Book Review - Anirudh Krishna's One Illness Away: Why People Become Poor and How they Escape Poverty. Review by Priti Irani. Published Fall 2011 Newsletter.
Anirudh Krishna’s One Illness Away: Why People Become Poor and How They Escape Poverty published by Oxford University Press in 2010 is a concise summary of intense work done over six years. Between 2001 and 2007, Krishna worked with teams of investigators in different parts of four developing countries – India, Kenya, Uganda, Peru - and some parts of North Carolina, USA. They visited nearly 400 diverse communities, rural and urban, large and small and over 35,000 households.
Community meeting in Uganda. Photo courtesy of Anirudh Krishna
Krishna developed “Stages-of-Progress” methodology borrowing insights from several pre-existing methods, including panel studies, participatory poverty assessments, and ethnographic examinations. The process involved asking and probing questions like: “What does a household in your community typically and usually do when it gradually climbs out from a state of acute poverty?” In this carefully conducted retrospective study, Krishna seems to have thought through and addressed many of the potential pitfalls of conducting retrospective studies.
Image of Krishna’s webpage, http://sanford.duke.edu/krishna/ has explanation of “Stages-of-Progress” methodology. Image used with permission from Anirudh Krishna
In their microanalysis, the teams found out that the “poverty flow” is bi-directional - people climb out of poverty and fall into poverty all the time. Hence, to address poverty, policies have to protect for people at risk for falling into poverty and provide opportunities to climb out of poverty. Among the most common reasons people become poor are major life events like death or serious illness of wage earner, and illustrated in the book: “Thousands of households in every region studies have succumbed to poverty on account of a combination of ill-health, lack of access to qualified medical attention and high health care costs. Thousands of other people continue to live only one illness away from poverty”.
When people did climb out of poverty, it was due to diversification of income and agriculture. Disappointingly, Krishna notes, hardly anyone who escaped poverty became rich. Education was not, Krishna found much to his surprise, a critical factor in escaping poverty, as he found many people with good education who were unemployed. To overcome poverty, people need access to information about opportunities, adults who encourage and are invested in helping people access opportunities. This point was poignantly illustrated through two stories.
One story involved a young lady, Vasundhara, who became software engineer overcoming many odds. Vasundhara studied in her village until Class 5, and then in an neighboring village where her grandparents lived until Class 7 where a teacher recognized her exceptional academic talent. He recommended to her father that she study in an urban high school, got the application and completed it for her. The teacher assured her father that living in the city was safe and had relatives in the city who would look out for Vasundhara. Only then her father allowed her to continue where she continued to excel, performed well in a competitive examination, and was able to get into a well-regarded engineering college.
Contrast this with another story of a young boy, Chandra crippled by polio who said his favorite subject was mathematics. The author wrote out some Math problem for the boy to solve which he did easily. The boy in turn wrote some math problems for the author to solve and the author was stumped. So he talked to the boy’s father and asked about what was in store in the boy’s future. The father said that the boy wanted to be an engineer but they were poor and could not afford it. So the author sought the help of his colleagues in the city, and identified a fellowship that the young boy would be eligible for, and gave the father the information. However, the father did not take it up saying “It is not for the likes of us.”
Krishna’s methodology and the questions he has attempted to answer, provide a wealth of information. The book concludes with tangible policy recommendations for poverty prevention and reduction policies.
Acknowledgement: I heard about the book through Afia Yamoah’s review of the book in the new journal ," Poverty & Public Policy: Vol. 3: Iss. 2, Article 11. DOI: 10.2202/1944-2858.1171 Available at: http://www.psocommons.org/ppp/vol3/iss2/art11