Abstract and Introduction
Of all of the forms of inequality, injustice in health care is the most shocking and inhumane.
Dr. Martin Luther King, Jr.
March 12, 2015, will mark the tenth anniversary of World Kidney Day (WKD), an initiative of the International Society of Nephrology and the International Federation of Kidney Foundations. Since its inception in 2006, WKD has become the most successful effort ever mounted to raise awareness among decision makers and the general public about the importance of kidney disease. Each year WKD reminds us that kidney disease is common, harmful, and treatable. The focus of WKD 2015 is on chronic kidney disease in disadvantaged populations. This article reviews the key links between poverty and chronic kidney disease and the consequent implications for the prevention of kidney disease and the care of kidney patients in these populations.
Chronic kidney disease (CKD) is increasingly recognized as a global public health problem and a key determinant of poor health outcomes. There is compelling evidence that disadvantaged people, that is, those from low-resource ethnic minority communities and/or indigenous and socially disadvantaged backgrounds, suffer from marked increases in the burden of unrecognized and untreated CKD. Although the entire populations of some low- and middle-income countries could be considered disadvantaged, further discrimination on the basis of local factors creates a position of extreme disadvantage for certain population groups (peasants, those living in some rural areas, women, the elderly, religious minorities, and so on). The fact that even in developed countries ethnic minorities bear a disproportionate burden of CKD and have worse outcomes suggests there is much to learn beyond the traditional risk factors contributing to CKD-associated complications.
About 1.2 billion people live in extreme poverty worldwide. Poverty negatively influences healthy behaviors, health-care access and environmental exposure, all of which contribute to health-care disparities (Table 1). The poor are more susceptible to disease because of lack of access to goods and services, in particular clean water and sanitation, information about preventive behaviors, adequate nutrition, and health care.