The poor are more likely to suffer serious illness during their lifetime. They tend to live in higher-risk areas, with greater exposures to pollution, disease agents, and natural hazards such as floods. They also tend to work more dangerous jobs and have less access to services than the wealthy. Once ill, they face greater challenges in receiving adequate care. A shortage of trained health personnel and gaps in clinics and hospitals may mean that the poor must travel substantial distances and wait in long lines to receive treatment, particularly in rural areas (Narayan et al. 2000:72, 95; World Bank 2004:135).

Corruption in the public health care sector is also widely reported among the poor in the developing world. Patients may be forced to pay for services and medicines that should be free, and are turned away or given inferior care if they cannot afford to pay (Narayan et al. 2000:102;World Bank 2001:83). In Pakistan, a survey found that 96 percent of patients reported some type of corruption associated with visiting the local hospital, such as having to pay extra for beds, X-rays, tests, or medicines (Transparency International 2002:22). As a result, the public health care system is often the last resort of the poor, and many avoid using it at all (Narayan et al. 2000:100; Narayan and Petesch 2002:33-34).