Empowering destitute people towards transforming communities

4.1Physical problems

This refers to health and health-related issues experienced by destitute people.

4.1.1Substance abuse and addictions

According to studies by Oakely & Dennis (1996:179-186) and Wright & Rubin (1997:45), untreated addictive disorders do contribute to destitution. These authors state that, for those with below-living wage incomes and just one step away from destitution, the onset or exacerbation of an addictive disorder may provide just the catalyst to plunge them into residential instability. For people who are addicted and destitute, the health condition may be prolonged by the very life circumstances in which they find themselves. Alcohol and drug use may help meet immediate needs by providing respite from otherwise stressful and sometimes violent conditions, and thus distract from activities oriented toward stability. For people with untreated co-occurring serious mental illness, the use of alcohol and other drugs may serve as a form of self-medication. For still others, a sense of hopelessness about the future allows them to discount their addictive disorder. These explanations for addiction's sway over some destitute people should not obscure another reality: that many destitute persons with addictive disorders desire to overcome their disease, but that the combination of the destitute condition itself and a service system ill-equipped to respond to these circumstances essentially bars their access to treatment services and recovery supports.

4.1.2Poor physical health and illness

The health status of destitute people has been a long-standing concern. The physical conditions and daily stress under which they live render the homeless extremely vulnerable to both acute and chronic health problems (Wright et al., 1998:23). This in turn keeps them destitute, or promotes a further slide into destitution.
Poverty creates ill-health because it forces people to live in environments that make them sick, without decent shelter, clean water or adequate sanitation. Poverty creates hunger, which in turn leaves people vulnerable to disease. Poverty denies people access to reliable health services and affordable medicines, and causes children to miss out on routine vaccinations. Poverty creates illiteracy, leaving people poorly informed about health risks and forced into dangerous jobs that harm their health (1998:23-26).
AIDS as a major illness should be mentioned separately. According to the Joint United Nations Program on HIV/AIDS (UNAIDS) and the World Health Organization (WHO), AIDS is now second only to the Black Death⁵ as the largest epidemic in history. AIDS kills about 2.9 million people a year, or about one person every 11 seconds. This death toll surprisingly includes many children, who are often infected with the HIV virus during pregnancy or through breast-feeding. The toll is worst in Africa, where millions of parents have died, leaving children as orphans. Often teachers have died as well, leaving schools empty. Doctors and nurses have died, leaving hospitals and medical clinics with nothing. Farmers have died, leaving crops in the fields. Entire villages have been devastated. Yet AIDS is a preventable and increasingly treatable disease. The huge majority of deaths can be stopped. Through education, the use of condoms, and proper medicine, AIDS has been brought under control in the developed countries. The same could be true in Africa and other poor areas of the world.
Added to this is the huge number of AIDS orphans in the country, a number that is growing daily. They grow up in abject poverty. People with HIV/Aids are also stigmatized: leading to isolation and exclusion from society, and thereby further contributing to destitution. “Although the government conducted campaigns to reduce or eliminate discrimination against persons with HIV/AIDS, the social stigma associated with HIV/AIDS remained a general problem” (Human Rights Report 2006:17).
There are also numerous barriers to health treatment and recovery opportunities for destitute people. Barret, C.B., Carter M.R. & Little, P.D. (2006:169-170) explains the challenges of health care in South Africa in the following words:

The most pressing (challenges) include: low pay for health workers; despair about AIDS and the government's reluctance to provide clear treatment guidelines; lack of basic infrastructure such as roads and telephones in remote rural areas, which makes TB testing difficult (South Africa has the highest TB rates in the world, fanned by HIV); and the growth of multi-drug resistant TB, which has already killed health workers. To add to this, there is a high incidence of poverty-related illnesses, including TB, malaria, cholera, hepatitis B, and measles. Malnutrition is rife – stunting affects up to 27% of children. About 2.5 million people are malnourished and a further 14 million at risk. There is concern that the massive poverty-alleviation program, together with improvements in water supply, sanitation, nutrition, and vaccination, could be submerged by the tidal wave of HIV. Already AIDS patients fill 40% of beds in some hospitals.

Other barriers to treatment include lack of transport, lack of documentation, lack of supportive services, and abstinence-only programming (Cousineau et al, 1995: 112).

4.1.3Mental illness

This has been a chicken-and-egg question for decades: Does the misery of poverty breed mental illness, or does the burden of mental illness cast people down into poverty? The two clearly tend to accompany each other, but which causes which? Hudson (2003) conducted a study between 1994-2000, and found that unemployment, poverty and housing unaffordability were correlated with a risk of mental illness. Draine et al. (2002:565-572) strongly assert that poverty and its associated problems tend to bring about mental illness, rather than the other way around. They also make a case for the fact that the resulting mental illness “disables” a person from becoming non-destitute again.
It should be clear that mental illness could be either a cause or result of destitution, or both at the same time. Suffice it to say that mental illness can be considered a cause of destitution.

4.1.4Physical handicaps

For Odera (1998:1) although a physical disability should not automatically lead to marginalisation, it is a fact that those who are disabled in one way or another are often led to engage in undesirable activities such as begging in the streets. The Country Report on Human Rights Practices for South Africa in 2006 (2006:13-14) found that, even though our laws prohibit discrimination on the basis of disability, government and private sector discrimination in employment existed. The law mandates access to buildings for persons with disabilities, but such regulations are rarely enforced, and public awareness of them remained minimal.
This marginalization directly impacts on destitution, by excluding handicapped people from jobs or normal participation in society, thereby sliding them into poverty and possible destitution.