Social determinants of health in countries in conflict - What is GIS ...

12 Social determinants of health in countries in conflict
interconnectedness of the security of all people”, “the global community’s responsibility
for everyone’s welfare”, “respect for the rule of law” and the “accountability of
governments for their actions” [2]. An ethical and human rights viewpoint and the UN
doctrine of the “responsibility to protect” also motivates the documentation of the ways
in which conflicts, such as those in the Region, have a devastating impact on the daily
life, health and well-being of civilians caught up in conflict [3].
In 1995, WHO established the Commission on Social Determinants of Health in
recognition of the need to act to reverse the increasing differentials in health status,
both within and between countries, which have been observed since the early 1990s.
These differentials in health status can be attributed in large part to the differences in the
conditions in which people live, and in their capabilities to lead healthy lives. Armed
conflict results in life settings that produce high levels of mortality, disability and
morbidity (physical as well as mental), directly or indirectly resulting from the conflict,
when compared to health outcomes in otherwise comparable non-conflict settings.
The Commission recognizes the distinction between inequalities or disparities in
health, and inequities. Inequities are defined as unfair or unjust differences in health
status that are avoidable, and hence, can be remedied [4,5]. In a conflict setting, health
inequalities are clearly inequities, in so far as differentials are the result of human action,
rather than unavoidable biological or natural phenomena. A corollary of this distinction
between inequalities and inequities in health is the recognition of WHO that health is a
fundamental human right. This is currently expressed in terms of “the right to the highest
attainable standard of health” [6,7].
The Commission on Social Determinants of Health identifies several ways of looking
at social determinants. The structural determinants originate in the socioeconomic and
political context at the country and global level. These affect power relationships
that determine the distribution of power, prestige and resources globally and within a
particular country or society, including those needed to maintain health and social wellbeing.
These, in turn, result in intermediate determinants, the social relations, behaviours
and psychological characteristics which can be seen as intermediaries between structural
determinants and final health outcomes.
The structural determinants of health in conflict settings are especially important.
They include the broad economic, cultural, historical, environmental and “political”
determinants of health. All these determinants can be reflected in the intermediate, and
strictly more “social” determinants, the conditions in which people live which affect
their health status.
Thematic areas can be identified as starting points for policy action and intervention.
These relate to specific life situations, especially groups or areas disadvantaged with
regard to issues such as gender inequity, employment, urban settings, social exclusion
and early childhood development, which are known, or suspected to be, associated
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