1.5 Taking action to address the social determinants of health

In every region of the world, the survival of a child past the age of five is shaped, to a large extent, by the wealth of their household, the region in which he or she lives, and the education of his or her parents. Children born in rural areas or urban slums, children born to mothers with lower levels of education, and children born to families with lower incomes do worse than others. For example, from a selection of countries where data is available in Africa, Asia and the Americas, a child born to the wealthiest 20 per cent of households is more than twice as likely to reach the age of five compared with children born to the poorest 20 per cent of households in urban areas. In Europe, it is the same: under-five mortality rates are at least 1.9 times higher among the poorest 20 per cent of households than among the richest 20 per cent.

Statistics like those above illustrate the need for measures to address the inequalities that are affected by the social determinants of health. Every child counts and every stakeholder has a responsibility to do what he or she can to support their right to health. Action to address the social determinants that lead to health inequities for children needs to take place at all levels of society – from the family up to the national and even international level (Figure 1.1).

Figure 1.1 Those responsible for a child's right to health

It is important as a health worker that you understand the very powerful effect of social conditions on a child’s health. It can affect how you treat and advise children and their families. In the following module, you will have the opportunity to learn about how to use advocacy and community mobilisation to try and change some of the underlying conditions that prevent children from realising their right to the best possible health. However, at the individual level you can:

  • Use community health clinics and outreach to raise awareness of the socio-economic differences and how they impact on children’s health, for example, lack of knowledge about diet and nutrition, impact of poor housing, poverty, and lack of electricity on children's health.
  • Ensure that there is no discrimination in the services you provide. The social or other circumstances of the child should not affect the treatment they receive. For example whatever the education status, religion, disability, or economic background of the child and their care givers.
  • Take the social situation of each child into account when providing health advice and treatment.

Activity 1.4: Identifying action to address the social determinants

Think about the many children that you meet every day to provide health services at your facility:

  1. Which common illnesses or sicknesses do they present with?
  2. What do you know about their different home and living conditions?
  3. Can you think of examples when awareness of a child’s social situation has been crucial to successful treatment and/or intervention?
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Children will often arrive at your clinic or hospital with illnesses or conditions that are the result of the social determinants in the child’s life. Many children experience health inequities as a result of their backgrounds and their parents’ situation. It is important when treating these children that you are aware of their background and social and economic situation, as this could affect the advice or information you provide. For example, if a child is suffering from malnutrition, it is important to understand the reasons why before suggesting a solution. It may be that the mother needs help and guidance on good nutrition for her child. However, there is little point in providing such advice if the real problem is poverty rather than ignorance. In such circumstances, you might need to think about how to help the mother access the food she needs for her child. Obviously it is important that you treat children with the same respect, irrespective of their social backgrounds and status of their parents/care givers. However, sometimes the response to a situation may require interventions that go beyond the medical, where you see an opportunity to address some of the social determinants that are critical to their prevailing condition. For example, it is little use just providing a child with treatment to address illness caused by drinking polluted water if the child is going to return to a situation where she or he is forced into using the same water supply. You could use your role as a health professional to make sure the parents are aware of the risks, to encourage action to clean up the water supply or help the family find an alternative source of drinking water.

1.4 Understanding social justice and health inequities