Putting It All Together – Sustainable H&HD

This page is the be-all and end-all when it comes to answering those 5 or 6 mark questions about how a certain determinant affects a person or community’s health status and human development. Examiners do not want to hear “low income means someone can’t afford medicine, so then they’re more likely to suffer when they get sick”, they want to hear that low income has not only a short term effect on a person’s health and human development by preventing them from accessing healthcare or engaging in activities which enrich their lives, but also has a longer lasting effect on H&HD for a, b, c reasons. Here we will discuss those reasons and effects – namely the vicious and virtuous cycles – to ensure that you can make enough relevant points to fully answer such questions.

The Vicious Cycle (poverty cycle)

Living in poverty promotes continued poverty, and the poverty of future generations. Thus, poverty can be expressed as a cycle, where experiencing a certain determinant puts you at risk of, or directly forces you into experiencing another determinant which leads you to poorer health or decreased human development.



NOTE: the green line represents a generational transition – a child is affected by the low income of their parents


To explain this diagram, lets follow some of the arrows using an example of 27 year old, Sudanese male, Joe.
Sadly for Joe, his wife Nara passed away 2 years ago from AIDS, leaving Joe as the sole provider for their 4 children. Joe also has AIDS, and recently he has become so sick that he cannot go to work. Because Joe can’t work, he has low income, which in turn means he can’t pay for medications to help him feel well enough to work. This means that Joe can’t provide for his kids. Joe’s youngest child, Jack, is almost school-aged, but will not be able to attend school because his family cannot afford it. This makes Jack far more likely to be unemployed or low income earning himself. It also makes him more likely to experience poorer health, directly through lack of health and disease education, and indirectly through his low income meaning he likely can’t afford vaccines or medicines – and so the cycle continues.

Any of the determinants on the cycle can act as a ‘starting point’ and plunge a person into the poverty cycle. Similarly, other determinants which are not in this diagram may influence those that are and so cause a person to enter the cycle. For example, in some countries, girls are not allowed or not encouraged to attend school, so gender means a person has a lack of education and enters the cycle that way. Natural disaster can cause a farmer to lose all their livestock and thus become low income, poor housing conditions can breed disease and thus poor health, etc.

The Virtuous Cycle (affluence cycle)

The virtuous cycle is essentially the opposite of the vicious cycle. It suggests that if you are educated you can get a job, earn money, pay for healthcare, good nutrition and the education of your children so that they may get a job. Your better health will mean you take less time off work and can be productive and gain sustainable employment with steady income. Again, any determinant can be a ‘starting point’ or an influence.

The aim of most development programs is to break people free of the vicious cycle and instead put them into a cycle of good health and prosperity. This is why they target areas such as education/literacy, sustainable income, immunisation, sanitation – improving these determinants can free people from the poverty cycle.

How Health Affects Human Development

Having choice to do what makes you happy and live the type of life you wish to lead are fundamental to human development. Being educated and enjoying societal and social involvement and interaction are also key.

When a person experiences poor health, they can be confined to a hospital, a bed, their own home, or accessing specific areas which can cater to their health needs. They may no longer be able to participate in activities which they enjoy, go to work or school, or have as much social interaction as they should or would like to. As such, being in poor health negatively impacts human development as it restricts choice, is a barrier to education, and may leave a person unable to interact with friends and family or participate in what gives their life meaning and purpose.

In contrast, someone in good health can make choices about their life and how they live it and does not have health-related barriers preventing them from being educated, working and living life to the full.

Tying in Sustainability

Due to the cyclic nature of poverty or affluence, once you begin to experience one, you tend to continue in that cycle – thus they are self-sustaining to a point. Obviously, it is not beneficial to be stuck in the poverty cycle. However, it is beneficial that the virtuous cycle is sustainable. This means that projects that manage to full immerse an individual or community into the virtuous cycle are easily sustained. The generationally transitional nature of the cycle of affluence is also favourable, as not only does it avoid compromising the ability of future generations to meet their own needs, it actually aids them in meeting their needs.

Most development programs work around an area of the poverty cycle, and so in order for them to be sustainable they must not let other areas of the cycle prevent them from succeeding. Affordability is one of the pillars of a sustainable program because it ensures the income section of the cycle does not impair access. Appropriateness ensures that the specific determinants that are pushing people of a certain group into the poverty cycle are the ones the program addresses. Finally, equity maintains that funds are directed to people who need assistance in order to be given an equal shot at flourishing and not wasted on those who don’t. It also basically defines the breaking of the poverty cycle in terms of the intergenerational equity suggested at the end of the above paragraph.