In Botswana, there is growing evidence that the country is regressing from achieving health equity and eliminating health disparities. Inequalities in health are becoming a serious problem and this has also been exacerbated the Covid-19 pandemic. While assessments of inequalities in health might differ from one country to the other, in Botswana, health inequalities are attributed to the difference in health status between socioeconomic groups, employment status as well as gender.
A World Health Organisation (WHO) report entitled “Social determinants of health in all public policies: The case of health development in Botswana” notes that “income inequity is a major determinant of health inequity,” adding that “employment and working conditions have powerful effects on health and health equity. When these are good they can provide financial security, social status, personal development, social relations and self-esteem, and protection from physical and psychosocial hazards – each important for health.”
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.
Over the past few years, health inequalities have become a vital public health concern and the subject of both research and policy attention in Botswana. In Botswana, healthcare services are more accessible to the rich, while healthcare benefits for the poor remain limited. Government reports, as well as many epidemiological studies, have provided evidence that a wide range of health outcomes and health-related behaviours are socioeconomically patterned, and that the magnitude of health inequalities is even increasing.
While tackling inequalities in health is a predominant aim of most governments, with some countries going as far as setting the goal of eradicating all inequalities in health by 2030, public health officials say Botswana must structure her overall public health policy to tackle the underlying determinants of inequalities in health.
Speaking to The Telegraph, a former public health official, Tlotlo Seboni said it is awkward that a middle income country like Botswana has high health inequality.
“Policymakers must first of all realise that national socioeconomic factors in Botswana are the main determinants of inequalities in health,” she says. At the moment, there is evidence on the ground which validates the fact that social factors such as employment, education and income level play a huge difference on how healthy a group of people or individual is.
“Prior to Covid-19, vulnerable groups in Botswana were already disproportionately affected due to their specific health and socioeconomic circumstances, poor living conditions and lack of access to high-quality public health care,” she adds. However, the arrival of Covid-19 has worsened what was already a worrisome situation and has amplified health inequalities.
This was also corroborated by the United Nations (UN) which recently highlighted that the collateral effects of Covid-19 have resulted in people losing their jobs or in some cases earning half of their salaries and this has inequitably affected those who are already marginalised.
“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,” says Seboni.
When the government of Botswana realised income inequity has a gender dimension, they moved quickly to put forward strategies to close this gap. These strategies are contained in the National Development Plan 10, or NDP 10, which guide the overall development of the country.
Some of the strategies include promotion of broad-based employment growth with extensive sectoral and geographical spread, assisting informal sector development as a source of entrepreneurial activity, and supporting informal sector enterprises to graduate to the formal sector.
Health inequality is an important indicator of a society’s health and research shows that there is higher risk of Batswana suffering from poor health because of the lower socio-economic position of most citizens.
“Botswana needs a policy on inequalities in health which emanates from the department of health. Such a health policy must not be confused with policies on poverty or social inclusion which are motivated by a general concern for human rights and dignity, of which health is only a small part,” says Seboni. However she is quick to add that issues such as low income are directly relevant to health.
Inequalities in health in Botswana are deep-seated and addressing them requires a sustained and systematic effort. Some public health officials say in order to close the inequality health gaps, there is need for concerted efforts at national and local community level.
Another health official who spoke to this publication on condition of anonymity said the lower an individual’s socio-economic position, the higher their risk of poor health. He 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.
As recommendations, WHO says since poor health is a barrier to meeting policy challenges, the health sector needs to engage systematically across government and other sectors.
“For that reason, governments need institutionalised processes which value cross-sector problem-solving. This approach is now commonly referred to as the “Health in All Policies” approach,” says WHO adding that the “situation includes incorporating health outcomes in all government policies and strategies, such as those addressing poverty reduction and education. This, in fact, is applicable to all development policies and strategies”.
