Upon reflection of this course, consider what you can do as a social change agent and
scholar-practitioner. This class has challenged you to think beyond the individual-level
influences of biology, behavior, and harmful organisms to embrace a broader perspective
on health for populations. You have repeatedly seen how social determinants influence
health of populations. That understanding carries an implicit challenge: What can you do
as a scholar-practitioner?
Practicing Public Health
Different countries face varied health problems. Kenya and South Africa are examples of
the countries, which both share similar and different challenges when it comes to health matters.
HIV/AIDS is a major problem facing at least 7 percent of Kenyan population, hence, affecting its
development directly. The spread is rampant due to inadequacy of medical facilities and lack of
funding making access to antiretroviral a tall order. Another health problem in Kenya is malaria
where more than 70% of its population is susceptible to this disease. Besides all the diseases that
cause death in Kenya, car accidents are still major perpetrators, where Kenya comes first before
South Africa. Maternal mortality is another challenge in Kenya where women die while giving
birth, as well as tuberculosis, which is also a leading cause of death (Biggs et al., 2010).
Health problems in South Africa are equally a big challenge. The people are provided
with healthcare through the public hospitals and private hospitals. However, the public health
system serves most of the citizens despite the fact that it receives very little challenges and is
PRACTICING PUBLIC HEALTH 2
also underfunded. HIV/AIDS is a life-threatening problem in South Africa with more than 5.6
million people having contracted the disease. In addition, national insurance system is facing
problems since there is unequal access to healthcare amongst different socio economic groups.
Water and sanitation is another huge challenge facing the South Africans. Majority of the people
are unable to access clean water. On average, 15 million people are not supplied with clean
water. This has resulted into reports of diarrhea in children and outbreak of cholera. The people
in South Africa live an average of 49.56 years. Besides all these health problems, some other
contagious diseases in South Africa are Bacterial Diarrhea , Typhoid Fever, and Hepatitis A .
Another health problem in South Africa is mental illness. Majority of the adults (16.5%) are
suffering from a very serious mental problem. Some of the factors leading to mental problems in
South Africa include excessive use of drugs. Other predisposing factors to mental problems
include malaria , typhoid, fever , and HIV, which contribute to a large extent to the mental
Economic level and income inequality in Kenya and South Africa has influenced social
determinants like social dynamics, the status of women, education and violence/homicide. The
South African general population is made up of all races hold a view that women in the society
are less important. The men ever since time in memorial believes that women are not supposed
to hold any position in the society hence are economically disadvantaged. In Kenya, all the
important sectors that control the economy of the country are controlled by men. Not long ago,
women were made to walk or keep distance behind men in some places as a sign of obedience.
The women have, therefore, been subjected to so harsh conditions in that they have to ensure that
basic needs are provided in the family a role that should be played by men.
PRACTICING PUBLIC HEALTH 3
In South Africa, Income differentials are a phenomenon that is manifest among
individuals, regions and nations. The high presence of inequality in the society has had far
reaching implications on the provision of education. Education is the main determinant of
someone s economic status since without education one cannot access any professional job hence
low income. This problem of Income inequality is manifested mostly in uneven and unequal
access to education by majority of the people or to some extent access to very poor quality of
education (Spiegel & Yassi 2004). Consequently, this leads to so much ignorance in the general
public due to lack of information. These factors heighten the already existing inequality since the
distribution of earnings is to a large extend determined by the level and distribution of schooling
across population. In Kenya, inequality in income has led to variation in different class of people
in terms of education, hence, poor economic growth, which eventually affects the country and
the people at large due to poverty (Rudan et al., 2010).
In both Kenya and South Africa, poverty levels determine crime rates since they are the
more invisible barriers to crime set up by social norms and social cohesion. Poverty leads to loss
of trust in the government, hence, increase in criminal activities. It is, therefore, directly related
to crime and prostitution in the society, which leads to various health problems. In Kenya, poor
people have fewer cases of obesity and use of drugs. In South Africa, the children of poor
parents have a significantly lower chance of becoming wealthy (Norman et al., 2010).
Kenya and South Africa face health problems due to economic inequality, which directly
affects social determinants in the society. Lack of money to purchase food as a result of
economic inequality translates into people suffering from malnutrition due to poor diet. In
addition the parents get a problem in getting money to take care of their
PRACTICING PUBLIC HEALTH 4
Economic inequality in social, economical or political scenario in the society directly
impacts on the health status of that society. Some of the symptoms of poor health status in a
given society include death of very young children and death of mothers when giving birth (IMR
and MMR). Besides preventable death in Kenya, there is persistence and resurgence of many
infectious diseases. There is a high number of people who lose their lives due to tuberculosis and
the problem is not improving due to poor economic status. In addition, Malaria is another
challenging problem. The problem of malaria incidence has remained a challenge since the mid
eighties. Economic inequality results into poor health services, which in turn accelerates the
spread of the diseases like dysentery (Coovadia et al., 2009). The total number of children who
lose their lives due to this problem is 0.6 million; the main reason being economic hardship. The
problem of diarrhea in Kenya can only be avoided by the government providing clean water to
every citizen and also by providing drugs that can stop the death of the patients. Cancer claims
over 0.3 million lives per year and tobacco related cancers contribute to 50% of the overall
cancer burden, which means that such deaths might be prevented by tobacco control measures
(Kyobutungi, Egondi & Ezeh 2010).
These health revelations are alarming especially in the health provision to the public
sector. The most disappointing scenario is that these revelations are not improving despite the
various measures taken by the governments including investment in private health sectors and
indications of the improvement of the gross domestic product. These challenges that affect
people directly are the main causes of health problems in many countries that endanger the lives
of many people.
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Biggs, B., King, L., Basu, S., & Stuckler, D. (2010). Is wealthier always healthier? The impact of
national income level, inequality, and poverty on public health in Latin America. Social
Science & Medicine, 71(2), 266–273 Retrieved from the Walden Library databases.
Coovadia, H., Jewkes, R., Barron, P., Sanders, D., & McIntyre, D. (2009). The health and health
system of South Africa: Historical roots of current public health challenges. Lancet,
374(9692), 817–834.Retrieved from the Walden Library databases.
Kyobutungi, C., Egondi, T., & Ezeh, A. (2010). The health and well-being of older people in
Nairobi’s slums. Global Health Action, 45–53. Retrieved from Walden Library
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Norman, R., Schneider, M., Bradshaw, D., Jewkes, R., Abrahams, N., Matzopoulos, R., & Vos,
T. (2010). Interpersonal violence: An important risk factor for disease and injury in South
Africa. Population Health Metrics, 8, 32–43. Retrieved from the Walden Library
Rudan, I., Kapiriri, L., Tomlinson, M., Balliet, M., Cohen, B., & Chopra, M. (2010). Evidence-
based priority setting for health care and research: Tools to support policy in maternal,
neonatal, and child health in Africa. PLoS Medicine, 7(7), 1–5. Retrieved from the
Walden Library databases.
Shelton, J. D., Cassell, M. M., & Adetunji, J. (2005). Is poverty or wealth at the root of HIV?
Lancet, 366(9491), 1057–1058. Retrieved from the Walden Library databases.
Spiegel, J. M., & Yassi, A. (2004). Lessons from the margins of globalization: Appreciating the
Cuban health paradox. Journal of Public Health Policy, 25(1), 85–110. Retrieved from
the Walden Library databases
Wilkinson, R., & Pickett, K. (2010). The spirit level: Why greater equality makes societies
stronger. New York, NY: Bloomsbury Press.