Social determinants of health

Discuss about the Water and its social determinants of health.

The health status of a population depends on a variety of different factors, and each of these factors has a significant and unique impact on the health status and living conditions of a community. By definition, health is not just the mere absence of disease, but it can be defined as the state of absolute physical emotional and mental wellbeing is an individual. Hence, the health of a particular individual can be recognized as a multifaceted phenomenon that transcends the idea of mere absence of illness in an individual (Shahraz et al., 2014). Undoubtedly, with so many factors associated with it, the impact of the different social, economic and physical environment on health cannot be ignored; and the external and internal factors associated with the above mentioned aspects of health are known as the determinants of health.

The determinants of health can be defined as the social, physical, and economic environment where the individuals are born, live, work and age in, and the impact of these conditions on the access to health care services. Hence, these determinants can be defined as the socio-economic variables that have the potential to influence the individual and group differences in health status of a community. Among the various different kinds of socio-economic determinants of health, water can be considered a significantly important one. Many under-developed countries have a variety of different communities that have very limited access to the clean and hygienic water. According to Maguen, Luxton, Skopp and Madden (2012), the lack of access to clean and hygienic water is the fundamental factor leading to a variety of different water-borne communicable diseases; and adds to the burden of mortality and shorter life expectancy in communities. Hence, it can be easily stated that the water is a considerably important determinant of health and the lack of access to it or the socioeconomic impact on the access to clean and hygienic water can be considered as an imperative public health priority for certain populations. One such population that has been burdened by the diseases and reduced health status due to the lack of clean water is the population of children in Afghanistan (Elyan, Monestersky, Wasfy, Noormal & Oyofo, 2014). This assignment will attempt to explore water as a social determinant of health, its impact on the target population, and the possible intervention or recommendations to address the issues.

Water as a social determinant of health

In order to better understand the impact of social determinants of health and its association with clean and hygienic water for populations, it is important to understand what social determinants are and how they impact the health status of populations. According to the definition provided by www.who.int (2018), social determinants of health can be defined as the conditions in which people are born, live, work, grow and age. On a more elaborative note, the circumstances that contribute to the social determinants of health in a certain population are shaped by the unequal distribution of money, power, and global, local, or national level resources. According to Shahraz et al. (2014), among different types of determinants of health, the social determinants of health contribute mainly to the inequality in health status across socio-economic stratifications based on unfair and avoidable disparities in the health status across different SES statuses.

According to the www.who.int (2018), the economic condition or employment status is one of the greatest social determinants of health, which has a significant impact on the living condition and in turn the health status of the key populations. Different type of professional roles and responsibilities or even the lack of any employment, which leads to a crucial threat to financial sustainability and the ability to avail basic necessities of life, can deteriorate the health conditions of a population significantly. Another very important social determinant of health is the discrimination in the society leading to social exclusion, based on gender, race, socioeconomic status, and even cultural background. The public health programs and policies addressing the different inequities and disparities in health status across populations is another very important social determinant of health. According to Madani (2014), it is very important for the health policies and schemes to understand and address the particular health needs of different underprivileged populations in order to restore equal distribution of health resources in the society. Lastly, early child development is a new addition to the social determinants of health and it is intricately linked with the concept we are exploring in this essay. As per Chellaney (2012), the lack of resource availability necessary for optimal growth and development of the children can lead to persistent and multifaceted health issues in the children as they grow. Among these basic necessities, access to nutritional food, clean and hygienic water, immunization, and hygienic living conditions are the most imperative. Hence, as the target population selected for the assignment is the children in Afghanistan, the social determinant that will be discussed in the essay is selected as water, which is a key requirement for sustaining life and optimal growth and development, especially in the childhood.

Impact of lack of access to clean and safe water on children in Afghanistan

According to Ikram et al. (2014), water is a basic commodity which plays a fundamental role in nurturing and maintaining the health of a particular individual. Now, it has started to receive adequate attention from the healthcare industry as well. It has been discussed by the research that water can be considered as a powerful underlying dynamic which can affect a particular individual at different levels and in various degrees. As the human body is made up of two-third of water, the basic functioning of a body system can easily be disrupted and improved by water.  Hence, it can be stated that water is a significant factor in deteriorating the health of an individual, whether it is by infectious waterborne disease or dehydration due to low consumption of water. This basic commodity plays a fundamental role as a significant determinant of health across different populations (Elyan, Monestersky, Wasfy, Noormal & Oyofo, 2014).

Researchers are of the opinion that an environment that has guaranteed access to clean and hygienic water has been reported to improve the living conditions in the health status of the people living in the environment on a large scale. Potable water does not just ensure protection from certain water-borne infections or communicable outbreaks, but can also uplift satisfaction and preserve the dignity of the residents. Considering the target population, the war conflict in Afghanistan has resulted in many casualties in the nation and the water crisis that is going on in the country is one of the most significant consequences of the same. According to the research, one of the casualties of the war conflict going on in the country for decades is the destruction of the infrastructure that used to supply the residents of Afghanistan with clean and safe water (Elyan, Monestersky, Wasfy, Noormal & Oyofo, 2014). Hence, the lack of clean and safe drinking water has become one of the greatest public health priorities in Afghanistan and the children in Afghanistan are the most affected population due to this crisis. This crisis has led to 80% of the residents having no access to safe drinking water and 60 among 100 children born in Afghanistan dying from water-borne infections before the age of 5. Hence, the selected social determinant of health for the target population of children in Afghanistan is the lack of access to clean and safe water.

The current assignment focuses upon the social determinants of Health and how the effect upon the target population. For the current assignment, the target population chosen is children in Afghanistan. Afghanistan was once victimized by the terrorist group of Taliban which greatly affected the social life of people. The oppression by the terrorist groups affected the well being and progress of the Afghans as a society.  One of the most tormented social groups in this regard is the women and the children. As mentioned by Overbo et al.  (2016), due to the terrorist activities the women and the children were  confined within the four walls of their  homes  or would often keep on travelling from one place  to  the next like a nomad and had no permanent residence. This often affected their living conditions as they had no access to safe drinking water and food.  Therefore, the inequitable distribution of resources along with lack of safe drinking water often made the children suffer from health issues such as jaundice and cholera. As mentioned by Schwendicke, Doost, Hopfenmüller, Meyer, Lueckel and Paris (2015), such situation would often changed into epidemic where a large segment of the population would be affected at the same time. Additionally, the situation of political unrest further deteriorated the medical resources required to treat the population or cope up with the burden of diseases. This in particular worsened the situation of the children and women recuperating from a disease. Afghanistan has been home to many world refugees particularly the ones who have been residing in the war-stricken areas of Pakistan, Bangladesh and China. The lack of concern from the Government and the rampant terrorist activities such as testing and launching of missiles further deteriorates the local water bodies.  Additionally, the pressure exerted by the refugees over the limited resources further leads to contamination of the water bodies. The poor living conditions also mean that people are using the water bodies for performing all sorts of basic living activities. For example, washing of clothes, cleaning of dishes, passing faeces, they are all done close to  the water bodies. Moreover, this same source of water is also used for consumption purposes. The polluted river water also causes a number of health issues within the population such as gastritis, dysentery, diarrhoea etc.

Possible interventions and recommendations

The problem could be represented with reference to official figures and statistics. Between 2003 and 2015, Afghanistan experienced a 29% decline in the mortality rates of children below the age of 5 years (who.int, 2018). The problem lies with respect to the childhood vaccination rates which are very low for Afghanistan.  As mentioned by Lassi et al. (2015), the equitable access to healthcare resources remains a challenge, as the present delivery models have high transactional cost.

It had been seen in Afghanistan that more than  257 children per 1000 births would not survive will the age of  5 years as they would be contracted with health issues mostly diarrhoea, jaundice, cholera form the consumption of polluted and unclear water (Akseer et al., 2016).  Additionally, the unequal access to vaccination programs further made the problem worse.  As reported, among 60% children below the age of 5 years were acutely malnourished, whereas 50% children aged between 6-24 months were anaemic, while three-fourths of school-aged children were iodine deficient (who.int, 2018).

In this respect, some of the diseases with their exact figures could be provided over here such as there were 144605 annual cases of diarrhoea reported from Afghanistan alone. Out of this 25 % of the diarrhoea was accounted to children alone (who.int, 2018). It pointed towards the lack of safe drinking water. A camp in Darfur recorded 50% weekly attack rates of diarrhoea (Bain, Cronk, Wright, Yang, Slaymaker & Bartram, 2014). As reported by Cabada et al. (2016), 2 out of the 3 infant deaths could be attributed to infectious diseases.  Hence, there was a lack of adequate access to safe drinking water, which enhanced the problem of the community manifold times. The acts of terrorism along with the pressure of inhibition put by the refugees made the water bodies insufficient to meet with the large-scale demands. As mentioned by Schwendicke et al.  (2015), the improper use of the scarce water resources further made the problem worse. Though , there  have been a number  of initiatives taken on the part of the government which  aimed to supply clean drinking water  to the children living  in the marginalized  areas, the efforts have not been distributed equally  which worsened the problem. Additionally, the health workers had been sceptical in travelling to the war-stricken areas.

 The lack of clean drinking water has undoubtedly become a significant crisis for the population of Afghanistan especially for the children who are dying at an alarming rate due to different water-borne infectious diseases. Along with that, their developmental pattern is also being affected significantly due to the lack of this basic necessity. Hence, it is very important for the global and national authorities to address the present water crisis with strategic recommendations so that the target population can be relieved from the water crisis and can have the privilege of a commodity as basic for sustaining life as water.

• The first recommendations that can address the present water crisis needs in Afghanistan is a global initiative taken by World Health Organization and the United Nations to provide clean and sanitary bottled drinking water to the residents at free of cost. It has to be mentioned that the climatic changes and the destruction of infrastructure providing clean and safe water due to the war has made it nearly impossible for the local water bodies to be immediately used for delivering clean and hygienic water to the residents (Unicef for every child, 2018).  Hence packaged drinking water supplied to the families, especially with children under the age of 12 regularly and periodically at free of cost can be the first initiative towards the people in Afghanistan having the access to the privilege of clean drinking water without any hassle.
• The second recommendation for improving the water crisis and the associated health problems in the selected population is the initiation of awareness campaigns (Dehgan, Palmer-Moloney & Mirzaee, 2014). It has to be mentioned that the level of awareness or health literacy is more or less negligible in the target population and their families which have led to extensive unhygienic practices regarding acquiring water from contaminated water bodies. This has significantly added to the burden of infectious waterborne diseases in the country, and the children are the most affected by it. Hence it is crucial for the families and the children to be educated and made aware about the importance of consuming clean and sanitary water and the health consequences of consuming contaminated unhygienic water (Chellaney, 2013).
• Another very important recommendation that can improve the water crisis going on in Afghanistan in a long-term basis is initiative from global not-for-profit organizations investing in improving the water supply infrastructure in the country (Zolnikov, 2013). However, it has to be mentioned that it is a long-term goal and will be a time-consuming Although, if successful, it can rid the country of the water crisis it is facing.
• The fourth recommendation is advocacy strategy for the needs of the target population towards the local and global government bodies by different non-for-profit organization which can facilitate implementing different treaties and policies for both clean water supply without any cost and infrastructure development for improving water supply facilities in the country (Habib et al., 2013).
• Lastly, it is very important for the children to be screened and assessed in a periodic manner to help recognize and manage infectious waterborne diseases or different health consequences resulting from consuming water that has been exposed to pollutants and radiation waste due to the war (Granit et al., 2012). Hence, quarterly medical camps organized by the national and local authorities and with the help of World Health Organization can help in preventing and recognizing the health consequences in the children of Afghanistan due to consuming and hygienic water at an early stage and reduce the rate of mortality in the target population effectively.

Conclusion

Conclusion

The study over here focuses upon the social determinants of health and the effect of the same over the children in Afghanistan. It had been mentioned already that Afghanistan is a war-stricken area and hence it is central to a lot of terrorist activities and terrorist attacks. The testing of the explosives or the explosives dropped amidst a war situation often pollute the water bodies. This water, in turn, is consumed by the poor and the marginalized population resulting in stunted growth and poor health in children. The war conditions have disrupted the social life of Afghanistan, as they do not have proper access to a lot of healthcare resources. The inequitable distribution of healthcare resources further results in problems such as inadequate vaccination. The improper vaccination deteriorates the natural immunity standard within the children. Additionally, the pressure over the limited and peaceful residential dwelling areas further limits the access to adequate resources. In  most of the cases , it has been seen that the people coming from refugee areas do not lack proper education  upon maintaining effective hygiene standards  which are reflected in the manner in which they handle the limited resources such as littering around the  water bodies which makes the problem such as maintaining overall well being of children worse.

In this respect, a number of steps have been undertaken by the World Health Organization and United Nations. These aim to package drinking water free of cost to children in the marginalized area. However, the healthcare workers most often do not want to travel or relocate to the remote areas. Therefore, effective  push and involvement from the government is required along with  providing education to the  local inhabitants over the  just use of drinking water can reduce the propensity of the problem

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