Your health is decided by politicians!
Article published in the Island. 23 March 2007
-Your health is decided by politicians!
by Dr Saroj Jayasinghe
The lay public is bombarded with information on what to eat, when to sleep, how to exercise and methods of relaxation. The media is adding fuel to this with slogans relating to health: "healthy life styles", "prevent non-communicable diseases" and an abundance of articles by experts who describe diseases and complicated procedures or heroic operations. This article is provocative. It attempts to convince the reader that a population’s health is more often than not determined by social and political factors, rather than doctors, pharmaceuticals and hospitals. In order to develop the argument, it is necessary to define and understand a few relevant concepts.
A few concepts
Health is not the mere absence of illness or disease.
It is a state of positive well-being. One can feel healthy even with a debility such as an amputated limb. Health also encompasses several dimensions. The World Health Organisation describes four dimensions:
physical, psychological, social and spiritual. This means, even with a ‘fit’ physical body, one can be psychologically unhealthy.
What does this broader definition mean in practical terms? Let us reflect on our own experiences for a moment. Consider the life span from birth to death.
For a greater part of an average life-span (which is almost 70 years in Sri Lanka), one remains healthy.
Sickness is often limited to a few short periods, until a serious sickness ends the innings! Look around and at a given moment, a majority of people around feel healthy and well. Even the few who unfortunately become ill with a chronic illness, have led a healthy life for a greater part of their lives, before falling sick.
The long-term goal of society should be to maintain and improve the health of the population, and to prevent persons from prematurely dying or going down with illness. Caring for those who are sick is essential, but the overall emphasis of society’s goal should be to find ways and means of maintaining health and promoting health of the whole population. Thus one should not confuse the subtle difference between the main focus of the current health services (i.e.
‘caring for the sick’) with that of society’s main goal (i.e. maintain and promote population health).
Once the goals of society are clear we need to pose the next obvious question "Who contributes most to maintain and promote our health? What contributions do the health services make towards maintaining and promoting health?"
Who is responsible for health of the population?
Health services play a crucial role in caring and curing for those who have unfortunately fallen ill.
However, maintaining health and health promotion are less reliant on the health services and are dependent on ‘other sectors’. Therefore if one adds up the totality of health of a population the key determinants are beyond ‘hospitals and doctors’.
Population health is determined to a greater extent by society working through other sectors, more than through health services. The next few paragraphs describe what these ‘other’ sectors are and the link to politicians.
Other sectors which contribute to health
A few examples are education, employment conditions, housing, and economic status. (I have deliberately left out well known sectors such as provision of clean water, sanitation, air pollution etc.)
Education is a key determinant of health of a population. Those with high quality education (e.g.
university education) have a larger proportion of healthy persons, than the uneducated. The poorly educated die younger and are more often affected by illness.
Employment conditions are also important for health.
Being employed in a secure job is good for health.
Unemployment (even threat of unemployment), manual work, night shifts, and lack of a supportive work environment contribute to people falling physically sick, absenteeism and low productivity.
Housing has a complex influence on health. In general terms, good housing leads to improved health. Research in Sri Lanka carried out by the Malaria Research Unit of the University of Colombo had shown that poor housing is linked to higher rates of malaria. More recently, the British Medical Journal of 3 March 2007 describes a study where mere provision of good insulated housing improved the health of the population .
Economic status is a key determinant. Economic development (with equity) promotes health. On average, the richer survive longer than the poor. The richer groups suffer less from communicable and non communicable disease such as diabetes, stroke and heart attacks. (It is a myth that these diseases are confined to the affluent). Scientists use the term ‘social determinants of health’ to describe all these ‘other sectors’ which impact on health.
These social determinants are largely a result of political decisions. Lack of housing (e.g. 50% of Colombo city population live in unsuitable houses (i.e. ‘slums’), poor quality education in the country (e.g. 18% sixth graders cannot write as highlighted in the Island editorial of 21 March 2007) , the status of labour laws (e.g. increasing pressure from multi-nationals to restrict labour rights) are finally based on political decisions. Doctors and hospitals deal mostly with the final detrimental effects of these decisions. Health is a wider issues not limited to the Ministry of Health. It is the responsibility of all the ministries of government and a cross-cutting issue, with political overtones. One pays a price if this reality is not appreciated, and often the price is in human lives.
The politics of health and specific disease prevention
What are the implications of knowledge on social determinants of health for disease prevention? This topic is of interest because the health services have several programmes aimed at disease prevention and health promotion. The specific simple example is used because currently there is a lot of in Sri Lanka to prevent an ‘epidemic’ of non-communicable diseases (NCDs, such as diabetes, coronary heart disease, hypertension, stroke).
The following facts must be mentioned. Firstly it is well known that the diet taken by the population is an important determinant of the prevalence of these NCDs.
Secondly, marketing campaigns by the food industry leads to unhealthy dietary habits among children, a consequence of which is childhood obesity. These obese children are at a higher risk of developing diabetes, heart disease and a many other chronic diseases in later adult life. One needs to view the numerous TV channels in Sri Lanka for a few hours (especially the children’s programmes) to observe how ‘unhealthy’ fast foods are being aggressively marketing to children.
This includes sausages, ice creams, sweetened drinks, biscuits, sweets etc. If Sri Lanka is to take comprehensive action to curb an epidemic of NCDs it also needs to discourage unhealthy food habits in the population. Should the government take any action to curb such marketing methods (*see foot note) or restrict the opening of fast-food outlets?
Any action on part of the government will be based on political pressures and realities. One common political decision in such circumstances is to be deliberately indecisive (i.e. not to take any action on promotion of fast-foods aimed at children). If this happens, victory for the fast-food industry is almost assured. The dull faces of the well meaning health professionals on TV attempting to educate the public on healthy life styles and the detrimental effects of fast foods is no match to the smart sportsmen or cartoon characters who promote the fast-foods! Thus extending this argument further means that the public have to bring on pressure at the political level to implement ‘pro-healthy’ policies. Failing to appreciate this fact may condemn the next generation of children to premature death and illness.
Conclusion
The article challenges the commonly held views on the definition of health and the belief that population health is largely determined by the health services.
Instead we propose a broader view of health with the hope that once these concepts are understood, the public and the health profession will direct more attention to policies which promote health, rather than be limited to curative services and hospitals. In order to be effective most such policies require action in the political arena.
(*Foot note: A similar debate is underway in the US, and there is an interesting article on food marketing and childhood obesity in the prestigious medical journal ‘New England Journal of Medicine’ 15 June 2006. It can be accessed freely from
http://content.nejm.org/cgi/content/full/354/24/2527
).
The writer is Professor, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Sri Lanka & Consultant Physician, The author can be contacted using the following e-mail address:
societyandhealth@yahoo.com
-Your health is decided by politicians!
by Dr Saroj Jayasinghe
The lay public is bombarded with information on what to eat, when to sleep, how to exercise and methods of relaxation. The media is adding fuel to this with slogans relating to health: "healthy life styles", "prevent non-communicable diseases" and an abundance of articles by experts who describe diseases and complicated procedures or heroic operations. This article is provocative. It attempts to convince the reader that a population’s health is more often than not determined by social and political factors, rather than doctors, pharmaceuticals and hospitals. In order to develop the argument, it is necessary to define and understand a few relevant concepts.
A few concepts
Health is not the mere absence of illness or disease.
It is a state of positive well-being. One can feel healthy even with a debility such as an amputated limb. Health also encompasses several dimensions. The World Health Organisation describes four dimensions:
physical, psychological, social and spiritual. This means, even with a ‘fit’ physical body, one can be psychologically unhealthy.
What does this broader definition mean in practical terms? Let us reflect on our own experiences for a moment. Consider the life span from birth to death.
For a greater part of an average life-span (which is almost 70 years in Sri Lanka), one remains healthy.
Sickness is often limited to a few short periods, until a serious sickness ends the innings! Look around and at a given moment, a majority of people around feel healthy and well. Even the few who unfortunately become ill with a chronic illness, have led a healthy life for a greater part of their lives, before falling sick.
The long-term goal of society should be to maintain and improve the health of the population, and to prevent persons from prematurely dying or going down with illness. Caring for those who are sick is essential, but the overall emphasis of society’s goal should be to find ways and means of maintaining health and promoting health of the whole population. Thus one should not confuse the subtle difference between the main focus of the current health services (i.e.
‘caring for the sick’) with that of society’s main goal (i.e. maintain and promote population health).
Once the goals of society are clear we need to pose the next obvious question "Who contributes most to maintain and promote our health? What contributions do the health services make towards maintaining and promoting health?"
Who is responsible for health of the population?
Health services play a crucial role in caring and curing for those who have unfortunately fallen ill.
However, maintaining health and health promotion are less reliant on the health services and are dependent on ‘other sectors’. Therefore if one adds up the totality of health of a population the key determinants are beyond ‘hospitals and doctors’.
Population health is determined to a greater extent by society working through other sectors, more than through health services. The next few paragraphs describe what these ‘other’ sectors are and the link to politicians.
Other sectors which contribute to health
A few examples are education, employment conditions, housing, and economic status. (I have deliberately left out well known sectors such as provision of clean water, sanitation, air pollution etc.)
Education is a key determinant of health of a population. Those with high quality education (e.g.
university education) have a larger proportion of healthy persons, than the uneducated. The poorly educated die younger and are more often affected by illness.
Employment conditions are also important for health.
Being employed in a secure job is good for health.
Unemployment (even threat of unemployment), manual work, night shifts, and lack of a supportive work environment contribute to people falling physically sick, absenteeism and low productivity.
Housing has a complex influence on health. In general terms, good housing leads to improved health. Research in Sri Lanka carried out by the Malaria Research Unit of the University of Colombo had shown that poor housing is linked to higher rates of malaria. More recently, the British Medical Journal of 3 March 2007 describes a study where mere provision of good insulated housing improved the health of the population .
Economic status is a key determinant. Economic development (with equity) promotes health. On average, the richer survive longer than the poor. The richer groups suffer less from communicable and non communicable disease such as diabetes, stroke and heart attacks. (It is a myth that these diseases are confined to the affluent). Scientists use the term ‘social determinants of health’ to describe all these ‘other sectors’ which impact on health.
These social determinants are largely a result of political decisions. Lack of housing (e.g. 50% of Colombo city population live in unsuitable houses (i.e. ‘slums’), poor quality education in the country (e.g. 18% sixth graders cannot write as highlighted in the Island editorial of 21 March 2007) , the status of labour laws (e.g. increasing pressure from multi-nationals to restrict labour rights) are finally based on political decisions. Doctors and hospitals deal mostly with the final detrimental effects of these decisions. Health is a wider issues not limited to the Ministry of Health. It is the responsibility of all the ministries of government and a cross-cutting issue, with political overtones. One pays a price if this reality is not appreciated, and often the price is in human lives.
The politics of health and specific disease prevention
What are the implications of knowledge on social determinants of health for disease prevention? This topic is of interest because the health services have several programmes aimed at disease prevention and health promotion. The specific simple example is used because currently there is a lot of in Sri Lanka to prevent an ‘epidemic’ of non-communicable diseases (NCDs, such as diabetes, coronary heart disease, hypertension, stroke).
The following facts must be mentioned. Firstly it is well known that the diet taken by the population is an important determinant of the prevalence of these NCDs.
Secondly, marketing campaigns by the food industry leads to unhealthy dietary habits among children, a consequence of which is childhood obesity. These obese children are at a higher risk of developing diabetes, heart disease and a many other chronic diseases in later adult life. One needs to view the numerous TV channels in Sri Lanka for a few hours (especially the children’s programmes) to observe how ‘unhealthy’ fast foods are being aggressively marketing to children.
This includes sausages, ice creams, sweetened drinks, biscuits, sweets etc. If Sri Lanka is to take comprehensive action to curb an epidemic of NCDs it also needs to discourage unhealthy food habits in the population. Should the government take any action to curb such marketing methods (*see foot note) or restrict the opening of fast-food outlets?
Any action on part of the government will be based on political pressures and realities. One common political decision in such circumstances is to be deliberately indecisive (i.e. not to take any action on promotion of fast-foods aimed at children). If this happens, victory for the fast-food industry is almost assured. The dull faces of the well meaning health professionals on TV attempting to educate the public on healthy life styles and the detrimental effects of fast foods is no match to the smart sportsmen or cartoon characters who promote the fast-foods! Thus extending this argument further means that the public have to bring on pressure at the political level to implement ‘pro-healthy’ policies. Failing to appreciate this fact may condemn the next generation of children to premature death and illness.
Conclusion
The article challenges the commonly held views on the definition of health and the belief that population health is largely determined by the health services.
Instead we propose a broader view of health with the hope that once these concepts are understood, the public and the health profession will direct more attention to policies which promote health, rather than be limited to curative services and hospitals. In order to be effective most such policies require action in the political arena.
(*Foot note: A similar debate is underway in the US, and there is an interesting article on food marketing and childhood obesity in the prestigious medical journal ‘New England Journal of Medicine’ 15 June 2006. It can be accessed freely from
http://content.nejm.org/cgi/content/full/354/24/2527
).
The writer is Professor, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Sri Lanka & Consultant Physician, The author can be contacted using the following e-mail address:
societyandhealth@yahoo.com
posted by Aloyzio Achutti at 8:44 AM
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