Note: This blog is part of Lustig, N. & Tommasi, M. (2020). El COVID-19 y la protección social de los grupos pobres y vulnerables. UNDP. (Forthcoming)

We know that in 2017 138 million people in Latin America lived in monetary poverty (according to the USD 5.5/day benchmark) (See Table 2 of the Lustig & Tommasi paper, 2020) [1]. Lack of income is undoubtedly a fundamental deprivation, as it inhibits many achievements and restricts freedom of choice and action. Regretfully, the above is not the only deprivation of many of these households. We are also aware that in Latin America and the Caribbean 39 million people (7.5% of the population) live in households that are in acute multidimensional poverty, according to estimates of the Global Multidimensional Poverty Index (MPI) (OPHI, 2019).[2] This means that they experience deprivation in one third or more of ten indicators of health, education and living standards associated with the Sustainable Development Goals.[3] The MPI uses the following indicators: any malnourished members in the household, any child that has died in the household (child mortality), low educational level of adults (no one has completed 6 years of education), children who do not attend school, and lack of: safe drinking water, improved sanitation, electricity, clean energy for cooking, adequate housing (floor, wall and ceiling materials), and a minimum number of assets (durable goods). Just like monetary poverty, multidimensional poverty has a greater incidence on children than on the rest of the population. In the Latin American and Caribbean region, approximately one in ten children lives in a household in acute multidimensional poverty (OPHI, 2018).

According to the global MPI, out of the 39 million poor people, 10 million (2% of the population) experience severe acute multidimensional poverty (OPHI, 2019). Furthermore, there are another 40 million people (7.7% of the population) who do not yet live in acute multidimensional poverty, but are vulnerable to such a condition (OPHI, 2019). Moreover, there are other non-monetary deprivations such as precarious jobs, lack of health coverage and overcrowding that, although not included in the global MPI[4], greatly affect the region, as evidenced in the Multidimensional Poverty Index for Latin America (MPI-LA, Santos & Villatoro, 2018)[5]

By looking at direct simultaneous deprivations, multidimensional poverty measurements reveal the complexity of the scenario in which the region receives the COVID-19 pandemic. Firstly, because people in acute multidimensional poverty are, to a great extent, a high-risk group for COVID-19. Secondly, because it evidences the fragility of these multidimensionally poor households to comply with the health-based measure of preventative social isolation. Thirdly, because we can predict that the lockdown measures will have a lasting impact on many poverty dimensions.

Regarding the first issue mentioned above, many of the multidimensionally poor are in this category because they experience deprivations such as malnutrition, lack of access to drinking water, improved sanitation, or lack of access to clean energy, experiencing a combination thereof, or all these deprivations at once[6]. These indicators predict a high risk for COVID-19 (see deprivation rates by indicator for Latin America in Table 1 of Lustig and Tommasi’s paper, 2020). Malnutrition increases vulnerability to any disease. Although not measured in the global MPI, in addition to this, many people in poverty experience malnutrition in the form of obesity, which is also a risk factor for COVID-19; others, due to their lack of access to health coverage, are “under-diagnosed” in different pathologies that entail a risk of getting COVID-19.^[7]. In turn, exposure to unclean energy for cooking and heating (firewood, charcoal, kerosene), frequently aggravated by living in overcrowded homes with poor ventilation, makes people more susceptible to chronic respiratory diseases. Finally, the lack of access to drinking water and / or adequate sanitation is critical when utmost hygiene standards become an essential element to avoid contagion and spread of a virus. The latter only gets worse in homes where no adult has completed a minimum level of education, which makes it even more difficult to incorporate these hygiene habits.

Regarding the second issue, complying with the “stay-at-home” slogan can become impractical when the home is a dwelling made out of inadequate material, often overcrowded, and with lack of access to basic services. And if the order of staying at home is fulfilled, it is breeding ground for other diseases that are currently left in the background due to the COVID-19 health emergency, and may not receive the necessary attention. On the other hand, confinement under these housing conditions can also trigger or accentuate intra-family dysfunctions; in extreme circumstances, domestic violence and child abuse (see related indicative figures for Latin America in Table 3 of the Lustig & Tommasi paper, 2020). Although not included in the global MPI, precarious work highly prevails in the region, as shown in Table 2. Unemployment and lack of affiliation to the social security system emphasize the social exclusion that characterizes poor households: either they do not have a job or, if they do, it is informal. The requirement to stay home interrupts the meager income for their subsistence.

Regarding the third issue, isolation measures, although essential to avoid contagion, will have long-term effects on many aspects, education among them. The educational gap between children in these households and children in non-poor households will inevitably widen due to the difficulty adults in the poor homes have to do “classwork at home”, further accentuated by the technology divide and economic barriers for accessing on-line teaching (see figures in Table 2 of the above-mentioned paper). Deprivation in terms of adults' ability to support children in the learning process blends with housing deprivation to provide appropriate space in the house to “do homework”.

In essence, we are then faced with a difficult dilemma of choosing the lesser of two evils: contagion and spread of COVID-19 among the multidimensionally poor, which is a high-risk group due to the fragility of their health, besides their scarcity of assets to deal with a health shock, versus discontinued earnings that these households usually use to subsist, the interruption of interactions with state reassurance and support networks (mainly kindergartens and schools) and non-state networks (churches, neighborhood development committees, clubs and different NGOs), and confinement to overcrowded and unhealthy spaces.

It is clear that governments have naturally chosen the second evil which appears to be less harmful. However, we cannot underestimate its seriousness, which is a special challenge for developing countries with high rates of urban poverty, largely concentrated in slums or informal settlements. Undoubtedly money transfers, although very important, will not be able to address many of the non-monetary dimensions of poverty[8]. It is necessary to think of dimensions other than the monetary one, to mitigate the impact of this epidemic on the poorest sectors.

This poses a huge challenge of not only ensuring a minimum income for the poor, but also of designing effective measures to protect them against the spread of the virus (in addition to isolation measures, and also taking into consideration the potential development or exacerbation of other diseases and problems). It is moreover necessary to implement reassuring support mechanisms for families living in multidimensional poverty. Mechanisms that provide continuity to the in-person assistance they typically received from schools and different social organizations, although under a different modality and -no doubt- as a very imperfect substitute for the above. Otherwise, the time to “make up for lost time” during this lockdown period may become too long or, even in some dimensions, endless, particularly for the youngest.

References

Alkire, S., Dirksen, J., Nogales, R. & Oldiges, C. (2020). ‘Multidimensional poverty and COVID-19 risk factors: A rapid overview of interlinked deprivations across 5.7 Billion People’, OPHI Briefing 53, Oxford Poverty and Human Development Initiative, University of Oxford.

OPHI (2018), Global Multidimensional Poverty Index 2018: The Most Detailed Picture to Day of the World's Poorest.

OPHI (2019) Global Multidimensional Poverty INdex 2019: Illuminating Inequalities. Universidad de Oxford.

Santos, M. E., & Villatoro, P. (2018). A multidimensional poverty index for Latin America. Review of Income and Wealth, 64 (1), 52–82.

[1] A version with more references to the Argentine case can be found here.

[2] Population figures for 2017. The global MPI estimates cover 20 countries in Latin America and the Caribbean.

[3] Indicators have been weighted (1/6 for education and health, and 1/18 for living standards).

[4] The global MPI is an acute poverty index that uses the Demographic and Health Surveys (DHS) and the Multiple Indicator Cluster Surveys as data sources. Many of these indicators are not included because they are not available in these surveys.

[5] MPI-LA uses the household surveys of the statistical and census institutes of the region’s countries.

[6] Alkire et al (2020) estimate that, in Latin America and the Caribbean, there are 35471 multidimensionally poor and at risk of getting sick from COVID-19 ('at risk' defined as experiencing deprivation at least in nutrition, water or clean energy for cooking), and 7954 are multidimensionally poor and at high risk of contracting COVID-19 because they experience all three of the above-mentioned deprivations.

[7] Table 1 of the Lustig & Tommasi paper (2020) shows the rates of prevalence of pre-existing health conditions.

[8] Note also that there are many poor people not yet covered by the social protection system. Their affiliation becomes extremely difficult at a time when face-to-face procedures are not in place and when barriers to accessing technology (both devices and knowledge) are one of the characteristics of poverty.