Role of poverty must be emphasised

BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7461.352-d (Published 05 August 2004) Cite this as: BMJ 2004;329:352
  1. Jim Black (james.black{at}mh.org.au), head, epidemiology,
  2. Bebe Loff, head,
  3. Helen Potts, lecturer
  1. Victorian Infectious Diseases Service, Grattan Street, Parkville, Victoria 3050, Australia
  2. Human Rights and Bioethics Unit, Department of Epidemiology and Preventive Medicine, Central and Eastern Clinical School, Monash University, Alfred Hospital, Prahran, Victoria 3181, Australia

    EDITOR—Malnutrition in children is the end point of a complex chain of causation, including infectious disease, traditional weaning practices, maternal (and paternal) knowledge of child development, standards of hygiene, and much more. Underlying all of these is the real root cause—the unjust distribution of wealth and other resources both within and between countries. Government health workers are commonly the only professionals actively interested in children's malnutrition, and yet they are hampered by the health service's paradigm, which tends to see only the proximate causes and does not see a role for itself in tackling the deeper problems. A study such as the one by Powell et al might come about in two ways.1 It might be part of a community development process, in which parents and carers are in the process of identifying the factors preventing their children from developing their full potential and are taking steps to tackle their situation and take more control over their lives. If so, this study is to be commended, and we would like to see more discussion of its community development aspects. If, on the other hand, this is just another study of proximate causes, with health workers once again deciding what is good for mothers and children without involving them in the process, then it will probably largely be wasted effort.

    In addition, the study seems to accept culturally conditioned assumptions about the singular role of women as child rearers. Studies of this nature can lead to the belief that it is not food that is the problem but mothers who lack the requisite skills.2 Regardless of the results of the study, the problems it tackles are not susceptible to a public health solution that simply addresses behaviour. Public health advocates must tirelessly reinforce the message that poverty is not consistent with good health.


    • Competing interests None declared.


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