Experience over the last few decades has provided ample evidence that Botswana is regressing from achieving health equity and eliminating health disparities. Health inequalities have become a vital public health concern and the subject of both research and policy attention. Country reports, as well as many epidemiological studies, have shown that a wide range of health outcomes and health-related behaviours are socioeconomically patterned, and that the magnitude of health inequalities is even increasing.
Tlotlo Seboni, a public health researcher who has many years of research experience in researching public health trends as well as hazards and different environmental risks across southern Africa says, currently, there is a lot of proof which validates the fact that social factors such as employment, education and income level in Botswana play a huge difference on how healthy a group of people or individual is.
”Health inequality is an important indicator of a society’s health and there is higher risk of Batswana suffering from poor health because of the lower socio-economic position of most citizens,” she says adding that “as economic inequality in Botswana has deepened, so too has inequality in health. Almost every chronic condition, from stroke to heart disease and arthritis, follows a predictable pattern of rising prevalence with declining income.”
With regard to the Covid-19 pandemic, she says measures to control the coronavirus, such as quarantining and restricting travel, are exacerbating existing economic hardship hence creating a perfect storm of factors that harm health in the short and long term.
Botswana also has a sanitation problem. In his research, Botswana Institute for Development Policy Analysis (BIDPA) researcher, Khaufelo Raymond Lekobane says “a total of 64.7 per cent of the population is deprived in sanitation. That is, they lack access to a safe toilet facility, while 9.7 per cent of the population has no access to safe drinking water.”
According to Seboni, lack of sanitation, clean water and basic services makes the recommended methods of controlling Covid-19 – such as regular handwashing a challenge in some communities. “Furthermore, restrictions on travel and the economy limit work opportunities and access to quality healthcare for a lot of citizens,” she says.
Health inequalities are the methodical differences in the health status of various population groups or individuals that occur mainly because of the uneven distribution of social, environmental and economic conditions within societies. Such differences also play a part in the risk of people getting ill and their ability to prevent sickness.
Health inequality in Botswana is linked to life expectancy and the more there is high health inequality the more ordinary citizens are likely to be deprived and limited in their chances to live longer. The existence of health inequalities in Botswana means that the citizens’ right to the best measure of physical and mental health is not by any chance being achieved.
A policymaker, Letso Masilo who spoke to this publication indicated that the lower an individual’s socio-economic position, the higher their risk of poor health. She also added that health inequalities are the unfair and preventable differences in people’s health across the population and between specific population groups.
“Health inequalities go against the ideology of social justice because they are preventable. They do not occur randomly or by chance. It is time that researchers take into account the need to measure local disease burdens because health problems concentrated in a certain place in a country could be very different from those experienced a couple of hours away from that area,” he says.
Masilo also says Botswana’s ability to record an increase, decrease or stagnation in health inequality solely depends on how policymakers address vital health drivers.
“First we need to analyse the reasons why health inequality exists in Botswana and some of the reasons include poverty, income inequality, low employment, social exclusion and health behaviours or lifestyles,” he says.
In terms of life expectancy, data from the World Health Organisation (WHO) shows that women in Botswana still live longer than their male counterparts with an average life expectancy rate of 68.4 as compared to men’s 63.6 years. Life expectancy is an estimate of the average age that members of a particular population group are expected to die and this is a valuable barometer of the health of Batswana. Some also say it can be viewed as an indication of the potential return on investment in human capital.
Masilo said many factors could explain why Batswana women are likely to live five years longer than men.
“The past few years has shown that men are more abusive of their bodies than women. Factors such as smoking, drinking and substance abuse are more concentrated on the male population, whilst it is lower for the female population,” he says.
Masilo also revealed that HIV/AIDS and tuberculosis remain the country’s leading cause of death as they account for over 40% of deaths and the youth still remains the most affected demographic when it comes to HIV/AIDS.
“More men are also dying from tuberculosis than females,” he says adding that this could explain why women have always lived longer than males.
Life expectancy is also a valuable indicator of how the general populace is weathering all kinds of struggles, from disasters to emerging diseases wars to disease to disasters—natural and man-made. Data from the World Health Organisation also revealed that overall life expectancy in Botswana is now 66.1 and this gives Botswana a World Life Expectancy ranking of 138. When these latest figures are compared to a study conducted in 2013 by the Institute for Health Metrics and Evaluation (IHME), the men’s life expectancy has increased by 1.9 years whilst the women’s life expectancy has reduced by 2.8 years.
Masilo also said the idea that a middle income nation like Botswana is experiencing health inequality just doesn’t seem right. “This must be a wake up call because we cannot afford losing too many Batswana, too early and too often, to health inequality which is preventable.”
