In almost all low to middle income countries with available data, mortality and morbidity rates are higher among those in less advantaged socioeconomic positions, and as a result differences in health expectancy between socioeconomic groups typically amount to 10 years or more.
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.
Speaking to The Telegraph, a public health official, Tlotlo Seboni said the idea that a middle-income nation like Botswana is experiencing health inequality just doesn’t seem right. “This must be a wakeup call because we cannot afford losing too many Batswana, too early and too often, to health inequality which is preventable”.
Currently there is a lot of proof 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.
“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,” she says.
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. 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,” says Seboni.
Among other things, she says 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,” she says.
Seboni 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,” she 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.
Seboni 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,” she says.
Seboni 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,” she 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.
Seboni also says the idea that a middle income nation like Botswana is experiencing health inequality just doesn’t seem right. “This must be a wakeup call because we cannot afford losing too many Batswana, too early and too often, to health inequality which is preventable.”
