Poverty and the economic effects of TB in rural China

OBJECTIVE: To investigate the economic effects of illness on individual tuberculosis (TB) cases in rural China and to use a case-control study to show a strong TB-poverty link. SETTING: In 2002-2004 we studied 160 new smear-positive pulmonary tuberculosis (PTB) cases and 320 age- and sex-matched controls living in neighbouring houses in four rural counties of Henan Province. DESIGN: Cases and controls were interviewed 1-3 months after patients were diagnosed. We used matched multivariate logistic regression to compare cases with controls for poverty status using household income, household assets and relative wealth within the village. We conducted follow-up interviews of patients 10-12 months later to assess economic effects by collecting data on treatment costs, income losses, coping strategies and treatment completion. RESULTS: Poverty is strongly associated with TB incidence even after controlling for smoking and other risk factors. Excluding income losses, direct out-of-pocket treatment costs (medical and non-medical) accounted for 55.5 % of average annual household income, and most TB cases fell into heavy debt. The DOTS cure rate was 91 %. When DOTS was incomplete or not done, mortality was high. CONCLUSIONS: Poverty is both a cause and a devastating outcome of TB. Ongoing poverty reduction schemes in China must also include reducing TB.

Mixed communities: a new approach to spatially-concentrated poverty in England

This article examines the adoption, by the New Labour government, of a mixed communities approach to the renewal of disadvantaged neighbourhoods in England. It argues that while there are continuities with previous policy, the new approach represents a more neoliberal policy turn in three respects: its identification of concentrated poverty as the problem; its faith in market-led regeneration; and its alignment with a new urban policy agenda in which cities are gentrified and remodelled as sites for capital accumulation through entrepreneurial local governance. The article then draws on evidence from the early phases of the evaluation of the mixed community demonstration projects to explore how the new policy approach is playing out at a local level, where it is layered upon existing policies, politics and institutional relationships. Tensions between neighbourhood and strategic interests, community and capital are evident as the local projects attempt neighbourhood transformation, while seeking to protect the rights and interests of existing residents. Extensive community consultation efforts run parallel with emergent governance structures, in which local state and capital interests combine and communities may effectively be disempowered. Policies and structures are still evolving and it is not yet entirely clear how these tensions will be resolved, especially in the light of a collapsing housing market, increased poverty and demand for affordable housing, and a shortage of private investment.

Place, ethnicity and poverty in England’

Examination of the relationship between ethnicity, poverty and place has tended to focus on the spatial distribution of minority ethnic groups. This summary paper reviews some key themes in this literature, in order to review the following key questions: •Where are different ethnic groups located, and how does this location relate to their experience of poverty? •Is clustering a good or bad thing, and what is the role of location – regardless of concentration – in terms of impacts on access to housing, employment, and other resources? However, it is notable that existing research in this area continues to present ethnicity as a factor that shapes outcomes only for minority ethnic groups. A wider discussion increasingly recognises the working of ethnicity in the lives of majority communities. Some of the most consistently impoverished areas in Britain, for example, are in regions with relatively small minority ethnic communities. For example, examinations of poverty in Cornwall (Cemlyn, et al., 2002) and Wales (Kenway and Palmer, 2007) identify longstanding concentrations of poverty and social exclusion among relatively static populations. Instead of assuming that ethnic identity influences propensity to poverty when concentrated in particular places, the experiences of Cornwall and Wales encourage us to consider the manner in which places of poverty also have an ethnic character and the impact of this in the wider experience of poverty. In what follows, and in order to reflect the existing literature, we review key points in the debate about the spatial concentration of minority ethnic groups and the impact of this concentration on experiences of poverty. Where possible, we seek to extend these ideas to consider possible implications for spaces of poverty characterised by concentrations of majority ethnic groups.