Chronic diseases and health promotion

Part Two. The urgent need for action

Chapter Two. Chronic diseases and poverty

Community deprivation. Spotlight: United Republic of Tanzania

Economic deprivation often leads to reduced access to the requirements of a healthy life, including affordable, nutritious foods, adequate housing and health care, and a good social support network such as family, friends and community groups. Many people live in areas that cause them to be concerned for their safety, thereby reducing opportunities for outdoor physical activities. People living in disadvantaged communities marked by sprawling development are likely to walk less and weigh more than others. People from deprived communities suffer more from cardiovascular diseases than residents of more affluent communities, even taking into account other known risk factors.

Poor access to quality health care and medications

Inadequa e access to good-quality health services, including diagnostic and clinical prevention services, is a significant cause of the social and economic inequalities in the burden of chronic diseases. The poor face several health-care barriers including financial constraints, lack of proximity and/or availability of transport to health-care centres, and poor responsiveness from the health-care system.

Financial considerations can act as barriers to health-care access. Some people are unable to afford out-of-pocket charges for health care and might forfeit their wages by missing work. Transport costs can also prevent people from seeking care, especially those who must travel long distances to health centres. The poor usually have much more limited access to prescription drugs.

Even when health services are subsidized by the government or provided free in low and middle income countries, it is the wealthier who gain more from such services. Findings from South Africa, for example, showed that among people with high blood pressure, the wealthiest 30% of the population was more than twice as likely to have received treatment as the poorest 40%. In rural areas, health workers and health centres are more dispersed, and health services might be of lower quality than in urban health centres.

The poor and marginalized are often confronted with insufficient responsiveness from the health-care system. Communication barriers may significantly decrease effective access to health services and inhibit the degree to which a patient can benefit from such services. Migrants, for example, often face language and other cultural barriers.

Risk factors in the United Republic of Tanzania

The United Republic of Tanzania demonstrates a mixed picture with regard to risk factors. Higher social and economic status is associated with higher body mass index, but lower systolic blood pressure and lower prevalence of tobacco use. This finding supports the idea that as countries develop economically, different risk factors affect different social and economic classes at different rates.