A sweeping new review of poverty by a Duke University researcher who spent the past decade studying more than 35,000 households on four continents says policymakers are focusing too much on new ideas for lifting people out of poverty instead of coming to terms with why billions of people became poor in the first place.
"It seems almost as if we have taken it for granted that all poor people are born poor -- which they are not," writes Anirudh Krishna, whose team spent the past decade conducting thousands of interviews in nearly 400 diverse communities around the world. "A large proportion of currently poor people were not born to poverty; they have become poor within their lifetimes."
His new book, "One Illness Away: Why People Become Poor and How they Escape Poverty" (Oxford University Press), calls on government officials, economists and others to pay more attention to the everyday lives and ordinary events that underlie poverty. Beyond country-level statistics and political headlines that grab attention, he says, people in barrios and remote villages are confronting challenges whose solutions may not lie with economic growth alone.
By way of example, Krishna tells the story of Kadijja, a Ugandan woman who worked with her husband in a coffee-processing plant. The couple owned a house and sent their children to private school. Then the husband died in a road accident, for which Kadijja received no compensation even as she paid for his costly funeral. Five years later, she lost her job when a disease devastated the local coffee crop. Then her son became ill, causing her to sell her cows and goats, and finally her land, to pay his medical bills. He died anyway. Now Kadijja lives with her daughter, depending on odd jobs.
Poverty unfolds every day with stories like Kadijja's as individuals are overwhelmed by illness, debt, drought and other pressures, according to Krishna, an associate professor of public policy and political science at Duke's Sanford School of Public Policy.
"No universal solvent exists that can ‘fix' poverty," he says. "We need to learn more about accelerating growth, but we also need to learn more about macro-micro links and about grassroots-level opportunities and threats."
The factors that drive individuals into poverty vary from place to place, although unexpected illnesses are a major cause almost every place where health care resources are lacking, Krishna says. Expensive funerals and weddings are common in some countries, while high-interest debt is more of a problem elsewhere.
Concepts such as "poverty level" inadequately capture the lives of those affected, since someone earning a penny above a poverty level of one dollar per day fares little better than a neighbor earning a penny below the level. Too often, Krishna says, such statistics mask the harsh realities facing those living at the margins.
"Commentators who applaud the rapid economic strides taken by China and India should take note of the large-scale human tragedies that are occurring in parallel," he writes. "The official Chinese news media are regularly filled with accounts of the desperate choices that people are regularly forced to make over health care, of brothers who must draw lots to see whose serious illness will be treated because their family cannot afford to treat both, or of a father who sells a kidney to treat an ill son. A similarly grim picture is emerging in many other developing countries."
Working with other scholars, Krishna has developed a methodology to understand poverty from the perspective of the poor themselves, highlighting the pathways by which their lives change. "New tactics are required along with new methods of investigation," he writes. "The thrust and direction of targeting policy has to change. In the past, programs have focused attention on whom to target, ignoring what to target, which is a mistake."
Few people become or remain poor because of alcoholism, drug use or idleness, according to Krishna, who says "laziness is not particularly a trait of those who are poor." What's more common is people succumbing to dangers that are largely preventable.
Even when they do escape the starkest poverty, they are unlikely to rise much higher. "Raising a mass of people out of poverty is certainly a praiseworthy achievement -- but it is hardly enough," he writes. "Imagine if someone like Einstein had been born into poverty. Would it be a sufficient achievement to raise him to day laborer?"
Some nations have succeeded in counteracting the factors within their borders that lead people to become or remain poor, according to Krishna. He cites countries as diverse as Costa Rica, Cuba, Thailand, Malaysia and Colombia that established health care systems that help citizens avoid financial ruin from illnesses. The Grameen Bank in Bangladesh, founded by Nobel laureate Muhammad Yunus, has shown how to combine innovative financial programs with effective social initiatives. Similarly deliberate actions on a wider scale helped Japan reduce its poverty rate to 2 percent, much lower than the U.S. rate of more than 13 percent, he argues.
"Waiting until someone has fallen into poverty is hardly the time when assistance can or should be provided," writes Krishna, who recently returned to Durham after another summer of research overseas. "Preventive assistance must become the norm. In parallel, efforts must be made to substantially augment the prospects for upward mobility. By addressing descents directly and effectively, and at the same time, by promoting more and better pathways for escape, we will be able to make faster progress against poverty than we have at any time in the past."
By telling the dramatic stories of individuals affected by these pathways, Krishna puts a human face on a subject he plans to keep studying with his colleagues and students.