Country Comparison Paper: A Multisciplinary Analysis of the Health Disparities as a Result of Conflict in Somalia, Syria, Iraq, and the United States
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California State University Long Beach
In today’s interconnected world, health has no boundaries. In every country, a variety of different factors and variables constitute the overall health of that nation. This multidisciplinary nature of the underlying factors that attribute to the health of countries creates the stage for a thorough consideration why health is a certain status in these different countries. In this paper, four different countries from four different levels of income, as reported by the World Bank, will be investigated in order to analyze the health disparities that are present within their borders, as well as what factors or reasons create these disparities. Further, potential global responses to remedy these disparities will be evaluated. The nations of Somalia, Sudan, Iraq, and the United States will be the four countries analyzed, representing low, low-middle, middle, and high levels of income respectively. These four countries all have variations in what determines the health status of their people, but all have one common theme: conflict. Whether it be an armed conflict and/or a political conflict, all four of these nations are dealing with this destructive element of civilization. Through analyzing the history, education, and economics of these nations, it is apparent that conflict has a major negative impact on the health status of a country’s people.
Analysis of Health Indicator Disparities
In order to adequately assess the present status of the health disparities between the four nations, first an assessment of five different health indicators will be compared and contrasted from a data table, as seen in Table 1. All of these indicators represent variations in the socioeconomic status, environmental risks, health care access, nutrition, as well as many other factors in a country. Life expectancy is a rate that reflects the overall mortality of a population. Next, literacy rate is an indicator that is useful in measuring the education of a population. Total fertility rate reflects the average number of children per woman, and high rates in this indicator represent increased risk of maternal morbidity and mortality. Infant Mortality Rate measures the risk of dying in infancy and childhood and is a major area of concern in developing nations (Veneman, A.M., 2007). Finally, Maternal Mortality Rate is an indicator that represents the risk of maternal death during pregnancy (World Health Organization, 2017a).
In all of the five indicators examined, a clear trend presents itself: low income nations suffer the worst health outcomes and these health outcomes become better as the income of a country increases. In low income countries, having money to finance a health care system for it’s people is an incredibly difficult task. Without enough money, a government cannot ensure its people access to staples of good health, which include: clean drinking water, proper sanitation, adequate nutrition, education opportunities, among others. Moreover, all four of these countries are dealing with varying levels of conflict, which has major implications on a nation’s health.
Analysis of Factors Contributing to the Health Challenges of the Countries
In order to understand how the rates of the health indicators among the different countries are where they are now, it is crucial to examine how they got there. An important perspective to consider when analyzing the health disparities of these nations is their respective histories. History plays an important role not only in the current health status of a country, but also why the health status is what it is. In Somalia, Sudan, and Iraq, civil conflict has dominated their histories for a long time. All three of these nations have endured decades of regimes controlling the political landscape, mostly at the expense of the people living there. In a 2008 research article, Epidemiologists Victor Sidel and Barry Levy explicated just how much war impacts the public health of a nation by detailing how war not only causes widespread death and disability, but also destroys many structural factors in a nation such as families, cultures, resources, and health infrastructures (Sidel, V.W., Levy, B.S., 2008). With these key structural factors being depleted due to armed conflicts, it is no surprise the health of these nations has struggled over the years. Somalia, Sudan and Iraq are dealing with many of the same results from a war torn history: high infant mortality rates, high maternal mortality, and a mass amount of displaced persons and refugees.
On the other hand, while not suffering from violent civil conflict, the United States ultimately has some health outcomes defined by a history of political conflict, whether it be civil rights movements, movements against the wealth inequality, or conflicts surrounding health care. The United States is often viewed as a nation that should have far better health outcomes considering they spend the most on health care by a wide margin (Centers for Disease Control and Prevention, 2015). These specific health inequalities will be examined further through other perspectives; although, a 2016 study on the health care of eleven countries puts it best, “in comparison to adults in the other 10 countries, adults in the United States are sicker and more economically disadvantaged” (Osborn, et. al, 2016). It is important to note that although these rates could certainly be better, these rates are far better than the other three, economically-disadvantaged, countries.
History of conflict has led to less than ideal health outcomes in these four countries, and these conflicts have affected many structural factors within each of these nations, one of those being education. Higher levels of education tend to yield better health outcomes for a population, particularly in reducing infant and maternal mortality rates. Through increased access knowledge about healthy behaviors and how to protect oneself from negative health outcomes, the health of a population will increase. As detailed in a United Nations article on the connection between education and health, children who get an education will go on to have children that will be provided with better health care and better health outcomes (Veneman, A.M., 2007).
Educational attainment is closely related to the literacy rates of a country. As Table 1 shows, In Somalia, literacy rates are at around 50% for men and just 26% for women. These terrible literacy rates in women coincide with an extremely high infant mortality rate, 96.6 deaths per 1,000 live births, and an extremely high maternal mortality rate, 732 deaths per 100,000 live births (CIA, 2017b). In Sudan and Iraq, literacy rates are quite similar; yet, women have lower literacy in Sudan, and thus have higher infant mortality and maternal mortality rates than Iraq (CIA, 2017a/c). Lastly, the United States, with a reported 99% literacy rate for both men and women, have a incredibly lower infant mortality and maternal mortality rate (CIA, 2017d).
As mentioned earlier, in all of these countries, cultural norms have not only affected women’s education rates in the past, but in the present as well. Issues regarding the freedom and ability for women to attain education continue to this day, and many of the negative health outcomes fall onto women because of this, especially in the war-torn state of these countries. Lack of facilities and ability to obtain education thus transcend onto the next generation and the cycle is perpetuated. Without the knowledge of positive health, many of these lower income nations lack the ability to pull themselves out of poor socioeconomic status, and thus high rates of infant mortality and maternal mortality are slated to continue unless major solutions are implemented. In the United States, women were structurally disadvantaged and struggled to gain the same right to education as men for a long time. However, this has changed over the years to where now females are more likely than males to graduate from high school, as well as from college (Autor, D., Wasserman, M., 2012). This change reflects the U.S.’s much better rates of infant and maternal mortality.
A final perspective that explains the trends in the health indicator table is economics. For a nation to have good health, they need to be able to afford good health. Table 1 clearly shows that higher income leads to better health, and the statistics support that claim. Without adequate money, a nation cannot afford all of the resources and structural necessities that attribute to these outcomes. Furthermore, income is a major source of inequalities and disparities. Economics is greatly impacted by conflict, and all four of these countries are dealing with the financial ramifications, as well as the health costs, of conflict.
As a result of the civil conflict that has affected Somalia, Sudan, and Iraq for decades, their health care systems have been largely destroyed. Lack of trained personnel and lack of financing for their health care system has laid the landscape for a multitude of health problems. This is particularly dangerous, as in lower income nations, communicable diseases are a major threat and cause many negative health outcomes, such as infant and maternal mortality. The United States, while instead enduring a political conflict surrounding health care, has seen economics impact their system in regards to how to finance health care, which has led to widespread inequality between different socioeconomic statuses.
Health care undoubtedtly creates a dillema about how to finance it. According the World Bank, the United States spends a staggering $9,403 per person per year, Iraq spends $292, Sudan spends $130, and Somalia spends just $33 (World Bank, 2015). In the comparison of these four countries, the health care spending coincides with the trend that more money spent on health care leads to better health outcomes. The highest per capita spending nation, the United States, has the financial power to provide nearly all people with a baseline level of clean water, proper sanitation, and a multitude of health care services. Lower income countries like Somalia, Sudan, and Iraq do not have nearly the same financial abilities the United States have, and thus are not able to control all of the negative health outcomes that arise from lack of economic resources.
It is clear that economics plays a big role in whether a nation has the capacity to provide the opportunity for good health for its people. The lower income countries have much higher rates of infant and maternal mortality, an indicator of poor sanitation, poor drinking water quality, improper nutrition, among other factors. Developing nations also have much higher fertility rates, which follows the income trend in the health indicator table and typically results in higher mortality rates as well. The United States, having a much higher financial capacity, enjoys much better rates of these indicators. Despite this, large income disparities within the United States has led to heated conflict on how to allow all citizens alike to have access to the same quality of health care that the wealthier citizens have.
Potential Global Responses
With a variety of perspectives analyzed in order to assess the factors determining the health status and disparities of the four countries examined, the less than ideal state of the health of the nations is clear. Potential global reponses to this lie in the United Nations-founded Millennium Development Goals. The Millennium Development Goals deadline was 2015; yet, they should still serve as inspiration for much needed solutions to be implemented in the near future (United Nations Foundation, 2012).
One of the Millennium Development Goals is to achieve a universal primary education. By achieving universal primary education, all boys and girls can be ensured to receive a full course in primary schooling. If boys and girls are properly educated, it will allow them to partake in behaviors that are beneficial to their health, as well as end the cycle of poor education and negative health that tends to pass from generation to generation (United Nations Foundation, 2012). Educated mothers will lead to increased literacy rates and thus lower infant mortality, total fertility, and maternal mortality rates. In war-torn nations like Somalia, Sudan, and Iraq, major structural changes need to occur in the education and literacy of women if this solution is ever to be achieved.
Other MDG’s are dedicated to reducing child mortality, improving maternal health, and developing a global partnership for development. These goals directly relate to the health indicators analyzed in the table. Infant and maternal mortality are immensely high in the lower income countries, through efforts such as: increasing access to clean drinking water, improving sanitation, and reducing environmental risks, these rates will continue to be high. While this is far fetched for countries who cannot afford massive systems to ensure these resources are achieved, the global partnership for development goal inspires possible solutions to this problem (United Nations Foundation, 2012). Globally addressing and implementing solutions to the needs of the less developed nations of the world, such as Somalia, Sudan, and Iraq, can help ease some of the burden of the problems they face.
Through the detailed research required to adequately compare and contrast the different health disparities affecting countries of different income levels, invaluable learning has been achieved. Primarily, assessing the health of different nations is certainly not a simple task, and truly requires a multidisciplinary approach in order to truly be able to analyze and draw comparisons between countries. This approach has given me a lot of insight into how valuable this depth of research is to an analysis. Furthermore, the nature of the analysis in its own opened my eyes to information I had never before considered fully. The true nature of health disparities is widespread globally, and learning about nations of different income levels and how all of these factors impact their health has given me an abundance of insight into the global burden of disease, and what factors attribute to it. As a learner, I have acquired many skills from this analysis and feel as though I am a much better researcher and advocate for better global health having completed this assignment.
In compiling statistics on different health indicators from Somalia, Sudan, Iraq, and the United States and then comparing the health disparities and factors behind them, a vivid detailing of the global burden of disease presents itself. Clear trends in how income affects a nation, as well as how different historical, educational, and economical factors create these trends display an invaluable need for a global push for better health outcomes to be reinvigorated. Moreover, conflicts within these nations, whether armed and/or political, have major implications on the health status and resources of a country. The world is growing increasingly more interconnected as the years pass, and it is up to every country in the world to collaborate and get on board with ensuring certain basic goals are met to ensure people of all walks of life have the opportunity to attain a quality standard of living.
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