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Social Determinants of Health That Affect the MMR in Sierra Leon

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It is increasingly being recognized that health outcomes are a result not only of biological and individual risk factors but also of other factors like wealth, ethnic background, gender, education and so on

Inequalities in people’s access to information, decision making and life opportunities contribute to their ill health and levels of well-being. Political choices and social organization that distribute power and resources unequally across populations reproduce unequal health outcomes.

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Many African economies have achieved substantial economic growth over the past recent years, yet several of the Millennium Development Goals (MDGs) including those concerned with health, remain considerably behind target

This paper examines whether progress towards these goals is being hampered by existing levels of poverty and income inequality. It also considers whether the inequality hypothesis of Wilkinson and Pickett applies to population health outcomes in African states. A substantial proportion of Africans live below the poverty line. A focus on poverty alone however might not be the best way to improve population health. Another factor is income inequality. Empirical evidence suggests that it is impossible to address health-related problems without simultaneously addressing economic problems. The channel through which a healthy population is an engine for economic growth and conversely wealth undoubtedly leads to better health. How society organizes its scare resources for production and the distribution of both income and wealth has significant impact on health and well-being. For instance, poor people who are economically or socially disadvantaged often suffer from an increasing burden of the social determinants and consequently worse health, on average, than their better-off-counterparts. If the inequitable distribution of income across population groups remains unchecked or is allowed to worsen, then economic growth may not result in the health gains anticipated. The adverse impact of income inequality on health has been demonstrated. More egalitarian societies have been identified with lower health inequality.

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Women who are socially or economically disadvantaged and geographically isolated have an increased risk of dying during pregnancy, even though most of these deaths are largely preventable if they receive interventions in time. For instance, poorer women in sub-Saharan African countries lack timely access to both skilled attendants at delivery and institutional delivery care services, unlike in rich countries, where the skills to use life saving devices and to carry out emergency procedures (caesarean section, blood transfusion and effective antibiotics) are widely available. When inequities in accessing delivery services are reduced, there are fewer maternal deaths. After Rwanda expanded access to institutional deliveries between 1990 and 2015, the proportion of women delivered by skilled birth attendants increased over three-fold, from 25.8% to 90.7%, and the MMR declined by 78% in the same period. Aside from health system determinants, household income contributes to maternal mortality. In low-income countries, poor women are unwilling to use the formal health sector if they must pay for maternal health services [Khan K, Wojdyla D, 2006]

This is an important observation as countries that successfully lowered maternal deaths also improved financial access to professional care [WHO, UNICEF, UNFPA, 2015]. There is evidence of a rise in facility births and reduced deaths among newborns following the removal of user fees [Khan K, Wojdyla D, 2006]. In the face of such strong evidence governments in developing countries were urged to put in place maternal fee exemptions as a strategy to reduce maternal deaths. Thus far, 15 sub-Saharan African countries have abolished fees.

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In short, such timely interventions were crucial to reduce the likelihood of this national tragedy becoming a public health crisis, with severe flooding and damage to water and sanitation systems increasing risks of the spread of diarrhoeal and vector-borne diseases. Beyond this, however, the rapid implementation of these activities are also testament to improved capacity within the public health sector to recognize such threats, to lead, and to respond.

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WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division . Trends in Maternal Mortality: 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: WHO; 2015.

Khan K, Wojdyla D, Say L, Gülmezoglu A, Van Look P. WHO analysis of causes of maternal death: a systematic review. Lancet. 2006

United Nations Development Programme. Discussion Paper. A Social Determinants Approach to Maternal Health. Roles for Development Actors. 2011.

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