Promoting positive social change in your community and the world
Share some of your ideas on how you can use the knowledge and insights gained in this course to
promote positive social change in your community and the world.
Final Project (7�10 pages), not including the cover and the references:
In developing a policy in the country you selected, consider the following:
� Explain the rationale for selecting the country (any African country).
� Describe the social determinants of health in the country that you would need to address. Explain why
you need to address these determinants.
� Explain the possible public issues you might encounter in health literacy and cultural awareness in this
country.
� Describe the relationship between health inequality/inequities and life expectancy for the population in
your selected country.
� Describe two current efforts in this country (you selected) to reduce health inequities.
� Explain how you might develop a health policy so that it gets the support of the country you selected.
Note: Take into account the culture of the country.
Use APA formatting for your Final Project and to cite your resources. Expand on your insights utilizing the
Learning Resources.
2
PROMOTING POSITIVE SOCIAL CHANGE IN THE WORLD
Promoting positive social change in your community and the world
Reducing health inequities has the potential to bring about substantial gains in terms of
improving health outcomes and increasing life expectancy of disadvantaged groups. This paper
looks into the social determinants of health for Botswana, a landlocked African nation located in
the southern part of the continent. The possible public issues that I may encounter in health
literacy and cultural awareness of Botswana are described exhaustively. The current efforts in
Botswana to reduce health inequities are described, and an explanation is provided on how I
might develop a health policy so that it gets the support for Botswana.
The choice of Botswana
Botswana was selected owing to the effort made by the government of Botswana to
improve the health status of its people. Moreover, Botswana was selected because of the high
prevalence of diseases particularly tuberculosis and HIV/AIDS in this country. It is of note that
this southern African nation has been severely hit by the HIV/AIDS epidemic with 25% of the
adult population – persons aged 15 years to 49 years – are infected and more than 90,000
children have lost either the mother or father (Clause et al., 2009). Owing to HIV/AIDS, life
expectancy in Botswana dropped from 67 years in the year 1990 to 52 years in the year 2000.
3
PROMOTING POSITIVE SOCIAL CHANGE IN THE WORLD
However, because of free universal antiretroviral treatment provided by the government since
2002, the life expectancy increased slightly to 54 years today (World Health Organization,
2013). The most prevalent diseases are respiratory such as tuberculosis and pneumonia, and
intestinal such as digestive and diarrheal illnesses (Clause et al., 2009).
The Botswana government understands that people’s social development is integral to
improving their health status. The government considers education as a foundation for life, thus
is one of the main areas which has been targeted for reducing health inequities. This is true
considering that the Ministry of Education has the biggest share of government financing.
Additionally, 5 percent of health funding actually goes to education (Pleasant, 2013). Not-
withstanding Botswana’s status as a middle-income nation, there are poor sections of society in
which ⅓ of children have stunted growth and 1 out of 10 are underweight. In contrast, with the
growing prosperity of lots of families, one out of 10 children is actually underweight (World
Health Organization, 2013).
Social determinants of health in Botswana
The conditions wherein people are born, live, grow, age and work, as well as the health
system greatly determine the level of health that the people get to enjoy (CDC, 2014). These
conditions are understood as the social determinants of health and include housing,
socioeconomic status, access to services, transportation, environmental or social stressors,
discrimination by social group such as class, or gender. Others are education, culture, healthy
child development, social support networks, as well as personal health practices and coping skills
(CDC, 2014). It is of note that these social determinants are actually shaped by the distribution of
4
PROMOTING POSITIVE SOCIAL CHANGE IN THE WORLD
power, resources, as well as wealth at local district and national levels. In turn, these are
influenced by policy choices in the various sectors that are involved.
In Botswana today, there is a substantial homogeneity among various ethnic groups and
the majority of them are quickly altering their lifestyles. Studies indicate that factors such as
inadequate physical activity, cigarette smoking, substance abuse, unhealthy food habits, and
alcohol abuse are common among adults in Botswana (Eyal et al., 2010). Even though the
Botswana government is committed to alleviating the effects of climate changes, its impact is
already clear. This could actually have a considerable impact on health, for instance, malaria
prevalence is expected to rise as temperatures increase, and conditions are more favorable for
mosquitoes to breed in rainy seasons. Moreover, the prevalence of cholera may rise in rainy
seasons. With a decline in rainfall, production of food is expected to reduce and can result in
malnutrition in the longer-term (Stover et al., 2008). I need to address these social determinants
since they detract from or contribute significantly to the health of communities and health.
Moreover, they influence the health of people in Botswana; hence, it is important to address
them.
Possible public issues I may encounter in health literacy and cultural awareness in
Botswana
Health literacy is understood as the ability of a person to get, process, and comprehend
health information and services required to make suitable health decisions (Phaladze & Tlou,
2006). At present, I may encounter low health literacy in Botswana. Health facilities in Botswana
are learning the significance of health literacy and they are developing health literacy
programmes aimed at addressing the complexities that patients in this country have in getting
5
PROMOTING POSITIVE SOCIAL CHANGE IN THE WORLD
and comprehending health information. In Botswana, health literacy depends on systemic and
individual factors including the following: culture; context or demands of the situation;
professional and lay knowledge of health topics; demands of the public health and health care
systems; and communication skills of professionals and lay people (Pleasant, 2013).
Health literacy is founded on the notion that if individuals are more aware of the science
behind their illness and the way their medicine works, then these people are more able to
comprehend strategies for prevention, how they can decrease their infection risk, how the ARVs
medications work, and the importance of adherence (Stover et al., 2008). The Botswana
government has collaborated with the national nongovernmental organizations, the private sector
and community-based organizations to address the epidemic of HIV/AIDS by increasing health
literacy about this disease. The health literacy program was initially introduced in Botswana in
2007 (Bana, 2011).
Cultural awareness is an integral element of cultural competence. Cultural awareness is
understood as being conscious, observant, and cognizant of differences and similarities between
and amongst cultural groups (Eyal et al., 2010). Cultural sensitivity is of major importance to
developing a policy that can be accepted by the government and people of Botswana. Working in
the cultural context of Botswana could be both challenging and unique, and some experiences
might be more difficult compared to other experiences. For instance, there is stigma associated
with HIV/AIDS since when someone dies of AIDS, many family members do not acknowledge
it and rather claim that the person died of low blood pressure or another condition but not AIDS.
Moreover, many men in Botswana are not receptive to the notion of having protected sex by
using condoms and they claim that: one cannot taste a sweet with its wrapping on (Bana, 2011).
Therefore, it is useful to understand such underlying ideologies to allow me to be culturally
6
PROMOTING POSITIVE SOCIAL CHANGE IN THE WORLD
sensitive in my work. It is important to engage the people of Botswana in discussion on condoms
in order to dispel myths and offer correct information.
Relationship between health inequality/inequities and life expectancy for the population in
Botswana
Inequities in health are unfair and avoidable systematic disparities in accessing and using
health services between various social and economic groups. Ill-health and inequity are
intertwined considering that unequal access to health services by gender, urban/rural location,
and income groups leads to lower health outcomes for deprived groups (Clausen et al., 2009).
Inequitable distribution of healthcare is a key challenge in Botswana given that the population is
unevenly distributed and country is large geographically. Attaining equitable universal health
coverage calls for the delivery of necessary, accessible services for the whole population devoid
of imposing an unaffordable burden on households or individuals.
In Botswana, Bana (2011) stated that socioeconomic status, urban-rural location, and
insurance status are associated with access to health care, with people in the rural regions, the
uninsured, and the poor experiencing greatest barriers to health care. Utilization of higher-level
healthcare organizations in Botswana is greatest amongst the insured, urban and richer people.
There are equality concerns since tertiary hospitals are mainly concentrated in the wealthier,
urban regions of Francistown and Gaborone, and they are better specialized, equipped and
resourced compared with the rural or district facilities (Bana, 2011).
Costs of accessing health care services could be very crippling for low-income and poor
households. In essence, the poorest in Botswana bear disproportionate cost of burden. The
wealthy Botswanians and people living in cities and towns have ready access to high quality care
7
PROMOTING POSITIVE SOCIAL CHANGE IN THE WORLD
whereas those who are poor, in rural areas lack access to quality health care and have limited
access to care services since there are few and far between facilities in Botswana’s rural regions.
Travel distance and costs of transportation are barriers to access to health care, particularly for
rural, poor residents. This means that access barriers pertain to geographic inaccessibility of
health facilities, especially in largely poorly resourced and rural districts (Phaladze & Tlou,
2006).
As a result of the inequities in health care, the life expectancy of people in Botswana at
birth is 54.4 years – 60 years for females, and 48.8 for males. On average, the lifespan of poor
people in the countryside with virtually no access to quality health care is 47.5 years whereas
that of the wealthy Botswanians is 62.5 years (World Health Organization, 2013). The presence
of inequalities because of differences in wealth means the need for a policy that will address the
source of inequities between the poor and the rich.
Efforts in Botswana to reduce health inequities
Botswana strives to address the health inequities evident between and within districts in
the state. The Botswana government has made several efforts aimed at reducing health inequities
in the country and has adopted a multisectoral approach to health development and it
acknowledges the concept of social determinants of health.
I. Healthy places – healthy people
The place wherein citizens live has a considerable effect on their health and their odds of
enjoying flourishing, prosperous lives. Neighborhoods and communities that are socially
cohesive, which ensure access to essential goods, are protective of the natural environment, and
which are designed to foster good psychological and physical well-being are integral for health
8
PROMOTING POSITIVE SOCIAL CHANGE IN THE WORLD
equity (World Health Organization, 2013). The government of Botswana has taken into
consideration several areas in order to make living areas healthy and improve the levels of health
equity. Housing and shelter: the NDP 10 affirms that the dignity of the poor Botswanians would
be reinstated, and the quality of basic shelter would be improved through civil society schemes,
Self Help Housing Agency (SHHA), and the Destitute Shelter Programme (World Health
Organization, 2013). There are several schemes that provide housing to people of Botswana.
However, the SHHA is the main scheme that focuses on the low-income population.
Environment: regarding the disposal of human waste, the Botswana government has established
programmes that relate to latrines. For instance, there is change from using pit latrines to the use
of water-born systems in towns and cities, or encouraging more environmentally friendly –
ventilated improved – pit latrines in the rural regions in order to avoid contamination of
underground water as it has happened in some areas. Disposal of solid waste is increasingly
better managed using landfills (World Health Organization, 2013). Water: this is a key
determinant of health. Provision of water is a key element of rural development in Botswana.
The government supplies portable water to every recognized village and settlement in an effort to
address health inequities.
II. Universal health care, and early childhood development and education
Health care systems are an important determinant of health. The National Development
Plan seeks to ensure that Botswana’s population is within 5 kilometers of a health facility. The
public sector is the key healthcare services provider, and provides roughly 80 percent of all
health services via public healthcare organizations and facilities (World Health Organization,
2013). Health care services in Botswana are offered by a network of clinics in towns and villages
throughout Botswana, and by referral to big state hospitals in Francistown and Gaborone. Basic
9
PROMOTING POSITIVE SOCIAL CHANGE IN THE WORLD
health care in this country is available for a small cost in facilities that are state-run. Educational
accomplishment is associated with improved health outcomes, to a certain extent, through its
effect on adult income, living conditions, and employment. Botswana government’s 10 th National
Development Plan encompasses the period from April 2009 until March of 2016. Chapter 7 of
the NDP 10 – An Educated and Informed Nation – asserts that the objective of this particular
plan is to provide a sufficient supply of competitive, productive, and qualified human resources.
Moreover, it stresses that the sectors which contribute directly to this goal include youth, public
service, education, health, finance and labor (World Health Organization, 2013).
How I might develop a health policy so that it gets support for Botswana
I might develop a health policy so that it gets support of the people of Botswana by
involving every important stakeholder in the development. These stakeholders comprise the
government, nongovernmental organizations, and the citizens of this country. Their input will be
of major importance in developing a health policy that will not only be relevant to Botswanians,
but also one that all Botswanians can be receptive of. I will take into account the culture and
beliefs of the people of Botswana in formulating the health policy so that they can find it
applicable and improve their health outcomes.
Conclusion
In conclusion, the country selected is Botswana, and it was selected owing to the high
prevalence of HIV/AIDS and tuberculosis here. The most prevalent illnesses are respiratory such
as tuberculosis and pneumonia, and intestinal such as digestive and diarrheal illnesses. Social
determinants of health in Botswana include housing, socioeconomic status, access to services,
10
PROMOTING POSITIVE SOCIAL CHANGE IN THE WORLD
transportation, and environmental or social stressors, and I will address them since they influence
the health of people in Botswana. Presently, I may encounter low health literacy in Botswana.
There are health equality concerns as tertiary hospitals are mainly concentrated in the wealthier,
urban regions of Francistown and Gaborone, and they are better specialized, equipped and
resourced compared with the rural or district facilities. The government strives to reduce health
inequities by providing universal health care considering that HIV/AIDS medication are
provided free of charge. It also seeks to provide adequate housing to all Botswanians and high-
quality education. I will develop a health policy so that it gets support from the people of
Botswana by taking into account the culture and beliefs of the people of Botswana, and involving
all key stakeholders.
11
PROMOTING POSITIVE SOCIAL CHANGE IN THE WORLD
References
Bana, R. (2011). The Importance of Cultural Awareness in Global Health – Experiences from
Botswana. UBCMJ, 2(2).
CDC. (2014). Social Determinants of Health Maps.
