The intersecting epidemics of poor health and poverty have been identified as significant global issues for over a decade by the World Health Organization (WHO, 1999), organizations and researchers (DFID, 1999; World Bank, 1999; Wagstaff, 2002), and are included as main targets of the United Nations Millennium Development Goals (Goal 1: Eradicate Extreme Poverty & Hunger; Goal 4: Reduce Child Mortality; Goal 5: Improve Maternal Health) (United Nations, 2011). Kofi Annan, addressing the World Health Assembly in 2001 succinctly stated, “The biggest enemy of health in the developing world is poverty” (United Nations, 2001). Poor health and lack of access to health services is both a cause and consequence of poverty, as reported by the World Bank in a 1999 survey of more than 60,000 people in developing nations (World Bank, 1999). Health is a primary concern for people living in poverty and they describe maintaining health, preventing diseases, and acquring medical care as major daily struggles (Dying for Change, 2002). Social factors have long been recognized as leading contributors to health inequalities (Marmot, 2004), but taking action to eradicate poverty and ill-health is a complex task requiring integrated and innovative approaches.
The health statistics of poor nations strongly demonstrate the connection between poverty and health. The same percentage of people living in poverty (46%) are not meeting their daily food needs (Kenya Integrated Household Budget Survey, 2006). Maternal and child health statistics are commonly used as indicators for overall progress of national health. In Kenya, 17% of children under 5 are malnourished, the mortality rate is 84 per per 1,000 live births (DFID, 2009), only 23% of children with malaria symptoms are receiving treatment (World Development Indicators Database, 2010), and the maternal mortality rate is 530 per 100,000 births (World Development Indicators Database, 2010).Throughout Kenya, 46% of the 38 million population is living in poverty (World Bank, 2009), and the average per capita income is $770 (DFID, 2009). Nationwide poverty is severely affecting public health, preventing families from accessing adequate nutrition, engaging in preventative health behaviors and accessing life saving testing and treatment.
Not only is Kenya affected by the infectious diseases that have plagued the nation for decades – malaria, tuberculosis, HIV/AIDS- which account for 69% of deaths throughout Africa, but non-communicable diseases such as hypertension, diabetes and cancer, are increasing at an alarming rate and currently account for 22% of deaths across the continent (WHO, 2011). With the combination of infectious and chronic diseases affecting a significant proportion of the population, it is necessary for health programs to not only address multiple health issues simultaneously through horizontal integration, but they must also tackle the root cause of all ill-health – poverty.
Overview of Health
- Malaria is endemic in 42 of the 46 countries of the African Region.
- More than 90% of the estimated 300–500 million clinical cases of malaria that occur across the world every year are in Africans, primarily children under the age of five years.
- There are nearly a million deaths due to malaria each year, the vast majority among children under five.
- The African Region has 11% of the world’s population, but an estimated 60% of people with HIV/AIDS.
- HIV/AIDS is the leading cause of death for adults in the Region.
Water & Sanitation
- Only 58% of the population in sub-Saharan Africa had access to safe water supplies and only 36% had access to sanitation in 2002.
Maternal & Child Health
- Of the 20 countries with the highest maternal mortality rates, 19 are in Africa. In 2002, in the African Region, an estimated 231 000 women died due to pregnancy and childbirth complications.
- The African Region’s neonatal death rate is the highest in the world. An estimated 43 out of every 1000 babies born in 2005 died during their first 28 days of life.
- Deaths among African children have been on the rise. In 1960, 14% of deaths among children under five years of age worldwide occurred in the Region. That proportion had risen to 23% in 1980 and 43% by 2003.
- Violence against women, including domestic violence and coercive sex, occur against 1 in 4 women, this rate increases to 1 in 3 among adolescent women
Noncommunicable Diseases & Injuries
- Noncommunicable diseases, such as hypertension, heart disease, diabetes and stroke and injuries represented 27% of the total burden of disease in the Region in 2001 and are on the rise. Surveys in Cameroon, Congo, Eritrea and Mozambique have found a very high prevalence levels of risk factors for these diseases.
- By adopting broad prevention plans African countries could achieve 10 more healthy life years for their people.
- Road traffic collisions are a major health problem in countries in the Region. For example, road traffic collisions costs the Ugandan economy US$ 101 million each year, which is 2.3% of gross national product.
- An estimated 2.4 million new tuberculosis cases – 24% of all notified cases worldwide – and half a million tuberculosis deaths are reported in the Region each year.
- Tuberculosis has been on the rise in tandem with HIV/AIDS, because people with HIV, whose immune systems are weakened, easily contract tuberculosis and go on to develop active tuberculosis.
- Tuberculosis was declared a public health emergency in the African Region in 2005.
In the African Region, 72% of all deaths are from communicable diseases, such as HIV/AIDS, tuberculosis, malaria, respiratory infections and the complications of pregnancy and childbirth; compared to 27% in all other WHO Regions combined.
Chogoria In Focus
The HopeCore health program collected information from 1,055 individuals (male & female, all ages)in Chogoria at the start of the public health program.
Here are the highlights:
- 62% of households boil their water
- 51% have had malaria in the past year
- 37% have been tested for HIV
- 17% of children under 5 have had diarrhea in the past year
- 38% have a family history of hypertension
- 65% of female heads of households of reproductive age are using a hormonal or barrier method of family planning