The World Health Organization states “major depression is now the leading cause of disability globally and ranks fourth in the ten leading causes of the global burden of disease” (World Health Report, 2001). Developing countries, especially those burdened with disease and caught in violent conflict are the ones suffering the most. “Today, some 450 million people suffer from a mental or behavioral disorder, yet only a small minority of them receive even the most basic treatment” (World Health Report, 2001). This number will continue to rise without proper support for the people who need it and only increase the deficits in already impoverished countries.
Millennium Development Goal number one looks to “eradicate extreme poverty and hunger” through programs that focus on “combat[ing] child malnutrition” and among other projects, increasing access to physical health services (Health and the Millennium Development Goals, 15). However, there is a lack of development in access to mental health services, a cyclical issue that binds itself with poverty. Both the World Health Organization (WHO) and the International Union for Health Promotion and Education (IUHPE) show strong correlations between poverty and mental illness.
According to the IUHPE “mental health promotion and disease prevention can progress strongly, and there is an urgent need for it to do so. Already, “up to one in five adults suffer a mental disorder, of one kind or another” and “mental health promotion results in widespread economic benefits and shows cost-effective outcomes” (IUHPE, 2000). The World Health Organization also states “the poor and the deprived have a higher prevalence of mental and behavioral disorders, including substance use disorders” and “this higher prevalence may be explained both by higher causation of disorders among the poor and by the drift of the mentally ill into poverty” (World Health Report, 2001). It is evident that poverty and mental illness are tightly woven into each other and must be jointly addressed to make a substantial difference. Unfortunately, there are many other factors that contribute to the cyclical nature of mental illness and poverty, which can hinder progress and take away from the focus of mental health in a country of concern.
HIV/AIDS, Tuberculosis and Malaria are of great concern to developing countries. These and other diseases can be a factor in the initial cause of much of the poverty and mental illness, and further perpetuate already existing problems within the affected communities. The Organization for Economic Co-operation and Development (OECD) state that “developing a public and private-sector services that are of good quality and responsive to the health needs and demands of poor people is a priority, necessitating a focus on those diseases – such as malaria, TB, and HIV/AIDS – that affect the poor disproportionately” (OECD, 2003). The call to action to eradicate these devastating diseases by world governing powers is wonderful. However, without groups dedicated to taking action against mental illnesses we fall short on our words, and let the cycle of poverty and diseases continue to flourish.
Thankfully groups like the Joint United Nations Program on HIV/AIDS (UNAIDS) and the Global Fund to Fight AIDS, Tuberculosis and Malaria do take “global action” in developing policies, strategies, and allocating resources to countries in need (United States Mission, 2004). For example, the Global Fund to Fight AIDS, Tuberculosis and Malaria “was created to dramatically increase resources to fight three of the world’s most devastating diseases and to direct those resources to areas of greatest need” (The Global Fund to Fight AIDS, Tuberculosis and Malaria, 2007). Though the outcomes generated by these groups are substantial, there are still pieces that are missing in addressing and treating mental illnesses and disorders that can accompany a country or community affected by these diseases.
For example, the World Health Organization states that “in 16 countries of sub-Saharan Africa more than 10% of the population of reproductive age [are] now infected with HIV” and that “the HIV/AIDS epidemics has lowered economic growth and is reducing life expectancy by up to 50% in the hardest hit countries” (World Health Report, 2001). This in turn prompted the World Health Organization to mention that “the psychological effects on members of families broken and children orphaned by AIDS have not been studied in any detail, but are likely to be substantial” (World Health Report, 2001). This further shows the lack of resources going directly to supporting mental health in developing countries.
Another factor that substantially shapes the mental health and poverty of a country is whether or not it has been, or is involved in violent conflict.
Such situations take a heavy toll on the mental health of the people involved…between a third and half of all the affected persons suffer from mental distress. The most frequent diagnosis made is post- traumatic stress disorder (World Health Report, 2001).
Part of the criteria for a patient to be diagnosed with post-traumatic stress disorder is “ the patient must have been exposed to a stressful event or situation (either short- or long-lasting) of exceptionally threatening or catastrophic nature, which would be likely to cause pervasive distress in almost anyone” (ICD-10, 1993). Sierra Leone is an example of a developing country caught in recent conflict that has most likely left many with an array of mental disorders. The conflict also lead to “the government’s refusal to do more to address crushing poverty in the face of high unemployment among young adults and continuing insecurity within the sub-region renders Sierra Leone vulnerable to future instability” (Human Rights Watch, 2006). Conflict can have a profound impact on peoples’ mental health and at the same time the severity of poverty they must face.
There is hope however, thanks to groups who help refugees and internally displaced people like the United Nations High Commissioner for Refugees (UNHCR). They aid over “20.8 million people in 116 countries” and provide adequate services that meet all the required basic human needs (UNHCR, 2006). But even with all this aid and support to countries dealing with disease, disaster and conflict, there is still the major disparity that is mental illness. Currently “mental and behavioral disorders are estimated to account for 12% of the global burden of disease, yet the mental health budgets of the majority of countries constitute less than 1% of their total health expenditures. More than 40% of countries have no mental health policy and over 30% have no mental health programme” (World Health Report, 2001). To substantially change the lives of people in developing countries affected by mental illness, there will need to be more concrete programs available to them. It is necessary to address mental disorders directly in developing countries to improve the overall quality of life and diminish the vicious cycle that binds these people to poverty and inadequate health.
References
Global Fund to Fight AIDS, Tuberculosis and Malaria, The (2007). Who we are what we do. Geneva, Switzerland: The Global Fund to Fight AIDS, Tuberculosis and Malaria.
Human Rights Watch (2006). World report 2006: Events of 2005. New York, NY: Seven Stories Press.
International Union for Health Promotion and Education (2000). The evidence of health promotion effectiveness: Shaping public health in a new europe. Paris, France: Jouve Composition & Impression.
Organisation for Economic Co-Operation and Development (OECD) World Health Organization (2003). DAC guidelines and references series: Poverty and health. Geneva, Switzerland: OECD Publications.
United States Mission to the United Nations in Geneva, The (2004). The briefing book on international organizations in Geneva. Geneva, Switzerland: AGL.
World Health Organization, The (2001). Mental Health: New understanding, new hope. Geneva, Switzerland: The World Health Organization.
World Health Organization, The (2003). The icd-10 classification of mental and behavioral disorders: Diagnostic criteria for research. Geneva, Switzerland: The World Health Organization.
World Health Organization, The (2005). MDG: Health and the millennium development goals. Geneva, Switzerland: The World Health Organization.
United Nations High Commissioner for Refugees, The (2006). Helping refugees: An introduction to UNHCR. Geneva, Switzerland: UNHCR Media Relations and Public Information Service.