Stepping Outside the Clinical Setting: How Social Supports Enhance Wellbeing

“Health For All”  by 2000 was put forward by the Declaration of Alma-Ata in 1978, and yet, 20 years later we are still well short of that goal with growing inequities in healthcare. Among the approximate eight million avoidable deaths that occurred in 2015, 96 percent occurred in low- and middle-income countries.¹ The gap between the rich and the poor is only widening and the consequences of health inequalities are widespread and devastating.² With seemingly limited options for improvement within a clinical setting, several countries have decided to tackle this issue through the provision of social supports.

Social supports are resources, including cash transfers, housing upgrade programs, vocational training, and transportation subsidies, that aim to alleviate poverty and improve health. One may ask, how can better housing improve health? The answer is that wellbeing is determined by so much more than what goes on in the immediate clinical setting. Going beyond healthcare means tapping into the social determinants of health—“the conditions of the environment in which people are born, grow, live, work, and age” that influence health and quality of life outcomes.³ There is growing evidence that these factors, or more generally non-medical determinants, substantively influence health outcomes—even more so than medical factors such as biological predispositions to an illness.⁴ Leveraging this evidence, provisions of social supports have been made for those living in resource depleted settings to improve wellbeing. 

In Nicaragua, conditional cash transfers were found to be associated with a decrease in the magnitude of stunting and proportion of under-weight children aged 0–5 years.⁵ A slum housing upgrade program in India resulted in an 18 percent decrease in the incidence of waterborne diseases.⁶ Additionally, transportation reimbursements through voucher programs in Pakistan resulted in an increase in the number of births delivered by skilled birth attendants.⁷ Other supports, such as programs for increasing access to education, providing vocational training, and agricultural support, can also be used as a stepping stone to improve one’s wellbeing. 

Much has been documented about the role of social supports in improving physical health outcomes, but such supports impact all aspects of wellbeing, not only those limited to physical health. Social isolation caused by poverty can have damaging effects on health and social supports directly tackle social isolation by addressing structural barriers of income and health inequalities. Specifically, supports such as educational and vocational training endow individuals with a sense of autonomy to shape their lives and feel connected to themselves and their communities. 

Social supports make way for a brighter future for many and shape the world for a better tomorrow. Partners In Health (PIH), an organisation that aims to improve health in resource limited communities across the globe, has been a pioneer in providing such social supports. PIH’s Program on Social and Economic Rights in Malawi demonstrates the impact social supports can have in helping individuals live a longer and more fruitful life. By increasing the scope of similar programs put in place by organisations and political actors of low- and middle-income countries, I believe the aim of achieving “Health For All” is not only possible, but not far away.

Notes:

1. Alkire, Blake C., Alexander W. Peters, Mark G. Shrime, and John G. Meara. “The Economic Consequences Of Mortality Amenable To High-Quality Health Care In Low- And Middle-Income Countries.” Health Affairs 37, no. 6 (2018): 988–96. https://doi.org/10.1377/hlthaff.2017.1233.
2. Blake, Peters, Shrime, and Meara. “The Economic Consequences Of Mortality Amenable To High-Quality Health Care In Low- And Middle-Income Countries.”
3. Chapman, Audrey R. “The Social Determinants of Health, Health Equity, and Human Rights.” Global Health, Human Rights and the Challenge of Neoliberal Policies, n.d., 248–82. https://doi.org/10.1017/cbo9781316104576.007.
4. Taylor, Lauren A., Annabel Xulin Tan, Caitlin E. Coyle, Chima Ndumele, Erika Rogan, Maureen Canavan, Leslie A. Curry, and Elizabeth H. Bradley. “Leveraging the Social Determinants of Health: What Works?” Plos One 11, no. 8 (2016). https://doi.org/10.1371/journal.pone.0160217.
5. Huntington, D., “The impact of conditional cash transfers on health outcomes and the use of health services in low- and middle- income countries. (2010). Retrieved from https://www.who.int/elena/titles/commentary/cash-transfers/en.
6. Butala, Neel M., Michael J. Vanrooyen, and Ronak Bhailal Patel. “Improved Health Outcomes in Urban Slums through Infrastructure Upgrading.” Social Science & Medicine 71, no. 5 (2010): 935–40. https://doi.org/10.1016/j.socscimed.2010.05.037.
7. Agha, Sohail. “Impact of a Maternal Health Voucher Scheme on Institutional Delivery among Low Income Women in Pakistan.” Reproductive Health 8, no. 1 (2011). https://doi.org/10.1186/1742-4755-8-10.