NEW YORK — Poverty cannot be defined solely in terms of lack of income. A person, a family, even a nation is not deemed poor only because of low economic resources. Little or no access to health services, lack of access to safe water, illiteracy or low educational level and a distorted perception of rights and needs are also essential components of poverty. Poverty is one of the most influential factors for ill health, and ill health — in a vicious cycle — can lead to poverty. Every effort to improve one of them will positively affect the other.

Thus, there is a two-way link between poverty and health. Illness impairs learning ability and quality of life, has great impact on productivity and drains family savings. Poor people are more exposed to environmental risks (poor sanitation, unhealthy food, violence and natural disasters) and less prepared to cope with them. Because they are also less informed about the benefits of healthy lifestyles and have less access to quality health care, they are therefore more at risk of illness and disability.

Close to 1.5 billion people in the world live in extreme poverty, and 80 percent of them live in the developing world. Poor people have little or no access to qualified health services and education, and do not participate in the decisions critical to their day-to-day lives. Those who live in extreme poverty are five times more likely to die before age 5, and 2 1/2 times more likely to die between 15 and 59 than those in higher income groups.

The same dramatic differences can be found with respect to maternal mortality levels and incidence of preventable diseases. Poor people are not only more exposed to health-impairing factors but are less resistant to levels of those factors that would not affect people in better economic condition.

Poverty affects the nutritional status throughout the life span. Those living in poverty and suffering from malnutrition have an increased propensity toward a host of diseases, a lower learning capacity and an increased exposure and vulnerability to environmental risks. Poor children are more exposed to the consequences of carelessness and the lack of stimuli crucial to growth and development. The permanent stress in the struggle for survival does not allow poor families the awareness or the opportunity to provide these stimuli.

It has been amply demonstrated that undernourished children suffer from more severe illnesses and have higher risks of mortality than well nourished children. Fifty-four percent of mortality in children under 5 worldwide is attributed to low weight for age. The vast majority of these deaths are due to the added effect of mild to moderate under-nutrition.

Girls who survive malnutrition during childhood and reach reproductive age have higher risks of bearing low-birth-weight babies, who in turn have less chance of survival than normal-weight babies. Low-birth-weight newborns have greater mortality risk, are more frequently affected and less resistant to infectious diseases during early postnatal life, and are prone to develop diabetes, hypertension and other chronic illnesses later in life.

When income distribution is unequal, economic growth usually does not reach the undernourished, and their nutritional status may stagnate or even deteriorate. However, higher income alone does not guarantee maximal nutritional benefit; to achieve that, other factors are also important, such as educational attainment, appropriate housing conditions and a healthy environment.

Successful experiences in Africa, Asia, Latin America and the Caribbean have shown the power of education to increase the nutritional levels of the poor. Only empowered individuals and communities can make better use of their knowledge and resources, even in situations of economic stagnation, to ensure healthy and sustainable choices for them and their families.

Economic growth can lead to substantial improvements in nutrition only if the results of economic expansion are used rationally and distributed equitably. Therefore, efforts to reduce malnutrition should be accompanied by a policy of greater equity, both as a matter of human rights and as an economically appropriate and sustainable strategy.

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