Aisha Hanif
PM 565
04/28/15
Global Health Country Report
Pakistan: Child Health and Mortality
Introduction
Since it’s separation from India in 1947, Pakistan steadily grew to a country with a population of about 184.35 million people in 2013, making it the sixth most populous country in the world (“About Pakistan”). Pakistan is broken into four provinces: Punjab, Sindh, Balochistan, and Khyber Pakhtunkhwa (“About Pakistan”). Its capital is the city of Islamabad. While Pakistan has taken many steps to improve the state of its people in recent years, the prevalence of poverty, gender inequality, inequities, political instability and a struggling economy have proved very challenging for the country (“About Pakistan”). These factors also
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Balochistan is the worst performing province in terms of MDGs while Punjab seems to be performing the best (“Millennium Development Goals”). While there have been improvements in certain indicators and a few have been achieved in some provinces, no province in Pakistan will be able to achieve a MDG in its entirety (“Millennium Development Goals”).
Major Determinants of Health
There are many different determinants of health in a country. Social determinants of health are conditions in which people are born, grow, live and work ("Addressing Social Determinants of Health in Pakistan”). These determinants are contributors to health inequities and burden of disease in countries across the globe, including Pakistan ("Addressing Social Determinants of Health in Pakistan”). Some of the most prominent factors in Pakistan include gender inequality, uneven distribution of income, political instability and political reinforcement of inequality and are all determinants that need to be addressed in order to improve health outcomes ("Addressing Social Determinants of Health in Pakistan”).
Tables 1 through 4 in the Appendix highlight some major social indicators of health in Pakistan as well as summarize some of Pakistan’s largest health problems. The tables also include data on maternal mortality and fertility in Pakistan as well as the economic burden and
“Failure to acknowledge, and more importantly, to understand the role of Social determinants of Health (SDH) in health and access to health and social services will hamper any effort to improve the health of the population.” (Ompad, Galea, Caiaffa, & Vlahov, 2007). Unemployment, unsafe work environments, globalization and the inability to access health systems are some social determinants of health. Social factors would be considered place of residence, race and ethnicity, gender, and socioeconomic status are also part of social determinants of health. According to “Social Determinants of the Health of Urban Populations: Methodologic Considerations’ Place of residence and an individual’s status within the place are important determinants of health in urban settings. It is important to recognize that the place of residence is
Social determinants of health encompasses ethnicity, gender and social class. It is seen as the essential
Social inequities in health result from unequal distribution of social, economic, cultural and historical determinants. It is vital to identify these factors to reduce health inequalities and to improve health status of people. This essay depicts information on two social determinants of health that affect different vulnerable groups in terms of their socioeconomic position and ethnicity.
The circumstances in which people live are shaped by the distribution of resources, power and money at global, national and local levels. Economics, social policies and politics all have a part to play (World Health Organisation [WHO], 2016). Social determinants look at key aspects of peoples’ living and working circumstances, and what the implications of these circumstances are on their long-term health.
Health has been influenced by many factors such as poor health status, disease risk factors, and limited access to healthcare. All these factors are due to social, economic and environmental disadvantages. According to the World Organization (WHO) (2015), “the social determinants of health are mostly responsible for health inequities, which is the unfair and avoidable differences in health status seen within and between countries”
The World Health Organisation posits that the social determinants of health (SDoH) are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life which are in turn responsible for health inequities, the unequal and preventable disparities in health within population groups and between countries (WHO 2015). This broadly means that a person’s health can be negatively impacted or enhanced depending on their social status, educational attainment, level of income, living conditions and access to resources and social support networks.
Although seen within and between countries are the social determinates of health which are the unjust and avoidable differences in health status( National Rural Health Alliance 2016). The social determinates of health are the reason for increased health issues worldwide.
Health related policy (HRP) targets two of the fundamental causes, medical and health systems laws and policies, making it the primary solution for decreasing the maternal mortality rate (MMR). However, a wider discussion has emerged about the importance of social determinants of health, the second fundamental cause, at a global level. The Report of the World Health Organization 's Commission on Social Determinates of Health (CSDH) (2008) importantly acknowledged that poverty, exploitation, oppression, and injustice damage health (CSDH, 2008). This document expanded the discussion on the
Pakistan with a population of 182,143,000 in 2013, it is one of the most populated countries in the world, but it is also one of the least developed (poverty in Pakistan) (WHO reference). Poverty is a prevalent issue through out Pakistan: “about one quarter of the population lives below poverty line” (Poverty in paki). Pakistani’s living in poverty being less common in the urban areas, and more common in the rural areas with about half of the rural population still under the category of absolute poverty (Poverty in paki). Poverty in Pakistan and throughout the world impacts the population’s ability to live healthy lifestyles. Without the means to acquire adequate nutrition, health care, and services, these people are unable to meet their individual health needs. Due to the link with poverty and health, it has remained priority in almost all national plans of Pakistan (Pakistan poverty).
Pakistan has grown much more than other low-income countries, but has failed to achieve social progress commensurate with its economic growth. The educated and well-off urban population
The current death rate is 29 per 1,000 live births and of the 2.8 million newborns dying at birth worldwide, India accounts for 700,000 children dying at birth or shortly after. The National Health Policy to improve care children and women. Poor neonatal health conditions, widespread illiteracy, poverty, poor sanitation and nutrition have also been identified and India’s hopes to tackle these issues by passing this policy.
Determinants of poverty are the following: location (rural/urban), household size, low education, gender, high dependency ratio and lack of access to basic utilities such as Electric, water, and trash. The first ever health policy was established in 1990. 49 health initiatives primarily focusing on diseases from the creation of Pakistan in 1947 until 2005. For the first time in 2005 the natural development agenda in Pakistan, provision for safe drinking water. Data revealed that people less than 20 years of age
Over the last decade, Pakistan has faced its share of disasters; both natu-ral and artificial. It was struck by a massive earthquake in 2005 and continues to be fixed with religious and militant groups in its northern regions. Compromised regions of security make health care access problematic. Pakistan 's population will also be a fu-ture concern for health care delivery. A consistently high population growth rate ex-ceeding 2% annually has led to Pakistan being quite a young nation with over 35% of its population being under the age of 14 years old.
Pakistan, like many international countries, contains a plethora of healthcare delivery complications when providing services to its citizens. This is immensely concerning for the international community because Pakistan is the 5th most populous country in the world, and the largest land mass in the Eastern Mediterranean. Littered with an array of different terrains, climates, and features, Pakistan’s land mass is approximate 800,000 square km. Geographically, Pakistan divides its providences into five large and one small, with an additional three territories. The providences are listed below in sizes from smallest to largest: Gilgit-Baltistan, Pakhtunkhwa, Khyber, Balochistan, Sindh, and Punjab. (see fig. 1)
Gupta (1990) examined, amongst other things, socio-economic determinants of child mortality in rural Punjab. For the purpose of her study she collected the required data by surveying eleven villages from Ludhiana district of Punjab. Her study shows that education improves mother’s child-care practices, her domestic management of ill-health, efforts at preventive care and use of modern medical services helping ultimately to reduce child mortality.