Health and social protection: experiences from Cambodia, China and Lao

It is widely recognised that ill-health is one of the most serious challenges that many individuals, households and families have to face. But there is limited knowledge of the complex processes involved in suffering from and coping with multiple and diverse health-related challenges. Provision of support to those suffering ill-health has focused on acute illnesses which are often implicitly assumed to follow the pattern: get sick, consult with a provider, receive diagnosis, obtain treatment and recover. It has similarly become commonplace for economists to associate serious illness with ‘catastrophic health expenditure’. These presumptions have lead to support mechanisms being seen primarily in terms of providing assistance in meeting the cost of in-patient treatment. Such approaches fail to address the multiple and complex pathways which link ill-health and well-being. Individuals suffering from dengue fever, tuberculosis, emphysema, diabetes, lymphatic filariasis or AIDS might all be classified as having a ‘serious illness’. However, in terms of risk to life, level of disability and distress, duration of illness, prognosis, stigmatisation, availability and cost of treatment, and a range of other factors, their situations may differ radically. The impact of an illness is also highly dependent on the demographic and socio-economic characteristics of the individual falling ill, the household of which they are a member and the extended family and social networks to which they belong. 1 Paper presented at the Global Forum For Health Research conference: ‘Equitable access: Research challenges for health in developing countries’, Beijing, 29 October 2 November 2007. It should be noted that the methodology described reflects the collective work of the multiple partners involved in the POVILL project.