. Dr Francine Watkins, Senior Lecturer in Public Health and Director of the Master of Public Health Programmes at the University of Liverpool in this article sent in to Medicalworld Nigeria, she discusses the key issue of health inequalities, and the need for public health professionals to continually develop their knowledge and skills to tackle these inequalities.

 

It has long been acknowledged that the poorest people in society will have substantially shorter life expectancy and be more prone to ill health than more affluent people. These differences in life expectancy and health outcomes have been linked to the specific social, environmental and economic conditions in which people are born, live and work. 

 

These conditions include the social determinants of health such as access to good education, healthy working environments, clean water and sanitation and high quality housing which will determine the degree of health and the opportunities individuals will have. So if you have access to good education, you improve your chances of getting a good job, with a good income and the better your living conditions will be. 

 

This enables you to have greater access to resources in society and the healthier you will be. Therefore, the social determinants of health do not exist in isolation but are interlinked, and the interplay of these determinants will impact on an individual’s ability to access healthcare and on their chance of living a healthy life. This is clearly illustrated in the 1993 Dahlgren-Whitehead Social Model of Health which demonstrates the relationship between an individual, his or her environment and health, exploring the layers of influences that either promote or damage health. 

 

According to the 2015 Revision of World Population Prospects published by the Population Division of the United Nations Department of Economic and Social Affairs (UN DESA), the average life expectancy (for the period 2010 to 2015) in Nigeria was 50, compared to the UK average of  79.5. There is clearly a health inequity between countries but differences in life expectancy also occur within countries. 

 

Dr Francine Watkins

 

The nature of the public health challenges facing public health professionals also varies depending on where you are in the world. While, in the UK, key public health challenges include obesity, heart disease and diabetes, in Africa, the challenges faced by populations are quite different.

 

In many parts of Africa, tackling malnutrition and reducing the prevalence of diseases such as HIV and Malaria is of paramount importance. To be effective, public health practitioners need to understand how the social determinants of health interlink within particular communities. This will enable them to learn how best to implement strategies for different communities. Building relationships with communities can, in turn, help to provide individuals with the vital resources they need in order to take steps to improve their personal health. 

 

It is therefore important to identify where inequalities stem from within a community and wider society, in order to create the right social conditions to allow individuals access to the resources and services they need. This places a greater emphasis on ensuring that there are the wider social systems in place to improve overall public health. For public health professionals, it is not simply a case of understanding how to treat disease. 

 

It is also about understanding how issues such as lack of housing, poor sanitation and water, lack of access to health care, poor employment opportunities and lack of education interlink to impact on the wider organisation of society. Breadth of knowledge, as well as depth, is crucial for developing awareness of specific problems affecting the communities you are working with. This requires a wide range of knowledge and skills including strong research skills to gather data, and the ability to analyse and interpret this evidence to understand what it tells you about health and inequalities in your area, and what needs to change.

 

This is an area that we place great emphasis on as part of the online and on-campus Public Health courses I teach at the University of Liverpool. The aim is to provide students with the skills and knowledge to not only develop health improvement projects and prevention strategies, but also to learn how to effectively implement them by educating the communities that practitioners are working within. For public health professionals, ongoing learning is crucial so that they are able to respond to the changing needs of their communities, formulate strategies, and influence policy and decision making. Through the fully online platform, students are part of a global classroom where they are able to learn about other projects and find out how effective they have been in different countries and cultures around the world. This enables students to build a solid knowledge base of how to approach and tackle health inequalities. 

 

Through participating in a global conversation, sharing knowledge and refining our understanding of health inequalities, we can help to begin closing the health gaps across the world. 

 

Dr Francine Watkins, 

Senior Lecturer in Public Health and Director of the Master of Public Health Programmes

University of Liverpool