Being poor exposes people to a number of unbearable conditions that prevent individuals, families and communities achieving fulfilment and being the best they can be. People in poverty suffer pain: physical pain – when they have too little food and they work long hours – and emotional pain – from being humiliated daily, the shame of dependency, lacking power and being unable to express themselves, and from the moral indignity of needing to choose whether to eat or heat. The ability of a group to express its concerns and take control of its future is associated with the degree of power they have in society and their ability to access resources. As with all toxins, there are consequences to poverty, such as cognitive dysfunction and emotional disturbance, which perpetuates a vicious circle. The impact of poverty can be felt across the age continuum.
Poverty is material in origin, but it also has psychological consequences, such as distress when people are unable to feed their family, uncertainty of not knowing when the next meal will come, and the gross shame of having to go without. Social exclusion often comes about as a result of poverty and can erode social networks that can provide support. Escaping and recovering from poverty can be difficult, and its effects can be lifelong.
In dealing with food insecurity the head of the family will often go hungry, so other family members do not starve. Poverty brings humiliation for the parent unable to feed their family; material poverty reinforces a sense of personal limitations, causing unhappiness and often disenfranchisement. Being in this situation is to live inhumanly, where the person is deprived of more than food or money – an existential hunger. No human need should be seen as basic, all needs are, indeed, essential.
As time passes, those who find themselves in these circumstances begin to feel that they are not human beings like others and are not as valued as others. The person can become fatalistic and feel that, if happiness exists, it is not meant for them – and they accept their dehumanising condition. Penury (extreme poverty) really does have the potential to kill.
As with any public health concern or condition with the potential to kill, to do harm, the nurse is duty bound to step in and support those in poverty. The role of the nurse is multifaceted and touches people's lives in so many ways. The gaping wound caused by poverty, like any wound, has to be treated. The material disadvantage causing it needs to be addressed, but we must also reach out and offer support to those who have been wounded, to return that feeling of being human. Poverty lends itself toward ill health and, conversely, ill health can put people at risk of becoming poor. In 2005, Mowafi and Khawaja noted that the social and economic determinants of health play a great part in the discourse of poverty. The symptoms of poverty are multidimensional and the relation of poverty to health and wellbeing is complex.
Nurses have been concerned with poverty and its impact on health for decades. In this issue of BJN, Waterall et al (2022) encourage nurses to enhance their knowledge of key public health issues such as financial wellbeing. Nurses, they note, as the most trusted profession, have a critical role in supporting people to gain access to the information and services that may help them manage concerns about money. Waterall et al offer readers practical tips that they can use in their practice to identify potential financial hardship concerns.
Poverty brings inequity and social injustice. Policy, in its various forms, must address institutional biases that are contributing to ongoing poverty, and ensure that there is accountability and clarity as new solutions are determined. There is a battle to be fought and this is the battle against poverty and the suffering it brings.