After nearly a decade of studying poverty by reviewing more than 35,000 households on four continents, Anirudh Krishna, associate professor of public policy and political science, has published a new book “One Illness Away: Why People Become Poor and How they Escape Poverty.” In the book, Krishna argues that instead of focusing primarily on how to lift people out of poverty, policy makers should be trying to prevent poverty from occurring in the first place. The Chronicle’s Sonia Havele spoke with Krishna on poverty, policy and his new book.
The Chronicle: You have been working on the research that has been described in your book for nearly a decade. Can you tell me a little about your book and this research?
Anirudh Krishna: I found that over the space of the last 25 years, almost as many people have come out of poverty as have fallen into poverty. The difference between those two numbers was just 2 percent. There is simultaneously a flow out of poverty and a flow into poverty. This flow into poverty is something that’s off the radar screens of policy makers. I also found that the factors that were taking people out of poverty were very different from the factors that were bringing people into poverty. People were falling into poverty as a result of a number of different kinds of adverse events—but bad health and high health care costs were common to a vast majority of stories of falling into poverty. Coming out of poverty was basically through developing additional income sources. So the story of coming out of poverty was about income, the story of falling into poverty was about expenditure. Sudden large expenditures, primarily health care but also things like death feasts, marriages, droughts—these were the factors that were leading people into poverty, so you need one set of policies for that. To take people out of poverty, you need things like education, irrigation and better jobs.
TC: Why did you decide to write a book?
AK: I did a lot of research articles earlier—each location had a separate research article. One day I thought, you know, these research articles are read by academics, but this is important knowledge about poverty to put out to the world.
TC: How did you originally become interested in studying the individuals and communities affected by world poverty?
AK: I have, from the very beginning, worked on issues of poverty and development. For the first half of my working life, I was a practitioner. I worked for the government in parts of rural and urban India dealing with various kinds of issues of poverty and managing programs to deal with it. [Later I] did my Ph.D. and went back to looking at the same things as a researcher. A lot of the thinking about poverty at that time was driven by the top down, macro-national view that when countries grow, everybody’s lot improves and poverty goes down. But, as I was doing my research in communities in India, I realized that this wasn’t always true. I saw lots of people in poor communities, some of whom were as poor or poorer than before, some of whom had moved up and out of poverty. Now what was the difference between the two of them? It wasn’t national economic growth, it wasn’t the difference in national programs or even [non-governmental organizations], because all of them were living under the same umbrella of policies, programs, growth rates and so on. So it seemed important to investigate what people were doing by themselves to break out of poverty. What were their circumstances? What were the setbacks and liabilities they were suffering from? There is a lot that goes on in terms of the effects of policy, but there is also a lot that’s going on in terms of people’s own efforts and people’s own experiences. And it’s the second part of this knowledge, the micro-level knowledge, that’s really missing, which is where I thought I would make a contribution.
TC: How have your views changed since you began your research of poverty around the world?
AK: They’ve changed radically. My view earlier, as the view of a lot of people is, is that you should help people in poverty. And I think that is still true, but what I think is more true is that you should prevent poverty first. You should have things, policies, interventions in place that assist people before they become poor.... Among them, I would rank affordable, high-quality health care as number one, which is the title of the book—“One Illness Away.” There are millions of people all over the world including in rich countries, like the United States, who are one illness away from acute poverty, and it’s only countries and communities which have made available affordable, high-quality health care to all their citizens that have the lowest poverty rates, not the countries with the highest [gross domestic product] per capita. The second thing that changed was I used to believe that large masses of people in a country could be raised out of poverty by doing the one right thing. The search was for the perfect program, the magic bullet so to speak, and now I realize that that’s like the Holy Grail. You’re not going to find it because the factors that take people out of poverty or that put people in to poverty—the threats and the opportunities—vary considerably not just across countries, but also within countries. The third thing I learned was the most painful thing, which was that people who are breaking out of poverty aren’t becoming rich. Even the smartest and most hardworking among them are rising just a tad above the poverty cut-off.
TC: In which country did you feel most affected by the poverty and devastation you were witnessing?
AK: Frankly, the United States. To put it bluntly, finding poor people in a poor country where lots of people are poor is not a surprise. Finding poor and hopeless people in a country that has so much was unnerving. That was one factor. The second factor was... people who are poor in these other countries are not deemed to be poor for their own faults. People are more forgiving, people are more aware of the real reasons for poverty. But in the United States, along with poverty comes this acute sense of personal failure and stigma. As a result, even talking about poverty in the U.S. is very difficult. [Talking about poverty] is not as stigmatized in the other places I studied partly because this cant about poverty being a result of personal failure is less prolific and less subscribed to in those other domains. The vast majority of people don’t become poor or remain poor for faults of their own. It’s a product of experiences rather than personal qualities.
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