Introduction
Researchers rarely dispute the effect of social determinants of health, such as where people live and work, on global health outcomes (Baum, 2008; Dankwa-Mullan, et al., 2010). Although health indicators depend on several intrinsic factors that concern a country’s national health system, recent research has shifted our attention to the effects of wider social, economic, and political issues (social determinants) on health outcomes (Dankwa-Mullan, et al., 2010).
Many western countries enjoy improved health outcomes because of low health inequalities. Although some of them are struggling in this regard, developing countries have a greater challenge realizing the same positive health outcomes because of health inequalities (Venkatapuram, 2010). Based on this background, this paper focuses on understanding the effect of health inequalities on the health outcomes of sub-Saharan countries (Alles et al., 2013).
To have a proper grasp of this issue, this paper further narrows down the study to Kenya, as a sub-Saharan country that continues to report negative health outcomes because of prevailing health inequalities and inequities. This project aims to develop a public health policy for the East African nation, which should improve its health outcomes.
Country Selection and the Rationale for Doing So
Kenya is a low-income country that continues to grapple with health care inequalities because of rapid urbanization and a poor health care system (among other factors). In this regard, the country has reported a decline in its human development index (HDI) since the 1990s (Muchukuri & Grenier, 2009). This paper chooses to focus on the East African nation because its peers, in the wider sub-Saharan region, enjoy improved health outcomes (World Health Organization, 2012). Furthermore, Kenya’s health care system has suffered from rapid urban growth, which experts estimate is 6% annually (World Health Organization, 2012).
Based on this analysis, Kenya’s health care sector chokes from unfavorable social determinants of health. In this regard, it is unsurprising that global health care organizations rank the country at position 148 out of 177 in global health care rankings (World Health Organization, 2012).
Social Determinants of Health in Kenya
Being a low-income nation, several social determinants of health affect Kenya’s health outcomes. Access to health care services, unemployment, working conditions, education, and housing issues are the main social determinants of health in Kenya (Muchukuri & Grenier, 2009). Poverty and economic status mainly shape these social determinants.
Why Address these Determinants?
Although health experts say people should pursue a path towards positive health outcomes, some social determinants of health could lead people towards realizing negative health outcomes (Hashim et al., 2012).
In this regard, it is important to discuss social determinants of health because doing so helps governments to manage health problems in a long-term way. Since addressing social determinants of health also means tackling short-term health issues, improving them also provides both long-term and short-term solutions to health challenges. For example, treating an ailment means that a doctor treats the causes of the disease and its associated symptoms as well. In Kenya, addressing the social determinants of health allows policymakers to manage the country’s health care problems similarly.
Public Issues I May Encounter in Health Literacy and Cultural Awareness in Kenya
Health literacy has recently gained root in the wake of public debate about social determinants of health. The concept mainly refers to people’s ability to get and understand basic health information. Deep-rooted cultural beliefs are the greatest impediments towards health literacy in Kenya (Weiss et al., 2008). Similar to most parts of sub-Saharan Africa (and by extension, Africa), health literacy has yet to gain root in the country.
Here, demographic differences in health literacy indicators outline varying health literacy levels because health literacy has widely spread among elitist groups in Kenya, but not among illiterate and low-income people (Osborne, 2004). Many reasons account for this outcome. Language is one of them. While Kenya’s education system mainly uses English as the main language, some communities are unable to speak the language (Osborne, 2004).
This means a language barrier exists between health care service providers and some of the local communities. The language barrier includes how health care practitioners dispense medicine because most imported medicines have English instructions. Therefore, non-English speakers have trouble using such medicine correctly. Besides language barriers, Kenya is a diverse country with different cultural practices. Muchukuri and Grenier (2009) put this issue in perspective by saying that the East African nation has more than 40 ethnic groups that have different cultural norms and beliefs.
Similar to other parts of the world, some of these communities may disregard the teachings of different health programs for their cultural norms and beliefs. Such actions predispose certain ethnic groups to diseases and poor health outcomes. Lastly, illiteracy levels in Kenya also affect health literacy levels in the country. UNICEF (2014) says the adult literacy rate in the East African nation is 72.2 years. To overcome illiteracy challenges, many health workers have often used mass media to promote health awareness in Kenya. Others have used vernacular radio stations to meet the same goal (Osborne, 2004).
The relationship between Health Inequities/Inequalities and Life Expectancy for Residents of Kenya
Kenya’s life expectancy is 61.08 years (according to 2012 statistics) (Fengler, 2012). This figure is slightly higher than the African average life expectancy of 56.5 years (UNICEF, 2014). However, Kenya’s life expectancy is still lower than other parts of the world. For example, India has a life expectancy of 66.21 years, the UK has a life expectancy of 81.5 years, and the world average is 70 years (World Health Organization, 2010; Fengler, 2012).
Much of the low life expectancy in Kenya stems from unfavorable socioeconomic determinants of health. More so, economic inequalities have contributed to this outcome. In the 1970s, experts feared that Kenya would have “10 millionaires and 10,000,000 beggars” (Muchukuri & Grenier, 2009). Such fears emerged from imbalanced social and economic structures that made the rich people wealthier and impoverished poor people.
Many countries experience the same problem. For example, In America, the widening gap between the rich and the poor and its effects on the country’s health outcomes worries stakeholders in the health sector (Fengler, 2012). Today, income inequalities and inequities attract political and media attention. Researchers have tried to understand their relationships with different health outcomes. Consequently, they have affirmed a negative correlation between health inequalities and health outcomes (Weiss et al., 2008). For example, Jones (2010) affirms a positive correlation between income inequality and decreasing life expectancy rates. This correlation applies to Kenya (Muchukuri & Grenier, 2009).
Efforts by Kenyan Authorities to Reduce Health Inequities
The Kenyan Ministry of Health has introduced several interventions to improve the country’s health outcomes. For example, ministerial initiatives introduced from 1963 (when the country got its independence) to 1990 have led to significant declines in infant and child mortality rates (Muchukuri & Grenier, 2009). However, most of these interventions have focused on disease prevention and curative strategies. Therefore, there has been little focus on social and environmental factors affecting health outcomes. However, recently, the Kenyan government recognized the need to adopt more proactive measures of improving the country’s health outcomes.
For example, WHO (2014) says, in 2006, the President’s office developed an action plan for reducing maternal mortality by linking urban planning and health action and introducing equity monitoring into a medium-term expenditure framework. Besides this intervention, the health ministry has also integrated several millennium development goals in the country’s vision 2030 plan (WHO, 2014).
This intervention aims to integrate health goals into the country’s economic blueprint. For example, the main economic policy document (the economic recovery strategy for wealth and employment creation) integrates several health goals in the country’s economic blueprint (WHO, 2014). Health experts made sure that the goals of this integration aligned with the old policy reform frameworks, such as the 1994 Kenya Health Policy Framework (WHO, 2014). However, trends in welfare indicators show that these initiatives have not yielded fruit, in terms of improving the country’s health indicators.
How I may Develop a Health Policy that Would Garner Support in Kenya
Successful health policies are action plans that could meet strategic health care goals. However, policymakers need to have a careful understanding of the social, economic, and political dynamics of a country if they want to develop such successful health policies. In Kenya, it is difficult to develop a successful health policy without involving local communities (Muchukuri & Grenier, 2009). This is true because cultural factors affect policy implementation processes.
Therefore, community support is crucial when developing successful policies in the country. Besides community involvement, Kenya is a liberal country that has different non-governmental organizations, churches, and other non-state actors that take part in the country’s health care system (Muchukuri & Grenier, 2009). Ignoring their contributions to the country’s healthcare system may affect the quality and success of newly introduced healthcare policies.
In this regard, it is important to improve coordination and harmonization of health policies when developing new health policies in the country. This strategic move should reduce organizational clashes, or conflicts, which may emerge when implementing new health policies. Furthermore, it should reduce redundancies because different organizations could already be involved in the same health initiative. Therefore, this strategy should increase the efficiency of health care policies.
Overall, observing coordination and harmonizing health processes should introduce new policy mechanisms, such as sector-wide approaches, medium-term expenditure frameworks, and similar initiatives to improve policy implementation. In line with these recommendations, some interested groups have recognized the need to introduce harmonized and coordinated health policies in Kenya (successfully) (Muchukuri & Grenier, 2009). For example, in June 2006, commissioners from CSDH met with representatives from local government and civil society groups to introduce a raft of recommendations for improving Kenya’s health policies (Muchukuri & Grenier, 2009). Most of these policies aimed to improve the country’s social determinants of health.
Muchukuri and Grenier (2009) affirmed this fact when they studied how to reduce social disparities of health in Nakuru (the fourth largest Kenyan town). They recommended the need for policymakers to foster collaboration in health (especially in care delivery) because many organizations take part in the same process. They further pointed out that a model of good governance should outline this framework (Muchukuri & Grenier, 2009).
This means that political goodwill should outline the bedrock of proposed collaborative strategies. Besides outlining the need for a collaborative framework, Muchukuri and Grenier (2009) further highlighted the need for community involvement in formulating health policies. For example, they said, Kenya needs to reorganize its health care system by involving all segments of the population in policy planning (Muchukuri & Grenier, 2009). Indeed, the country lacks adequate infrastructure for equitable access to development benefits (Rudan et al., 2013). This fact continues to undermine the country’s growth towards health equity (especially for low-income communities) (Kruk, Porignon, Rockers, & Van Lerberghe, 2010).
Therefore, policymakers need to identify local determinants of health and include them in the policy planning process. This strategy should outline the first step in defining and monitoring the action at the community level. Furthermore, it should help policymakers understand the cultural impediments of policy implementation, which characterize Kenyan communities, and how to overcome them during the policy planning and implementation processes (Koh & Nowinski, 2010).
Conclusion
This paper has shown the effects of social determinants of health on a country’s health outcomes. It has paid close attention to Kenya because the country grapples with significant health inequalities that contribute to its poor health outcomes. Although the Kenyan government continues to introduce policy changes to promote its health outcomes, it needs to refocus its energy on addressing the country’s social determinants of health and refrain from focusing on disease-oriented interventions only. However, as it does so, this paper highlights the need for policymakers to involve local communities during the policy planning process. Similarly, this paper recognizes the need for harmonizing current initiatives on the same.
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