Prof Arthur Hibble, Emiritus Professor at ARU and former GP, talks about social determinants of health, and the capability approach
The words “sustainable” and “global” have become popular terms to attach to new products, ideas and projects. So for the sake of clarity, “sustainability” is about durability over time, having minimal negative impact on the environment and requiring effective and efficient effort to maintain. “Global” in health terms is about scope not geography, and “health” follows the World Health Organisation (WHO) definition of a state of physical, mental and spiritual well-being.
The social determinants of health have been well defined by WHO. Major factors include poverty, education, race /ethnicity, gender, housing, employment, water, sanitation nutrition, violence and trauma, tobacco and alcohol. It is clear that improving global health requires international partnership and cooperation between many groups beyond medical professionals: teachers, town planners, water and sanitation engineers, road builders, politicians, food producers and Spiritual leaders all have a part to play.
Health inequity, usually associated with poverty, is the marker of global health problems and will be the marker of success. We use inequity, as it is the unfair distribution - often due to social determinants- rather than inequality which is the uneven distribution of resources.
The Capability Approach (CA) was developed by the economist and philosopher, Amatyr Sen. The basic rationale is that people as individuals or groups would like to improve their states of well-being and that they understand their situations. They often have resources that they do not have the capability to turn into utilities. The thesis is that they will own and continue to use the resources if they have the capabilities.
In a recent educational project, selected global health fellows were appointed to work as health needs assessors in socially and financially deprived communities in a low income country (Kenya) and a high income country (the UK). We chose to use the Capability Approach as the philosophical foundation for the research, to try to enhance the sustainability aspect.
By listening to the people in these communities, and discussing the analysis, a list of important themes were defined and resources identified. It only remained to enhance their capabilities. Some of this was education of individuals, others required the cooperation of local policy makers and providers.
The important sustainable outcomes of this project were that the community, the local authorities and the fellows were empowered, their problems were addressed and there was a true exchange and development of understanding of global health.