Realising that I work for an organisation that is actively working to bring health care to the poorest people in Africa, I have become attuned to the need for social epidemiology.
So what does PharmAccess Foundation do in Namibia? The main line of business is using mobile clinics as innovative way to harness both public and private sector funds (with the help of donors) to bring primary health care to those who have limited access to it. The reason for this is distance – people in the farms of Namibia and in the informal settlements of Windhoek are far away from health facilities. However, its important to point out that in this country, there are few options for poor people who live far from health facilities. This is precisely the reason for our ‘Mister Sister Mobile Clinic’ project. In a country where people had more options, such as Canada where people live in remote areas, perhaps this clinic would not be as crucial as it is here.
My involvement has been in reviewing data from a survey among our new patients. The goal is to find out how frequently did they have access to primary health care before the arrival of our mobile clinic with the aim for measuring how this access changes. So far, I have produced the descriptive statistics of their primary health care access at baseline and I will do so again once data is collected at the 12 month point since the implementation of the intervention. Here is what I cannot do: effectively assess their health status before the intervention and measure how it changes and the covariates accompanying the change. Learning the appropriate methods – namely epidemiological study design – is what I lack and hopefully what I will learn at UCL.
Social epidemiology looks at how factors at the individual level, family level , neighborhood level and larger community level determine health. What I find fascinating is how these layers of determinants impact on health from the moment of conception up to the end of a persons’ life. I believe that it is then important to understand to what extent can Mister Sister improve health outcomes through neonatal survival, for instance, and what other factors play a role in the survival of an infant. As social epidemiologist Nancy Krieger said, public health is about accountability, and so I seek to uncover those determinants of health our government is accountable for, such as social inequity, and demonstrate how they are limiting factors to improved health.
This brings the main question I have about social epidemiology. It seems almost obvious that in countries such as Namibia where a decent standard of living is contingent on income, that there would be a social gradient of health. On the other hand, as a society we reject simplistic relationships between health and social position, such as the infamous assertion by Thabo Mbeki of South Africa that poverty caused AIDS. And yet, it has been shown, even in Namibia, that poor people are disproportionately affected by HIV. I then peer down at the field of social epidemiology with the intention of diving in. I just need to learn how to swim.