As doc­tor I see about a pa­tient’s in­di­vid­ual health at every con­sul­ta­tion. But, in the grand scheme of things, it is re­al­ly the col­lec­tive pop­u­la­tion’s health that is a true mea­sure of our na­tion’s progress when we speak in terms of achiev­ing mil­len­ni­um goals and sus­tain­able de­vel­op­ment. As we con­tin­ue to in­crease in­vest­ment in health­care, the in­ci­dence and preva­lence of chron­ic dis­ease and their com­pli­ca­tions con­tin­ue to rise to alarm­ing pro­por­tions. One may say that, the flaw is in the health­care sys­tem it­self, which re­sults in no re­turns in this sub­stan­tial in­vest­ment of our bud­get. How­ev­er, if we look at de­vel­oped coun­tries like the USA and in Eu­rope, the same sce­nario oc­curs. There­fore, fo­cus­ing on health­care alone, and one that is on­ly cen­tered on the in­di­vid­ual con­sul­ta­tion, means that we are def­i­nite­ly miss­ing the boat where pop­u­la­tion health is con­cerned. Apart from health­care and its fund­ing, there are oth­er vari­ables that im­pinge on in­di­vid­ual health, which in turn af­fects pop­u­la­tion health that may not be ob­vi­ous to us and, more im­por­tant­ly, our pol­i­cy mak­ers.

Based on sol­id re­search spear­head­ed by Sir Michael Mamoth, Pro­fes­sor of Epidi­mol­o­gy and Pub­lic Health at Uni­ver­si­ty Col­lege Lon­don, UK, we have now re­al­ized that our health is in­ti­mate­ly linked to the so­cial and eco­nom­ic con­di­tions in which we live. These con­di­tions are shaped by po­lit­i­cal, so­cial, eco­nom­ic, en­vi­ron­men­tal and cul­tur­al forces, and can cre­ate or de­stroy our per­son­al health and well-be­ing. Peo­ple fur­ther down the so­cial lad­der usu­al­ly run at least twice the risk of se­ri­ous ill­ness and pre­ma­ture death, com­pared to those at the top. So­cioe­co­nom­ic prob­lems are now viewed as health prob­lems that must be ad­dressed to en­sure every­one has the best chance at a healthy life. These con­di­tions are termed the So­cial De­ter­mi­nants of Health (SDH) and in­clude:

The So­cial Gra­di­ent (where we find our­selves on the so­cial lad­der)

Un­em­ploy­ment and a lack of job se­cu­ri­ty

The type of trans­port avail­able to us

Ear­ly life ex­pe­ri­ence which start be­fore we are born in the form of sup­port re­ceived by our par­ents.

So­cial ex­clu­sion, pover­ty, dis­crim­i­na­tion and prej­u­dice

The amount of con­trol we have at work

Ad­dic­tion to al­co­hol, drugs and to­bac­co

Stress, both at work and every­day life

The type and qual­i­ty of food to which we have ac­cess

Our net­work of so­cial sup­port, at home and in the com­mu­ni­ty'

This means that just in­vest­ing in health­care will not solve our health prob­lems, as the SDH show that a vast ma­jor­i­ty of fac­tors with­in the non-health sec­tors af­fect our health. Due to our un­der­stand­ing of the SDH we can now see that think­ing that our health prob­lems are due to a lack of health care is a bit like say­ing that your bro­ken win­dow is due to the lack of some­one to come and re­pair the win­dow. We do need health­care when peo­ple get dam­aged, but it is not lack of health­care in the first place that leads to peo­ple get­ting ill. Re­search in­to the SDH has re­vealed that there are in­equities in the con­di­tions of dai­ly life that give rise to un­avoid­able in­equal­i­ties in health. Ac­cord­ing to Prof. Sir Michael Mar­mot, "The un­equal dis­tri­b­u­tion of health dam­ag­ing ex­pe­ri­ences is not any sense a 'nat­ur­al' phe­nom­e­non, but is the re­sult of a tox­ic com­bi­na­tion of poor so­cial poli­cies and pro­grammes, un­fair eco­nom­ic agree­ments and bad gov­er­nance". By us­ing the term in­equities one gets the sense that it is gross­ly un­fair that we could make a huge dif­fer­ence in health through pol­i­cy change at an ad­min­is­tra­tive lev­el and we do not. Gov­ern­ment pol­i­cy on health need to fo­cus on these in­equities and so­cial jus­tice in its pol­i­cy, if it is to ever make any no­tice­able im­pact on the health of the na­tion.

We must al­so re­mem­ber that our sys­tem of gov­er­nance is al­so a ma­jor fac­tor in de­ter­min­ing pop­u­la­tion health. In a democ­ra­cy, the rul­ing par­ty main fo­cus is on re­elec­tion. This means spend­ing to­day and wor­ry­ing about debt to­mor­row. This re­sults in in­vest­ment in short-term health­care plans like; build­ing new hos­pi­tals or ter­tiary care fa­cil­i­ties that are tan­gi­ble to an elec­torate that is obliv­i­ous to the larg­er sub­merged part of the ice­berg called pop­u­la­tion health. It is no won­der then, that no mat­ter how many new hos­pi­tals we build there will nev­er be enough bed space and pa­tient wait­ing time con­tin­ue to be­come longer.

Clear­ly, when it comes to pop­u­la­tion health in T&T, an in­di­ca­tor of Gross Do­mes­tic Prod­uct, we have been fail­ing in our ap­proach and con­tin­ue to the same thing ex­pect­ing a dif­fer­ent re­sult. If we are to make any dent in pop­u­la­tion health we can­not con­tin­ue to be guid­ed by neg­a­tive fo­cus­ing events and align our po­lit­i­cal pri­or­i­ties to the SDH.