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Social Determinants of Health

A shanty town in Manila, Phillipines, where poverty & related social conditions place inhabitants' health at greater risk. Photographer: Mike Gonzales, used under the Creative Commons Attribution-Share Alike 3.0 Unported license. Photo accessed from Wikimedia Commons.

Poverty & related social conditions are key factors in the health of people & nations. These are factors now faced across the world. NIGH seeks to tell the story of how to connect the dots between the social determinants of health & healthcare delivery, worldwide.

If prevention is the heart of public health, then equity is its soul, according Magaret Chan, Director-General of the World Health Organization, WHO.

Different national and international government policies, depending on their nature, can either improve or worsen health and health equity.

Poor economic policies and the current financial crisis are having a serious impact of the lives of nurses throughout the world. For instance, every aspect of government and the economy has the potential to affect health and the livelihood of nurses – finance, education, housing, employment, transport, and health, just to name a few. Coherent action across government, at all levels, is essential to improve the lives of nurses throughout the world and ensure health equity for all.

Throughout the world, World Bank's structural adjustment policies have eroded carefully created health programmes and the working conditions of nurses. They have led to drastic cuts in health budgets, laying off nurses and members of other essential workforces. The IMF policies have a direct impact on the health sector and its personnel. The real income of nurses has decreased, buying less with the same amount of money. Reduced government spending has resulted in downsizing much-needed health facilities. Says Rose Wanjiru, Policy Coordinator at ActionAid Kenya: “In Kenya, we have been able to train enough nurses and teachers, but they have remained unemployed. We have a requirement to have 70,000 health workers, but we have only employed 40,000. The remaining 30,000 are launching out, looking for other things and are looking for ways to get to the US or to Europe, and in the process, we have a lot of our investment lost.”

Helping lift the burden of poverty: Teaching first aid to the Dalits of rural India

Each graduate of the first-aid course for Dalits received a certificate of completion, a first responders kit and a widely used textbook titled Where There Is No Doctor.

By Susan C. Benedict, CRNA, DSN, FAAN

Each graduate of the first-aid course for Dalits received a certificate of completion, a first responders kit and a widely used textbook titled Where There Is No Doctor. Like many Americans, I thought Gandhi had eradicated India’s Untouchables caste years ago. Unfortunately, although “untouchability” was abolished by law in 1955, it is very much alive in the rural areas of the southern Indian state of Tamil Nadu and governs almost every aspect of life. The caste system is a socioeconomic tradition of placing people into hereditary categories. It is thought to have originated around 1500 B.C. as a means for prescribing economic and social order based upon occupation.

Nursing and Village Life Outreach Project in Tanzania Rural Villages

As a profession, nursing is committed to dramatic social and economic advancement by empowering under-served communities through health education, the creation of networks to access health care resources, and hands on service to contribute to world health. It is through these ideals that nurses can assist communities in the performance of activities that contribute to their health, thus strengthening local and global communities.

In 2007, I partnered with the Village Life Outreach Project, Inc., a non-profit organization working with rural villages in Tanzania, East Africa to fight poverty by promoting life, health and education at the grassroots level. As a non-profit organization, Village Life seeks to unite communities by promoting social responsibility and empowering villagers to address a broad range of social and biological determinants of health, such as health care, oral health, nutrition, water, sanitation, and agricultural development. Village Life ties community involvement to support from nurses, engineers, doctors, teachers and students in an effort to enact long-lasting, sustainable improvement measures in the communities served.

Community Organization: The Key to Empowerment

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Kusadgaon is a village in rural Maharashtra, India. Of the 274 families living here, 75 have toilets. There were 30 births in 2009 and no deaths. All deliveries were safe deliveries and most babies were delivered in the village. Only 32 villagers were hospitalized in 2009. One villager was cured of TB and one is having treatment. In Kusadgaon, 92% of the children go to school, 154 girls and 159 boys. The village council puts chlorine in the drinking water daily.

There is a farmer's club and women's group, working together to meet identified health and development goals. The mobile health team used to visit once a week but village health has improved so much, they now only visit once each month. A woman sings in Marathi, 'Have a cup of tea instead of children,' a family planning message she has learned.

How will the financial crisis affect health?

Global recession is likely to damage our health as well as our wealth, but it also offers an opportunity to build a more equitable economic model.

The G20 Summit: can we trust the IMF with global health?

The G20 summit in London agreed in principle to raise a staggering $1.1 trillion to help save the world from the effects of the global economic meltdown. Much of the funds pledged would be funnelled through the International Monetary Fund (IMF). But according to a document published by ActionAid USA, there is mounting evidence that the economic policies promoted and enforced by the IMF may prevent developing countries from being able to spend more in their national budgets, with drastic consequences for health and education budgets being constrained at unnecessarily low levels.
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Governments not giving adequate priority to tackle global health

NIGH highlights a recent interview with Prof. Sir Michael Marmot - Chair of the Commission on Social Determinants of Health, which deals with the impact of the financial crisis on global health. Against the extraordinary ability of world governments to quickly find billions of dollars to bailout banks and failed businesses, Sir Michael chastises governments for not giving adequate priority to address critical global health needs.

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Focus

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Visitors at the Mapparium in the Mary Baker Eddy Library in Boston, Massachusetts. This was the site to launch Dr. Jean Watson's Million Nurse Project—during the 2010 International Year of the Nurse—to radiate heart-centered Love, Caring and Compassion through individual and collective global meditations. Photo Courtesy of the Mary Baker Eddy Library.