When individuals suffer from extreme poverty and lack the meager income needed to cover even basic needs, a single episode of disease, a drought, or a pest that destroys a harvest can be the difference between life and death. In households suffering from extreme poverty, life expectancy is often around half that in the high-income world, 40 years instead of 80 years. It is common that, in the poorest countries of sub-Saharan Africa, of every 1,000 children born more than 100 die before their fifth birthday, compared with fewer than ten in the high-income world. An infant born in sub-Saharan Africa today has only a one-in-three chance of surviving to age 65.

In the MV Sim, a family member can die if he or she suffers a drop in health below a minimum level. In addition, a person can die depending on his or her average health over the past three periods: the lower the health, the more likely death becomes. Finally, death can occur from maternal mortality during childbirth.