MODULE 2 | Case Study Determinants of Health and Health Systems Around the World

MODULE 2 | Case Study Determinants of Health and Health Systems Around the World

Let’s apply all the concepts you just learned in a case study. Here, we will begin with individual snapshots of various community elements. After each set of images, we will provide a few examples of how this information may impact the health of the individual or the population. Further, consider how this insight may affect the delivery of healthcare programming, and how you may incorporate these elements and the risks and/or resources they provide into a health promotion proposal.

Start

Scenario: Education Access & Quality

In this community, there is one school for the children from primary school through high school. For many kids, their ability to attend school from year to year is variable, dependent on their parents’ ability to pay. This means that a child’s age does not always correlate with their grade or literacy level, and within one classroom, there can be a wide variation of the ages of students.

​​​​​​​Jamar, William, and Malik are learning how to read in their first-grade classroom. This is Jamar’s favorite activity, but for William it is very difficult. It takes him a long time to sound out words, and he gets embarrassed easily when he has to read out loud. His teacher is concerned and worries he may need additional help, but it is very difficult for her with a classroom of thirty-six students. She doesn’t want to see any of her students give up, because she knows how important reading and writing is for their futures. She loves her work and wants to see every one of her students succeed.

Scenario: Economics

Many of the men in this community are employed in the agricultural fields that are nearby. This is one of the most stable sources of income available, which allows them to support their family fairly well every week. Unfortunately, it involves intensive manual labor, so many of the employees suffer chronic joint and arthritic pain for most of their lives due to this repetitive strenuous activity. Youssef has worked in these fields since he was 17 years old, and so did his father and grandfather before him. His income allowed him to send his own son to receive an education, and he is in university now. Youssef hopes to retire in a few years, because every day he wakes up with pain in his knees, wrists, and hips. He hopes he can stay healthy long enough for his son to be able to finish university.

​​​​​​​For women like Esther, stable jobs can be difficult to come by. Every day, she tries to sell head scarves in the local market to make enough money for her to live off. As a widow, it is hard on her to support herself since her husband died a few years ago. She doesn’t know how to read or write, but she is smart at making deals and has a couple customers who frequently buy her goods from her. One day, she dreams of opening her own shop so that she can help other women (especially widows like herself) find work, too.

Scenario: Social/ Community Context

There is one small church in this region, which is attended by many of the surrounding communities also. It is a Christian church, and it was started over forty-five years ago!

It is a central source of support for the community, and well trusted locally for fellowship, worship services, and celebratory gatherings.

Scenario: Social/ Community Context

Because of the small population size, many of the people in this village have known one another for the majority of their lives. This contributes to a communal sense of belonging, and it is not uncommon for non-related individuals to care for the needs of one another, much like an extended family. There is a deep sense of trust between individuals, and members of the community frequently support one another as they encounter both trials and joys throughout their life.

​​​​​​​Recently, many individuals have migrated to this region to escape ongoing violence in their home country. These individuals are from the different region of the continent, where the predominant majority are of Muslim faith. As these individuals have started to settle into this community, they sometimes struggle to feel accepted by the existing community. Many of the women are grieving losses of their husbands, homes, and/or family members due to the war outbreak.

Scenario: Environment

Three years ago, a new water well was dug in a neighboring community. On average, it takes one hour to walk to and from this water well. Most women walk this distance every morning to retrieve the water they need for drinking, cooking, and washing activities of the day. Occasionally, some people still use the small stream nearby for water needs because it’s significantly closer in distance.

Most homes in this region are hut structures, which are very common for this area and all materials needed are easily accessible. These huts are known to hold up well for many years, and often need very little repair work unless a severe rainy season occurs. These homes are built without electricity or running water, so most meals are traditionally cooked over open fires.

Scenario: Healthcare Access & Quality

This young child has been having a number of episodes lately of tremors, fainting spells, and loss of memory. One day at school last week, he fell from his desk and shook violently on the ground for three minutes. During this time, he hit his head on one of the nearby desks. He received timely and appropriate treatment at the local clinic for his head injury, but the doctor is concerned he might be having seizures. Unfortunately, there are no clinics in this country with the technology needed to diagnose this condition. The cost affiliated with traveling and receiving this specialty level of care would be more than the father earns in a year of work.

These three newborns were all recently birthed at home last week. Two of them were accompanied by their family members during the birth of the child, and one of them was attended by a trained birth attendant. All three babies currently look healthy, but none of the three mothers received any prenatal care, reporting a lack of information on what it includes or how to access these services. During birth, one mother had a tearing complication. The child’s grandmother is bringing her to the clinic, because the mother is still bleeding heavy amounts and is very weak and tired. The other two mothers report no complications to delivery.

​​​​​​​This national doctor grew up in this country, and knew he wanted to be a doctor since he was a young kid. He worked hard in school, and his family sacrificed greatly to support him through university and medical school. He is so proud and grateful for this work but is often extremely stressed and anxious every day when he leaves the clinic. He loves serving the people of this community, but he is the only doctor for 100 miles. His patients sometimes need to wait multiple days to receive care, and there have recently been a number of tragic deaths in the clinic that he could not provide care for in time. He recently has thought about moving to a city hospital, where he’ll have more support, but fears about what will happen to this community if there is no doctor available in the clinic anymore.

Putting It All Together

You will now answer four questions, incorporating both individual and population-based health outcomes. You’ll want to consider the impact of each of the health determinants in isolation, as well as the cumulative effect that these individual elements may have on others. Feel free to refer back to images and information presented as you respond.

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The Great Reveal

Welcome to a rural eastern village of Kenya, a region of rich and diverse cultures and strong communal values. Education and economic opportunities are closely linked here, and the environment plays a large factor in the health and safety of the population. The healthcare clinic in town has an excellent staff physician, but daily they battle to have the resources necessary to provide care for such an extensive and robust population. As you consider all these elements on an individual and communal basis, I hope you have identified ways that each of these healthcare determinants provide salient information that is vital to the design of health promotion efforts. The cumulation of these determinants creates the community you will practice within, and the key stakeholders that live within that context carry the most valuable perspective you can gain. As you move forward in these modules, remember to always consider ways in which you can apply these investigation and inquiry skills to gain new awareness and knowledge about global conditions and contexts worldwide.

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Example

A primary concern for me is the lack of access to clean water in the community. I am especially concerned about vulnerable (elderly, disabled, chronically ill) individuals who may not be able to make a one-hour commute daily to receive their water needs. This may not be a primary concern for the community, because they may enjoy their daily walks to the water well with their friends, children, and family members. A primary concern for them may instead be the lack of economic opportunities for women in this region, and their inability to find jobs with stable income. A key stakeholder for me to engage with is the local physician, as he may be able to provide me with valuable information about the rates of typhoid, dysentery, and other water-related illnesses that the community suffers from. Additionally, he may know who the individuals are within the community who are at highest risk for inability to access clean water. I can discuss with him if they have ever trained individuals within the community to provide care in difficult to reach areas, or for persons who are home-bound due to an illness. Sometimes, community members can go through specialized healthcare training to learn how to provide basic healthcare support in a variety of settings. We call them “community health workers,” but it’s okay if they choose a different name for these individuals that they might prefer. We might be able to hire women from within this community to go through this training and eventually work for the clinic, which could provide economic opportunity for them while addressing some of the primary health concerns that the physician and I have for the community.