Good health is among the most valuable assets the poor possess. Not only is good health essential to almost any income-generating activity, but most of the other assets of the poor—such as livestock and farmland—yield few returns without the physical capacity to maintain or use them (Barrett and McPeak 2003:8; Lawson 2004:20). Individuals who are sick or disabled are less likely to be hired for wage work, may have difficulty working effectively, and will often be paid less for their services (Narayan et al. 2000:96).

Ill health is not just the lack of an asset, but a negative asset. Having a household member fall ill can destroy a poor family’s standard of living. Household and village-level studies show that the illness of a key income-earner—a so-called “health shock”—is one of the leading causes of a household’s decline into abiding poverty (Krishna 2004:11; Lawson 2004:3). The immediate loss of income is only the start: health bills can mount quickly and create an urgent need for cash, and since the poor possess few liquid assets that can be used for such emergencies, they may have to sell land or items central to sustaining their livelihoods. Families facing a health shock very often fall into substantial debt, from which they can only emerge with difficulty. One common coping strategy is to pull children out of school and send them to work, depriving them of training they will need in the future to keep themselves out of poverty (Narayan et al. 2000:98).