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The efficacy of new waves of treatments aiming at longer quality of human life could be counteracted in the health systems of people who lack employment, access to decent housing, good education, income equality or struggle to get clean water, a PwC Health Research Institute report has shown.
These social determinants, which often lack in the lives of the majority of Nigerians, are in themselves ingredients of good health, and essential to facilitate the effectiveness of enhanced medical interventions.
Despite the staggering pace of health innovations being imported from advanced countries, the report shows it may not easily translate to better health outcomes when people stress to commute to work on poor road networks in highly polluted cities and low-income levels place them one illness away from poverty.
“Treatment alone won’t ensure that the level of human health improves; it may not even guard against its decline. The reality is that our systems are not built or designed to truly achieve health for societies.
“If healthcare organisations and governments do not take greater account of the social determinants of health, nations will not fully realise the tremendous potential of those medical advancements,” according to the report.
One in five respondents indicated they could not afford a healthy lifestyle, and a similar share said they did not have the time to focus on healthy behaviours in PwC’s 2019 HRI global consumer survey. Clinical care, while vital, is, in fact, responsible for only 20 percent of a person’s health. The other 80 percent is attributed to health behaviours, the physical environment and socioeconomic conditions.
But some health experts differ on the position that the efficacy of treatment will be jeopardised if people live under poor condition.
Adetokunbo Fabamwo, chief medical director of Lagos State University Teaching Hospital (LASUTH), argues that deplorable living conditions may predispose people certain health conditions, it does not neutralise the efficacy of treatments. He agrees it is important that the government needs to tackle the environmental mess, feeding, transport, water and poverty, which sum up as social factors and determinants of health. However, the distribution of health challenges among the population could be blind to economic status.
“I do not agree that if you are offering treatment for a health condition and the patient is living in Mushin, for instance, he will not get better. It depends on what you are treating. The man does not have to live in Ikoyi to get better. Not everyone has to live in a posh area yet everybody will develop health conditions and has to be treated,” the professor of obstetrics and gynaecology explains.
“There are some health conditions that even the rich develop them. There is nothing you can do about cancer. But the government must take people away from living in deplorable conditions. If people have good transport and live in good conditions, they may not be predisposed to health threats.”
The potential abounds for Nigeria to grow from a lower-middle-income country into a sizeable middle class as national income per capita grossed $2,100 in 2017, according to the World Bank. But high poverty rate clouds that prospect. While one in five Nigerians were middle class, 48.2 percent were estimated to be living in extreme poverty in 2016 going by per capita purchasing power parity of $1.90 a day.
The country is growing slower than its population and a large number of the poor. Opportunities for substantial employment are increasingly scarce and lagging significantly behind its growing labour force. As of Q3 2018, the unemployment rate was 23.1 percent, the underemployment rate 20.1 percent, according to the National Bureau of Statistics (NBS). The combined unemployment and underemployment rate was 43.3 percent.
Whether compared with peers or with sub-Saharan Africa, Nigeria’s health care system has not successfully delivered basic primary services nationally. It has only a few examples of improvements to show in a few states. The most vulnerable in society carry the brunt of poor investment in healthcare as public expenditures on health care remain inadequate and inefficiently used.
Nigeria is among the countries spending a low share of public funds on health services. Total public health expenditures were about 0.5 percent of the total amount of economic activities, gross domestic product (GDP) or 5.9 percent of total government spending in 2016.
From 2017 to 2020, the health budget dangled between 3.90 per cent and 4.75 per cent of the national budget, making it difficult for the sector to deliver its expectations. The government still largely struggles to deliver basic healthcare services such as vaccinations, long-lasting insecticidal nets distribution, family planning, simple curative services for children and care for pregnant women on government revenues.
The result is placing the heavy burden of high out-of-pocket expenditures on households, accounting for 72 percent of total health expenditures in Nigeria. The poor often choose between forgoing care or incurring huge out-of-pocket expenditures to obtain care.
The main challenges facing the health care system are insufficient access, affordability, quality and extent of services. These aspects can be improved by addressing delivery, financing, accountability and the architecture of development assistance for health, according to the 2019 World Bank report titled ‘Nigeria on the Move: a Journey to Inclusive Growth’.
But the PwC report indicates that social determinants such as employment status, income level, educational attainment, pollution levels and neighbourhood crime all affect how people experience life and the choices they make.
It advocates that bold action is required to rethink how all players in the healthcare ecosystem can work together not just to treat diseases, but to address the root causes of disease.
In its five-step recommendation of how to lead social determinants of health actions, the report identifies building collective will, developing standard but acceptable frameworks, generating data insights to informed decision making, engaging and reflecting the community and measurement and redeployment as ways forward.
