Growing up, most parents have a uniformly scary way of making their wards focus on their academics. They go thus, “The only thing I owe you is your education. That is your lot, so do not ever nurse the idea of inheritance from me”. A typical educated Yoruba father back in the day would have told his children this several times over to make sure his children stayed focused and performed excelled academically.
The tactics often worked as they made the children stay grounded, get good grades, and ultimately bag university degrees. However, what was lacking in the admonishment was addressing the “WHYs.” Why should I get an education? Why is a university degree so significant? If it’s about money and being comfortable, why are some people still poor even with their degrees? Our parents failed to link education to health and wealth in the real sense of it, coupled with diverse opportunities that could emerge as a result, so here is the link.
Contrary to the old belief that an individual’s health outcome is determined mainly by biomedical conditions and lifestyle choices, many health researchers now consider some interesting factors as the major determinants of health. Even though bio-genetic causes are critical to health outcomes, they now only represent 30 percent of an individual’s health status. Meaning non-medical factors are responsible for the remaining 70 percent, known as social determinants of health.
Dr. Dennis Raphael, a professor at York University, did a good job in identifying about 14 of these key factors determining health outcomes like never before. His findings and other scholars’ work have shown that good health involves many non-biological elements. Such elements include reducing levels of educational failure, reducing food insecurity, lowering unemployment, increasing access to healthcare, improving housing standards and others.
These discoveries have been fundamental in achieving population health in countries with higher life expectancies. For example, despite spending just about 11% of its GDP on healthcare, Japan has the third highest life expectancy rate in the world at an average rate of 85 years. On the contrary, the United States, which spends about 19% of its GDP on healthcare, almost doubling Japan’s health expenditure, is only able to make the sixtieth position on the global life expectancy chart at an average age of 78 years. This comparison shows that availability and access to world-class healthcare may not necessarily translate to excellent health outcomes or population health.
Adamu’s story may paint a clearer picture here. Adamu, in his twenties, started working in a factory far away from home. He was constantly afraid of losing his job as a daily wage worker because there was no job security. His remuneration did not have perks like health insurance or a pension. To stretch his wages far enough, he would hang around the factory sites on weeknights because he couldn’t afford to commute home daily, so he was exposed to harsh weather, poor sleep, and terrible hygiene. He often faced food insecurity as he is always hungry with little cash to feed. He would settle for more filling but less nutritious meals to sustain his strength to work at the factory.
Due to all these purely social and economic issues, Adamu was diagnosed with hypertension and type 2 diabetes a few years into this hard life. The diseases would have seemed farfetched for a young man his age but for the high cortisol level mainly caused by stress.
Adamu’s fight or flight response has been overly frequent, intense, and sometimes inappropriately activated over the years, drowning Adamu in cortisol. The high cortisol level in his blood due to constant stress increases his blood sugar level, which is unimaginably challenging to manage. Despite the absence of any pre-existing bio-medical and behavioral conditions, Adamu’s current poor health status got determined by several socio-economic factors: poor education, low income, poor housing, job, and food insecurity. However, Adamu’s case could have been different if he had good quality education and landed a job with great pay and necessary perks, including a free staff bus ride home; type 2 diabetes and hypertension would probably have been averted.
The list of social determinants of health that significantly shape individual health has since been growing from socio-economic factors, physical environment, and health behaviors to clinical care. With Africa’s life expectancy still below the world average, Nigeria ranking the least three with 54/56 years life expectancy for men/women respectively, is quite worrisome. For a country like ours, achieving population health would be easier, faster, and more cost-effective if we adopt an upstream approach to healthcare.
Aside from the fact that the upstream approach to health is far-reaching and faster in achieving population health. A low-income country like Nigeria can achieve population health with interventions that involve identifying root causes and formulating policies that positively impact the citizenry’s quality of life, such as quality education, food security, and decent housing. The growing evidence that an upstream approach that drives the public health prevention and promotion mandates shows a greater impact on the wider population compared to the downstream approach of responding to emergencies that we currently lack the capacity or resources to perform.
Opaleye, a wellbeing specialist, writes from Lagos