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Student Network Resources, Inc.Topic: TACKLING HEALTH INEQUITY USING PRIMARY HEALTH CARE AND EMPOWERMENT APPROACHES
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The social determinants of health which according to WHO (2011) are the conditions in which individuals are born in, grow, live their lives, work as well as age is an integral to the achievement of health equality worldwide. These situations are basically shaped by the level and pattern of the distribution of money, power as well as other resources at a local, national, regional and international level, factors that are also dictated by the laid down policies of a given regime. These social determinants of health have been noted to be responsible for the cases of health care inequities the world over. Health inequity refers to the unfair as well as the unavoidable difference in the cross country health status. Social determinants of health have also been noted to include living conditions, educational facilities and opportunities as well as the health care services that have a profound effect on the health of the populations. The rural population has been noted to be the ones that suffer the worst health inequity (Li and Dorsten,2010).
Scholars have long suggested that health care is one of the most credible indicators of a population’s well-being as well as a social stratification factor. Daniels, et al., (2006) pointed out that health equity and good health for members of a given society are usually advocated for even by the adherents of other social stratification measures like income. Li and Dorsen (2010) on the other hand pointed out that most of the studies on societal and community stratification have a deep focus on the level of economic development with health being neglected. This paper however, is a demonstration of an in-dept comprehension of the social determinants of health with a particular sharp focus on the state of childhood obesity in Saudi Arabia. We are to do this with a demonstration of an in-depth comprehension of and analysis of Comprehensive Primary Health Care. The concepts of power as well as empowerment are also explored .The health inequity scenario in the previous assignment is referred to in an effort of addressing the problems that were identified using the Comprehensive Primary Health Care framework as a suitable model for the achievement of the vision 2030 goals.The vision 2030 is to be aligned with the Millennium Development Goals (MGDs) in the Saudi Arabia context which is the eradication of extreme poverty as well as hunger , achievement of universal primary education, promotion of gender equality as well as the empowerment of women, reduction of child mortality, improvement of maternal health, combating HIV/AIDS, malaria as well as other diseases, ensuring environmental sustainability and the development of global partnership for the sake of development (WHO,2011b).The particular MDGs to be affected by this case are reduction in childhood mortality as well as the combating of HIV/AIDS, malaria as well as other diseases. This is because they are to be tackled through a health care framework, a similar framework necessary for tackling childhood obesity in Saudi Arabia (UNDP,2009).The vision 2030 in this case is to reduce and if possible eradicate childhood obesity from all Saudi Arabian provinces.
An overview of the social determinants of health
As mentioned earlier in this work, the social determinants of health are those conditions in which a person is born in, grow, live their lives, work as well as age is an integral to the achievement of health equality worldwide (WHO, 2011).The distribution of wealth, power as well as services globally at the local, national, regional and global level plays an important role in the health of the masses in addition to the laid down policies.The World Health Organization in 2005 established a special commission called the Commission on Social Determinates of Health (CSDH) and mandated it with the reduction of global health inequity (WHO,2011). The Commission on Social Determinates of Health employs three main principles in an effort of closing the health gap in a given generation. These three principles are aimed at improving the daily living conditions of the global population, solving the problem of power, wealth and resource inequity at all levels of the society as well as measure and understand the various problems with an impact assessment of the same. The process of eliminating health inequity must be approached as a coordinated action involving governments, civil societies, local communities, corporate organizations as well as international agencies. All of these sectors must participate in the drafting of the appropriate policies as well as the formulation of programs that are aimed at promoting global health equity.
Understanding Comprehensive Primary Health Care (CPHC) with the health inequality in Saudi Arabia (Childhood Obesity)
Comprehensive Primary Health Care (CPHC) is a developmental process that has an emphasis on the principles of equity, empowerment and social justice for a social change to be achieved that would be able to impact health as well as the wellbeing of a population. It emphasizes on addressing the various determinants of health which are the condition that results in good or ill health (Talbot and Verinder ,2010).
A Comprehensive Primary Health Care approach should be able to effectively address the various health issues including the associated social, economical, environmental and behavioral variables within a given time period. Baum (2008) pointed out that the principles that are involved in this approach are aimed at addressing the health inequities through people empowerment at the community level in the promotion of health endeavors. The Primary Health Care approach should be able to provide appropriate health care services that are appropriate and sustainable to the target population.
The principles of primary health care can ac effectively address child health care issues such as obesity through the provision of appropriate plans as well as programmes that are based on the unique characteristics of the Saudi Arabian communities. The process of modelling primary health care systems requires the involvement of various sectors of the economy and organizations in order for the implementation of the laid down programmes of child health promotion to be effective. The models must be able to engage the communities through the provision of suitable opportunities to aid in the decision making stage as well as the process of implementation.
Saudi Arabia has one of the highest rates of childhood obesity in the Middle East (Lobstein, 2010).About 18 % of children between the age of one and eighteen years in Saudi Arabia are overweight according to a survey conducted between 1994 and 1998 (El-Hazmi and Warsy,2002)In Central Saudi Arabia, boys aged 6 to 14 were shown to have experienced an increase in the case of being overweight from 3 percent in 1998 to 25 percent in 2005 (Al-Hazzaa,2007).Bahrain has been shown to have the highest prevalence rates of childhood obesity (Lobstein,2010).
Presenting the vision in the last 19 years
The Saudi Arabian healthcare system has experienced several changes in the last 19 years. The Saudi Arabian healthcare system can be classified easily as a national healthcare system that entails the provision of healthcare services by the government via a number of governmental agencies. The private sector has also been observed in the last 19 years to increase its participation in the provision of health care services. The major government agency that is mandated with the provision of preventive, rehabilitative and curative health care to the Saudi Arabian Kingdom citizens is the Ministry of Health (MOH).The provision of primary health care by the ministry is via a networl of health care centers that totals 1,925 (Ali,2010).In the last 19 years the healthcare system in Saudi Arabia has witnessed several changes. In 1993, there was the establishment of the national guidelines to be used for quality assurance in the provision of primary healthcare. These guidelines outlined the aspects of the comprehensive primary health care such as child heath care, community participation, prescribing, healthcare education, immunization, maternal healthcare, management of chronic diseases, management of communicable diseases as well as environmental healthy (SCQA,1993). A management development program also called Supportive Supervision was established in 1995.
Cause of childhood Obesity in Saudi Arabia
The causes of childhood obesity in Saudi Arabia are numerous. They range from genetic, social, psychological and even cultural factors. The main one is the lack of activity by the children due to overindulgence in video games and too much television. Parents also exuberate the situation by making poor nutritional choices; they reward their children with candies and fee them with junk food. Poor eating habits are therefore another cause. In regards to cultural causes, some schools ban girls from playing due to the belief that it would break their hymen. This leads to in activity among the girl child and hence high prevalence of obesity
Obesity in Saudi Arabian children
According to Reilly, (2005), at the sunset of the 20th century, obesity was identified as a universal problem by the world health organization. It was one of the greatest risks that was faced the well being of the world’s population. It was a condition that in the past was associated with adults alone but as time went by the problem presented itself in the children’s population causing a lot of concern amongst the general populace. Obesity, overweight and underweight all have impacts that are negative on self esteem of many children and adolescents that if not checked can have long term effects on the success in lives of these children and their general happiness in the future (Moran ,1999).
The persistence of chronic diseases in more in the developing than in the developed countries. The World Health Organization posits that by 2020, a quarter of deaths in the least developed countries will be caused by the so called non communicable diseases, WHO, (1997). In this regard, a major mind blowing public health problem in the developing world may the reality of increasing obesity in children populations which might result to major social and economic burdens on these developing nations in the coming years, (Freedman et al, 2001).
This health care problem is present in almost all parts of the world and the Arabian Gulf region is not exempted. Surveys done in this region in the different areas and provinces specifically in Saudi Arabia show that there exists a prevalence of overweight, commonly known as obesity, local authorities implement programs in the education system that would help curb the rising weight problem among the school going children or prevent the obesity problem all together. The problem of obesity presents a big threat to the quality of life in the population present in the Arabian region (Al- Mahroos et al, 2001).Several reasons have been put forward to try and explain the prevalence of obesity that is on the rise in Saudi Arabia. The most notable one is the major economic growth that the kingdom of Saudi Arabia has experienced in the last thirty years. This economic boom has resulted in very noticeable changes in both eating habits and the level of physical activities amongst the Saudi population. Combined with the effects of westernization in the lifestyles, reduced activities that involve physical efforts and the sedimentary ways involved in the daily lives, these make the bulk of contributors to the prevalence of the problem of obesity and overweight in the Saudi population, (Al-Quaiz , 2001).
According to El- Hazmi & Warsy’s (2002) Comparative Study of the Prevalence of overweight and obesity in children in different provinces of Saudi Arabia ,many experts argue that over weight in children can be caused by many a factors including dietary imbalance, poor eating habits and in some instances hormonal etiology that is still a bone of contention in the scholars world. To help understand the problem of obesity in Saudi Arabia, a study was conducted in the Eastern province from where data collected was compared to those of children who are not of Saudi origin. The data was collected for a period of six months from January 2006 in the city of Al-Khobar. The sample that was studied included seven thousand and fifty six children aged between two (2) and eight (8) years. Of all the children, the males made up 55.7% while the female constituted 44.3% while in terms of nationality , 79.4% were of Saudi origin and 20.6 5 were from various non Saudi nationalities . When classification was done in terms of body mass index, it was found out that 57.7% had normal weight for their ages and sexes. On the other hand 19.0% were found to be overweight and the other 23.3% were obese. None of the children was found to be underweight but the study also found out that the rates of obesity was higher in older children. Regarding the distribution of weight according to sex, the study showed that obesity was prevalent among males at 26.5% than among the females at 19.3%. In terms of nationality or country of origin, the statistics showed that there was an insignificant difference in normal weights, obesity and overweight 9in children from either within or without Saudi Arabia.
In its report on global strategy on diet released in (2004), the World Health Organization asserted that obesity has been a will always be a problem that the world will grapple with till the appropriate actions are taken on the prerequisite conditions put in place to help address this menace among both the adult and children populations of the world. In 2001 the world body shouldered with the responsibility of health, World Health Organization confirmed the fear that 10% of the world’s children were suffering from obesity and that the figures were in the upward trend in the developing countries amongst whom Saudi Arabia falls.
Barlow et al ( 1998), posits that the statistics released by the World Health Organization in 2002 indicates that there has been a shift in disease burden with many deaths in the world being associated with non communicable diseases who major causes include malnutrition, and lack of physical activities in the general population of the world.
Of the many studies that have been done in Saudi Arabia to evaluate the impact of obesity among the Saudi Children, one occlusion can be easily arrived at. This s that obesity and overweight is present in all provinces in Saudi Arabia, Al- Nuaim (1996).In his journal, Obesity amongst female children in North West Riyadh in relation to affluent lifestyles, Alam (2008), insists that the studies should be done in schools were the prevalence of class is common as this would help in coming up with concrete theories and statistics that can be used in future studies on the same subject
In his analysis of most of the studies done on the area of obesity and overweight in Saudi Arabian school going children, El- Hazmi (2002), concludes that the Eastern Province in Saudi Arabia, that mostly consists of affluent neighborhoods, has the highest rates of obesity and overweight in children compared to the Southern Province, which has the lowest rates in the country and is considered to be a rural setting.
Obesity and overweight are now a major problem in public health world over. Quick fixes will not help due to the complexity of the problem and given the fact that there is a constant interaction in the sense availability of high energy foods while the lifestyles we live decrease the demand for energy expenditure. These two have great bearing in the genetics make ups of the bodies that are taken through this process of excessive intake of high energy foods and limited activities to dispense that energy. The difficulty of treating obesity and overweight makes this problem a food for thought for medical researchers and all interested stakeholders. Despite the skeptics surrounding this issue, it is believed that dietary balance, physical activity and behavioral change used concurrently, can be a good management strategy at least in the short term (Henderson et al ,2003). Efforts it mitigate this problem should be directed in the prevention of obesity being carried from childhood to adult hood as this will in turn reduce the socio economic effects and the psychosocial burden that obesity or overweight will have in one’s life in the later years (Langenberg et al, 2003).
Presenting the vision 2030
The Saudi Arabian government has put in place a number of policies that are geared towards the reduction of obesity (Amin,Al-Sultan and Ali,2008). In order for the programs and policies of combating obesity to work, they need to be focused on nutrition and encouragement of an active lifestyle. The programmes are also to empower women so as to make them make appropriate nutritional choices for their children and even for the entire family. The Saudi Arabian government should work together with the stakeholders, private health care providers, international agencies and the citizens in ensuring that the programs are a success. These policies are to be framed in line with the millennium development goals (MDGs).
Access to healthy food
change in the country’s nutritional as well as lifestyle habits Vito et al.,(2009).The fact hat food has become more affordable to a majority of the households as well as a substantial reduction in the prices in relation to the income has resulted in food becoming a source of pleasure and not a means of nourishment. This has been noted to be a major cause of childhood obesity in Saudi Arabia. Programmes should be put in place to target households and enable them to have access to healthy foods. The government for example should put strict regulations on the sale of junk foods. Investment on healthy food alternatives should be made. The government should encourage the growth of fruits and vegetables in all regions as well as encourage their consumption since they are linked to healthy nutritional outcomes.The Saudi Arabian government should therefore encourage the development and investment in farmer’s market in order to increase the level of availability of both fruits and vegetables to the general population.
Equity sport between girls schools and boy
Gender equity should be encourage in Saudi Arabia.In regard to the prevalence of obesity, the government should allow girls just as boys are allowed to participate in equal physical activities in their schools and at home.
Socio-cultural and institutional transformation
Empowerment that is a key pillar in the process of socio-cultural transformation is very key in determining accessibility to health services by the masses. Economic, political and socio-cultural institutional changes facilitate the process of having the feeling of inclusion and respect of an individual’s rights in the society, Marmot et al (2008). According to Baum, (2008), transformative empowerment can take place at different levels. The first level is the individual, then community level and finally the organizational level. Transformative strengthening of institutions in the society, from the individual, community and organizational, has the potential to help in arresting the bid disparities that exist in the health sector in any one society or community. This can be done through imparting the relevant skills, knowledge and information on the general population and then encouraging them to participate in health related activities within their communities. This will result in a healthy population that is vibrant and consequently have positive impact on a country’s economy to help spur growth and development. In many cases, people’s beliefs, traditions, and cultural practices act as hurdles in the implementation of policies and programmees that are meant to improve their lives. This therefore puts a lot of responsibility on health workers to try and clearly understand a people’s beliefs , traditions and cultural practices to enable them find friendly ways of implementing the policies and programmes with the endeavor of improving the lives of the local.Another important and fundamental issue in transformation is collaboration and partnership in all endeavors geared towards the genuine improvement of the status of a health in any given population. This therefore calls for a multi- sectorial approach in which the government , the public and the private sector partner in the implementation of the policies and programmes which will result in the well being of the entire population and supportive environments that facilitates growth and development
Provision of Quality Health care system the key to alleviating childhood obesity in Saudi Arabia
For all stake holders in the health in the Saudi Arabian Sub Continent to achieve all the set targets, there is need for a concerted effort and allocation of resources for the implementation of the programs and policies geared towards the improvement health services to both children and mothers. The Saudi Arabian government has also committed itself to facilitate the improvement of accessibility to quality health care services to all Saudi Arabians but with special focus to the to the rural areas. The government has also started the process of instituting universal health insurance to all Saudi Arabians.The partnership between the government and the private sector has also facilitated capacity building in the health sector and at the same time provide an all inclusive implementation framework. This will enhance the addressing of the weakness in a collaborative approach after processes of evaluation. Another issue that needs to be addressed is the scheme of service for the personnel in health sector. Then retention of the current employees through improving their scheme of service and offering god terms and conditioned for prospective employees would go a long way in ensuring quality service provision to general public (SCQA,1993).The Saudi Arabian government should collaborate with the relevant stakeholders in ensuring the improvement of the quality of healthcare in Saudi Arabia.
In conclusion, the determinants of health that are of social origin have continually increased the rates of childhood obesity in Saudi Arabia. The inequality in the distribution of resources meant for improving health care services partnered with poor policies and lack of enthusiasm in the implementation process has crippled the health care system in Saudi Arabia. As a result many programmes have been implemented to help mitigate the problems facing the health sector in Saudi Arabia. Some programmes by NGOs such as Al Wafa Philanthropic Association and Alkarama for Human Rights Saudi Arabia have greatly impacted on the lives of the Saudi Arabian people by reducing the blaring inequality in health care services between the rural and urban areas. Although the Saudi Arabian health sector is still ailing, the efforts being made are definitely steering the sector in the right direction.
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