Health Inequalities: Wealth is Health

In Health Policies on February 1, 2013 at 5:00 am

The slogan on the Global Health Africa website reads “Health is Wealth” but “Wealth is also Health”. By wealth I mean various resources -power, education, employment, inheritance, living conditions-which gives one individual an advantage over another. Possession of any of these resources increases one’s likelihood of a better health.  A number of researchers have written about the influence of these socio-economic factors on one’s health; most notably, Michael Marmot. Below we discuss the link between these factors and health as well as implications for organizational policy.

Exploring the link between Wealth and Health

In his article published in a 2005 edition of the Lancet, Marmot provides an apt description of the variation in health outcomes within countries, by socio-economic status. Using Indonesia, Brazil, India and Kenya as examples, under-5 childhood mortality was shown to be highest among the poorest households in all these countries. While in Bangladesh, mortality rate among men differed by educational status

poorest of poor As a result, Marmot warns that addressing surface public health issues may not be the solution. Rather, there is a need to identify the causes of causes by examining the social conditions in which individuals live and work. Still, I am not in full agreement with his suggested methods for addressing these social conditions as they comprise of policies such as cash transfer programmes, which may encourage dependency on government welfare and are largely, unsustainable.

A recent example of health inequalities between nations can be seen in the newly released Global Burden of Disease Study 2010 by the Institute for Health Metrics and Evaluation in Seattle, Washington.  Wealthy Western and Asian countries have the longest years of healthy life expectancy while some of the poorest African Nations are at the bottom of the ladder. So the question is: How can public health organizations address these health inequalities in Africa?

Changing the way we work

There is no one size fits for addressing health inequalities in Africa neither do I claim to know it all. Still, I make some suggestions.

  1. People empowerment approach rather than a people giving approach: A widely used proverb goes, “Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime”. Governmental and non-governmental public health organizations need to recognize that ill-health and premature death is often times a symptom of social conditions. Therefore, in planning public health interventions, it is pertinent to include measures that will aid individuals to acquire skills needed for self subsistence. This could include training breadwinners on business skills, providing loans for start-ups, as well as scholarships.
  2. Targeted interventions: This would ensure that the poorest of the poor have access to health information and services, education and an opportunity for their voice to be heard
  3. Working together: It is imperative that public health and non-public health organization work together  to ensure that there is a focus on community priorities rather than organizational agenda
  4. Research and Advocacy: A lot of work still needs to be done to identify best practices for addressing health inequalities in African nations. There is also a need for organizations to advocate for policies that address the needs of the poorest of the poor in African Nations.

So what do you think? How best can health inequalities in Africa be addressed?

  1. I think it is important to remember good health also functions as a commodity such that when the local population does not invest in it the diversity of intelligent solutions they will not spur change. I think a clear and continuous dialogue with citizens in poor countries regarding attitudes and choices for health care would yield a wealth of information for creating adequate interventions. Afterwards, locally derived solutions need aggressive advocacy and support; especially with inexpensive emerging communications platforms and technologies.

  2. Hello Eric, Thanks for your comment. We are not saying that health is less important. Rather, this post is advocating for an approach to health that looks at broader socio-economic issues and that takes these issues into account. Attitudes and health choices are not just the only determinants of health. Social conditions are even more important as they have a huge influence on attitudes and health choices.

  3. Great thoughts on here. I do agree with both yours and Marmot’s policy suggestions, and not just either or. If the suggestions are used in combination they each have advantages and so should be complementary to each other. In systems that have gone so low that recovery will take a while, and with strategies in which your outcomes may not become obvious for another several years, you may need some immediate solutions. For example, some systems in rural areas in LMICs will take a while before reaching the optimal standards, and in addition building capacity and empowerment for the populations in these areas may not produce results overnight. Therefore you may need some quick fixes working alongside your mid/long term solutions. These quick fixes are not meant to be sustained. There is just no two ways about it, you need some short term solutions like the cash transfers if your are going to be relevant.

  4. Hello Rhona, Thanks for stopping by.I also agree that short-term solutions are important. However, I will clarify that I only support them to the extent that beneficiaries understand that they are “short term”; there are checks and balances, and organizations have long-term plans for the populations they work with.

    Cash-transfer and welfare programs are easily abused; monies can be siphoned and those that need those funds may not access them. I have witnessed such ugly realities both in African nations and in the West. For instance, in the US, individuals have come to depend on food stamps even when their incomes go above eligibility levels. Many of them do not have an incentive to work. Therefore, I believe that such quick fixes such be used sparingly. Good things don’t come easy.

  5. Thank for the article and comments. I will use those points in my Community Development and Health Promotion/Education Classes..

  6. You are welcome! We would love to know what you found the most helpful as well as your thoughts on health inequalities based on your experience and interaction with students and community members

  7. I really like this discussion, poverty is such a big monster and very hard to define. I believe the biggest problem in Africa is poverty of the mind! We do have resources in Africa but we do not know how to tap into these resources without depending on developed countries. I think that because of colonialism Africans are stuck without the colonial powers to think for them. I long for a time when the donor dependency mentality will stop to exist in Africa.
    I think we need freedom to exercise our knowledge and thinking capacity without following prescribed donor given rules. In other words think outside the box!!We need to formulate our own interventions that are applicable to the African situation. I can go on and on…. We need to focus on empowering the community to engage in income generating activities especially agriculture with value addition. It amazes me to see a local farmer selling his coffee at a peanut price to the exporters and buying the same coffee at an exorbitant price after value addition.
    Public health interventions like health education and sensitization could also help to change attitude and practices, but enrich knowledge of the people. Governments need to support their own health systems and ensure equal and equitable access to health services. This is only possible if CORRUPTION is eliminated.
    I pray that God intervenes in African countries to give us wisdom and understanding of how to utilize the resources He gave us to make our living here on earth worth enjoying with negligible childhood mortality, neonatal mortality and maternal mortality!!!!
    Thank you for this article

    • Wow! Thank you so much Liz for your contribution. I agree that we have resources, natural resources but not enough “social and economic resources”. African nations are yet to learn how to utilize these natural resources to empower their constituents and that is sad because Africa should be one of the richest continents if things are done right.

      Do I think there is poverty of mind? yes! This is evident in the way African leaders enrich themselves using their nation’s wealth. However, there are very rich minds among the budding youth population who just need the support and the opportunity to innovate and create wealth. The growth of these individuals will be stunted if social conditions that impact people’s health and progress is not addressed by both public health and non-public health organizations.

      I like that you mentioned strigent donor procedures which do not allow public health organizations to think outside the box. That is why, in the post, I touched on the importance of focusing on community priorities rather than organizational agenda. Lets keep talking about it and keep our fingers crossed that the wind of change will blow.

      The onus lies, in large part, on African Governments, like you mentioned, to change these social and economic condions . African nations have all it takes to become super powers and hopefully, they will get there!

  8. Your contention that food stamps create “dependence” in the U.S. and remove the “incentive to work” sounds like extreme conservative bilge. I am a full-time worker and a part-time student. My wife is a full-time pre-nursing student. We have two very small children. We receive a small amount in food stamps and other subsidies each month — not because we are lazy, but because my employer pays me an extremely low salary (about half of the average salary in the U.S.). We are using this opportunity to improve our education and embark on new careers in the long term. The argument that programs like this “create dependency” is completely false. In reality, they ENABLE people to improve their education and career prospects and succeed in the long term. Furthermore, partially-subsidized preschool is what allows my wife to attend school to become a nurse someday. Don’t listen to Fox News — we are not the “takers” and we are not lazy! Please stop repeating this false propaganda.

  9. I would also like to add a further comment. Your view of food stamps is extremely cruel and creates misery and depression for families like mine. When my wife goes shopping at a mostly-white, well-to-do grocery store, whenever she takes out here SNAP (food stamps) card people (shoppers and cashiers) give her disapproving looks, as if she is nothing but a lazy moocher. She is trying SO hard — she works very hard as a student and she is a fantastic mother to our children — and then people treat her like a bum. I am just so sick of this type of attitude toward people like us. There are some lazy people who are not doing anything to improve their lives, but we are not among them. And I would say that MOST food stamp recipients do WORK or are at least looking for work. And even if only one family uses food stamps responsibly, which I really doubt, please don’t be cruel to that one family. We work hard, we get straight As, yet people still look down on us. Can you see how that would become very depressing?

    • Dear Bob, Thank you for your comment! My opinion of SNAP is not just based on observations alone but also from reports such as this: It would be interesting to see the results of a through investigation into SNAP. Still, majority of individuals that use SNAP are not fraudsters or lazy. I believe that there are a lot of hard-working individuals for which such programs can be a life-saver. However,programs such as SNAP have a limited impact on the root causes of health inequalities as this article tries to point out. They are short-term solutions.

      I am of the opinion that in addition to short-term solutions(which have checks and balance), it is important to develop sustainable long term solutions that addresses social and economic conditions which prevent an individual from reaching their highest potential. Scholarships for formal and vocational training, and easy access to loans for entrepreneurship in addition to creating an environment for businesses to thrive are some of my suggestions which can help create jobs and reduce the use of welfare programs

  10. Dear GHA, I agree with Bob that you are shortsighted in your assessment of conditional cash transfers and food stamps. These are instruments used by nearly every developed country to reduce the gaps between rich kids and poor kids. Canada has child tax credits which function much like the programme you cite in Colombia. In addition, Canadian provinces provide additional incentives to families raising children, so that payments from governments may constitute a large percentage of a family’s income. This enables the children in low-income homes to have a normal childhood with good education. All of this is provided in a country with free healthcare. And it works. Compare pretty much any health and education indicator between the US and Canada and you’ll see Canada comes out ahead. Look at how most European countries provide funding to low income families and you will see that the US is an outlier, unable to provide for the basic needs of low income families. If it does not work in the US, why are you suggesting we export a “pro business” system, one that benefits only a small percentage at the top, to African countries? Poverty will exist in every country regardless of productivity or the rate at which resources are exported. Cash transfers are not a short-term solution, but something that developing countries should be working towards. The goal should be to collect enough taxes and royalties so that the money can be spent on social programming, following the example of successful democracies in Northern Europe, Japan and Canada. Unfortunately most African countries are practically giving away their natural resources in the name of creating jobs, rather than collecting royalties which could be used to eliminate extreme poverty.

  11. The research conducted by Michael Marmot not only point to the intractable nature of often growing inequalities. In most African nations, we will not succeed in reducing inequalities if we don’t start by asking the frank questions: Is social inequality a problem? Is economic inequality a problem? We can only move to solutions if decision makers and communities agree that inequalities are a problem and that 2) they need to be reduced for the greater good of all. The premise of those who researched this question (and the WHO report on social determinants of health) was to raise awareness that health inequalities will be reduced when we address macro-economic factors and issues like income distribution in wider society. They also highlight that health is determined by good work and education FOR THE MAJORITY. Not for the poor alone. The efforts to address poverty suggested by some do not even begin to address the issue.

  12. Hello Chiekh, thanks for your comment. Health inequalities is rarely discussed in Africa but it does exist as we highlighted in the article and the decision to address it is critical to improve health outcomes for large numbers of people within a population. Like you rightly said, there should be a macro focus but we believe that it should not be a one size fits all approach as different sub-populations and social strata are faced with different challenges.

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