The Honourable Minister, Dr Aminath Jameel, Dr Luna, WHO Representative for the Maldives, Mr Mansoor Ali, the Acting UN Resident Coordinator, ladies and gentlemen.
It is my pleasure to inaugurate this very important National Workshop on Social Determinants of Health. I am especially pleased that we have so many guests who have arrived from abroad, especially from Bangladesh, from Bhutan, Thailand and Sri Lanka. Also I would like to welcome or colleagues from CRO and also WHO Headquarters in Geneva. Welcome to you all.
From the two previous presentations it is quite obvious that health sector cannot succeed by it self. It requires the support of all the other sectors. Unfortunately in government we tend to work in our own sectors, and the sectors continue to function as silos with very little interaction with each other. I hope this workshop will help to breakdown some of these barriers and force people to work together to solve the critical issues our population faces in health sector.
I will try to just briefly address mostly, social and cultural issues that we also need to take into account when we talk about social determinants of health. It is very difficult to separate the health of the individuals, their families and communities – they all seem to be related. Individual health comprises, as you all very well know, both mental and physical health, each contributing to the other. An individual lives in a family and in a community environment, in a society that comprises people, organizations and institutions. Individual, is in a way, surrounded by the social, cultural and physical environment.
I tend to think, therefore, the individual’s mental and physical make up is, to some extent, an extension of the cultural and physical environment. Our thoughts are shaped by the collective thoughts within the society as if the individual mind is an extension of the societal mind or minds. As a result a large majority of the people often think alike.
Societal beliefs about the causes of disease, for example, affect the way people treat them. Cultural factors’ affect on health include the perception of disease, the causes of it, and its prevention and cure.
Until recently, in Maldivian society, we did not acknowledge stunting as an important health issue, or obesity was seen as a sign of good health. As a result malnutrition was not recognized as a public heath issue. Similarly, prevention from disease included keeping children indoors and hidden from evil eyes.
Until today, many societies are struggling to stop harmful practices. Most widely recognized one in some countries is female circumcision.
Societal beliefs about the role of women affect women’s health and development. Women are systematically deprived of life saving care. The result: maternal mortality rates remain high in societies where gender inequality is also high.
With advances in science, our understanding of the causes and effects of diseases have changed to a great extent. Therefore, one of the most important dimensions of health systems reform has become the substitution of traditional beliefs with modern ones based on proven results verified according to empirical studies.
Through public awareness programmes people’s understanding of health has to be changed. For that to happen, collective beliefs about health in society must also change. For example you cannot have an influential cultural institution spreading traditional messages that contradict modern scientific findings.
Cultural intervention in health must include training of tradition leaders and spreading the new knowledge among influential institutions within society. We have been talking about, what I call the societal mind and how that affects individual beliefs and values.
What is equally important are the physical and institutional manifestations of those beliefs. For example, traditional healers and medicines co-exist side by side with modern health systems.
Any new system requires training of its professionals and the development of new institutions to a level that will be acceptable to the beneficiaries. Health service providers at all levels need professional training and recognition and respectable remunerations. In short, new systems of healthcare must replace traditional systems and become part and parcel of the social system.
The extent to which health systems reach out to the population depends on how it is organized and what underlying interests determine its social formation.
Those who are following the US healthcare reform efforts will understand that health systems like other social systems are affected by material interests. History has taught us that conservative political thought has always represented narrow interests and those of the wealthy. Health systems that are entirely run by private corporations tend to exclude the poor. Universal health coverage, including the poor, will require state interventions as social protection programmes.
This is especially so at time of economic distress. Unemployment, reduced wages, and absence of social protection can put excessive stress on families and reduce their ability to excess health services. We also know that at times of hardship women and girls tend to suffer most. Families make decisions to allocate their limited resources according to values they attribute to individual members of their families – men and boys often get preference.
In the Maldives, an additional societal factor that affects the quality of health services is population congestion in Male’, and de-population in remote areas. Relatively better but stretched services in Male’ continue to attract more customers from other islands. Continued in flows can cause systems breakdown.
Perhaps there is no area where you see the relationship between values, societal circumstances and health of people than in the area of youth health and development. Youth unemployment and lack of opportunities for young people in the Maldives is alienating them and causing societal distress and societal diseases such as drug addiction and mental health. I believe, we must seriously, in all sectors begin to address this issue of youth unemployment and development.
Time has come for us to re-examine the provision of health services from a more holistic perspective, taking into account these social dimensions. We can no longer focus entirely on the management of the existing institutions or existing services.
Changing hands do not necessarily create additional capacity required to extend services or to improve quality. Therefore, we must assess what the additional requirements for services is and plan them according to demographic changes, population migration, in flow of migrant workers and the changing need for health services.
We just heard from the honourable minister that the disease burden and the patterns of diseases are changing in the Maldives with changing socio economic conditions.
It is my hope that the new report that we saw on social disparities in health in the Maldives, and this workshop will greatly contribute to strengthening the national health systems.
Thank you for inviting me, and once again welcome to those colleagues who have come from abroad.