The social determinant of health that contributes to the issue of malnutrition and poor care among children and pregnant women in the Philippines that I have chosen to discuss is poverty. As mentioned by the WHO, medical care can prolong survival and help diagnose serious diseases, but the most important things for the health of a population are social, economic, and political aspects (Wilkinson & Marmot, 2003). Political aspects include laws, taxes, social security benefits, and public services that will ultimately produce the health and other societal outcomes of interest of citizens who can afford these benefits (Mackenbach, 2014). Obviously, universal health care is one of the biggest social determinants of health, but it is often limited by monetary deprivation and access to health facilities (transport)–particularly in rural areas of the Philippines. There are many social determinants listed by the World Health Organization, such as: health determinants in early childhood, the effects of poverty, drugs, working conditions, unemployment, social support, healthy food and transportation (Wilkinson & Marmot, 2003). The one I will focus on in this post is poverty.
The growing amounts of maternal deaths and child deaths under 5 in the Philippines in the latest decades are largely due to a family’s wealth. Lifestyle and conditions in which people live and work in are huge determinants of their health and rural communities in the Philippines foster large portions of the people with low paying jobs and dirtier environments in the country. On the top of the Millennium Development Goals for the country is to deal with poverty causing premature deaths. These goals include reducing child mortality–the health issue most prevalent among the impacts of material or monetary deprivation (Marmot, 2005). Child mortality or illness in the Philippines is often brought on by poverty because poor circumstances during pregnancy leads to poor fetal development, nutrition deficiency in the womb and out, maternal stress, higher chances of maternal drinking or smoking, and overall inadequate prenatal care due to the lack of resources. This inadequate fetal upbringing can lead to health complications later in life, if not death of the child (Geneva, 1999).
There is actually a cycle within poverty being a health determinant: poverty can cause more illness, and in return illness can cause poverty. For example, if a child is born from a mother who did not receive prenatal care and didn’t have available resources for a healthy pregnancy (a.k.a. poverty), they likely will have an insecure attachment style and poor stimulation, which can lead to low educational attainment, problems with behavior and social marginalization as an adult, which in turn would lead to an inadequate job and poverty (Wilkinson & Marmot, 2003).
Specifically, in the Philippines, a study on the causes of inequalities in childhood survival in Cebu, Philippines showed several determinants of health: mother’s education, income, heath insurance, drinking water availability, sanitation, travel time to hospital, and access to key drugs. Among these, income had the largest contribution to survival inequalities between non-poor and poor kids (Wagstaff, 1970). On top of this, insured individuals (health insurance) reported much higher hospitalization rates when needed, higher rates of births with a professional attendant, lower rates of home delivery, more primary-care physician encounters, more diagnosed chronic diseases, and better drug compliance (Dror, 2005). Overall, the public has started to realize that there is more to health issues than just biology and social aspects, like poverty, are largely contributing to these problems. This recognition is very important and a big step in the right direction to start addressing these issues.
Marmot, Michael. “Social Determinants of Health Inequalities.” TheLancet.com, 2005, anthropology.msu.edu/anp270-us18/files/2015/05/Social-determinants-of-health-inqualities-Marmot-2005.pdf.
Wilkinson, Richard, and Michael Marmot. “Social Determinants of Health: THE SOLID FACTS.” World Heath Organization, 2003, anthropology.msu.edu/anp270-us18/files/2015/05/Soc-Determs-of-Hlth-the-solid-facts-WHO-2003.pdf
Geneva, World Health Organization, 1999 (http: //whqlibdoc.who.int/hq/1999/WHO_CHS_CAH_ 99.3.pdf, accessed 14 August 2003)
Mackenbach, Johan P. “Political Determinants of Health.” European Journal of Public Health, Anthropology.msu.edu, 2014, anthropology.msu.edu/anp270-us18/files/2015/05/Political-Determs-of-Hlth-Mackenbach-2014.pdf.
Wagstaff, Adam. “Poverty and Health Sector Inequalities.” Ciência & Saúde Coletiva, ABRASCO – Associação Brasileira De Saúde Coletiva, 1 Jan. 1970, www.scielosp.org/article/bwho/2002.v80n2/97-105/en/.
Dror, David, et al. “Field Based Evidence of Enhanced Healthcare Utilization among Persons Insured by Micro Health Insurance Units in Philippines.” Science Direct, Elsevier, 2005, www.sciencedirect.com/journal/health-policy/vol/73.