Poor people have been asked again and again by governments, donors and non-governmental organisations (NGOs) what poverty means to them. What do these studies find? That poor people often define poverty more in terms of assets than incomes, that risk is frequently key to the way people understand poverty, that having a job is widely seen as the best route out of poverty, and that access to roads, transport and water, in particular, are often the things that poor people think will make the biggest difference to their lives.

Then what happens? Development professionals continue to measure poverty mainly in terms of incomes, often ignoring such factors as ownership of assets and levels of risk. Donors and NGOs have, until recently, almost always ignored employment and jobs when looking at ways to bring ‘development’. They have tended to focus instead on microcredit and other ways for poor people to set up small businesses, forgetting the fact that, like most of us, they may well prefer steady employment to the risks and uncertainties of running their own enterprises.

Why is it that we are so bad at translating the views and priorities of poor people into development decision-making? This Background Note outlines an approach in the UK’s National Health Service that puts patients in the forefront of their own treatment. It asks whether such an approach is applicable to the development context and sets out potential next steps.