Growing up, my father had a consistently intimidating way of encouraging his children to focus on academics. He would say, “The only thing I owe you is your education. That is your lot, so never entertain the idea of inheritance from me.” A typical educated Yoruba father back in the day would have repeated this sentiment numerous times to ensure his children remained focused and excelled academically.
The strategies often worked, as they kept the children grounded, motivated to achieve good grades, and ultimately earn university degrees. However, what was missing in this admonition was addressing the “WHYs.” Why should I pursue an education? Why is a university degree so significant? If it’s about money and comfort, why are some individuals still poor despite university degrees? Our parents failed to connect education to health and wealth in more meaningful ways that highlight diverse opportunities that could arise; thus, we must establish this connection.
Contrary to the outdated belief that an individual’s health outcomes are determined primarily by biomedical conditions or genetics, many health researchers now consider a range of fascinating factors as significant determinants of health. While biogenetic causes are crucial to health outcomes, they now only account for 30 percent of an individual’s health status. This indicates that non-medical factors, known as social determinants of health, are responsible for the remaining 70 percent.
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Dr Dennis Raphael, a professor at York University, has effectively identified 14 key factors that determine health outcomes like never before. His findings, along with the work of other scholars, have demonstrated that good health encompasses many non-biological elements. These elements include reducing educational failure, alleviating food insecurity, lowering unemployment, increasing access to healthcare, improving housing standards, and encouraging healthy lifestyle choices.
These discoveries have been fundamental in achieving population health in countries with higher life expectancies. For instance, despite spending 19 percent of its GDP on healthcare—nearly doubling Japan’s healthcare expenditure—the life expectancy of residents in the United States is 78 years. In contrast, Japan, which allocates approximately 11 percent of its GDP to healthcare, boasts the world’s third-highest life expectancy at an average of 85 years. This comparison illustrates that the availability of world-class healthcare does not necessarily translate to superior health outcomes or overall population health.
Adamu’s story provides a clearer picture. In his twenties, Adamu started working in a factory far from home. He constantly feared losing his job as a daily wage worker, which brought no job security. His compensation did not include benefits like health insurance or a pension. To make his wages stretch, he hung around the factory on weeknights, unable to afford the commute home daily, exposing himself to harsh weather, poor sleep, and inadequate personal hygiene. He often faced food insecurity, leaving him perpetually hungry with minimal cash for meals. He opted for more filling but less nutritious food to maintain his energy for factory work. Due to these social and economic challenges, Adamu was diagnosed with hypertension and type 2 diabetes a few years into this difficult life. Such diseases would have seemed far-fetched for a young man his age, were it not for the high cortisol levels primarily caused by stress.
Adamu’s fight-or-flight response has been overly frequent, intense, and sometimes inappropriately activated over the years, resulting in elevated cortisol levels. The persistent high levels of cortisol in his blood due to ongoing stress elevate his blood sugar levels, creating unimaginable challenges in management. Despite not having any pre-existing biomedical or behavioural conditions, Adamu’s current poor health status has been shaped by several socioeconomic factors: low education levels, very low income, inadequate housing conditions, and job or food insecurity. His situation could have been different if he had received a quality education and secured a well-paying job with essential benefits, including a free staff bus ride home; this would likely have helped him avert type 2 diabetes and hypertension.
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The social determinants of health, including physical environments, health behaviours, and clinical care, significantly impact individual health. Nigeria, among Africa’s poorest countries, has life expectancies below the global average. To improve population health, adopting an upstream approach to healthcare would be more accessible, quicker, and cost-effective. This would involve identifying root causes and formulating policies that improve quality of life for citizens, such as education, food security, and housing. Evidence suggests that an upstream approach to public health prevention and promotion has a more significant impact on the broader population.
Call to Action
The SAIL Quadrant, a personal wellness assessor, offers eight dimensions to identify the root cause of health challenges. By deep diving and answering personal questions through personal scoring, individuals can determine if they are sailing strong or sinking.
Olayinka Opaleye is a Wellbeing Specialist and Corporate Wellness Strategist. She can also be reached at +234 8100371304 or by clicking on www.linkedin.com/in/olayinkaopaleye.
