Political Decisions Based on the Social Determinants of Health (SDOH) Approach

Former Minister of Foreign Affair and Health for the Republic of the Marshall Islands, Tony DeBrum, notes that the military bases located on Ebeye attract desperate job seekers whose only goal is to find a job, no matter what it is, and so long as people who are pulled into a military base cannot be accommodated in a better situation per government policy, the social problems of Ebeye are going to be persistent. More health care providers alone are not going to solve the existing health problems.

What Debrum referred to is that place matters. We may never get caught up with treating people who are already sick, and therefore we have to start paying attention to neighborhoods in need of preventive care. Epidemiologist S. Leonard Syme comments, “if we took everyone at risk of disease and cured them so they were no longer at risk, it would do virtually nothing to solve our problem because new people would continue to enter the at-risk population at an unaffected rate forever.” Place ultimately is one of the critical social determinants of health, and that political decision has to be made to improve Ebeye and its resident’s health.

Tuberculosis (TB) is an infectious disease mostly attacking the lungs and other parts of the body. Mycobacterial causes aside, risk factors for TB as one of the principal diseases of poverty is HIV, overcrowding and malnutrition. High-risk groups are those who inject illicit drugs, inhabitants and employees of locales where vulnerable people gather (e.g., prisons and homeless shelters), medically underprivileged and resource-poor communities, predisposed ethnic minorities, as well as children and health care providers in close contact with high-risk category parents.

A medical approach to onset TB is an antibiotic combo for the length of six months, and different regimens that last for 24 months could be prescribed in recurrent cases. Effective TB treatment is difficult, even more so if medication resistance occurs due to the unusual structure and chemical composition mycobacterial cell wall, which hinders the entry of drugs and makes many antibiotics ineffective. It calls for direct observed therapy where a health care provider closely monitors the patient’s antibiotic intake amount and schedule.

The likelihood of exposure to environmental pollutants takes more than drugs to reduce, so does the eradication of TB. Improving living conditions on Ebeye Island, alleviating crowded living conditions so one infected patient would not infect others, strengthening residents’ immune system so they have the physical strength to fight off the disease, etc. are all possible measures that policy makers and community activists can do. Such environments often have fewer structural opportunities that support healthy behaviors and promote health.

Factors that harm Ebeye, as factors that harm immigrants’ health, are manifold and often interrelated. Ameliorating those requires a comprehensive community and political approach. A simultaneous focus on the social, economic and neighborhood environments, while enhancing the way these environments sustain health with the government being the residents’ support mechanism, will have a long-lasting positive effect on individual health behaviors. This will in turn lead to a reduction of health disparities.

Immigrants across the nation are facing a unique set of factors that unfortunately contribute to fear, anxiety and stress that pose institutional barriers to their health outcomes. As a result, political involvement is highly crucial to assist Ebeye as a place where poverty is so deeply entrenched and where its residents’ health issues are so easily left out of today’s political agenda.

This article was written by Mildred D. Li, a writer for dusk magazine. 

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