More must be done to overcome Pakistan’s health disparities
Most of the indicators of a country’s development are taken from its healthcare provision. In developing countries, including Pakistan, people of low socioeconomic status and ethnic and racial minorities have poorer health outcomes than others. They are more frequently exposed to multiple social and environmental stressors.
These stressors include poverty, which translates to inadequate access to wholesome, nutritious food, leading to malnutrition; poor housing quality; a lack of sanitation and hygiene; unsafe drinking water; and social inequality. Communities beset with multiple environmental stressors, like air and water pollution and substandard housing, are more prone to the development of communicable as well as non-communicable diseases.
Existing policies and regulations fail to protect these vulnerable populations because they are not focused on the pollutants and their sources. Evidence suggests that social stressors including poverty, crime, malnutrition, multiple pregnancies and an inability to access health services also affects these communities. Environmental, behavioral, psychosocial and biological factors, as well as social status, are intrinsically related to health outcomes.
Research in developing countries shows how the cumulative effects of social and environmental stressors combine to produce health disparities. The root causes of health disparities are the socioeconomic disparities. Traditionally, the level of education, occupation and income defines socioeconomic status. Each of these plays a different role in various health outcomes and is addressed by different policies. Hence, while policy-makers discuss the merits of increasing access to education, they rarely take into account improvements in the health of the population.
While policy-makers discuss the merits of increasing access to education, they rarely take into account improvements in the health of the population.
Dr. Mehreen Mujtaba
Exposure to damaging agents in the environment — including lead, asbestos, carbon dioxide and industrial waste — varies with socioeconomic status. Those lower down the socioeconomic hierarchy are more likely to live and work in worse physical environments. Poorer neighborhoods are disproportionately located near highways, industrial areas and toxic waste sites, since land there is cheaper and resistance to the polluting industries less visible. Housing quality is also poorer for low socioeconomic status families. As a result, compared with high-income families, children and adults from poor families show a six-fold increase in the rates of high blood lead levels, while middle-income adults and children show a two-fold increase.
As a conclusion, we can summarize that, in developing countries like Pakistan, social and environmental stressors converge to create health disparities among disadvantaged and vulnerable populations, who are on the lower rung of the socioeconomic ladder and hence disadvantaged by this status in accessing to affordable healthcare.
In Pakistan, there is a dire need for targeted, location-based and proactive policy-making. There is a lack of the expertise required to prepare meaningful and implementable policies based upon the needs and in accordance with the available and sustainable resources. Policy documents are usually donor-driven and hamstrung by of bureaucratic red tape. It is hence imperative to map, characterize and target vulnerable populations and communities for policy interventions to improve their existing conditions, prevent future harm and overcome health disparities.
Holistic and evidence-based decision-making can help regulators and policy-makers efficiently focus on efforts to mitigate the cumulative effects of environmental inequalities and social stressors and focus regulatory action at the regional and country level in order to achieve health for all.
– Dr. Mehreen Mujtaba is a freelance consultant working in the areas of environment and health. She has a keen interest in climate change and its impacts on population health and human security.
