SECTION II Literature Review
4.4. Risk factors relevant for children in high prevalence HIV/AIDs communities
4.4.1. Poverty
educational opportunities and resources; higher unemployment rates; increases in child labour and exploitation; and widespread malnutrition (Hunter & Williamson, 2000). Poor people live without fundamental freedom of action and choice, often exposed to discrimination and ill treatment by institutions of the state and society, powerless to influence key decisions affecting their lives (WDR, 2000/200 l).These dimensions add impetus to the downward spiral into extreme poverty.
The numerous ramifications of growing up in poverty are well recognised in the literature. It affects children both directly and indirectly (Sherman, 1994). Poverty affects children directly by reducing the quality of food, shelter, health care, education, recreation and transport that a family can afford.
Poor children live in less safe and more hostile physical environments. Poverty affects children indirectly by "bringing out the worst in parents who struggle to manage in often impossible circumstances" (Lamer & Collins, 1996, p. 72). When they are exhausted from low-paying jobs and debilitated by the sheer demands of coping with inadequate resources, parents simply find it harder to be consistent in discipline, to be sensitive and responsive to children's needs and to provide a range of socially and educationally stimulating experiences (Brooks-Gunn, Klebanov & Duncan, 1997; Duncan, Brooks-Gunn & Klebanov, 1994; Hart & Risley, 1995). McLoyd's (1998) empirical work on children raised in poor homes shows that by age 5, these children have more fears, are unhappier, are more prone to aggressive behaviours, infections and have lower IQ's. The financial difficulties in themselves lead to increased risks of exposing children to the other risks associated with poverty, including mental health and social problems (Richter, 1994). Thus the longer children live in poverty, the more severe the impact (Toomey & Christie, 1990).
Maslow's (1971) hierarchy of needs posits that the most basic human needs are for physical sustenance and shelter, followed by the needs for safety and security, a sense of belonging and love, self esteem and identity and finally self actualisation. For people living in poverty, it is probable that none of these basic needs are met. While this model of human needs had been widely accepted in western countries (and is consistent with human rights advocacy work), there have been serious critiques of the concept of a hierarchy of needs in which one needs must be satisfied before one can adequately contemplate meeting the next set of needs. Applying Maslow's model to people who live in poverty means that poverty-stricken individuals would experience less pressure to meet their needs for love and belonging (and even less so for self esteem and actualisation) while they struggle to meet their basic survival needs.
A fundamentally different view of human needs has been proposed by Max-Neef, a Chilean economist (Fisher, 2003). Max-Neef (1987) believes that the first world's materialistic assumptions about the nature of human beings have directly contributed to increased poverty, massive debt and ecological disasters. He and his colleagues have developed an alternate taxonomy of human needs that focusses on the "satisfaction of fundamental human needs, on the generation of growing levels of self-reliance, and on the construction of organic articulations of people with nature and technology, of global processes with local activity, of the personal with the social, of planning with autonomy, and of civil society with the state" (Max-Neef, 1987, p. 12). In his taxonomy, there is a distinction made between needs and satisfiers. Human needs are few, finite and classifiable (in contradiction to the western view of "wants" that are infinite and insatiable). Needs form an interactive and interrelated system that is constant across culture and history. With the exception of the basic needs for survival and subsistence, there is no hierarchy but rather processes of simultaneity, complementarity and trade-offs (Fisher, 2003). Max-Neef identifies nine fundamental human needs: subsistence, protection, affection, understanding, participation, recreation (leisure, time to reflect and be idle), creation, identity and freedom. Each of these needs can then be classified according to the existential categories of being, having, doing and interacting (See Table 5.1).
Although each culture develops its own ways of satisfying these needs, there are five types of satisfiers (ranked in ascending order according to their ability to promote development):
violators/destroyers, pseudosatisfiers, inhibiting satisfiers, singular satisfiers, and synergistic satisfiers. To demonstrate the systemic properties of these needs and satisfiers, consider the example of watching television. This activity may satisfy the need for recreation, but it interferes with the needs for understanding, creativity and identity. Many wealthy individuals are indeed poverty- stricken in terms of having their basic needs for understanding, affection, creation and participation violated in their singular pursuit for material possessions. Likewise many people who live on the brink of having their basic subsistence needs met, have their needs for participation, identity and freedom met.
Synergistic satisfiers lead to the simultaneous satisfaction of more than one need. Examples of synergistic satisfiers include breastfeeding, educational games, family rituals and ceremonies, particpatory action research and democratic community development programmes. Max-Neef (1987) claims that a paradigm shift is needed at each of the systemic levels, but especially in terms of global economics, to re-conceptualise human needs and gain insight into the key problems that impede the
Table 4.1: Max-Neef s taxonomy of human needs:
Fundamental human needs
Subsistence
| Protection
Affection
Understanding
Participation Leisure
Creation
Identity
Freedom
Existential category of human needs Being (Qualities)
Physical and mental health Care, adaptability, autonomy
Respect, sense of humour,
generosity, sensuality Critical capacity, curiosity,
intuition Receptiveness, dedication, sense of humour Imagination, tranquillity, spontaneity Imagination, boldness, inventiveness, curiosity Sense of belonging, self- esteem, consistency Autonomy, passion, self- esteem, open mindedness
Having (Things) Food, shelter, work
Social security, health systems, work
Friendships, family,
relationships with nature
Literature, teachers, policies, education
Responsibilities, duties, work rights Games, parties, peace of mind Abilities, skills, work, techniques
Language, religions, work, customs, values, norms
Equal rights
Doing (Actions) Feed, clothe, rest, work
Co-operate, plan, take care of, help Share, take care of, make love, express emotions Analyse, study, meditate, investigate Co-operate, dissent, express opinions Day-dream, remember, relax, have fun
Invent, build, design, work, compose, interpret Get to know oneself, grow, commit oneself Dissent, choose, run ricks, develop aware ness
Interacting (Settings) Living
environment, social setting Social environment, dwelling
Privacy, intimate spaces of
togetherness Schools family, universities, communities Associations, parties, churches, neighbourhoods Landscapes, intimate spaces, places to be alone Spaces for expression, workshops, audiences Places one belongs to, everyday settings Anywhere
actualisation of fundamental human needs in society, community and family. This becomes possible when satisflers are not perceived as economic goods, but rather as forms of organisations, political structures, social practices, subjective conditions, values and norms, spaces, contexts, types of behaviour and attitudes. Most effective community developmental organisations incorporate this paradigm into their work, by reformulating the fundamental human needs and their satisflers. Max-
Neef s (1987) model acknowledges the universal need for food security but sees that the form of society defines the way in which people go about satisfying this and other needs. For example, people from consumerist, communal, aesthetic societies all still have the same basic needs but have different methods of satisfying these needs. When people acknowledge that they can critically reflect on how to satisfy their needs, the other basic needs must be taken into consideration for people to feel satisfied and fulfilled. Poverty stricken and wealthy people have the same needs for participation, acceptance, understanding and so forth. Acknowledging this similarity, allows one to go forward towards a more ecologically viable and sound way of living. This may significantly reduce the risks that have been regarded as inherently the lot of poverty stricken individuals.