table 1. Population living on less than $1 per day and headcount index in developing countries, 1987, 1990 and 1998
Population covered by at least one survey (percent) 90.8 71.1 81.7 88.0 52.5 97.9 72.9 88.1 84.2 Population covered by at least one survey (percent) 1987 East Asia and the Pacific (excluding China) Eastern Europe and Central Asia Latin America and the Caribbean Middle East and North Africa South Asia Sub-Saharan Africa 90.8 71.1 81.7 88.0 52.5 97.9 72.9 26.6 23.9 0.2 15.3 4.3 44.9 46.6 27.6 18.5 1.6 16.8 2.4 44.0 47.7 14.7 9.4 3.7 12.1 2.1 40.0 48.1
Region East Asia and the Pacific (excluding China) Eastern Europe and Central Asia Latin America and the Caribbean Middle East and North Africa South Asia Sub-Saharan Africa Total (excluding China)
Number of people living on less than $1 a day (millions) 1987 1990 1998 417.5 114.1 1.1 63.7 9.3 474.4 217.2 1,183.2 879.8 452.4 92.0 7.1 73.8 5.7 495.1 242.3 1,276.4 915.9 267.1 53.7 17.6 60.7 6.0 521.8 301.6 1,174.9 961.4
Region
Headcount index (percent) 1990
1998
Total 88.1 28.3 29.0 23.4 (excluding China) 84.2 28.5 28.1 25.6 Source: Global Economic Prospects and the Developing Countries 2001. Notes: The $1 a day is in 1993 purchasing power parity terms. The numbers are estimated from those countries in each region for which at least one survey was available during the period 198598. The proportion of the population covered by such surveys is given in Column 1. Survey dates often do not coincide with the dates in the above table. To line up with the above dates, the survey estimates were adjusted using the closest available survey for each country and applying the consumption growth rate from national accounts. Using the assumption that the sample of countries covered by surveys is representative of the region as a whole, the numbers of poor are then estimated by region. This assumption is obviously less robust in the regions with the lowest survey coverage. The headcount index is the percentage of the population below the poverty line. Further details on data and methodology can be found in S. Chen and M. Ravallion, 2000, "How Have the World's Poorest Fared in the 1990s?", Policy Research Working Paper 2409, World Bank.
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Table 2. Population living on less than $2 per day and headcount index in developing countries, selected years, 1987, 1990, and 1998
Population covered by at least one survey (percent) 90.8 71.1 81.7 88.0 52.5 97.9 72.9 88.1 84.2 Population covered by at least one survey (percent) 1987 East Asia and the Pacific (excluding China) Eastern Europe and Central Asia Latin America and the Caribbean Middle East and North Africa South Asia Sub-Saharan Africa 90.8 71.1 81.7 88.0 52.5 97.9 72.9 67.0 62.9 3.6 35.5 30.0 86.3 76.5
Region East Asia and the Pacific (excluding China) Eastern Europe and Central Asia Latin America and the Caribbean Middle East and North Africa South Asia Sub-Saharan Africa Total (excluding China)
Number of people living on less than $2 a day (millions) 1987 1990 1998 1,052.3 299.9 16.3 147.6 65.1 911.0 356.6 2,549.0 1,796.6 1,084.4 284.9 43.8 167.2 58.7 976.0 388.2 2,718.4 1,918.8 884.9 252.1 98.2 159.0 85.4 1,094.6 489.3 2,811.5 2,178.7
Region
Headcount index (percent) 1990 66.1 57.3 9.6 38.1 24.8 86.8 76.4
1998 48.7 44.3 20.7 31.7 29.9 83.9 78.0 56.1 57.9
Total 88.1 61.0 61.7 (excluding China) 84.2 58.2 58.8 Source: Global Economic Prospects and the Developing Countries 2001. Notes: The $2 a day is in 1993 purchasing power parity terms. See notes to table 1.
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Figure 1. Number of Poor living below $1 per day in developing countries, 1987 and 1998 (millions)
1987
Eastern Europe and Central Asia
Middle East and North Africa (0.8%)
Latin America and the Caribbean 63.7 (5.4%) Sub-Saharan Africa 217.2 (18.4%)
9.3 1.1 (0.1%)
South Asia 474.4 (40.1%)
East Asia and the Pacific
Number of Poor (millions): 1,183.2 (100.0%)
417.5 (35.3%)
1998
Eastern Europe and Central Asia 17.6 (1.5%)
Middle East and North Africa Latin America and the Caribbean 6.0 (0.5%) 60.7 (5.2%)
South Asia 521.8 (44.4%)
Sub-Saharan Africa 301.6 (25.7%)
Number of Poor (millions): 1,174.9 (100.0%)
East Asia and the Pacific 267.1 (22.7%)
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Figure 2. Population living below $1 per day in developing countries, 1987-1998. Headcount Index (percent)
60.0
47.7 50.0 46.6 48.1 40.0
44.9
44.0
Headcount Index (Percent Poor)
40.0
30.0 27.6 26.6 20.0 14.7 12.1
15.3 10.0 4.3 0.2 0.0 1987 East Asia and the Pacific Middle East and North Africa
16.8
2.4 1.6 1990 Eastern Europe and Central Asia South Asia
3.7 2.1 1998 Latin America and the Caribbean Sub-Saharan Africa
Recent regional trends In general, poverty declined in countries that achieved rapid growth, and increased in countries that experienced stagnation or contraction. Indeed, the overall decline in extreme poverty during the 1990s was driven by high rates of growth in countries with large numbers of poor people. For example, China accounted for a fourth of the total number of poor at the start of the decade, and per capita GDP during the 1990s rose by 9 percent per year, so that by 1998 China contributed less than one-fifth to the worlds poor. Nevertheless, the decline in poverty in rapidly-growing countries was slowed by increases in inequality in a number of countries with a large number of poor, in particular in China, India, Bangladesh, and Nigeria.3 Income inequality is an important factor in determining poverty outcomes (see below, Trends in inequality).
A common way to measure inequality is to calculate the Gini coefficient. The Gini coefficient would be equal to 0 if all had the same income and to 1 if one person had all the income and everybody else had none. We observe Gini coefficients for income in the range 0.2-0.6 (the Slovak Republic has the lowest Gini, 0.195, while Swaziland has the highest (0.609); among OECD countries, Austria has the lowest Gini at 0.231 and the United States the highest at 0.408) (WDI 2001).
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East Asia and the Pacific In East Asia, poverty declined most rapidly during the 1990s, falling sharply in China. However, growth in Chinas poorer and more rural western provinces was much slower than in the more industrialized east. This divergence reflects slow growth in rural incomes related to declining prices for agricultural products and reduced opportunities for off farm employment. This widening of income inequality slowed the rate of poverty reduction for the country as a whole.4 Elsewhere in the region, poverty increased in the aftermath of the 199798 financial crisis. In Indonesia, the government responded to the crisis by strengthening safety nets, which helped cushion the impact of the crisis. However, the incidence of poverty still increased substantially, doubling from its precrisis level. Since early 1999, there have been indications that poverty has declined significantly as rice prices have fallen, and real wages are starting to recover. Survey results based on national poverty lines, not the $1/day lines, indicate increases in poverty in urban Korea (from 8.6 to nearly 23 percent at the peak of the crisis, and down to 15.7 percent by the end of 1998), but smaller increases than expected in Thailand, where the urban middle class seems to have been hit hardest. In Vietnam, the incidence of poverty, as defined on the basis of the national poverty line, dropped from 58 percent in 1993 to 37 percent in 1998. The big gains for poverty reduction came from but were not limited to growth of per capita expenditures, stimulated by agricultural diversification and economic growth. Poverty incidence among ethnic minorities, though, came down at a slower rate and remains high (75 percent in 1998 versus 86 percent in 1993). Poverty among children under 15 years old is also declining (from 66 percent in 1993 to 47 percent in 1998) but keeps being higher than the average. In Cambodia the incidence of poverty, as measured by the national poverty line, declined modestly between 1993/94 and 1997 (from 39 percent to 36 percent), and rural poverty declined less than urban poverty.
South Asia In South Asia, the share of the population living in poverty declined moderately through the 1990s, but not sufficiently to reduce the absolute number of poor. Household survey data indicate limited growth in average consumption in rural areas, reflecting slow growth in agriculture. Urban poverty appears to have declined at twice the rate of poverty in rural areas. However, poverty data in India are subject to considerable uncertainty. In particular, private consumption as measured in the national accounts has grown about
4
The data for China pose several problems. First, consumption per capita, as estimated by surveys, has been growing less rapidly than estimates of private consumption from the national accounts would suggest. Second, urban household surveys do not include rural migrants. Third, savings rates are very high in China even among the poor, so that poverty estimates based on consumption measures yield a higher poverty incidence than those based on income. Moreover, it appears that savings rates increased among the poor over this period. The estimates above differ from official estimates, and new survey work will be needed to reconcile the differences (work on urban surveys is underway). These discrepancies cast doubt on the estimates for China and therefore on the global estimates, given the size of the country.
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three times faster over the 1990s than household consumption as measured by the National Sample Survey. Discrepancies are to be expected, as the two sources track different aggregates.5 Moreover, the survey data tends to understate the consumption of higher-income households. Nevertheless, the size of this difference and the slowness of poverty reduction revealed in the survey data are difficult to account for, particularly given the improvement in human development indicators. Thus more accurate data could indicate more rapid poverty reduction than our current estimates. In Bangladesh, steady growth reduced the incidence of poverty during the 1990s, in contrast to the relative stagnation experienced in the 1980s. Poverty in urban areas fell at a considerably faster rate than rural poverty, partly reflecting slower growth in rural wages and higher rural unemployment. Landlessness has been key in holding back the reduction of poverty in rural areas.6 Performance has been poor in Pakistan: low growth rates throughout much of the nineties, a very weak human resource base, and a slowdown in poverty reduction. In Sri Lanka, there has been very slow progress in reducing poverty despite adequate GDP growth.
Sub-Saharan Africa In Africa, slow growth increased both the share and number of the poor over the 1990s; Africa is now the region with the largest share of people living below $1 per day. In Nigeria, which now accounts for nearly one-fourth of Sub-Saharan Africas poor, the number of people living in extreme poverty rose steeply following the reversal of the 1985-92 reforms, reaching an estimated 70 million (66 per cent of the population) based on the national definition (rather than the international, $1 a day definition). Urban poverty in the country has grown faster than rural poverty, owing to massive migration from rural areas to the cities, with the incidence of urban poverty now matching that of rural poverty. By contrast, the rural poverty rate fell in Ethiopia, Sub-Saharan Africas second most populous country and one of the poorest. The reforms implemented after the end of the civil war in the early 1990s spurred a strong recovery, ending a two-decade slump. The benefits of agricultural price liberalization have spread quickly, boosting growth of rural incomes. Urban poverty, on the other hand, has been stagnant. Urban inequality has risen, in part due to large population movements resulting from the civil war, and in part as a result of economic reform, as agricultural price liberalization raised consumer prices in urban areas and civil service rationalization reduced urban employment. Unfortunately, progress is likely to have been slowed by the border conflict.
The major differences are that consumption measures from household surveys sometimes do not include imputed housing, and private consumption in the national accounts typically includes spending by non-profit enterprises (NGOs, political parties, churches, charities and so on) as well as households. For example, compared to a landless rural household a household with at least 2.5 acres enjoyed 43 per cent higher per capita consumption in 1995-96.
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In African countries like Burkina Faso (between 1994 and 1998), Ghana (between 1988 and 1992) and Zambia (between 1991 and 1996) the percentage of people living below the national poverty line decreased in rural areas while at the same time increasing in urban areas. Security is a massive problem for the region. Internal conflict and civil war continue to threaten lives and livelihoods, and we have evidence from participatory assessments that the poor are particularly anxious about conflict and what it means for their lives and those of their children. Uncertainty due to lack of security only adds to uncertainties due to the vagaries of the weathermany households fear they will run out of food before the next harvest. The problem is exacerbated by the general absence of safety nets, such as workfare programs. These trends are leading to polarization in Africa. Countries with civil order, political openness and sound economic management saw improved economic performance and better outcomes for the poor (Cte d'Ivoire, Ghana, Mauritania, Tanzania and Uganda). Other countries slipped into disorder and experienced a breakdown of the state and institutions, with profound effects on poverty (Burundi, Rwanda, Sierra Leone, Somalia, Sudan etc.) The immediate challenge is to help countries in the middle countries like Cameroon, Chad, Kenyaso that they can achieve better living standards for their people.
Latin America and the Caribbean. In Latin America both the share and the number of poor declined between 1990 and 1998. In Brazil successful stabilization has stepped up the reduction of poverty, with the poor gaining from stronger growth and the decrease in inflation. Nonetheless, their livelihoods remain vulnerable. Evidence from employment surveys in metropolitan areas shows large swings in poverty, with an upturn in the poverty rate in the wake of the 1997-99 crisis and a decrease since late 1999 thanks to the rebound in growth. Low educational attainment has helped to perpetuate income inequality and poverty by preventing the poor from taking advantage of opportunities created by growth.7 It is important to note that more than 60 percent of Brazil's poor live in the North-East of the country. In Argentina poverty rates, as measured by the national poverty line, have grown since 1995, after falling from 40 percent in 1990 to a low of 22 percent in 1994. Income distribution has also deteriorated, reflecting the fact that the gains of economic growth have gone largely to the more skilled and educated in the labor force, and not to the poor. In addition, unemployment has risen, and unemployment rates are higher among the poor and the extreme poor. Poverty appears high among the indigenous groups. Nicaragua remains one of the poorest countries in Latin America: although poverty rates declined slightly from 50 percent in 1993 to 48 percent in 1998, the number of
In Brazil, poverty rates range from 46 per cent among those with less than one year of schooling to only 5 per cent for those with 8 to 12 years of schooling. In 74 per cent of poor households the head of household has only up to 4 years of schooling.
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people living below the poverty line increased by about 200,000 because of population growth. At a regional level, income inequality increased between 1986 and 1989, but stabilized thereafter, at least until 1996. Mexico and Brazil followed this trend, while Chile and Paraguay faced increasing inequality throughout the 1990s. In countries like Colombia, Ecuador, Uruguay and Venezuela, inequality did not change a great deal, and in others (Bolivia, Honduras and the Dominican Republic) inequality actually decreased.8 Even though income poverty has not decreased, social indicators have improved; adult literacy, life expectancy, access to safe water, infant mortality are at levels consistent with what would be expected given the regions level of economic development, but secondary school enrollment is below such levels, in part because of high levels of income inequality which do not enable the poor to continue beyond primary school. Worryingly, in Argentina enrollment rates at the secondary and tertiary levels have decreased between 1992 and 1997 for the poorest 20 percent of the population. The macroeconomic shocks that hit many Latin American countries have disastrous consequences for poverty. The 1995 Tequila Crisis in Mexico, for example, resulted in a 7 percent increase in poverty.9
Eastern Europe and Central Asia Poverty rose markedly in the transition economies during the 1990s. In Russia, the breakup of the central planning system was accompanied by a steep fall in output and a sharp increase in inflation. Poverty as measured by the national definition had jumped from an estimated 11 percent during the Soviet period to 43 per cent by 1996, and probably increased further with the 1998 crisis. Inequality widened dramatically during the transition, with the Gini coefficient of consumption expenditure rising from an estimated 0.24 in 1988 to about 0.49 in 1998. Increasing disparities in poverty across regions have also surfaced, exacerbated by a inefficient system of fiscal decentralization which left the more backward regions short of resources to assist the poor. Moldova, one of the countries hardest-hit by the 1998 crisis and today one of the poorest countries in Europe, experienced a dramatic worsening of poverty: the percentage of people living below the national poverty line increased from 35 percent in May 1997 to 46 percent in the fourth quarter of 1998. Inequality also increased sharply in the last decade: the Gini coefficient jumped from 0.24 in 1987/98 to about 0.40 in 1997. In the Kyrgyz Republic, poverty is fundamentally a rural phenomenon: in 1997, 80 percent of all poor in the country lived in rural areas and the gap between rural and urban areas appeared to be growing. Poverty rates also vary by age group: 56 percent of households with a head who is sixty years or older live in poverty (possibly
8 9
See Wodon and others (2000). See Wodon and others (2000).
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reflecting problems in the pension system), while about 35 percent of households with a head under age 30 live below the poverty line. In Turkey, the number of poor people decreased between 1987 and 1994, and income distribution remained broadly unchanged. Chronic poverty is emerging as a increasing concern in the region, as evidence suggests that even in countries with a robust growth record there is a growing group of the chronically poor. Recent poverty assessments by the World Bank highlight striking levels of poverty among the Roma population10. In Bulgaria, in 1997, over 84 percent of the Roma lived below the poverty line (compared to a national poverty rate of 36 percent); in Hungary, one-third of the long-term poor were Roma, although they make up only 5 percent of the population.
Middle East and North Africa In the Middle East and North Africa the percentage of people living below $1 per day declined slightly, but the percentage living below $2 per day increased, from 25 to 30 percent of the population, due to increases in Egypt, Morocco and Yemen. Poverty reduction in the region is strongly linked with economic growth: in the past, high growth has been accompanied by significant poverty reductionand sharp downturns in GDP have been accompanied by sharp increases in poverty. Recent data from Tunisia, however, suggests the elasticity of poverty reduction to growth may be declining, meaning that faster growth will be needed to achieve similar reductions in poverty as in the past.
Prospects for poverty reduction As noted above, progress in reducing extreme poverty during the 1990s was constrained by increasing inequality in a few countries that accounted for a large share of the worlds poor. The poverty scenarios developed for Global Economic Prospects 2001 (GEP 2001) show that continued increases in inequality coupled with less than robust growth would imply failure to reach the poverty target for developing countries as a group, and in particular substantial increases in the number of poor in Sub-Saharan Africa. Given the uncertainty surrounding the historical estimates for poverty and the risks associated with long-term growth projections, these scenarios should not be viewed as presenting the full range of poverty rates that are likely to occur. The three poverty scenarios outlined below require a projection of growth of the economy as a whole (and of population growth), a projection of the average growth rate
10
The Roma are a unique minority in that they have no historical homeland and are found in nearly all countries in Europe and Central Asia. The size of the Roma population is estimated at between 7-9 million, with the highest concentration in Central and Southern Europe. See World Bank (2000), Making Transition Work for Everyone.
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in per capita consumption for the household sector (measured by household surveys)11; and a projection of changes in the distribution of per capita consumption. Income growth The three scenarios differ only in terms of the assumed growth rate for the economy as a whole. Scenario A reflects the base case growth rates, and scenario B reflects the low case growth rates presented in GEP 2001. A third scenario assumes that the growth rate of each developing country region is reduced proportionately from the low case forecast, so that the average growth for developing countries as a group is equal to that experienced in the 1990s (1.7 percent in per capita terms). Consumption trends In previous poverty forecasts, the projected growth rate of per capita consumption for households was taken from forecasts of private consumption from the national income accounts. By contrast, the scenarios outlined below take account of recent research that shows that the growth in household consumption from survey data has been lower on average than private consumption growth as measured by the national income accounts. Data for 142 time periods (during the 1980s and 1990s) for 60 countries suggest that the growth of per capita consumption from household surveys was an estimated 87 percent of the growth rate in private consumption from the national accounts.12 The most likely explanation for this discrepancy is that the surveys do not pick up fully the growth in living standards of the rich.13 As the poverty estimates are based on consumption from household surveys, for the poverty forecasts for most developing countries we assume that the growth rate of this variable will equal 87 percent of the growth rate of private consumption from the national income accounts. The failure to adjust the forecast of household consumption growth to reflect the historical divergence from the national income accounts has resulted in substantial overestimation of the rate of poverty reduction in past forecasting exercises. The discrepancy between consumption growth from the household surveys and the national accounts is larger in China and India (that together account for more than half of the worlds poor) and in the Europe and Central Asia region. For China, the time series
11
12
13
This excludes consumption by other private entities such as nonprofit organizations, political parties, unincorporated enterprises and so forth that are often included in the national accounts estimate of private consumption. M. Ravallion (2000), "A Note on Forecasting Poverty Using National Accounts Growth Rates," background paper for GEP 2000 report. India, China and Europe and Central Asia are excluded from this estimation. There is a presumption that higher-income groups tend to under report consumption. Moreover, consumption measures from household surveys sometimes do not include imputed housing expenditures which, in fast growing economies, are likely to grow rapidly in the higher income groups. There are other explanations for the divergence between survey mean household consumption growth rates and those from the national accounts, including the fact that (for most countries) private consumption in the national accounts includes spending by non-profit enterprises (NGOs, political parties, churches, charities and so on) as well as households, and the share of the non-profit sector is probably rising.
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evidence indicates that 72 percent of a gain in private consumption is reflected in household consumption, and this adjustment is used in the projections. For India, only 28 percent of an increase in private consumption is reflected in the household consumption, and in Europe and Central Asia the time series evidence for the 1990s suggests virtually no correlation between the two consumption aggregates. It is difficult to understand these unusually large discrepancies, which probably reflect serious data problems, as well as the failure to capture the consumption levels of the rich. Thus, the projections for India and the ECA region assume that the share of national accounts growth reflected in the survey mean will equal 51 percent over the forecast period, the lower bound of the 95 percent confidence interval for the estimate for the developing world as a whole (excluding China, India, and Europe and Central Asia).14 Distribution The other determinant of the incidence of poverty is in the distribution of household consumption. Long-term cross-country evidence suggests that most countries have not experienced a systematic trend in household consumption inequality as measured using household survey data. Thus, the assumption for the bulk of the developing countries is that inequality will not change over the forecast period. However, there are exceptions. The 1990s did witness a dramatic rise in inequality in the Europe and Central Asia region. We assume that this was a transitional phenomenon and will not continue. Further, the available data do indicate a rise in inequality in China and India over the past decade, 15 in part due to slower growth in rural areas, where the majority of the poor live, than in urban areas. We assume that inequality will continue to rise in both countries over the forecast period. In China, the liberalization of trade in agricultural commodities and land markets is likely to allow a shift to more remunerative crops and larger land holdings. Since good quality land is scarce, the consolidation of land holdings and higher returns to good quality land are likely to lead to higher levels of inequality in rural areas. Moreover, continued integration with the world economy will increase the demand for skilled labor. Inequality within urban areas may rise, as wages increase rapidly for skilled workers in manufacturing and some services while low-skill service workers experience lagging wages under the twin pressures of migrant laborers and laid-off workers from the state enterprises. Rising demand for skilled labor may also increase inequality between urban and rural areas, as the gap in educational attainment between the two is high. Thus, both scenarios assume that urban incomes will increase more rapidly than rural incomes, and that inequality within both the rural and urban sectors will increase slightly, in the form of a 10 percent higher Gini index in each sector by 2015.
14
15
This assumption has an important impact on the forecasts. For example, if in India consumption were assumed to rise at 87 percent (rather than 51 percent) of the national income accounts growth rate, then by 2015 the forecast (using base case growth rates) for extreme poverty in South Asia would be only about half the 22 percent rates shown for Scenario A. For example, the per capita consumption (as measured in the household survey) of the bottom 10 percent of Chinas population increased by 2.5 percent per year during 1990-98, while per capita consumption of the top 10 percent increased by 11 percent per year. In India, per capita consumption of the bottom 10 percent did not increase at all during 1985-97, while the top 10 percent saw a rise of 4.7 percent per year.
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In India, rising inequality during the 1990s appears to have slowed the rate of poverty reduction relative to the previous decade. So far reforms have largely bypassed the rural economy where the majority of the poor live, leading to a wide divergence of growth between urban and rural areas. Weak infrastructure services, limited education and inadequate health care have made it difficult for the poor to share equally in the countrys rapid growth. For example, the liberalization process is increasing returns to education, while education is inequitably distributed (one third of men, and 60 percent of women, over the age of 15 are illiterate). The forecasts assume that the divergence in consumption growth between rural and urban areas continues along past trends.
Table 3. Population estimates and projections, 1998-2015 (millions of people) Region East Asia and the Pacific Excluding China Eastern Europe and Central Asia Latin America and the Caribbean Middle East and North Africa South Asia Sub-Saharan Africa Total Excluding China 1998 1,817 569 475 502 286 1,305 627 5,011 3,763 2015 2,099 708 483 623 390 1,676 914 6,185 4,794
Source: Global Economic Prospects and the Developing Countries 2001.
Scenarios In scenario A, with base case growth (adjusted for historical differences between household survey and national income accounts consumption) and rising household consumption inequality in China and India, the world as a whole would be on track to reaching the International Development Goal of reducing the share of people living below $1 per day by 2015 to half of what it was in 1990. The total number of poor people would decline to about 800 million people (see table 3 for the forecasts of total population in developing countries). But not all regions would be on track: Africa would be far from reaching the goal even under this favorable growth scenario. With low-case growth rates (scenario B) , the world as a whole would not reach the target. Only the countries of East Asia would be able to reduce poverty beyond the target of half the 1990 incidence. The total number of poor people in the world excluding China would remain unchanged from the 1990 level of about 1 billion.16 Finally, if aggregate GDP growth in
16
These results are roughly similar to the poverty forecasts in Global Economic Prospects 2000. In Scenario A, the headcount poverty index is 15.9 percent in 2008 (the last year of the GEP 2000 forecasts) compared with 12.3 percent in GEP 2000. The GEP 2001 forecast is more pessimistic because it is assumed that growth in household consumption will be slower than in private consumption in the national income accounts. Conversely, the GEP 2000 forecast for Scenario B was more pessimistic (headcount index of 21.9 percent compared with 19.5 percent now), because last year a rise in inequality in all regions was assumed.
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developing countries over the next 15 years were to equal the average of the 1990s, then progress in poverty reduction would be even slower than in scenario B, and the number of people living on less than $1 a day at the end of the forecast period would be only marginally lower than in 1998. The number of poor based on the $2 per day level would actually increase. Table 4 provides a summary of the poverty forecasts, and tables 5 and 6 give regional details for the two scenarios which use the base case and low case growth rates.
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Table 4. Poverty in developing countries under scenarios of base case growth (scenario A), low case growth (scenario B) and 1990s average growth, 1990, 1998, 2015
Year 1990 1998 2015 Scenario A (base case growth) 2015 Scenario B (low case growth) 2015 Growth as in 1990s $1/day Headcount ratio Number of poor (%) (million) 29.0 1,276 23.4 1,175 12.6 16.4 18.7 777 1,011 1,157 $2/day Headcount ratio Number of poor (%) (millions) 61.7 2,718 56.1 2,812 36.7 43.2 47.5 2,272 2,672 2,938
Source: Global Economic Prospects and the Developing Countries 2001.
Table 5. Regional breakdown of number of people living on less than $1 per day and headcount index in developing countries, under scenarios of base-case growth (scenario A) and low-case growth (scenario B), 1990, 1998, and 2015
Region 1990 East Asia and the Pacific (excluding China) Europe and Central Asia Latin America and the Caribbean Middle East and North Africa South Asia Sub-Saharan Africa Total (excluding China) Region 1990 East Asia and the Pacific (excluding China) Europe and Central Asia Latin America and the Caribbean Middle East and North Africa South Asia Sub-Saharan Africa 27.6 18.5 1.6 16.8 2.4 44.0 47.7 452.4 92.0 7.1 73.8 5.7 495.1 242.3 1,276.4 915.9 Number of people living below $1 per day 1998 2015 low case 267.1 100.7 53.7 20.1 17.6 9.0 60.7 58.3 6.0 6.2 521.8 410.7 301.6 426.2 1174.9 961.4 1011.2 930.6
2015 base case 65.1 9.4 6.3 42.8 5.1 296.7 360.6 776.5 720.9
Headcount index (percent) 1998 2015 low case 14.7 4.8 9.4 2.8 3.7 1.9 12.1 9.4 2.1 1.6 40.0 24.5 48.1 46.7 16.4 19.4
2015 base case 3.1 1.3 1.3 6.9 1.3 17.7 39.5 12.6 15.0
Total 29.0 23.4 (excluding China) 28.1 25.6 Source: Global Economic Prospects and the Developing Countries 2001.
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Table 6. Regional breakdown of number of people living on less than $2 per day and headcount index in developing countries, under scenarios of base-case growth (scenario A) and low-case growth (scenario B), 1990, 1998, and 2015
Region 1990 East Asia and the Pacific (excluding China) Europe and Central Asia Latin America and the Caribbean Middle East and North Africa South Asia Sub-Saharan Africa Total (excluding China) Region 1990 East Asia and the Pacific (excluding China) Europe and Central Asia Latin America and the Caribbean Middle East and North Africa South Asia Sub-Saharan Africa 66.1 57.3 9.6 38.1 24.8 86.8 76.4 1,084.4 284.9 43.8 167.2 58.7 976.0 388.2 2,718.4 1,918.8 Number of people living below $2 per day 1998 2015 low case 884.9 472.2 252.1 187.2 98.2 57.6 159.0 161.6 85.4 79.7 1,094.6 1213.6 489.3 690.3 2,811.5 2,178.7 2,675.0 2,390.0
2015 base case 323.2 114.6 46.9 132.9 57.5 1077.8 636.7 2,275.1 2,066.5
Headcount index (percent) 1998 2015 low case 48.7 22.5 44.3 26.4 20.7 11.9 31.7 25.9 29.9 20.4 83.9 72.4 78.0 75.6 43.3 49.9
2015 base case 15.4 16.2 9.7 21.3 14.7 64.3 69.7 36.8 43.1
Total 61.7 56.1 (excluding China) 58.8 57.9 Source: Global Economic Prospects and the Developing Countries 2001.
The preceding scenarios highlight the importance of achieving fast growth, as well as distributing the benefits of growth equitably. Without macroeconomic stability, sustained structural reforms, prudent and transparent use of public resources, improvements in the provision of public services and infrastructure to the poor, actions to reduce vulnerability and give the poor more voice over development choices, the pattern of inclusive and sustained growth that underlies the best scenario will not be realized and millions more people will remain enslaved in poverty. Achieving the poverty reduction targets also will require an increase in aid flows to the poorest countries. With slow growth and increases in inequality progress would be much slower everywhere, the target would be out of reach for all regions apart from East Asia, and more than 200 million more people worldwide would remain mired in poverty. If policies are inadequate to achieve more than the slow growth of the 1990s, then the number of people living in extreme poverty would remain near current levels for the next 15 years. In Africa, the number of people living in poverty would increase under all scenarios. If the lack of progress observed over the last decade with respect to other dimensions of povertylife expectancy, school enrollment, child mortalitycontinues, as may well be the case if the AIDS pandemic is not stemmed, then the gap between the region and the rest of the world could widen significantly. This would be a grim outlook, not just for
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Africa but for the whole world, and efforts are needed in the region and elsewhere to break with the recent pattern of conflict and crisis, and to deal with the AIDS epidemic. Even if the most optimistic scenario is achieved, 2.3 billion people would still be living under $2 per day in 2015. Thus, the global war on poverty is likely to be with us well into the 21st century. In closing, it is important to note that these projections have some serious limitations. First, despite enormous progress in measuring poverty over the past 10 years, the data base has significant weaknesses: recent data are missing for a number of countries, especially in Africa, where renewed efforts are needed to institutionalize survey work that began in the 1990s. Major questions remain as to the trends for India. Second, our understanding of trends in inequality and the divergence between national accounts and household-based measures of private consumption is limited. Research is underway to address some of these limitations, including further analysis of the data for India.
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Figure 3.
Share of the Population Living on Less than $1 per day, 1990, 1998, 2015 (projections), 2015 (IDG target) Developing Countries East Asia and the Pacific
60
60
50
50
Percentage below $1.08/day
40
40
30
30
Scenario B (low case growth)

20
20
Scenario B (low case growth) IDG target
Scenario A (base case growth)

10
IDG target
10

0 1990 1998 2015 0 1990 1998 2015
East Asia and the Pacific excluding China

60 60
Eastern Europe and Central Asia
50
50
40
40
30
30
20
20

10
IDG target

10
Scenario A (base case growth) Scenario A (base case growth)

0 1990 1998 2015 0 1990 1998 2015
IDG target
22
Figure3 (continued). Share of the Population Living on Less than $1 per day, 1990, 1998, 2015 (projections), 2015 (target) Latin America and the Caribbean
60 60
Middle East and North Africa
50
50
40

40
30
30
20
20

10
10
IDG target Scenario A (base case growth)

0 1990 1998 2015 0 1990
Scenario A (base case growth) IDG target

1998 2015
South Asia
60
Sub-Saharan Africa
60
40
50
50
40

30

30
IDG target
20
20
IDG target

10
10
0 1990 1998 2015
0 1990 1998 2015
23
Trends in inequality Countries with high levels of initial inequality (see Table 7 for examples of high inequality countries) have reduced poverty less for given rates of growth than countries with low initial inequality (World Bank 2000e), and if growth is accompanied by increasing inequality, its impact on poverty will be reduced. However, our understanding of long-term trends in inequality is limited, partly because of weaknesses in the data.17 Trends in inequality have been extremely diverse. For example, Malaysia saw declines in inequality (as measured by the Gini coefficient) during the 1980s, but this trend was reversed in the 1990s. Korea and Indonesia experienced rapid growth during the 1980s with little change in inequality, while China and Russia experienced large increases in inequality over the same period. The available data show no stable relationship between growth and inequality.18 On average, income inequality within countries has neither decreased not increased over the last 30 years. However, since within-country inequality has increased in some populous countries, overall more people have been affected by increases in inequality than by decreases. What drives inequality? Here, too, our knowledge is limited. Nevertheless, both crosscountry analyses and case studies have generated insights into the link between inequality and several policy and institutional factors. Policies fostering stable macroeconomic conditions, openness to trade, and moderate size of government tend to stimulate growth but have been found in one study not to systematically affect the distribution of income (Dollar and Kraay 2000). However, policies that reduce inflation from very high levels appear to benefit the poor more than the average. If growth is strong in areas where the poor live and sectors where they are employed (for example, smallholder agriculture), they benefit more; if growth takes place in areas or sectors that are not accessible to the poor, inequality can increase. Domestic policy distortions that hinder agriculture (along with international trade barriers) have restrained growth in rural incomes in many countries. This has also been reflected in rising regional inequality, as in poor regions farming is often the dominant sector of activity.19 Changes in income inequality reflect changes in the distribution of assets (for example, education) and in the return to these assets. In some countries, such as
17
18 19
Inequality is estimated with a certain degree of uncertainty, as it is based on sample surveys. Thus changes over time need to be considered carefully to assess whether they are significant to a certain degree or whether they fall within the margin of error. The estimation of standard errors is complex, and work on this is just beginning. See for example Deininger and Squire 1996; Ravallion and Chen 1997; Bruno, Ravallion, and Squire 1998; Dollar and Kraay 2000. For example, in the Indian state of Uttar Pradeshwhich has a population of 160 million and a poverty rate of about 40 percentagriculture accounts for 40 percent of GDP and provides 75 percent of employment.
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Mexico, more educated workers saw larger increases in earnings than did others workers, and these gains contributed to increasing income inequality. Gender bias and other forms of discrimination have led to increasing inequality where the groups that are discriminated against are poorer than others to start with. For example, discrimination led to lower returns to education and lower overall incomes for ethnic minorities in Vietnam and indigenous groups in Latin America. The impact of liberalization programs on inequality has differed among countries. If pre-reform controls benefit higher-income groups disproportionately, reforms can narrow inequality. If, on the other hand, pre-reform controls favor the poor, liberalization can have the opposite effect. For example, in the transition to an open trade regime, the poor may suffer if sectors where they have a stake are subjected to competition. This may happen especially in middle-income developing economies with intermediate skill endowments. These economies may have a comparative advantage regarding goods that require medium-intensity skills. These countries are likely to protect sectors intensive in unskilled labor where low-paid workers can be found. 20
Percentage share of income (poorest and richest 20 percent of the population) a Lowest 20% 1.6 1.9 1.9 2.6 2.7 Highest 20% 61.8 61.8 60.7 63.0 64.4 Low Inequality Countries Slovak Republic Japan Austria Czech Republic Bulgaria Lowest 20% 11.9 10.6 10.4 10.3 10.1 Highest 20% 31.4 35.7 33.3 35.9 36.8
Table 7. High Inequality Countries Honduras Bolivia Paraguay Brazil Swaziland
Note: a Latest available survey year. Source: World Bank, World Development Indicators 2001.
20
For example, in Mexico, a country that implemented one of the most ambitious trade policy reform programs from 1985 to 1988, the nominal tariff and import license coverage in apparel and footwear were among the highest in manufacturing (Revenga 1995). A similar prereform pattern of protection was also found in Morocco (Currie and Harrison 1997).
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Social Indicators Social indicators have generally been improving over the last three decades, and improve as incomes increase data on infant mortality and on access to improved water sources and sanitation facilities in the developing world, for example, indicate continued progress in all regions in the 1990s. 21 Nevertheless, more than 100 million school-age children remain out of school today, and in twenty developing countries, still more than 1,000 women die for each 100,000 live births. Furthermore, living conditions have deteriorated substantially over the last decade for many Africans. AIDS is causing declines in life expectancy and increases in infant and child mortality rates in the countries hardest hit by the epidemic (such as Botswana, Zimbabwe , South Africa, and Lesotho). Sub-Saharan Africa also experienced declines in enrollment rates between 1980 and 1994. On current trends, none of the International Development Goals on health and education are likely to be achieved: a two-thirds decline in infant and child mortality rate, a threefourths decline in maternal mortality rates, universal primary education (all by 2015), and gender equality in education (by 2005).22 It is important to note that, while these social development goals refer to country-wide averages, health and educational outcomes vary considerably by economic status. The mortality rates of the poor are systematically higher than the average and enrollment rates systematically lower. So efforts to improve literacy or reduce mortality may have to concentrate where they are most needed, namely among the poor. Population The links between population growth and poverty are complex: evidence suggests that high fertility is as much a symptom of poverty as a cause. In 1999, the world's population reached 6 billion. According to recent projections, it will reach 7 billion in 2014 - but adding the next billion people is expected to take longer than for the previous billion. More than half of the next billion will come from South Asia (310 million) and SubSaharan Africa (240 million); East Asia and the Pacific will add about 220 million. More than half the world's population (2.7 billion) live in urban areas, a number projected to reach 5.1 billion by 2030; about 98 percent of the increase will occur in developing countries. ! Intra-urban differences in living standards and welfare are often quite dramatic: in both So Paulo, Brazil, and Accra, Ghana, death rates from infectious diseases are twice as high for those living in the poorest areas compared to those living in the richest areas of the city.23
21 22 23
Unless otherwise indicated, data for this section come from World Development Indicators 2001 (www.worldbank.org/data/wdi2001/). See A Better World for All, 2000 (www.paris21.org/betterworld/). See Stephens et al. (1997). Data for So Paulo is for 1992; for Accra, 1991.
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Health Life expectancy On average, the life expectancy of people living in developing countries rose from 55 years in 1970 to 64 years in 1999, but it still lagged far behind that of OECD countries, which was 78 years in 1999 (table 8). Thirty-eight countries have seen life expectancy decline since 1990. Most are countries hit by the AIDS epidemics. 12 countries lost more than five years (table 9).
Table 8. Trends in life expectancy, selected years, 1970-1999 (years of life) 1970 59 n.a. 61 53 49 44 55 71 1982 66 68 65 60 55 48 61 75 1992 68 69 68 65 60 50 64 77 1997 69 69 70 67 62 49 65 78 1999 69 69 70 68 63 47 64 78
Region East Asia and Pacific Eastern Europe and Central Asia Latin America and Caribbean Middle East and North Africa South Asia Sub-Saharan Africa Developing Countries OECD
Source: World Bank, World Development Indicators 2001. Note: n.a. Not Available
Table 9. Botswana Zimbabwe South Africa Lesotho Zambia Swaziland
Declines in life expectancy between 1990 and 1999 (years of life) -17.4 -15.7 -13.5 -13.0 -10.7 -10.4 Kenya Namibia Congo, Dem. Rep. Korea, Dem. Rep. Malawi Tanzania -9.4 -7.5 -5.8 -5.3 -5.2 -5.1
Source: World Bank, World Development Indicators 2001.
Infant, child, and maternal mortality Actual or projected data on infant mortality indicate progress between 1990 and 1999 in all regions. But the 11 percent reduction in infant mortality in the developing world over the last nine years appears too slow to meet the target set in the International Development Goals for 2015 (table 10). Some countries have lost ground over the 1990s. North Korea saw its infant mortality rate rise from 45 to 58, while Kenya's went from 62 to 76, and Zimbabwe's increased from 52 to 70. Between 1970 and 1999, infant mortality differences between OECD and developing countries declined in absolute terms (from 86 in 1970 to 53 in 1999) but rose in
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relative terms: while infant mortality in 1970 was around 5 times as high in developing as in OECD countries, it is now about ten times as high (table 10).
Table 10. Trends in infant mortality, selected years, 1970-1999 (per 1,000 live births) 1970 78 41a 84 134 139 137 107 20 86 5 1990 40 28 41 60 87 101 66 8 58 8
a
Region East Asia & Pacific E. Europe & Central Asia Latin America & Caribbean Middle East & North Africa South Asia Sub-Saharan Africa Developing countries OECD (Diff. Developing countries-OECD) (Developing countries/ OECD)
1992 42 28 38 59 85 100 66 7 58 9
1997 37 23 32 47 76 94 60 6 54 10
1999 35 21 30 44 74 92 59 6 53 10
Reduction 1990-1999 13% 25% 27% 26% 14% 9% 11% 29%
Source: World Bank, World Development Indicators 2001. Note: 1980.
Child mortality rates in the developing world are also declining too slowly to attain the target of a two-thirds reduction by 2015: rates should have come down roughly by 30 percent in the 1990s, but they declined by only 6 percent (table 11). Between 1990 and 1999, child mortality increased in Sub-Saharan Africa from 155 per 1,000 to 161 per 1,000. In the same period, 11 countries experienced worsening rates; among them North Korea, where the child mortality rate increased from 35 to 93, and Namibia, where the mortality rate went from 84 to 108.
Table 11. Trends in under-5 mortality, selected years, 1970-1999 (per 1,000) 1970 126 n.a. 123 200 209 222 167 26 1980 82 n.a. 80 136 180 189 135 14 1990 55 34 49 71 121 155 91 9 1997 47 29 41 58 104 159 87 6 1999 44 26 38 56 99 161 85 6 % Change 1990-1999 -19% -22% -23% -21% -18% 4% -6% -26%
Region East Asia & Pacific E. Europe & Central Asia Latin America & Caribbean Middle East & North Africa South Asia Sub-Saharan Africa Developing countries OECD
Source: World Bank, World Development Indicators 2001. Note: n.a. Not Available.
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Goal: Reduce Infant Mortality Rates by Two-Thirds

(Source: "A Better World for All") Deaths per 1,000 live births
Goal: Reduce Under-5 Mortality Rates by Two-Thirds

(Source: "A Better World for All") Deaths per 1,000 live births
100 90 80 70 60 50 40 30 20 10 0 1990 1995 2000 2005 2010 2015
70 60 50 40 30 20 10 0
1990 1995 2000 2005 2010 2015
Progress 1990 - 1998
Average pat h to goal
Average path to goal
Maternal mortality rates also show mixed results. The international goals call for reducing maternal mortality by three-quarters by 2015, but significant improvements have not been seen. In twenty developing countries, still more than 1,000 women die for each 100,000 live births (table 12).
Table 12. Countries with the highest maternal mortality rates, 1995 (adjusted rates per 100,000 live births) Country Rwanda Sierra Leone Burundi Ethiopia Chad Sudan Burkina Faso Angola Kenya Central African R. Maternal Mortality Rate 2,300 2,100 1,900 1,800 1,500 1,500 1,400 1,300 1,300 1,200 Country Guinea Cte dIvoire Senegal Congo, Rep. Gambia, The Haiti Eritrea Nigeria Tanzania Uganda Maternal Mortality Rate 1,200 1,200 1,200 1,100 1,100 1,100 1,100 1,100 1,100 1,100
Malnutrition A recent study using data from nationally representative surveys for 19 countries looks at how three indicators of malnutrition (wastinglow weight for height; stuntinglow height for age; underweightlow weight for age) vary by income level.24 The study does find that malnutrition indicators are worse for the poor (see table 13): Wasting, stunting and underweight are higher amongst the poor in almost all countries. The difference between the poor and the non-poor is less pronounced for wasting, which is the more short-term indicator.
24
Wagstaff and Watanabe (2000).
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Differences between poor and non-poor vary across countries: in Peru, the rates of underweight and stunting amongst the poorest 20 percent are about five times those amongst the richest 20 percent; in Egypt the gaps are far smaller. Interestingly, poor-non-poor differences tend to be smaller in countries where average rates are relatively high (e.g. Bangladesh), and larger in countries where average rates are relatively low (e.g. Peru).
Table 13. Rates of under-5 stunting, underweight and wasting, by quintile of equivalent consumption (percent)
Average Rate 51 15 28 20 17 31 62 12 46 28 49 15 42 31 14 24 17 26 53 37 Stunting Poorest Richest 20% 20% 56 23 38 26 20 38 70 15 54 39 55 24 46 51 21 25 22 39 60 60 43 9 14 18 16 25 47 6 35 15 39 9 31 10 8 20 6 12 38 37 Poor/ Rich 1.3 2.6 2.7 1.4 1.3 1.5 1.5 2.5 1.5 2.6 1.4 2.7 1.5 5.1 2.6 1.3 3.7 3.3 1.6 1.6 Average Rate 54 6 13 17 11 26 33 19 40 15 47 8 43 12 21 7 6 18 41 22 Underweight Poorest Richest 20% 20% 59 9 21 21 10 32 41 25 46 23 60 15 48 22 26 9 7 24 48 29 44 3 6 15 10 19 25 8 33 6 27 4 35 5 13 6 5 11 29 14 Poor/ Rich 1.3 3.0 3.5 1.4 1.0 1.7 1.6 3.1 1.4 3.8 2.2 3.8 1.4 4.4 2.0 1.5 1.4 2.2 1.7 2.1 Average Rate 22 6 4 10 5 5 1 8 10 8 13 3 25 2 22 5 6 10 6 6 Wasting Poorest Richest 20% 20% 28 9 6 10 4 6 1 7 14 12 16 7 28 4 29 6 7 10 4 6 21 6 2 11 6 3 1 3 11 5 8 0 22 2 16 4 4 8 7 6 Poor/ Rich 1.3 1.5 3.0 0.9 0.7 2.0 1.0 2.3 1.3 2.4 2.0 1.3 2.0 1.8 1.5 1.8 1.3 0.6 1.0
Country Bangladesh Brazil China Cte dIv. Egypt Ghana Guatemala Guyana Indonesia Morocco Nepal Nicaragua Pakistan Peru Philippines Romania Russia S. Africa Vietnam Zambia
Source: Wagstaff and Watanabe (2000), Socioeconomic Inequalities in Child Malnutrition in the Developing World.
Health status and health care services for the poor Children born into poor families have a higher chance of dying before their 1st and 5th birthday than children born into better-off familiesbut the differences varies greatly across countries: in Ghana and Pakistan, the infant mortality rate for the poorest 20 percent of children is almost equal to the rate for the richest 20 percent. In the Philippines, South Africa and Nepal, it is twice as high; in NE and SE Brazil the under-5 mortality rate for the poorest 20 percent of children is over 6 times that of the richest 20 percent of children; Inequalities matter but so too do averages: Brazil's poorest children fare much worse in terms of their chances of surviving to their 5th birthday than their rich counterparts, but they fare far better, on average, than the richest 20 percent of children in other three countries; likewise, it is small consolation to poor Pakistani children that their survival chances are not dissimilar from those of the richest 20 percent of children, given that the latter have a risk of dying before their 5th birthday of 145 per 1,000 (see table 14).
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Table 14. Infant and under-5 mortality rate inequalities (per 1,000)
Country Average rate 43.2 68.4 82.1 61.9 71.9 124.4 38.8 74.1 33.9 Infant Mortality Poorest Richest 20% 20% 72.7 106.7 85.1 80.1 98.7 130.4 47.8 97.3 40.2 15.3 66.6 84.0 40.6 40.7 127.3 25.9 51.0 31.9 Poor/ Rich 4.8 1.6 1.0 2.0 2.4 1.0 1.8 1.9 1.3 Average rate 63.5 116.7 142.5 91.0 99.8 147.2 78.5 112.7 50.7 Under-5 Mortality Poorest Richest 20% 20% 113.3 163.1 155.5 126.8 141.7 160.1 109.0 159.7 53.5 18.7 99.7 129.7 64.6 51.3 145.2 44.0 76.7 47.4 Poor/ Rich 6.1 1.6 1.2 2.0 2.8 1.1 2.5 2.1 1.1
Brazil (NE & SE) Cte d'Ivoire Ghana Nepal Nicaragua Pakistan Philippines (Cebu) South Africa Vietnam
Source: Wagstaff (2000) Socioeconomic Inequalities in Child Mortality: Comparisons Across Nine Developing Countries.
The poor are less likely to obtain health care than are the rich: Between 1990 and 1998, in forty developing countries, only 29 percent of births among the bottom twenty percent of the population were attended by medically trained health staff, compared with 84 percent for those in the top twenty percent. In the same period, only 34 percent of the poor suffering from acute respiratory infections were treated in a health facility, compared to 57 percent of the non-poor (see Annex I).25 In Indonesia in 1997 only 21 percent of births of the rural poor and 49 percent of births of the urban poor were attended by a medically trained person, compared with 78 percent and 93 percent of the rural and urban rich (see table 15).
Table 15. Country Rural India 1992/93 Indonesia 1997 Nicaragua 1997/98 Nigeria 1990 Urban India 1992/93 Indonesia 1997 Nicaragua 1997/98 Nigeria 1990 Percentage of rural and urban births attended by a medically trained person Income Group Poorest 20% Richest 20% 11.5 20.7 30.4 11.3 26.5 49.5 56.9 48.1 69.8 78.2 80.2 74.3 81.3 94.0 93.2 68.7 Rich/ Poor 6.1 3.8 2.6 6.6 3.1 1.9 1.6 1.4
Source: World Bank's Country Reports on Health, Nutrition, Population, and Poverty (www.worldbank.org/poverty/health/data/).
25
Figures are calculated from the World Bank's Country Reports on Health, Nutrition, Population and Poverty (www.worldbank.org/poverty/health/data/).
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The poor are much more affected by communicable diseases than the rich: In 1990, 59 percent of all deaths among the poorest 20 percent of the world population were caused by communicable diseases, against 8 percent for the rich.26 The problems of AIDS and malaria UNAIDS has estimated that in 2000 there were 3 million deaths due to AIDS, the highest global total since the beginning of the epidemic, and 5.3 million newly infected individuals. In all, 36.1 million individuals are estimated to be living with HIV or AIDS. The vast majority of these are in Africa and South and South-East Asia: 70 percent of people living with HIV or AIDS (25.3 million) and of new infections of HIV (3.8 million) are in Sub-Saharan Africa; about 15 percent of people living with HIV or AIDS (5.8 million) and of new infections of HIV (780,000) are in South and South-East Asia (table 16). In eight countries in Africa (including Botswana, South Africa and Zimbabwe), 15 percent or more of adults live with HIV or AIDS. The rapid rise in adult deaths is leaving an unprecedented number of orphans: 13.2 million worldwide, 12.1 million of them in Sub-Saharan Africa alone. Today, in some African countries, one in 10 children is an orphan. The trend in Eastern Europe and Central Asia is worrisome: a conservative estimate puts the number of adults and children living with HIV or AIDS in 2000 at 700,000, compared with 420,000 a year before.
Table 16.
Region
The distribution of HIV/AIDS around the world

Adults and children newly infected with HIV, end of 2000 Number Percent 71.4 14.6 2.8 2.4 4.7 1.1 1.5 0.8 0.6 0.0 100.0 Adults and children and Adult living with HIV/AIDS, end HIV/AIDS of 2000 Prevalence Rate, end of 2000 a Number Percent Percent 25,300,000 5,800,000 1,400,000 640,000 700,000 390,000 400,000 920,000 540,000 15,000 36,100,000 70.1 16.1 3.9 1.8 1.9 1.1 1.1 2.5 1.5 0.0 100.0 8.8 0.6 0.5 0.1 0.4 2.3 0.2 0.6 0.2 0.1 1.1
Sub-Saharan Africa South and South-East Asia Latin America East Asia and Pacific East. Europe and Central Asia Caribbean North Africa and Middle East North America Western Europe Australia and New Zealand Total
3,800,000 780,000 150,000 130,000 250,000 60,000 80,000 45,000 30,000 500 5,300,000
Source: UNAIDS, Aids Epidemic Update (December 2000). Note: a The Adult Prevalence Rate is the proportion of adults (15 to 49 years of age) living with HIV/AIDS in 2000, using 2000 population numbers.
26
Gwatkin (1999a); households ranked on the basis of assets owned.
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The Human Immunodeficiency Virus (HIV) has so far been unique among infectious diseases in that it strikes rich people in the same proportion, or larger proportions, than it strikes poor people. Nevertheless, AIDS is a disease of poverty (see Confronting AIDS: Public Priorities in a Global Epidemic): AIDS is a disease of poverty in the sense that most people with HIV or AIDS are poor. The disease struck very hard in poor countries: 96 percent of infected people are in the developing world, and 70 percent are in Sub-Saharan Africa alone. Moreover, although infection rates are declining in the developed world, they are stable or rising in most developing countries. Recent studies in developed countries have shown AIDS incidence to be highest among the very poor. At the moment, there are no data to assess the precise proportions of poor and non-poor people who are infected in developing countries, but if trends for developed countries are replicated worldwide, the poor will be more likely to become infected than the non-poor. AIDS deepens and spreads poverty. Poor households are more adversely affected by an AIDS death of a prime-age adult than other households because they have fewer assets to draw on to cope with medical expenses and the loss of income and services that a prime-age adult typically provides. AIDS is also likely to increase poverty through the rise in the number of children who lose one or both parents. Evidence shows that orphans have significantly lower enrollment rates and are more likely to be malnourished than non-orphans. Lack of schooling and inadequate nutrition will make it more difficult for orphans to escape poverty. Malaria, a parasitic disease transmitted by anopheles mosquitoes, affects an estimated 300 million people and kills at least one million people each year, three-quarters of them children under five. Sub-Saharan Africa suffers the highest exposure rates (9 out of 10 cases occur there), followed by parts of Asia and Latin America. Malaria is not an unavoidable side effect of a tropical location: among the countries sharing a location close to the equator, a lower incidence of poverty is associated with lower levels of malaria morbidity. It has been estimated that, on average, the reduction in GDP growth caused by malaria exceeds 0.25 percent per year, and is about 0.55 percent in Sub-Saharan Africa.
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Education Primary enrollments Gross primary school enrollment data show an improvement over the last thirty years. Developing countries have made enormous progress in expanding access to schooling. However, regional trends diverged markedly, with Sub-Saharan Africa experiencing a slight decline in enrollment rates between the early 1980s and the mid-1990s.
Table 17. Trends in gross primary enrollment rates, selected years, 1970-1996 1970 90 n.a. 99a 70 71 51 82 100 1980 111 99 105 87 77 81 96 102 1990 120 99 105 97 90 76 103 103 1993 115 97 109 97 97 76 103 103 1996 116 100b 113 95 100 78b 107 104c
Region East Asia and Pacific E. Europe & Central Asia Latin America and Caribbean Middle East and North Africa South Asia Sub-Saharan Africa Developing Countries OECD
Note: Declines in gross enrollment ratios that are over 100 do not necessarily mean a decrease in the proportion of school-age children going to school. They might reflect a reduction in the numbers of over-age children as a result of improvements in quality and increases in efficiency as fewer children start school late or repeat grades. n.a. Not available, a1975, b1994, c1995. Source: World Bank, World Development Indicators 2001.
Although between 1990 and 1997 net enrollment rates have improved in all regions (except in the Middle East and North Africa, see table 18), today 110 million primaryschool-age children in developing countries are not in school. Of these, 60 percent (66 million) are girls. In Sub-Saharan Africa nine countries reported net primary enrollment rates of less than 50 percent in the 1990s (table 19). The International Development Goals call for universal primary enrollment by 2015: at the present rate of progress this target is not likely to be achieved, and more than 100 million school-age children will not be in school in 2015.27 In Sub-Saharan Africa the number of children out of school would actually increase to 50.7 million in 2005 and to 54.6 million in 2015 on present trends.28
27 28
See A Better World for All (2000). See Watkins (1999) Education Now: Break the Cycle of Poverty.
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Table 18.
Trends in net primary enrollment rates, selected years, 1980-1997 1980 86 92 86 74 64 54a 78 97 1990 97 95 89 87 74 56b 86 100 1992 97 94 91 87 76 n.a. 86 100 1996 99 99 94 87 77 n.a. 88 100 1997 99 100 95 87 77 n.a. 89 100 Increase 1990-1997 2% 5% 7% 0% 4% n.a. 3% 0%
Region East Asia & Pacific E. Europe & Central Asia Latin America & Caribbean Middle East & North Africa South Asia Sub-Saharan Africa Developing countries OECD
Note: n.a. Not available. a1981; b1989. Source: World Bank, World Development Indicators 2000.
Table 19. Countries with Net Primary Enrollment Rates of less than 50 percent in 1997 (percentage of relevant age group) Country Niger Eritrea Burkina Faso Mali Ethiopia % 25 30 31 31 32 Country Mozambique Guinea Chad Tanzania % 40 42 46 48
In 1998, 879 million adults in developing countries (one in four) were illiterate. Of these 64 percent (559 million) were women. In South Asia only 42 percent of women are literate compared to 66 percent of men. In Nepal and Afghanistan only about 20 percent of women are literate; in Pakistan 30 percent. The incidence of adult illiteracy in developing countries has fallen from 47 percent in 1970 to 26 percent in 1998; however, because of population growth and the failure of school systems to prevent children from growing up illiterate, today there are 41 million more illiterate adults than in 1970. Almost the entire decrease in illiteracy since 1990 has been achieved in East Asia, while the number of illiterates increased by 21 million in South Asia, 3 million in the Middle East and North Africa, and 2 million in Sub-Saharan Africa. Education of girls The International Development Goals call for equal enrollments of girls and boys in primary and secondary school by the year 2005. In 1995, girls made up only 43 percent of gross primary school enrollment in low-income countries. By 2005 they will still make up only 47 percent of all primary enrollment. In 1996, girls made up about 40 percent of secondary enrollment. Girls secondary enrollment has been rising at a faster rate than boys. By 2005 girls will make up about 47 percent of gross secondary enrollment also. 35
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Goal: Gender Equality in Primary and Secondary Education

(Source: "A Better World for All")
100
Female to male enrollments, %
95
90
85
80
75
1990
1995
2000
2005
Average path to goal
The extent of female disadvantage in education varies enormously across countries. Gender gaps in education are large in Western and Central Africa, North Africa and South Asia: In India there is a 16.6 percentage point difference between the school enrollment of girls and boys aged 6 to 14. In Benin, the enrollment rate of boys aged 6 to 14 is more than 60 percent higher than the enrollment rate of girls (table 20).
Table 20. Percentage of 6-14 year-old girls in school
% 6-14 YearOld Girls in School 55.5 32.6 44.3 45.8 48.9 59.1 24.9 41.7 % 6-14 YearOld Boys in School 76.1 53.1 64.7 63.9 65.9 75.7 40.4 55.8 Low/ No Female Disadvantage Countries Zimbabwe Zambia Brazil Kazakhstan Indonesia Madagascar Malawi Bangladesh Dominican Republic Colombia % 6-14 YearOld Girls in School 83.5 60.4 93.8 85.3 86.6 58.6 89.7 73.8 % 6-14 YearOld Boys in School 83.4 60.1 93.4 84.9 86.0 58.0 88.9 72.6
High Female Disadvantage Countries Nepal Benin Pakistan Morocco Central Afr. Rep. India Chad Cte dIvoire Turkey Togo
Survey Year 1996 1996 199091 1992 199495 199293 1998 1994
MaleFemale Gap 20.6 20.5 20.4 18.1 17.0 16.6 15.5 14.1
Survey Year 1999 199697 1996 1999 1997 1997 1996 199697
MaleFemale Gap -0.1 -0.3 -0.4 -0.4 -0.6 -0.6 -0.8 -1.2 -1.4 -1.8 -2.8 -2.9 -3.5 -4.5 -4.7
1998 63.4 76.9 13.5 1996 94.2 92.8 1998 64.4 77.5 13.1 1995 89.7 87.9 1995Egypt 96 75.7 85.6 9.9 Tanzania 1996 48.6 45.8 Mozambique 1997 51.7 61.0 9.3 Uzbekistan 1996 82.9 80.0 Comoros 1996 48.3 57.2 8.9 Namibia 1992 87.1 83.6 1992Senegal 93 27.4 35.8 8.4 Philippines 1998 88.4 83.9 1995Mali 22.3 30.4 8.1 Nicaragua 1998 80.0 75.3 96 Source: Deon Filmer (1999), The Structure of Social Disadvantage in Education: Gender and Wealth and authors updates. . Poverty is defined with respect to ownership of assets.
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Education for the poor In many countries, most children from the poorest households have no schooling. For example, in India and Pakistan, as well as in Benin and Mali (among other West African countries), the median grade completed among 15 to 19 years olds from the bottom 40 percent of households is zero (Annex II). There are often enormous gaps between the educational attainment of the rich and of the poor within countries. In India, for example, 15-19 year olds from the richest 20 percent of households have completed on average ten years of schooling. Children from the poorest 40 percent of households have on average no schooling (Annex II). In some countries school drop-out rates are very high, especially among the poor. In Brazil, for example, whereas almost all children (15-19 year olds) of the poorest households have attended some school, only about 15 percent have completed primary school. Wealth differences in school enrollment are large in almost all developing countries: The rich-poor gap in Western and Central African countries ranges from 5 percentage points (Kenya) to 52 percentage points (Nigeria). Gaps are also wide in North Africa, as well as in South Asia (table 21).
Table 21. Percentage of poor 6-14 year olds in school
Poor 6-14 Rich 6-14 in School in School Rich-Poor (%) (%) gap Poor 6-14 Rich 6-14 in School in School Rich-Poor (%) (%) gap
Country
Year
Country East Asia
Year
Western Africa Nigeria Namibia 1999 1992 39.3 84.0 91.3 91.8 52.0 7.8
Philippines Indonesia South America
1998 1997
78.9 80.5
94.8 95.0
15.9 14.5
Eastern Africa Madagascar 1997 Kenya 1998 North Africa Morocco Egypt 1992 1995-96
46.8 86.9
90.0 92.1
43.2 5.2
Colombia Peru
1995 1996
80.9 85.8
97.6 94.6
16.7 8.8
26.7 67.6
89.5 95.5
62.8 27.9
Central America and the Caribbean Haiti 199455.2 95 Dominican Rep. 1996 88.7
89.7 97.8
34.5 9.1
South Asia Eastern Europe and Central Asia Turkey 60.1 85.2 25.1 Pakistan 1990-91 36.6 85.6 49.0 1998 Bangladesh 1996-97 66.8 83.4 16.6 Uzbekistan 1996 80.2 81.1 0.9 Source: Deon Filmer (1999), The Structure of Social Disadvantage in Education: Gender and Wealth and authors updates. Poverty is defined with respect to ownership of assets.
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The Environment The links between environmental conditions and human welfare are strong and complex. For many people environmental resources provide their basic sustenance. Wise sustainable use of these resources can provide the basis for growth and poverty reduction. Millions more, who do not depend directly on the environment for their livelihood, are affected by environmental degradation. Diseases associated with environmental factors are highly concentrated among the poor. And the poor are disproportionately vulnerable to natural disasters -- droughts, floods, storms, earthquakes, and forest fires. Water and sanitation Lack of clean water and sanitation is the main reason disease transmitted by feces are so common in developing countries. Contaminated drinking water and an inadequate supply of water cause diseases that account for 10 percent of the total burden of disease in developing countries. Although access to improved water sources and sanitation facilities increased since 1990, in 2000 about half of the population of the developing world still lacked adequate sanitation (see table 22).
Table 22. Trends in access to improved water sources and sanitation facilities, 1990-2000 (percent of population) Access to improved water sources 1990 2000 70 75 n.a 90 81 85 85 89 79 87 49 55 73 79 Access to improved sanitation facilities 1990 2000 38 48 n.a n.a. 72 78 78 83 31 36 55 55 44 52
Region East Asia and Pacific E. Europe & Central Asia Latin America and Caribbean Middle East and North Africa South Asia Sub-Saharan Africa Developing Countries
Note: n.a. Not available. Source: World Bank, World Development Indicators 2001.
Access to safe water: In 2000, approximately 1.5 billion million people in low and middle-income economies lacked access to safe water supplies. And in Sub-Saharan Africa fewer than half the population has access. Some countries have shown improvements in access to water sources in the last decade: Sri Lanka: from 66 percent of its population in 1990 to 83 percent in 2000 Paraguay: from 63 percent in 1990 to 79 percent in 2000 Nepal: from 66 percent in 1990 to 81 percent in 2000
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But too many countries still had very low rates of access to safe water in 2000: Ethiopia: 24% Chad: 27% Sierra Leone: 28% Cambodia: 30% The poor are less likely to have access to water than are the rich: ! In Ecuador, 75 percent of households among the poorest fifth lack piped water, compared with 12 percent among the richest fifth.29 In many cities in the developing world, inequalities in water consumption between poor and rich zones are considerable, with those living in the richest areas consuming much more water than those in the poorest areas: ! In So Paulo, Brazil, the 9 percent of people living in the riches areas consume five times as much water per capita than the 41 percent living in the poorest areas. In Accra, Ghana, water consumption per capita is three times higher for the onethird of people living in the richest areas compared to those living in the poorest areas.30
Access to sanitation: In 1996, approximately 1.4 billion low-income and over 400 million middle-income people lacked access to sanitary facilities. At the present rate of progress, one-third of all low-income peopleover 900 millionwill still lack adequate sanitation in the year 2015. In many of the worlds cities, households lack sewerage connections: in one out of four major cities surveyed by UN Habitat, fewer than 10 percent of households had connections.
29 30
See World Bank (2000e). See Stephens et al. (1997).
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What the Poor Say Poverty is pain; it feels like a disease. It attacks a person not only materially but also morally. It eats away ones dignity and drives one into total despair- a poor woman, Moldova. The poor are the true poverty experts. The World Bank, in preparing its World Development Report 2000/2001: Attacking Poverty , wanted to make sure the voices of the poor -- their experiences, priorities, and recommendations would be taken into account. The result was Voices of the Poor, a series of studies trying to understand the voices of approximately 60,000 poor men and women from over 60 countries around the world. The voices are drawn from 81 participatory poverty studies. The field studies used participatory and open-ended methods, and were carried out mainly by local research institutes and NGOs, under the supervision of the World Bank.31 The pattern of findings from across countries is similar and striking. Poor people describe repeatedly and in distressing detail what has only been glimpsed before, the psychological experience and impact of poverty. The trends are sobering. The large majority of poor people included in Voices said they are worse off now, have fewer economic opportunities, and live with greater insecurity than in the past. They spelled out detailed reasons that varied by region. Poor peoples experiences with government institutions are largely negative, even when government programs were rated as important. Rudeness, corruption and poor quality services seemed to be the norm, whether in health care or in programs of social support. But the poor still greatly value government programs, and feel governments have important roles to play in their lives. The presence of NGOs in the various countries is uneven, but where they are at work their contributions are generally appreciated. The poor find their own local networks and institutions to be the most dependable. Gender relations are in troubled transition, with violence against women frequent. The Good Life and the Bad Life Being well means not to worry about your children, to know that they have settled down; to have a house and livestock and not to wake up at night when the dog starts barking; to know that you can sell your output; to sit and chat with friends and neighbors. A middle aged man in Bulgaria. A better life for me is to be healthy, peaceful and to live in love without hunger. Love is more than anything. Money has no value in the absence of love. A poor older woman in Ethiopia.
31
Financial support for Voices was provided by the UK Department for International Development (DFID), the World Bank, the Swedish International Development Authority (SIDA), the MacArthur Foundation and several NGOs.
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Poor people were asked to share their ideas of good and bad experiences of life, wellbeing and illbeing. To be poor was to experience illbeing in many ways, and to suffer multiple disadvantages that reinforce each other and interlock to trap them. Again and again, the psychological dimensions of wellbeing and illbeing were of paramount importance. Wellbeing was variously expressed as happiness, harmony, peace, freedom from anxiety, and peace of mind. In Russia, people said, Wellbeing is a life free from daily worries about lack of money; in Bangladesh, to have a life free from anxiety; in Brazil, quality of life is not having to go through so many rough spots and when there is cohesion, no quarrels, no hard feelings, happiness, in peace with life. In Nigeria, wellbeing is found in those that have peace of mind, living peacefully; in Bolivia, quality of life is high when you have a family, to feel supported and understood. You can have money but without a family its worth nothing; in Thailand, livelihood was simply defined as happiness; It is to be filled with joy and happy. It is found in peace and harmony in the mind and in the community. For many, too, spiritual life and religious observance were woven in with other aspects of wellbeing. The importance to poor people of the church, mosque, temple and sacred place was repeatedly evident from their comparisons of institutions, in which these frequently ranked high, if not highest, as key supports in their lives. Illbeing was described in terms of lack of material things, as bad experiences, and bad feelings about the self. In Bosnia, the poor described illbeing as follows: Children are hungry, so they start to cry. They ask for food from their mother and their mother doesnt have it. Then the father is irritated, because the children are crying, and he takes it out on his wife. So hitting and disagreement break up the marriage. A group of young men in Jamaica ranked lack of self-confidence as the second biggest impact of poverty: Poverty means we dont believe in self, we hardly travel out of the communityso frustrated, just locked up in the house all day. Poor people spoke about loss, grief, anguish, worry, over-thinking, madness, frustration, anger, alienation, humiliation, shame, loneliness, depression, anxiety and fear.
What Makes the Good Life Despite diversity and location specificity, there is a striking commonality of experience across countries, cultures, rural and urban areas, and age and gender divides. People explained wellbeing and illbeing in terms of five related dimensions: material wellbeing, physical wellbeing, security, freedom of choice and action, and good social relations.
1. Material Wellbeing We eat when we have, we sleep when we dont. Ethiopia. Not surprisingly, lack of food, shelter, clothing, poor housing and uncertain livelihood sources were critical and mentioned everywhere. Having enough to eat the whole year round was mentioned again and again in many countries, as was the possession of assets.
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In rural areas this took the form of land with secure tenure, together with assets that allowed cultivation and a good harvest. In urban areas, capital to start a business, access to loans, and above all dependable work were stressed. In Argentina, it was said: You have work, and you are fine. If not, you starve. It is so. In the urban areas of countries that have undergone severe crises of economic restructuring, study teams were shocked to learn about quiet and hidden starvation. Those who starve are often too proud to beg and too decent to steal. The research team in Russia wrote, a woman told us that sometimes she did not have food for several days and was only drinking hot water and lying in bed not to spend energy.
2. Physical Wellbeing My children were hungry and I told them the rice is cooking, until they fell asleep from hunger. An older man, Egypt. Poor people cannot improve their status because they live day by day, and if they get sick then they are in trouble because they have to borrow money and pay interest. Tra Vinh, Vietnam. Each day there is a funeral in a nearby village because of distance to the hospital. Musanya, Zambia. Physical health, strength and appearance are of great importance to the poor. This is not just for reasons of compassion for close relatives and friends, or because of concern for personal wellbeing. It is for quintessentially economic reasons. The body is poor peoples main asset, but one with no insurance. If it deteriorates, hunger and destitution hover at the doorstep. As a man in Ethiopia said, I told you. All I need is peace and health. Bad living and working conditions, together with material poverty, make a person highly vulnerable to becoming weak through sickness, or to permanent disability or death through illness and accident. Shortage of food and sickness not only cause pain, they weaken and devalue the asset. Poor people are more often sick, and sick for longer periods of time, and less able to afford treatment than the better off. So they just sleep and groan (Malawi). Women are taking on increasing burdens in expanded roles outside the household, and time poverty is driving many women to deeper and deeper exhaustion. When a poor woman in Zambia was asked her dream, she simply said, to have time to go into town and play [spend time] with my friends. Illness can plunge a household into destitution. Anguish and grief over watching loved ones die because of lack of money for health care is a silent crisis of poverty.
3. Security Security is knowing what tomorrow will bring and how we will get food tomorrow. Bulgaria.
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There is no control over anything, at any hour a gun could go off, especially at night. A poor woman in Brazil. Many people described security as peace of mind or confidence in survival. Survival referred not just to livelihood, but also to sheer physical survival in the face of rising corruption, crime, violence, lack of protection from the police and absence of recourse to justice, wars between ethnic groups, tribes and clans, frequent natural disasters, and the uncertainties of season and climate. Lawfulness and access to justice were widely seen as crucial aspects of wellbeing. In the Kyrgyz Republic people said, among all the wellbeing criteria, peace is the most important. In Russia, it was the absence of constant fear. In Ethiopia, women said we live hour to hour worrying if it will rain. The bad life is deeply embedded in insecurity and feeling vulnerable. Insecurity is related to the external world, to the individual and family -- exposure to shocks, stress, and risks that increase unpredictability and instability. In many countries, women spoke about widespread domestic violence, although there is evidence it may have peaked and be in decline in some countries. Insecurity is also the experience of worry and fear. Even where poverty has declined, the majority of poor people said that life had become more unstable and uncertain, particularly as a result of increased crime, violence and corruption.
4. Freedom of Choice and Action The rich is the one who says: I am going to do it and does it. The poor, in contrast, do not fulfill their wishes or develop their capacities. A poor woman in Brazil. Poverty is like living in jail, living under bondage, waiting to be free. A young woman in Jamaica. Wellbeing for many people means freedom of choice and action, and the power to control ones life. It means the power to avoid the exploitation, rudeness and otherwise humiliating treatment so often meted out to the poor by the rich or the more powerful in society. It also includes the ability to acquire skills, education, loans, information, services and resources; to live in good places; to withstand sudden and seasonal stresses and shocks and not slip further into poverty. Wellbeing was frequently linked to moral responsibility, with freedom of choice and action extending to having the means to help others in need. Lack of freedom or powerlessness confronts poor people with agonizingly constrained choices. They explain powerlessness as the inability to control what happens to one because of poverty. The poor are forced to trade off one bad thing for another bad thing. Their voices are seldom heard and sometimes silenced. Their lack of organization further constrains their ability to challenge authority or unfair practices. To add to these cumulative disadvantages, they frequently live in poor areas characterized by
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remoteness and isolation. In the Kyrgyz Republic, poor people said that they were forced to take many risks to survive, including stealing (with the risk of getting caught) or borrowing money (with the risk of becoming indebted). The rich do not have to take this risk, they have money to protect themselves, and they also have power.
5. Social Wellbeing To be well means to see your grandchildren happy, well dressed and to know that your children have settled down; to be able to give them food and money whenever they come to see you, and not ask them for help and money. An old woman in Bulgaria. It is neither leprosy nor poverty which kills the leper, but loneliness. Ghana. It is more worthwhile to bring up our children in a proper manner than to bring all those riches from abroad. What is the point in going abroad and sending money to build a house if the entire family life is destroyed in the process? Kehelpannala, Sri Lanka. Social wellbeing was defined as good relations within the family and the community. In post-conflict and transitional economies, the need for good social relations across the nation was also mentioned. Being able to care for, raise, marry and settle children was stressed over and over again. Social wellbeing included social respect and being part of a community. The stigma of poverty was a recurring theme, and participants frequently spoke about the shame of asking for help and accepting charity. Many spoke of how their poverty prevented them from participating fully in society, and the humiliation brought on by being unable to follow the traditions and customs of their culture. They spoke about their inability to exchange gifts and presents, and how in consequence they stay away from celebrations, weddings and festivities. Loneliness, alienation and estrangement are a source of great distress. Middle-aged men in Bulgaria said, When you are poor, nobody wants to speak with you. Everyones sorry for you and no one wants to drink with you. You have no self-esteem and thats why some people start drinking. The poor also spoke about discrimination that is, being denied opportunities and humiliating treatment by officials. There was a widespread experience of being treated badly, whether by guards at supermarkets or by uncaring doctors, nurses, schoolteachers, and traders.
Trends and Traps In the past people were at ease (Mertaha) and money was valuable (El-Felous Kan laha eema), but now it is not. Bong Meghezel, Egypt.
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Now there are hungry children, and before it was not so evident. There are children that knock on your door and ask for bread, children without shoes. This one would never see before. La Matanza, Argentina. If we knew that there would be an end to this crisis, we would endure it somehow. Be it for one year, or even for ten years. But now all we can do is sit and wait for the end to come. A woman from Entropole, Bulgaria. A large majority of poor people consulted felt they were either worse off or no better off today than they were previously. There were exceptions -- associated with broad positive changes in Vietnam, India, and Bangladesh (although in the latter case positive changes for the poor were adversely affected by the devastating floods of 1998). There were also exceptions at the level of individual communities, due to the positive effects of new infrastructure in parts of urban Brazil, tourism in Jamaica and export zones in Sri Lanka. In countries that had suffered civil disturbance or war, especially Bosnia-Herzegovina, Somaliland and Sri Lanka, poor people considered themselves much better off than during the periods of unrest, but had not regained their pre-disturbance levels. In Malawi, the gain in political freedoms was felt to have improved poor peoples wellbeing, but had on the whole not been matched in other domains of life. The experience of the majority of those who participated in the Voices was that the quality of their lives has become worse, not better. Economically, there was a widespread, if not universal, sense that opportunities were unevenly distributed, and that those who started with advantages had been able to exploit them, while the poor found it difficult or impossible to do so. In terms of security, conditions for poor people had become worse in most countries and at most sites. Heightened insecurity variously affected livelihoods, property, and personal safety. In discussing institutions, poor people did not give high ratings to government officials and political leaders, and NGOs were mentioned less and less highly rated than might have been expected. Poor people indicated repeatedly, and in many contexts, that they trust and rely on their own local, informal institutions for support in crisis and in daily life, and rank them high in importance even while recognising their limitations. The message from the poor is that outside organisations and development policies designed for their benefit have been less significant than is usually assumed by those who work in development agencies. The reasons for the lack of opportunities, increased insecurity, and flat or downward trend in wellbeing differed by region. There were, however, common themes: people said that they miss out on many opportunities because of the need to have connections and because of their lack of information, assets, credit, skills and business acumen. Repeatedly, their message was that it is the rich who benefit from policy changes. Particularly in Eastern Europe, Central Asia and Latin America, poor people spoke about macro-economic and political change. In Africa and East Asia, poor people tended to emphasize rising costs of living and prices and, in South Asia, economic and social issues
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at the family and community level. In Africa and Asia, the poor also discussed the uncertainty of depending on rainfed agriculture and land-related issues. The Voices showed that these disadvantages are compounded by a combination of time poverty, physical weakness, lack of energy, and powerlessness. Together, these multiple disadvantages not only hold poor people down, they make them vulnerable to losing even what they have. Analyses of life stories of men and women who had fallen back into poverty confirms the precariousness of small gains that are vulnerable to big slides back downwards. The most common triggers for the descent back into poverty were illness, injury, or death of a close family member. These had an especially large impact on households in Africa and Asia. Other triggers included a decline in economic opportunities, the cost of raising children, old age, cost of living increases, natural disasters, divorce and desertion (for women), declining profitability of agriculture and business, lower wages, theft, civil conflict, indebtedness, and many others. Life story patterns showed that the poor with few assets would, with great effort, slowly creep upward, only to be plunged back into poverty by illness, loss of employment, poor crops or, for women, desertion. There is usually nothing to prevent them from falling into the abyss. And when they do fall, there is often nobody waiting to catch them at the bottom or to lend a hand as they attempt to start over. A major trap for the poor is simply where they live. A resident of Nova California, a slum in Brazil, said The sewage runs in your front door, and when it rains, the water floods into the house and you need to lift the thingsthe waste brings some bugs, here we have rats, cockroaches, spiders, and even snakes and scorpions. Only too often, the poor live on marginal land, ill-served by transport, water or other amenities, isolated from information and subject to environmental hazards, inadequate shelter and insecure rights. Some slum areas in Sofia, Bulgaria are polluted and stink, as there is no garbage collection or other communal services. The Roma feel they are treated like dogs. In urban slums in Dhaka, Bangladesh, shanties of bamboo have been constructed on raised platforms over a big ditch, which is used for all sorts of waste disposal. When babies fall into the ditch they sink and are lost. In slums in Argentina, oil spills send fire down the clogged up canals along which the poor live, and factory waste clogs up drains. In slums in Malawi, the physical conditions were so bad and hopeless that the poor said, the only way we can get out of poverty is through death. Residents of such areas not only have to put up with these living conditions, they find an area stigma attached to them that deters potential employers.
Four Problems with the System You grow up in an environment full of diseases, violence and drugs you dont have the right to education, work or leisure, and you are forced to eat in the hands of the governmentso you are easy prey for the rulers. You have to accept whatever they give you. A young woman, Padre Jordano, Brazil
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A person doesnt have the strength or power to change anything, but if the overall system changed, things would be better. Bosnia. Poor people describe four pervasive and systemic problems that affect their lives adversely almost everywhere: corruption, violence, powerlessness, and insecure livelihood. 1. Corruption There is much bitterness, especially in the thought that any opportunities that may come will be taken by the rich and they could never find a wasta or middleman to enable them to find a better or more permanent job. If they have a right, they cannot take it because they cannot afford a lawyer. If the poor go to the police station to accuse a richer man, he is afraid: my accusation may turn out in the favor of the rich and against me. But if we are equal, I may have justice. Dashour Village, Egypt. I worked six years in a company that did not pay me correctly. So I sued them and they threatened to kill me. I had to hide. Sacadura Cabral, Argentina. Corruption is a core poverty issue, not just a problem affecting high levels of governments and business. The studies reveal how pervasive low-level corruption and lack of access to justice and protection affect poor peoples lives -- the problems of corruption, connections, and violation of basic human rights with impunity were voiced repeatedly. In Ecuador, the poor in Chota said, the government should make sure the congressmen do not steal. In Uzbekistan, bribes to get a job were standard: a friend told me to get a position, one must pay 25 thousand. I could not afford it, so I went back to pulling a cart in Tashkent. In India, poor women spoke of having to bribe forest officers for each bundle of firewood they collected and railway policeman for coal dust they gathered from railway tracks. In Bangladesh, the poor said, nobody can count on the judgment of the commissioner since he does not work for the poor and his bias is with the landlord. In country after country, and community after community, poor people spoke of corruption in the distribution of seeds, medicines and social assistance for the destitute and vulnerable; corruption in getting loans; corruption in getting teachers to teach; corruption in customs and border crossings; corruption in the construction of roads; corruption in getting permission to move in and out of cities or stay in certain areas; corruption in street and market trading; and corruption in identity cards. In many places, the poor reported having to pay managers, hooligans and the police protection money to save themselves from the worst forms of harassment, theft and abuse. Even humanitarian assistance is often waylaid when channeled through corrupt state systems. In Bulgaria, people reported that secondhand clothes destined for the poor were sold by doctors and nurses to shops. To overcome problems of this type, some NGOs hire a local representative to be responsible for distribution of humanitarian aid. But according to the poor this can in fact be worse still, because the local representative
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distributes the goods received from overseas selectively, twice a year, and then immediately films the occasion to send a report back to the donors. The Bulgarian poor had a simple remedy: they suggested that the donors names and addresses be announced at the time of distribution, so that recipients could send their comments directly to the donors. In many countries, poor peoples access to justice and courts is a distant dream because of lack of information, distance from the courts, and a strong belief (based on experience) that only money buys justice. In Uzbekistan, a man said, you have to pay the lawyer, the judge and the prosecutor. I have gone through it myself. Since the poor lack money and too often are dependent on those who violate their rights, they cannot afford justice. Almost everywhere, justice through political representation was laughed at and comments were frequent about the seasonal memory of parliamentarians. In Egypt, people said, when they reach their seats the parliamentarians forget us. All this said, there were also heart-warming even if few examples of public officials who refused the temptations of corruption. In Ozerny, Russia, poor people spoke with great respect for a local nurse whom they described as a valuable institution: You can go to her at any time - she will never refuse to make a shot, or give advice about how to treat something Her advice is listened to much more than the local doctors who is often criticized for lack of professionalism and for indifferenceShe is a good example of how shortages of medicines and lack of financing dont mean the impossibility to help. In Jamaica, the poor praised the female Superintendent of Police in charge of Constant Spring Police Station. Anyone can have access to the Superintendent in charge of Constant Spring Police Station. If you have a complaint you just walk in and ask to see her and they just send you upstairs to see her. She will call up the officer and deal with him.
2. Violence, Civil Conflict and Public Safety We do not expect any help from our neighborsthey cant help; in any case, they wont because everyone is just fending or grabbing for themselves. BosniaHerzegovina. The men compared increasing crime and conflict to burning fire rampaging through the community. They said that increasing crime levels are a result of everybody wanting to get rich.Some men, however, were of the view that social norms and taboos have been lost in what [they] called te nabaalee (our ancestry) resulting in a disregard for traditional methods of enforcing law and order and therefore keeping crime and conflict in check. Ghana. I do not know whom to trust, the police or the criminals. Our public safety is ourselves. We work and hide indoors. Brazil.
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The police have become the rich peoples stick used against common people. Dangara, Uzbekistan. In many countries in both rural and urban areas poor people reported a decline in social connectedness, concomitant with increases in crime, lawlessness, selfishness and violence. This is reflected not only in violence and public safety issues outside the home, but in conflict and violence within the home as well. Many of the poor linked these trends to decreases in economic opportunities, increased competition for resources, and poor government policies. In Eastern Europe and Central Asia the decline was also linked to the transition from communism to democracy. While there are some rural and urban differences, poor people generally reported an erosion of traditional social solidarity, sharing of food and resources with family, kin and neighbors, and participation in marriages, rituals and visits. In Nigeria, old men said, we poor men have no friends. Our friend is the ground. In Zambia the poor said, when food was in abundance relatives used to share it. These days of hunger not even relatives would help you. Increases in theft were linked directly to hunger in Zambia. In the Kyrgyz Republic groups said, there is no unity in our community. We dont visit each other. In the past, we used to help, pool money (razha) if somebody has a death in the family. We no longer do. In Bosnia-Herzegovina, a resident of the town of Vares said, no one helps anymore. I would gladly help someone, but how, when I am in need of help myself? This is misery. Our souls, our psyches are dead. In many countries youth complained about no place to hang out, to play sports; they linked nothing to do and the absence of sports facilities and community centers to a rise in drug use, alcoholism and theft. Women in Somaliland defined security as when an individual, family or community has no fear for their lives, property or dignity; where there is no security, there is no life. Although there were differences in scale and intensity, the problem of declining public safety as an element of increasing insecurity arose in almost every country, in both rural and urban areas. It was mentioned least often in India, most often in Brazil and Russia. In Sri Lanka, it was an issue of concern primarily to the Tamil minority and, in Somaliland people spoke of increased security after the peace treaty between clans. Elsewhere, increasing crime was linked to breakdowns in social cohesion, difficulties in finding employment, hunger, increased migration, and also to building of roads that allowed strangers to enter communities easily. In every country it was linked to declines in social community, competitiveness and people looking out only for themselves. A startling finding of the Voices was the extent to which poor people experience police as a source not of help and security, but rather of harm, risk and impoverishment. While there were some exceptions, including Zambia, Ethiopia, and Sri Lanka, in many places the police were considered a necessary evil, vigilantes and criminals. In Nigeria, the poor associated the police with illegal arrests, intimidation and extortion; in Bangladesh, the poor feared the police because of false cases that they can bring, especially when the poor try to file cases against the rich. In Brazil the police were rated as the worst institution; the poor said, the criminals have public safety, we do not. In Argentina, the
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poor equated police to rubbish, while women felt vulnerable to sexual assault by police. In Jamaica, the poor said the police lie and steal from the poor. In India, the poor said that the menace of the police had increased many times over, and in Russia, reports about the police and criminals working together were widespread. In Bulgaria, some of the poor said that they did not blame the police as much as the judges and prosecutors who let the criminals go free; others said, if you have connections with the police, you always will get free. On a different scale, civil wars based on clan rivalries and ethnicity in several nations have brought untold suffering to the poor, and even after years of peace life has not returned to pre-war standards. In Sarajevo, Bosnia Herzegovina, one person said, even if I were to establish a household over a hundred years, I would never have what I had if the war hadnt destroyed everything. Life for some was better during the war when there was some humanitarian assistance, but now many people interviewed appeared withdrawn, depressed, irritable, apathetic and not interested in having a conversation. In some areas where factories remained shut down people spoke about the death of the city; Vares is a dead city; the spirit is dead in the city. In Sri Lanka, the Tamil people reported that life was better before 1989, and that concerns about loss of assets and insecurity still prevail. The Singhalese there were concerned about employment, and when some Muslim groups spoke openly about the looting of homes and livestock that had taken place during the violence, the tension between groups became palpable. Households across the world are stressed. As employment and traditional livelihood strategies for poor men disappear, poor women in increasing numbers have had to make their way into the informal sector, primarily in low paying and often menial work -- piece work, vending, petty trading, trading, agricultural labor, collecting garbage, cleaning toilets, and factory employment. In almost every country in the study, both men and women reported womens greater ability to accommodate, bury their pride and do whatever job was available to earn the money to feed the family. This sometimes includes prostitution. In many societies, women working outside the home violate social norms; it can be a source of tension and shame, especially when the primary reason is mens unemployment. In some countries, such as Jamaica, Brazil and Argentina, women have higher levels of education compared to men, making it easier for them to find jobs. Tensions and conflict in the home are pervasive, more acute in some countries than in others. It was reported in the Kyrgyz Republic that unemployed men are frustrated, because they no longer can play the part of the family providers and protectors. They live on the money made by their wives, and feel humiliated because of that. Suicides among men have become more frequent. In Jamaica, men said if you lose your job outside, you lose the job inside, and expressed helplessness at the erosion of their power. In Brazil, a man said, today when a woman earns more than her husband he has to obey her he cannot complain about the kind of work, because it is with this wage that the family is maintained. Women are at the market and men in the kitchen, wryly observed an older woman in Bahsi, Kyrgyz Republic. Some older and younger men said that they secretly helped their wives but were afraid to be seen doing the laundry or sweeping the floors because they would be mocked.
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Both men and women spoke about domestic violence against women, the different forms of violence, and the reasons for it. In some communities physical abuse may have peaked and is on the decline, because of womens willingness to walk out of abusive relations and support themselves and because of women's increased economic power, as well as work done by NGOs to raise awareness. Domestic violence remains widespread, however. In Bolivia, some poor people reported that domestic violence was less acute now than in the past; whereas before men would tie the woman up on the mountain, now household disputes are resolved with just a small scolding. An elderly man in the Kyrgyz Republic commented Before, it was clear that the woman is to keep the house and take care of the family, while the man was earning the daily bread. Now the woman buys and sells stuff irrespective of the weather and earns the income for the family, while the man is sitting at home and takes care of the children, fulfilling the traditional womens work. This is not right, this is not good. In Bangladesh, women living in areas where NGOs have been active said they have greater freedom to move outside the home. Women also reported that over the last ten years the incidence of physical and mental abuse in the family has increased two to three times but the severity of physical abuse has decreased. In Vietnam, there was evidence of widespread wife beating that wife beatings occurred in both a remote minority village as well as a midland, economically integrated village indicates that domestic violence against women cuts across economic and ethnic lines, and may be more widespread than realized. And a woman in Ethiopia noted that Women are beaten at the house for any reason, that may include failure to prepare lunch or dinner for the husband. They may also be beaten if the husband comes home drunk or if he simply feels like it. Negotiating change in deeply rooted, identity-defining roles is not easy. Marriage counselors have emerged as important even in some rural areas in Malawi. In three communities, both men and women rated marriage counselors the third most important institution in their lives. People said without marriage counselors, most of the families could have separated; they are uniting families.
3. Powerlessness The policy of the party is that the people know, the people discuss, the people do, but here people only implement the last part, which is the people do. Ha Tinh, Vietnam. The poor are excluded not from society itself but from the process of benefit distribution and key decision-making. It happens due to the lack of moneyif you dont grease the palm. Ulugbek, Uzbekistan. Participation and the peoples voice have become part of the development lexicon. However, the Voices show that while participation may be happening in the context of poor peoples own organizations, by and large they are excluded from participation in decision-making and in equal sharing of benefits from government and NGO programs. The poor want desperately to have their voices heard, to participate, to make decisions
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and not always be handed down the law from above. They are tired of being asked to participate in other peoples projects on other peoples terms. Participation to them has costs with few returns. In Egypt the poor said, we are tired of self-help initiatives. These initiatives need money, and people are indebted and have other priorities like feeding and educating the children. Organizing is useless and things take a long time to get solved. In Kaoseng, Thailand, the poor called this lack of participation in decisionmaking discussion, meeting, and news announcement. Both poor women and men said, they consult with the powerful individuals, while the poor only found out about decisions when announcements were made. Poor people were asked in the study to list and rank the institutions that played important roles in their lives. Countries in which government institutions were relatively significant included Brazil, India, Malawi, Sri Lanka and Vietnam. In other countries and sites, government institutions were considered important but ineffective, and rarely anywhere near the top ranks. In some sites they did not feature at all. Participants in Chota, Ecuador, said: We are a community abandoned by the governmental authorities. They dont consider us. We seem not to exist, we are an imaginary community. In many countries, the poor ranked government-provided social assistance as important, if not always honest or effective. This included, for example, Plan Vida in Argentina; fair price ration shops in India; samurdhi in Sri Lanka; and entitlements for the elderly, children and the disabled in the former Soviet Union countries. Sometimes, and almost always with the police, government institutions were rated as having negative impacts. In Latin American countries, in South Asia, and to a lesser extent in Africa, NGOs featured in peoples rankings. But what mattered most were peoples own local organizations, including unions, farmers associations, credit groups, midwives, traditional institutions and networks. Religious institutions, such as the sacred tree or mountain or river, the mosque, the church, or the temple were consistently rated high in importance and trust. The Voices reveal that in much of todays world there is a hunger among the poor, not only for food, but for freedom, dignity, voice and choice. The poor in Morro da Conceio, Brazil said, the responsibility for the problem is 90% on the government, but we vote badly, we do not monitor, we dont demand our rights, and are not active to demand a correct action by the government. With the advent of political reform in Indonesia, the poor in some areas are beginning to protest against exclusion and corruption at the local level. In the village of Galih Pakuwon, for example, they are demanding fairer compensation for land acquired by force for a housing project; in Tangoing Redo, the neighborhood chief who embezzled money was forced to step down; and in Padamukti, the village head who sold the common land contributed by villagers to build toilets was forced to resign. In Jamaica, a young woman said, the government let us down, too many promises - never fulfilling themwe want to have more influence over government. In Bosnia-Herzegovina, a young man said, I still dont believe in the veracity of elections, but I always vote. It is necessary to work for democracy. And it is necessary to make accountable those who even today create chaos so that they will get richer.
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4. Insecure Livelihood Everyday there are more unemployed, every day one sees more men around the neighborhood. Argentina. We go for additional manual work because the income from our cultivation and animal husbandry is not sufficient. Sri Lanka. Young healthy guys are wandering around doing nothing all winter because they only have seasonal work. Kyrgyz Republic. There is great insecurity now. You cant make any plans. For all I know, tomorrow I might be told that well be laid off for a couple of months or that the factory is to shut down. We work three days a week even now, and youre in for a surprise every day. Bulgaria. She is worried about the future of her children and the struggles they have to face when they grow up. Her immediate concern is to which house she should go for a loan of some food grains for their food that day. An interview with a poor woman, India. The poor typically have few assets to make a living. Livelihood strategies are precarious and include a patchwork of low paying, dangerous, often backbreaking work for low returns. All over the world, even where poverty has decreased, such as in Vietnam and in Sri Lanka, the poor said that insecurity had increased. Excepting a few communities in Sri Lanka, India and the Kyrgyz Republic, the poor also said that economic opportunities had decreased. Most blamed governments for mismanaging the economy and for high taxes, inflation and privatization; declining agricultural productivity and declines in affordability of agricultural inputs; lack of cheap credit; corrupt government services; or simply lack of government care for the poor. Livelihood strategies for the poor are primarily in the informal sector, and are sometimes illegal. People survive through an enormously wide range of activities small-time vending, doing odd jobs, carrying brick and sand, working in quarries and mines, shuttling (the name given to constant movement while trading in Eastern Europe), borrowing from neighbors and moneylenders, working two or three jobs, growing vegetables on little plots, returning to subsistence agriculture in countries such as Bulgaria, Russia and the Kyrgyz Republic, collecting grass, herbs, and bamboo shoots, catching wild animals, selling cooked food, making crafts, working in factories, begging, washing blankets and carpets, putting children to work, praying for rain, selling assets one by one, surrendering to prayer, reducing the number of meals, changing their diet, selling their own blood, and in desperation engaging in criminal activities, including prostitution.
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Everywhere, poor people equated poverty and insecurity with lack of assets, which results in their lacking the ability to cope with income fluctuations and shocks. Lack of access to credit from formal lenders was cited with astonishing frequency. In Vietnam the poor said they either did not qualify for loans or were turned down: while the rich get loans, the poor get consideration of loans. In the absence of usable formal credit, people turn to friends and moneylenders. Moneylenders appeared frequently on the list of most important institutions in peoples lives, despite the fact that they charge high interest and insist on repayment. In Ethiopia, young men considered the moneylender their only hope for starting a business. In Sri Lanka, Indonesia, Vietnam, Bangladesh, India, and Egypt, the poor turn to moneylenders who give loans for consumption, who dont have bothersome procedures and who allow payments to be made in kind, including in labor. Many poor people said that they stayed away from microcredit loans because of their collateral requirements, lengthy application processes and difficult payment terms, including in many cases the need to start repayments immediately. With few assets, stressed family networks, problems in agriculture, and dismal job prospects, it is exceptionally difficult for the poor to be upwardly mobile. In the communities where the Voices took place, the researchers documented case studies of individuals who had managed to become better off. A review of 147 of these upwardly mobile people revealed that self-employment or entrepreneurship was their most frequent path out of poverty. This was followed by income from wages and salaries, benefits from family, and income from agriculture and access to land. Acquisition of multiple assets helped people cope with the inevitable stresses and shocks of life. Approximately one third of the upwardly mobile people managed income flows from all these sources. Skills acquisition, learning to run a business, or learning particular skills were mentioned in 27% of the case studies. Education was mentioned by only 15% of the individuals interviewed with strong regional differences; between 20% and 30% in Latin America and countries of the former Soviet Union; and between 4% and 7% in Africa and Asia. This relatively low contribution of education was echoed in poor peoples generally ambivalent attitude about education. In most countries, the poor value education as a potential route out of poverty. But sending a child to school can imply serious costs, both in terms of school fees, clothes, supplies and in the form of income loss. In several countries of the former Soviet Union the phenomenon of paying for education is new and, when combined with economic hardship, is having bad effects on childrens school attendance. Despite their belief in the potential value of education, the poor sometimes question its quality, language of instruction and relevance to employment. ***** What emerges from the collective voices of the poor is their remarkable resilience, hard work and grit. A young widow in India was perhaps typical, saying: Even at times of acute crises, I held my nerves and did not give in to circumstances. My god has always stood with me.
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References Ades, Alberto F. and Edward L. Glaeser. 1999. "Evidence on Growth, Increasing Returns and the Extent of the Market". Quarterly Journal of Economics 114(3):10251046. Bruno, Michael, Martin Ravallion and Lyn Squire. 1998. "Equity and Growth in Developing Countries: Old and New Perspectives on the Policy Issues", in Income Distribution and High-Quality Growth (edited by VitoTanzi and Ke-young Chu), Cambridge, Mass: MIT Press. Currie, J.; Harrison, A. 1997. "Sharing the costs: The impact of trade reform on capital and labor in Morocco", in Journal of Labor Economics, Vol. 15, No. 3, July, pp. S44S71. Deininger, Klaus and Lyn Squire. 1996. A New Data Set Measuring Income Inequality. [www.worldbank.org/growth/dddeisqu.htm] Demery, Lionel and Michael Walton. 1998. Are Poverty Reduction and Other 21st Century Social Goals Attainable? Washington, D.C.: World Bank. [www.worldbank.org/poverty/library/demwalt.htm] DAC/ OECD (Development Assistance Committee of the Organization for Economic Co-operation and Development). 1996. Shaping the 21st Century. Paris: Organization for Economic Co-operation and Development. [www.oecd/org/dac/Indicators/htm/stc.htm] Development Committee (Joint Ministerial Committee of the Boards of Governors of the World Bank and the IMF on the Transfer of Real Resources to Developing Countries). 2000. "Intensifying Action Against HIV/AIDS: Responding to a Development Crisis". Washington D.C.: Development Committee. [wbln0018.worldbank.org/dcs/devcom.nsf] Dollar, David and Aart Kraay. 2000. "Growth Is Good for the Poor". World Bank, Development Research Group. [www.worldbank.org/research/growth/absddolakray.htm] Filmer, Deon. 1999. "The Structure of Social Disadvantage in Education: Gender and Wealth," Gender and Development Working Paper No. 3 May 1999. The World Bank. [www.worldbank.org/research/projects/edattain/edattain.htm] Filmer, Deon and Lant Pritchett. 1999. "The Effect of Household Wealth on Educational Attainment: Evidence from 35 Countries Population and Development Review 25(1). [www.worldbank.org/research/projects/edattain/edattain.htm]
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Guillot, Michel, Davidson Gwatkin and Patrick Heuveline. 1999. The Burden of Disease Among the Global Poor. London : The Lancet, Volume 354, Number 9178. Gwatkin, Davidson R. 1999a. "Burden of Disease among the Global Poor." London: The Lancet, Volume 354, pp. 586-9. _____. 1999b. Poverty and Inequalities in Health Within Developing Countries. Washington, D.C.: World Bank. _____, forthcoming. "Reducing Health Inequalities in Developing Countries" in Oxford Textbook on Public Health. Oxford: Oxford University Press. IMF, OECD, UN and World Bank, 2000. A Better World for All. [www.paris21.org/betterworld ] Kakwani, Nanak 1993. Poverty and Economic Growth with Application to Cte d'Ivoire. Review of Income and Wealth 39: 121-39. Manuelyan Atinc, Tamar and Michael Walton. 1998. Social Consequences of the East Asian Financial Crisis. Washington, D.C.: World Bank. [www.worldbank.org/poverty/eacrisis/library/socconsq/index.html McCarthy F. Desmond, Holger Wolf, and Yi Wu. 2000. "Malaria and Growth". Policy Research Working Paper 2303. Washington, D.C.: World Bank. [wbln0018.worldbank.org/research/workpapers.nsf/policyresearch?openform] Narayan , Deepa, Robert Chambers, Meera Kaul Shah and Patti Petesch. 2000. Voices of the Poor: Crying Out for Change. New York, N.Y: Published for the World Bank, Oxford University Press. [www.worldbank.org/poverty/voices/reports.htm] Narayan, Deepa, Raj Patel, Kai Schafft, Anne Rademacher and Sarah Koch-Schulte. 2000. Voices of the Poor: Can Anyone Hear Us? New York, N.Y: Published for the World Bank, Oxford University Press. [www.worldbank.org/poverty/voices/reports.htm] Narayan, Deepa and Patti Petesch, forthcoming. Voices of the Poor: From Many Lands. New York, N.Y: Published for the World Bank, Oxford University Press. [www.worldbank.org/poverty/voices/reports.htm] Pritchett, Lant. 1997. "Divergence, Big Time". Journal of Economic Perspectives 11 (3): 3-17. Pritchett, Lant, Yusuf Suharso, Sudarno Sumarto and Asep Suryahadi. 2000. "The Evolution of Poverty during the Crisis in Indonesia, 1996 to 1999 (Using Full Susenas Sample)". Jakarta, Indonesia: Social Monitoring and Early Response Unit (SMERU). [www.smeru.or.id/data/report/report.asp]
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Ravallion, Martin. 1997. Can High Inequality Developing Countries Escape Absolute Poverty? Economics Letters 56: 51-57. _____. 1999. On Decomposing Poverty into Growth and Redistribution Components. World Bank, Development Research Group, Washington, D.C. Ravallion, Martin and Shaohua Chen. 1997. "What Can New Survey Data Tell Us About Recent Changes in Distribution and Poverty?" World Bank Economic Review. 11: 357-82. [Abstract available at www.worldbank.org/html/extpb/ review/revmay97.htm#Survey] _____. 1998. Growth Rates Needed to Halve the Poverty Rate in 25 Years. Washington, D.C.: World Bank, Development Research Group. _____. 1999. When Economic Reform Is Faster than Statistical Reform: Measuring and Explaining Inequality in Rural China. Oxford Bulletin of Economics and Statistics 61: 33-56. _____. 2000. How Did the World's Poorest Fare in the 1990s?" Washington, D.C.: World Bank, Development Research Group. [www.worldbank.org/research/povmonitor/method.htm] Ravallion, Martin, and Gaurav Datt. 1999. When Is Growth Pro-Poor? Evidence from the Diverse Experience of Indias States. Policy Research Working Paper. World Bank, Washington, D.C. Revenga, Ana. 1995. "Employment and Wage Effects of Trade Liberalization: The Case of Mexican Manufacturing." Policy Research Working Paper 1524. Washington, D.C.: World Bank. [http://www.worldbank.org/html/dec/Publications/Workpapers/wps1524abstract.html] Stephens, Carolyn, Marco Akerman, Sebastian Avle, Paulo Borlina Maia, Paulo Campanario, Ben Doe and Doris Tetteh. 1997. "Urban Equity and Urban Health: Using Existing Data to Understand Inequalities in Health and Environment in Accra, Ghana, and So Paulo, Brazil." Environment and Urbanization, Vol. 9, No.1. UNAIDS/ WHO (Joint United Nations Programme on HIV/ AIDS and World Health Organization). 2000. AIDS Epidemic Update: December 2000. [http://www.unaids.org/epidemic_update/report_dec00/index_dec.html] UNESCO. 2000. Education for All 2000 Assessment: Statistical Document. [www2.unesco.org/wef/en-docs/findings/efastatdoc.pdf]
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Wagstaff, Adam. 1999. Inequalities in Child Mortality in the Developing World: How Large Are They? How Can They Be Reduced? World Bank, Human Development Network, Washington, D.C. _____. 2000. "Socioeconomic Inequalities in Child Mortality: Comparisons Across Nine Developing Countries." Bulletin of the World Health Organization, 2000, 78 (1). [www.who.int/bulletin/tableofcontents/2000/vol.78no.1.html] _____ and Naoko Watanabe. 2000. Socioeconomic Inequalities in Child Malnutrition in the Developing World World Bank, Human Development Network, Washington, D.C. [econ.worldbank.org/docs/1189.pdf] Watkins, Kevin. 1999. Education Now: Break the Cycle of Poverty. Oxfam International. [www.oxfam.org/educationnow/] Wodon, Quentin, R. Ayres, M. Barenstein, N. Hicks, K. Lee, W. Maloney, P. Peeters, C. Siaens, and S. Yitzhaki. 2000. Poverty and Policy in Latin America and the Caribbean. Washington, D.C.: World Bank. [wbln0018.worldbank.org/external/lac/lac.nsf] World Bank. 1990. World Development Report 1990: Poverty. New York: Oxford University Press. _____. 1993. World Development Report 1993: Investing in Health. Washington, D.C.: World Bank. _____. 1996. Poverty Reduction and the World Bank: Progress and Challenges in the 1990s. Washington, D.C.: World Bank. _____. 1997. Confronting AIDS: Public Priorities in a Global Epidemic. Washington, D.C.: World Bank. [www.worldbank.org/aids-econ/confront/confrontfull/] _____. 1999a. Global Economic Prospects and the Developing Countries 2000, Washington, D.C.: World Bank. [www.worldbank.org/prospects/gep2000/] _____. 1999b. Update on Poverty in the Kyrgyz Republic. Washington, D.C.: World Bank. _____. 1999c. Vietnam Development Report 2000: Attacking Poverty. Washington, D.C.: World Bank. _____. 1999d. Moldova: Poverty Assessment. Washington, D.C.: World Bank. _____. 2000a. World Development Indicators 2000. Washington, D.C.: World Bank. [www.worldbank.org/data/wdi2000/]
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Annex I. Poor-Rich Inequalities in Access to Different Types of Health Care Immunization rates (children 12-23 months)
100 72.6 69.2 67.9 80 60 35.0
Treatment of acute respiratory infection

80 62.6 54.1 57.5 56.8 All countries 34.2
60
56.5
42.3
39.7
37.9
40 20 0
20
Sub-Saharan Africa
Asia, Near East Latin America & & North Africa Caribbean
All countries
Sub-Saharan Africa
Poorest population quintile
Richest population quintile
Use of oral rehydration therapy
Deliveries attended by a medically trained person

83.7 84.0 All countries 100 94.4 75.4 40.3
100 76.4 80 56.9 48.8 60 40 20 0 Sub-Saharan Africa Asia, Near East Latin America & & North Africa Caribbean All countries 71.3
63.9
64.0
80 60 40 20 0 Sub-Saharan Africa 25.7
51.6
54.1
28.8
40
32.4
36.5
25.6
Source: World Bank's Country Reports on Health, Nutrition, Population, and Poverty (www.worldbank.org/poverty/health/data/index.htm).
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28.9
Grade
10
12
Median grade completed by 15 to 19 years olds in the the poorest 40 percent
Annex II: Median grade completed by 15 to 19 year olds in the richest and poorest households
Gap in the median grade completed by 15 to 19 year olds from the richest 20 percent and the poorest 40 percent
61
May, 2001
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Poverty Trends and Voices of the Poor

Fourth edition May 2001

Poverty Reduction and Economic Management/ Human Development/ Development Economics

The World Bank Group