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Social Determinants of Health in Kenya

Kenya is an ethnically diverse middle-income nation in East Africa with 54.7 million people. Most of the Kenyan population is the youth because of years of a high fertility level and reduced mortality rate among children aged five and below following successful health promotion programs, especially programs that increase the rate of vaccination. According to Ngaruiya et al. (2019), more than 40% of Kenyans are aged 15 years and below, with 55% having the age between 15 years and 64 years, and only 4% of the population is 65 and above.

Cardiovascular disease (CVD), diabetes, and cancer are Kenya's highest priority health issues. Identifying the health concerns is grounded on various global indicators of priority health problems, including considering prevalence rates, mortality rates, and even conditions identified as a top priority in the Healthy People 2030. In Kenya, cardiovascular is one the leading cause of death-causing 13% of total deaths. In addition, 50% of the county's population is pre-hypertensive, while 25% of Kenyans aged between 18 and 69 years have heart disease. Secondly, cancer is the third highest death cause in the country, with an incidence rate of 47,887 per annum (Mbau et al., 2021). New cancer cases are estimated to increase by about 120% in 20 years. Diabetes is also a significant health problem in the country, with an expected prevalence of 3.3%, estimated to reach 4.5% by 2025.

Through prevalence and mortality rates health indicators, cardiovascular disease is the highest priority health issue in Kenya. Cardiovascular is responsible for 365,744 deaths annually, accounting for 13% of the total deaths in the country. In addition, 25% of hospital admissions in the country are cardiovascular disease-related patients. Various risk factors, including increased intake of tobacco, alcohol, and low intake of vegetables and fruits, are responsible for the high CVD cases in Kenya. For example, 11.6% of adults and 9.9% of youths below 15 years of age use tobacco, whereas 86.1% of adults are at risk of passive or second-hand tobacco smoking (Mwenda et al. 2018). Additionally, 24.8% of young people are exposed to passive smoking, increasing their risk of developing the condition.

Economic stability is the primary social determiner of health, with the most impact on the increased cardiovascular disease in Kenya. Many Kenyans have limited access to healthcare because of the ineffective care system following low funding for the health system. The national healthcare budget ranges between 5.5% and 9.5%, lower than the national target of 15% as set by (KHSSP) Kenya Health Sector Strategic Plan. 23% of sick Kenyans lack access to healthcare due to the high care costs, poor health literacy, and long traveling distances to seek healthcare services. Limited healthcare access and quality play a vital role in the high CVD prevalence and death rate. Many Kenyans in remote areas face the challenge of quality healthcare and accessibility due to a lack of resources and facilities. Many Kenyans have to travel long distances to major cities to access facilities to get quality healthcare.

A large Kenya population lives in poverty due to a lack of job opportunities and other factors, including inadequate rains in the country. Many low socioeconomic Kenyans cannot afford healthy lifestyles, including healthy, nutritious diets, and lack resources for physical activities (Mercer et al. 2019). One million people in Kenya live below the poverty line. As their primary source of entertainment and social activities, many have resulted in smoking and alcoholism, which are major risk factors for cardiovascular diseases. Other factors that increase the rate of CVD include stress, anxiety, and obesity. Due to economic struggles, many Kenyans struggle with stress and obesity due to poor nutrition. Poor diet is one of the significant risk factors attributed to CVD. Many Kenyans rely on processed food with high fat and sugar levels due to the affordability and accessibility of healthy food.

Lastly, people may not afford travel costs to major hospitals or out-of-pocket payments for health care with low-income status. Such people end up not getting the treatment needed, resulting in death, with adequate healthcare financing policy, resulting in the provision of healthcare facilities and in communities and professional expertise to provide healthcare services. Having health care facilities close to every community will encourage individuals to seek treatment and prevent other morbidities. Community healthcare professionals are experts in educating, preventing diseases, and helping manage existing problems. They will provide resources that address basic needs such as food and basic health education that promote a healthy lifestyle. These strategies will help promote and improve health outcomes in Kanya.

Conclusively, Kenya is a middle-economy country with 54.7 million people. Cardiovascular disease, cancer, and diabetes are significant diseases affecting lives in Kenya, with cardiovascular disease being one of the leading causes of death. Cardiovascular leading prevalence and mortality rates can be attributed to low-income and limited access to health and quality social determiners of health. Improving health system funding policy and providing infrastructures that will provide accessible health care services will help reduce the prevalence of CVD in Kenya.

References

Mbau, L., Fourie, J. M., Scholtz, W., Scarlatescu, O., Nel, G., & Gathecha, G. (2021). Kenya Country Report. CARDIOVASCULAR JOURNAL OF AFRICA, 32(3), 161-167. https://world-heart-federation.org/cvd-roadmaps/wp-content/uploads/sites/3/Kenya-Country-Report.pdf

Mercer, T., Njuguna, B., Bloomfield, G. S., Dick, J., Finkelstein, E., Kamano, J., ... & Akwanalo, C. (2019). Strengthening Referral Networks for Management of Hypertension Across the Health System (STRENGTHS) in western Kenya: a study protocol of a cluster randomized trial. Trials, 20(1), 1–13. https://doi-org.proxy.library.ohio.edu/10.1186/s13063-019-3661-4

Mwenda, V., Mwangi, M., Nyanjau, L., Gichu, M., Kyobutungi, C., & Kibachio, J. (2018). Dietary risk factors for non-communicable diseases in Kenya: findings of the STEPS survey, 2015. BMC Public Health, 18(3), 1-8. https://doi-org.proxy.library.ohio.edu/10.1186/s12889-018-6060-y

Ngaruiya, F. W., Ogendi, G. M., & Mokua, M. A. (2019). Occupational health risks and hazards among the fisherfolk in Kampi Samaki, Lake Baringo, Kenya. Environmental Health Insights, 13, 1178630219881463. https://doi-org.proxy.library.ohio.edu/10.1177/1178630219881463

30th March 2022

Terry Thomas, Community Health Worker

I write to inform you about the significant impact social determiners of health (SDOH) have on health outcomes and inequalities in our society. This email is directed to the health workers as community healthcare workers help people in the community they serve to meet their unique needs, including guiding and navigating them towards the healthcare and social system. SDOH involve environmental conditions where individuals are born, learn, live, worship, play, and age that impact their health, quality of life and functioning outcomes, and risk (Moise, 2020). The main domains of SDOH include accessibility to quality education, economic stability, social and community context, healthcare quality and access, education, neighborhood, and built environment. These factors are central to determining the population’s health outcomes.

Economic stability has a significant impact on the prevalent cardiovascular disease in Kenya. Many people in the country live in poverty, with 1,000,000 Kenyans living below the poverty line. Poor Kenyas cannot afford healthy lifestyles, including healthy diets and physical activities. The majority of Kenyans do not practice healthy lifestyles. They have a low intake of fruits and vegetables, increased intake of processed foods, and smoking and alcoholism, increasing the risk of developing cardiovascular disease. The high cost of living has left Kenyans stressed and obese due to poor nutrition (Mbau et al., 2021). This low-income population does not afford enough to engage in physical activities and other healthy practices like good diets. Limited access to quality care is another SDOH affecting CVD in the country. The national healthcare is funded below the 15% target set by (KHSSP) Kenya Health Sector Strategic Plan. According to Ooms et al. (2021), 23% of patients in the country do not access care services because of the high care costs, long traveling distances, and low health literacy levels.

References

Moise, I. K. (2020). Variation in Risk of COVID-19 Infection and Predictors of Social Determinants of Health in Miami-Dade County, Florida. Preventing Chronic Disease, 17, 1–5. https://doi-org.proxy.library.ohio.edu/10.5888/pcd17.20035

Ooms, G. I., van Oirschot, J., Waldmann, B., von Bernus, S., van den Ham, H. A., Mantel-Teeuwisse, A. K., & Reed, T. (2021). The Current State of Snakebite Care in Kenya, Uganda, and Zambia: Healthcare Workers’ Perspectives and Knowledge, and Health Facilities’ Treatment Capacity. American Journal of Tropical Medicine & Hygiene, 104(2), 774–782. https://doi-org.proxy.library.ohio.edu/10.4269/ajtmh.20-1078