Sub-Saharan Africa (SSA) remains the region most adversely affected by HIV/AIDS epidemic, accounting for about 70 percent of the global burden, despite the region accounting for just 13 percent of the global population. Of the global total of 37.7 million people living with HIV at the end of 2020, about two-thirds were in SSA. A link has often been made between poverty and the spread of HIV but the relationship remains complex. For a long time, it was believed that poverty drives the HIV epidemic, particularly in SSA. This argument seemed consistent with the statistics on the global burden of HIV attributable to SSA which is the world’s poorest region. Indeed, in 1997, a World Bank report stated that "widespread poverty and unequal distribution of income that typify underdevelopment appear to stimulate the spread of HIV“. However, most empirical evidence appeared to suggest the contrary. This talk is based on recent work in an effort to better understand the intricate link between HIV and poverty in SSA. It will (i) highlight an urban/rural divide in the relationship, showing a disproportionate risk of HIV among the urban poor; (ii) propose plausible theoretical explanations of the poverty-HIV link with respect to the theory of economics of sexual behaviour and social capital theory; and (iii) share recent findings on the effect of interactions between HIV and poverty on other reproductive health outcomes (i.e. teenage childbearing and contraceptive uptake) in SSA. The current pandemic is expected to have heightened vulnerability for people living with HIV and/or in poverty. This talk will conclude with some deliberations on emerging evidence of the disproportionate impact of Covid-19 on people living with HIV and/or in poverty, especially in SSA and other resource poor settings.
Food insecurity, defined as “the inability to acquire or consume an adequate quality or sufficient quantity of food in socially acceptable ways, or the uncertainty that one will be able to do so” (Radimeret al., 1992; Thompson et al., 2012), poses a major threat to the health status of populations. Economic uncertainty related to the COVID-19 pandemic and energy crisis caused by the current war, harsh climate conditions, limited agricultural resources, food waste, and the potential implications for food prices and food affordability, highlight existing systemic weaknesses in international food and nutrition security. Food crises have a particularly devastating impact on the poorest and most vulnerable people. Whereas, in the developing world, a typical poor family spends about two-thirds of its income on food, in Europe, the proportion of per capita spending on food is 15-17%. Experiencing food insecurity is strongly associated with increased risk of developing obesity, diabetes, coronary heart disease, chronic kidney disease, and obstructive pulmonary disease. On the one hand, this is the consequence of a high consumption of cheaper, energy-dense but nutrient-poor foods that contain more fats and low-molecular-weight carbohydrates and lower consumption of fruits and vegetables. On the other hand, chronic stress from food insecurity can stimulate the release of glucocorticoids, increasing visceral fat accumulation and storage, and boost cortisol levels, increasing blood glucose and insulin resistance, which play a role in the development of type 2 diabetes. Furthermore, alternating episodes of food availability and scarcity can cause binge eating patterns and subsequently increases the risk of being obese. In contrast, chronic diseases themselves can contribute to food insecurity, because of higher health care expenditures or lower household income due to the inability to work. Food insecurity is recognized as an important social determinant of health maintenance and screening for it should be emphasized to identify groups experiencing food insecurity for targeted interventions.
Living in poverty is a daily struggle. Lacking the financial means to sustain oneself has widespread effects on families, communities and even wider society. What is often less discussed are the psychological effects of poverty. This is short-sighted, as economic, social, and individual processes are closely interlinked. Not being able to satisfy basic health needs, to eat or live satisfactorily, affects how people think, feel, and act – in their private life but also their workplaces and wider community. This contribution will illustrate the link between a person’s material circumstances and their thoughts, emotions and behaviors. This is important to understand, as people’s perceptions will impact their capacity to cope with, or even progress out of poverty. Psychologically, poverty is a major stressor. Money worries – and worries about inflation continuously rank top in representative surveys on stress in developed economies. More significantly, poverty undermines decent, healthy, sustainable livelihood, and exposes people to stressors in multiple life domains. This talk will give an overview over psychological poverty research and outline how contexts of poverty and their resulting strain affect peoples’ health but also their attitudes and behavior in various areas of their lives. By acknowledging the psychological effect of poverty on individuals, the connection between contexts of poverty and various individual effects becomes clearer. The psychological lens does not only help with understanding health outcomes but it also allows to explain attitudinal and even behavioral consequences of poverty. This talk will argue that it is not enough to just regard the material realities of poverty, but that the subjective side of poverty plays an additional role. Because of its far-reaching consequences, it is in organisations’ and the wider public’s self-interest to prevent poverty and its harmful individual effects.
12:50 – Closing Keynote
Health in all policies approach in inequalities and vulnerabilities research and action
To be efficient in public health and health promotion actions in reducing inequalities and poverty, we do not need to understand only the situation and priorites in specific subpopulation groups. We also need to employ the knowledge transfer processes among research findings and policy implementation measures. We have to be aware of the concrete opportunities for the implementation of specific proportional measures to act towards closing the gaps. In addition, it is essential to understand the governance mechanisms and tools in support of productive response to the needs of most vulnerable in the population. Usually, different sectors and institutions are engaged in the response to the challenges of those most in need and actively built intersectoral competences are enabling that response to be much more efficient. One of today’s opened questions in public health is how to effectively link research results and policy response with appropriate measures. Finding and using appropriate mechanisms for transferring research into policy and practice has become one of the major policy drivers. It became more and more obvious that multisectoral competence, knowledge, strategies, measures and activities, inside and outside health sector, influencing health of the population, are important for better public health and wellbeing, moving governments and stakeholders towards a shared governance for health and well-being, using research knowledge translated to everydays’ practice. At the same time, health sector is increasingly engaged in initiating intersectoral approaches for health and acting as health broker and advocate and the power of knowledge is one of the crucial political forces for moving health and welbeing issues onto policy agenda and thus to implementation. This talk adresses these issues drawing on two exemplary multisectoral platform projects on EU-level co-conducted by the National Institute of Public Health in Slovenia (NIJZ, https://nijz.si/) and discusses outcomes and findings from these projects.