During the past decades, the problem of social inequality in health has become an acute topic of discussion for specialists in the sphere of economy, sociology, medicine, and others. They all agree on the point that the health care system itself is incapable of reducing inequality and improving the conditions of health in the population because numerous external factors are affecting public health. Such factors are called determinants of health; they embrace an array of spheres such as social, political, economic, demographic, and environmental.
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Being a worldwide spread phenomenon, socio-economic determinants of health influence the health of the populations of both developed and developing countries. The country chosen for the paper is Pakistan, which faces military instability and “problems with internal security and economic decline” that have impacted the population and its health (Nishtar et al., 2013, p. 2291). Various socio-economic determinants, such as age, education, gender, access to health, status, the burden of disease, and the environment combined with the instability in the region significantly affect health in Pakistan, imposing challenges for federal authorities.
Age as a health determinant is a significant influencer of health. There exists a vast difference between the health conditions and exposure to a variety of diseases in different ages (World Health Organization, 2018). The older a person is, the worse his or her health becomes and, consequently, the more intensive medical care this person requires. Also, age-specific diseases occur within specific age ranges.
These aspects should be thoroughly addressed by primary care planning and governmental programs. According to the analysis of health reform in Pakistan conducted by Nishtar et al. (2013), the country shows low health quality indicators, which are marked with high mortality of infants and working young adults. These age groups seem to be poorly addressed due to their exposure to diseases. It is important for the federation to identify specific dangers to the health of people in different age ranges and develop a proper system of work in this direction.
Similar to age, gender also requires a particular focus from the medical care sphere. Gender differences impose divergence in the health issues between men and women (World Health Organization, 2018). Improper attention to such differences might lead to lower quality of health in the population and higher rates of morbidity and mortality. As for Pakistan, the gender determinant is poorly included in its healthcare planning, which has some negative influences on the quality of medical services. For example, there is a high rate of maternal mortalities (Nishtar et al., 2013, p. 2291). This data shows a low level of attention to medical care for women in the country.
The level of education of the population determines the conditions of health in general. World Health Organization (WHO) (2018) states that “low education levels are linked with poor health, more stress and lower self-confidence” (para. 5). Thus, the inequality in educational levels among citizens imposes consequent inequality in healthcare. Regarding the situation in Pakistan, the government only plans to develop the sector of education under the 18th Constitutional Amendment due to the disparity between diverse groups of people (Nishtar et al., 2013). Thus, the overall poor education of the country’s citizens leads to obstacles on the way to health improvement.
Access to Healthcare
How people can access medical services in the institutions determines the health level of the population. According to the WHO (2018), health quality depends on the possibility to use treatment and preventive medical services. This determinant influences health in Pakistan since its different provinces have different levels of healthcare system development, which imposes inequality in access to health care for the people.
The 18th Constitutional Amendment identifies the federal government as the one “bridging inequities between federating units” (Nishtar et al., 2013, p. 2292). From this point of view, the situation with access to medical institutions and their services is difficult due to the private sector ownership over medical transportation. Also, the rural inhabitants have lower chances to be timely treated or checked in comparison to urban citizens. Thus, the inequalities in healthcare access diminish the overall effectiveness of the medical sphere services.
The connection between the quality of socio-economic life of people and the quality of their health is undeniable. The gap between the most financially fortunate and misfortunate layers of society leads to inequalities in health (World Health Organization, 2018). Socioeconomic status includes such factors as income and employment. Personal income rates have a “strong correlation with the achievement of health status and therefore levels of employment, poverty reduction, and pro-poor inclusive growth matter are crucial for health gains” (Nishtar et al., 2013, p. 2295). The socioeconomic status of a person is related not only to the income level but also to ethnicity and its perception by society.
The current situation in Pakistan needs crucial governmental steps toward ensuring ethnic and political security at the federal and provincial levels (Nishtar et al., 2013). The high rate of poor population in the country depends on the challenges Pakistan faces and the ineffective government programs implemented for the resolution of the issue.
Burden of Disease
People with diseases, especially chronic ones, constitute part of the population with special needs. It is a determinant of health that affects the country as a whole because the quality of medical services available to such people indicates the general condition of health. The analysis of the Pakistani population’s exposure to medical interventions within the current level of the sector’s development might imply that people bearing the burden of disease do not get the sufficient quality of services. The “high rates of non-communicable diseases” impose many problems in the healthcare sector and are linked to the poor development of medicine in Pakistan (Nishtar et al., 2013, p. 2291). Thus, the burden of disease is one of the significant determinants of health in Pakistan.
The environmental conditions of life significantly impact the quality of people’s health. It is especially acute due to global ecological problems. The clear water and air and good conditions of accommodation constitute a positive environment that increases the quality of health (World Health Organization, 2018). In Pakistan, climate change is already influential and presents a variety of ecological issues adversely affecting health (Nishtar et al., 2013). However, these issues are not addressed in the national planning aimed at the development of Pakistan. Thus, bad environmental conditions remain an essential determinant of Pakistani health and need urgent resolution.
The economy, as one of the most crucial sectors of a country’s life, is one of the leading determinants of health. The economic situation in the country is capable of affecting all the spheres of life, medical care being one of them. The lack of financial investments in the sector might lead to a decline in the development and an ultimate increase in morbidity and mortality rates. In Pakistan, “the public sector spends 0-9% of Pakistan’s gross domestic product (GDP) on health,” which is a very low indicator (Nishtar et al., 2013, p. 2291).
The budget of the country is mostly invested in failing public sector companies while omitting the important sphere of healthcare. According to Nishtar et al. (2013), health is a very corrupt sector in Pakistan. This fact underlines the acuteness of health inequality in the country, which needs to be eliminated on the governmental level.
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Summarizing the discussion of the health determinants in Pakistan, it is essential to conclude that the country has been going through a stage of recovery after the years of military instability that adversely affected its different spheres, including health. There are many challenges faced by the country in addressing age, education, and gender as the demographic determinants of health. It is essential to include these factors in the healthcare development program to improve the conditions of health among the Pakistani population.
The economy, as one of the most significant influencers in the sphere of health, imposes some barriers on the way of health promotion and improvement in the country due to the corruption and low financing in the sector. The elimination of these adverse elements would significantly increase the health rates in Pakistan. The state needs to direct substantial finances into the healthcare system to encourage scientific studies aimed at every health determinant with the ultimate purpose of utilizing the evidence for rapid development.
Nishtar, S., Bhutta, Z. A., Jafar, T. H., Ghaffar, A., Akhtar, T., Bengali, K., … Rahim., E. (2013). Health reform in Pakistan: A call to action. Lancet Series, 381, 2291-2297. Web.
World Health Organization. (2018). The determinants of health. Web.