Social determinants of health
AS a child, I found myself growing in a multi-cultural community in commercial farms in Mashonaland West in the late 1970s. My parents had joined this community from Malawi in the 1950s as farm labourers. Almost half of children born in this community died below the age of five and the majority in infancy. A few of my relatives stayed in mines. A few of them were in urban areas. I would pay them visits during school holidays. A few decades later, as a specialist Family Practitioner practising in Bulawayo, I had an opportunity to visit my roots in Malawi. The site of so many graves of children equalling those of adults, the majority of them below the age of 50 evoked my childhood anxieties about uncertainties of life in societies with the limited resources that I had grown in.
I remember being one of the few who managed to leave the commercial farming compound community for secondary school, university, professional life and later postgraduate studies. My journey to Malawi took me back to my childhood sombre memories. The privilege of years of quality education and later on specialisation as Specialist Primary Care Practitioner opened my eyes to a new world. The world where I see people as belonging to different beliefs and cultural practices. In turn, the cultural beliefs and practices impact how they perceive the world. This is more evident in the eating, drinking and social interactions including harmful habits like smoking.
Back then in farming compounds, the diseases that accounted for most of these deaths were easily preventable childhood illnesses like diarrhoea, chest infections, measles and malnutrition compounded by HIV/Aids and tuberculosis. This gives a picture of diseases that are easily passed from one person to the other. These diseases are also easily preventable. These diseases are called communicable diseases. Health workers have coined an acronym CDs for communicable diseases. These are largely linked to infrastructural challenges like lack of toilets, clean running water, deficient diets, overcrowding which are compounded by low levels of education. I still remember then, going to the nearest clinic for simple immunisations and simple primary care treatments was a very difficult because these were very far from our farming compound. I also know that the only vaccine I ever got back then was one for TB called BCG.
One day we were playing on the outskirts of the compound, a Land Rover truck with health workers came to where we were playing. The health workers persuaded us to get a vaccine in exchange for a small glass of cool drink. I was hungry and thirsty and needed a bit of food or drink so I took the offer. There are days I would get complicated disfiguring septic wounds from ringworm and scabies. Granny would use home remedies and I still remember the painful scrubs. The days lost from attending school due to these minor illnesses were unbelievably long, adding to barriers to education. Yes, one could not walk the long distance to school with such excruciating pain from septic wounds in joints and groins.
I have also had enriching experiences as part of teams of health workers who go for outreaches into the different communities in the whole country. On one of such outreaches, I was told a heart-rending story of schoolchildren who have to be fed at the school as an incentive to come to school. I was told of days when a large number of the children would not come to school because they would have gone to the waste dump site popularly known as Ngozi Mine on the outskirts of Bulawayo to collect ‘‘food’’. I remember as a child having to get a few meals from the dumps in the small farming town of Karoi in the early 1980s. I had an opportunity to have a small talk with one of the classes at the school. Seeing me meticulously dressed in front of them, they were inspired and all wanted to be doctors. I struggled hard to suppress my tears as deep in my heart; I knew that the odds were really against them in achieving their dreams.
We may at this stage, therefore appreciate the link between our infrastructure, education and these Communicable Diseases (CDs). We may also try to think of own circumstances and those of our communities.
I will introduce another term here; the fact that if we do not have or have these basic requirements and we all appreciate their link to health may evoke feelings of trying to do something about this. We then appreciate that certain social amenities are linked to health. If these are not provided we tend to get sick more easily and diseases tend to move from one person to the other much easily. These are the Social Determinates of Health. Yes, there is a link between social and physical services to the health we have. We may want to improve our homes to have these very important physical facilities like clean water and toilets. We then realise that we do also have to go to school, work, church and travel. It is the provision of these physical and social facilities that will make us healthy in these places. In turn, we need to appreciate and actively take part in making sure we do our best to look after these facilities. We should be advocates for the provision of these health determining services as active participants.
Access to health facilities that will address immunisation needs for easily preventable diseases like measles, when we are sick, getting quality education are needed to maintain the healthy state. Going back to my farming compound background, chemicals are used as pesticides and herbicides. When the rains come, these may be washed into the drinking water sources for the people, marine and domestic and wildlife. Toxic fumes or gases and waste from mining activities, may be pumped into the air we breathe from the industries, automobiles and burning of forests. We need clean air to stay healthy. We therefore have to actively engage our authorities to assist in the protection and preservation of our environments
On the other hand my travels for education and work experience in affluent communities showed different disease patterns. Deaths among infants and children were not of concern in these communities. On the contrary, deaths among adults were high due to; complications of high blood pressure, diabetes, obesity, cancers and road traffic accidents. There are also a significant burden of mental health problems and diseases related to smoking and harmful use of alcohol. There is a significant problem of addiction to different drugs. The pattern of diseases in this group is not passed from person to person. These are called non-communicable diseases (NCDs). The noncommunicable diseases cause disability due to strokes, extreme obesity which limits activities, life limiting chest complications due to smoking, dysfunctional relationships due to mental health diseases and premature deaths. These are largely preventable.
It seems, in the group, access to social determinants of health like clinics, doctors, pharmacies, quality education, clean water toilets and recreational facilities are largely available but there be limits in appreciation of the value or adaptation of health preserving living ways. Yes, there is outcry from early complication of ballooning burden of non-communicable diseases
There is also a growing trend of this noncommunicable disease in the community and with a concern of growing numbers of people from low income communities.
How many of us have parents, grannies and even our own children having to live with the Type 2 diabetes, high blood pressure, obesity, arthritis, mental health illnesses? How many of us have relatives who have issues with harmful use of alcohol and other harmful illicit drugs?
These experiences ignited the passion in me to share the knowledge and experience I had acquired over my professional career on what ordinary citizens like you and me could do to avoid such tragedies and stay healthy, thereby prolonging and enriching our lives. In the next few weeks I will share detailed information on some of these diseases and how we can prevent them.