Social determinant of health: Economics/Inequality
A social determinant of health that I see as heavily impacting the Haitian people and also enabling a continuation of the spread and lack of education on HIV/AIDS is lack of economic stability and inequality. One of the first points noted about the social determinants of health inequalities is about large gaps or inequalities between nations (or rural vs urban) as it pertains to healthcare (Marmot, 2005). In Haiti, the adult prevalence rate of HIV in 2012 was just over 2%, comparatively, developed nations like the United Kingdom have an adult prevalence rate of only 0.16% (UNICEF, 2012; Kirwan et al, 2016). Based on the differences in these statistics, we can tell that there is a gross health inequality between Western nations and Haiti.
Another aspect of inequality comes from an unequal disruption of wealth historically. As noted in previous posts, Haiti was a French colony until 1804 and post-independence the French demanded a massive payout to recognize Haiti as an independent country which was crucial to the Haitian state’s legitimacy due to the many countries ignoring a nation full of freed slaves at a time when slavery was still a large part of most Western economies (Schuller, 2012). To pay off this debt, Haiti took out massive loans from the French and spent over 120 years paying it off through about 80% of their tax income therefore the Haitians were unable to build proper infrastructure and thus an economy during a time when other independent nations were thriving and “modernizing” (Shuller, 2012). This lack of infrastructure and resources become part of the social determinants of health. According to Marmot, “Relief of such material deprivation is not simply a technical matter of providing clean water or better medical care. Who gets these resources is socially determined,” (2005). This quote illustrates that creating equality is not as simple as it may seem and stems from systematic problems that must be fixed first.
In addition to historical impacts, natural disasters in the region increase instability as well as destroying resources creating an inability to access for many and leaving some disabled (Danquah et al., 2014). In the last ten years, the nation has experienced two major natural disasters one being the massive earthquake in 2010 to strike the capital, Port-au-Prine leaving 220,000 deaths and over 300,000 people were injured (Danquah et al., 2014). This disaster left Haitians struggling, resorting to makeshift shelters out of plastic tarps, inadequate restrooms, and even trading sex for food (Scheuller, 2012). The second massive disaster was Hurricane Matthew that hit in 2016 devastating infrastructure, people’s lives, and access to necessities such as schooling (Cook & Beachy, 2018). A country increasingly more vulnerable to environmental impacts due to climate change along with a lack of stable infrastructure or resources to combat natural disasters, matters for health disparities among the country and Western countries might only continue.
Economic impairment for the country as a whole is also exacerbated by developmental loans and foreign aid. In the aftermath of the 2010 earthquake, the government was unable to respond due to the power international NGOs had over the area and the push to privatize sectors that would work in emergency services leaving the country without the power to intervene and help their people (Schuller, 2012). International political interests are so heavily involved in political priorities that they lack the ability to be directly helpful to the Haitian people and weaken the ability of the state creating increased economic disparities.
All of these aspects of Haiti’s economic situation makes it difficult for the nation to combat HIV and is central to understanding why the disease has taken such a stronghold in the area.
Cook, A. C., & Beachy, D. (2018). The Impact of Hurricane Matthew on School Attendance: An Analysis from Rural Haiti. International Journal of Environmental Research and Public Health, 16(1), 55. doi:10.3390/ijerph16010055
Danquah, L., Polack, S., Brus, A., Mactaggart, I., Houdon, C. P., Senia, P., Gallien, P. & Kuper, H. (2014). Disability in Post-Earthquake Haiti: Prevalence and Inequality in Access to Services. Disability and Rehabilitation, 37(12), doi.org/10.3109/09638288.2014.956186.
Kirwan, P.D., Chau, C., Brown, A. E., Gill, O. N., & Delpech, V.C. (2016). HIV in the UK. Public Health England, London. Retrieved from https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/602942/HIV_in_the_UK_report.pdf.
Marmot, M. (2005). Social Determinants of Health Inequalities. Thelancet.com Retrieved from https://drive.google.com/file/d/1bct-CtOGaE-NCBdQUDE11L9x1n4Riotk/view.
Schuller, M. (2012). Chapter 1: Violence and Venereal Disease: Structural Violence, Gender, and HIV/AIDS. In Killing With Kindness (14-42). New Brunswick, NJ and London:Rutgers University Press.
UNAIDS. (2019). Country Factsheets Haiti. Retrieved from https://www.unaids.org/en/regionscountries/countries/haiti.