What do national poverty lines tell us about global poverty?

The basic question about ‘how many poor people are there in the world?’ generally assumes that poverty is measured according to international poverty lines (IPLs). Yet, an equally relevant question could be ‘how many poor people are there in the world, based on how poverty is defined where those people live?’ In short, rather than a comparison based on monetary values, the latter question is germane to estimates based on a concept – ‘poverty’ – as defined by countries’ specific circumstances and institutions. Estimates of poverty by national poverty lines (NPLs) and international poverty lines (IPLs) may vary in terms of technical grounds. But how similar are they? How different is poverty captured by comparable (in PPP monetary value) cross-country measures as embodied by the IPL compared to that viewed in NPLs? This paper offers a new perspective on global poverty. It does so by estimating the distribution of poverty across countries, regions and income categories based on national poverty lines (NPLs). Even though comparing NPLs across countries means comparing poverty lines of different monetary value, we argue that exploring “poverty” as a nationally defined concept by countries at different stages of development unveils important and often unnoticed findings. By addressing the question of poverty as defined where those poor people live, this paper seeks to offer a new perspective on global poverty and at the same time extend thinking on the ‘middle-income countries poverty paradox’ – meaning that most of the world’s poor do not live in the world’s poorest countries Using data from 160 countries covering nearly 92 per cent of world population, we estimate that globally 1.5 billion people live in poverty as defined within their own countries (by NPLs), a billion of which are in middle-income countries (MICs) and - surprisingly perhaps - one in ten of world’s poor live in high-income countries (HICs). Our analysis shows that NPL and IPL-based estimates lead to similar poverty estimates only in a limited number of cases. In particular, we conclude that (i) there is a considerable difference between regional and national poverty estimates based on IPLs and NPLs – that is, differences for a same country could be as high as 55 percentage points in poverty rates, or about 45 million in the number of poor people; (ii) NPLs may be particularly important for analysis of poverty in MICs: indeed, their NPLs don’t feed into the construction of IPLs. Hence, poverty at national level may not be adequately captured by IPLs themselves; (iii) NPLs are not substitutes for IPLs, but instead enrich and complement international analyses. Yet, there could be trade-offs between the two, especially in terms of different development actors tracking different poverty estimates. Our findings also have implications for debates about global poverty targets and international assistance. Keywords: poverty; inequality; aid; Middle-Income; Low-Income Countrie

Prevalence of severe mental distress and its correlates in a population-based study in rural south-west Uganda

BACKGROUND: The problem of severe mental distress (SMD) in sub-Saharan Africa is difficult to investigate given that a substantial proportion of patients with SMD never access formal health care.This study set out to investigate SMD and it's associated factors in a rural population-based cohort in south-west Uganda. METHODS: 6,663 respondents aged 13 years and above in a general population cohort in southwestern Uganda were screened for probable SMD and possible associated factors. RESULTS: 0.9% screened positive for probable SMD. The factors significantly associated with SMD included older age, male sex, low socio-economic status, being a current smoker, having multiple or no sexual partners in the past year, reported epilepsy and consulting a traditional healer. CONCLUSION: SMD in this study was associated with both socio-demographic and behavioural factors. The association between SMD and high risk sexual behaviour calls for the integration of HIV prevention in mental health care programmes in high HIV prevalence settings

Post-conflict mental health needs: a cross-sectional survey of trauma, depression and associated factors in Juba, Southern Sudan

BACKGROUND: The signing of the Comprehensive Peace Agreement in January 2005 marked the end of the civil conflict in Sudan lasting over 20 years. The conflict was characterised by widespread violence and large-scale forced migration. Mental health is recognised as a key public health issue for conflict-affected populations. Studies revealed high levels of post-traumatic stress disorder (PTSD) amongst populations from Southern Sudan during the conflict. However, no studies have been conducted on mental health in post-war Southern Sudan. The objective of this study was to measure PTSD and depression in the population in the town of Juba in Southern Sudan; and to investigate the association ofdemographic, displacement, and past and recent trauma exposure variables, on the outcomes of PTSD and depression. METHODS: A cross-sectional, random cluster survey with a sample of 1242 adults (aged over 18 years) was conducted in November 2007 in the town of Juba, the capital of Southern Sudan. Levels of exposure to traumatic events and PTSD were measured using the Harvard Trauma Questionnaire (original version), and levels of depression measured using the Hopkins Symptom Checklist-25. Multivariate logistic regression was used to analyse the association ofdemographic, displacement and trauma exposure variables on the outcomes of PTSD and depression. Multivariate logistic regression was also conducted to investigate which demographic and displacement variables were associated with exposure to traumatic events. RESULTS: Over one third (36%) of respondents met symptom criteria for PTSD and half (50%) of respondents met symptom criteria for depression. The multivariate logistic regression analysis showed strong associations of gender, marital status, forced displacement, and trauma exposure with outcomes of PTSD and depression. Men, IDPs, and refugees and persons displaced more than once were all significantly more likely to have experienced eight or more traumatic events. CONCLUSION: This study provides evidence of high levels of mental distress in the population of Juba Town, and associated risk-factors. Comprehensive social and psychological assistance is urgently required in Juba

The influence of demographic characteristics, living conditions, and trauma exposure on the overall health of a conflict-affected population in Southern Sudan

BACKGROUND: There remains limited evidence on how armed conflict affects overall physical and mental well-being rather than specific physical or mental health conditions. The aim of this study was to investigate the influence of demographic characteristics, living conditions, and violent and traumatic events on general physical and mental health in Southern Sudan which is emerging from 20 years of armed conflict. METHODS: A cross-sectional survey of 1228 adults was conducted in November 2007 in the town of Juba, the capital of Southern Sudan. Multivariate linear regression analysis was used to investigate the associations and relative influence of variables in three models of demographic characteristics, living conditions, and trauma exposure, on general physical and mental health status. These models were run separately and also as a combined model. Data quality and the internal consistency of the health status instrument (SF-8) were assessed. RESULTS: The variables in the multivariate analysis (combined model) with negative coefficients of association with general physical health and mental health (i.e. worse health), respectively, were being female (coef. -2.47; -2.63), higher age (coef.-0.16; -0.17), absence of soap in the household (physical health coef. -2.24), and experiencing within the past 12 months a lack of food and/or water (coef. -1.46; -2.27) and lack of medical care (coef.-3.51; -3.17). A number of trauma variables and cumulative exposure to trauma showed an association with physical and mental health (see main text for data). There was limited variance in results when each of the three models were run separately and when they were combined, suggesting the pervasive influence of these variables. The SF-8 showed good data quality and internal consistency. CONCLUSIONS: This study provides evidence on the pervasive influence of demographic characteristics, living conditions, and violent and traumatic events on the general physical and mental health of a conflict-affected population in Southern Sudan, and highlights the importance of addressing all these influences on overall health

Protracted crisis, food security and the fantasy of resilience in Sudan

In the past decade, food security and nutrition practices have become central in the promotion of resilience in protracted crises. Such approaches have been welcomed by the aid community because of their potential for linking relief and development. Social and political analysts, however, have criticized resilience approaches for failing to consider power relations and because they entail an acceptance of crisis or repeated risk. In this context, regimes of food security and nutrition practices have become increasingly targeted, privatized and medicalized, focussing on individual behaviour and responsibility rather than responsibility of the state or international actors. This article uses examples from Sudan to examine how and why the resilience ‘regime of practices’ has functioned as a form of neoliberal governmentality, and argues that it has created a fantasy in which conflict in Darfur is invisible. This allowed food aid to be withdrawn and removed the need for protection despite ongoing conflict and threats to livelihoods; thus crisis-affected populations have been abandoned