Health affects poverty and poverty affects health. Poverty limits an individual's ability to respond to events, such as famine or a serious illness in the family. Lack of income is one limiting factor; lack of education, political freedom, ability to buy and sell goods, or land tenure is other limiting factors. Poverty can be absolute or relative. Reducing poverty to increase capabilities will increase freedom, which can be considered the ultimate goal. Poverty reduction remedies would seem to lie in a mixed bag of initiatives across a broad range of human endeavours – political, social, health, economic, security and education.
Malawi is the second poorest nation in the world measured by national income (GNP per head). In respect of absolute poverty, rural life is more disadvantageous than poverty in child mortality. The rural poor report less, but probably have more ill health. Full primary education eliminates unequal fertility rates. Both education and poverty seem to play a part in malnutrition. In respect of relative poverty, child mortality is becoming more inequitable as it improves, whereas malnutrition is becoming more equitable as it improves. The use of health services is inequitable (except EPI). Adult mortality including maternal mortality seems to be equitable (based on sibling's wealth). Underlying determinants of health show a mixed picture – some inequality, some equality. Recent efforts to improve health care have tended to increase inequality because the underlying determinants of disease have not yet been successfully addressed.