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October 24, 2018

Understand your village's role in your health

A maasai Moran and a friend
A maasai Moran and a friend

There are two things that everyone is sure of. The first is that they belong to a community and secondly that the community is very important.

But if you ask the typical Kenyan which community she belongs to, hesitation is the likely result until you first clarify the question by declaring what your agenda is. The constitution of Kenya mentions ‘community’ nine times chiefly in relation to land and specifically in trying to deal with marginalised groups.

So it talks about community land as land that is held by communities identified on the basis of ethnicity, culture or similar community of interest. Ethnicity is your DNA, and can be difficult to alter. White Englishmen, who colonised what is now Kenya, share one-third of their DNA with white Germans, a result of the Anglo-Saxon invasion of the British Isles 1,500 years ago.

So they may speak different languages, play in different football leagues but they really are much the same. You might wonder if the same DNA analysis was done in Kenya, how many tribes really are distinctly different.

The constitution gives a further definition of community based on occupation. Community land can also be defined as ancestral lands and lands traditionally occupied by hunter-gatherer communities.

Everyone has ancestors and by and large everyone buries their ancestors somewhere. In this case if you continue to be a hunter-gatherer in an area where your ancestors are buried, then the land you are hunting and gathering is defined as community land. Different from a hunter-gatherer community is ‘marginalized community’, which is defined as either having a relatively small population, has been geographically isolated, or is a traditional society that wishes to remain outside or has been unable to fully participate in the integrated social and economic life of Kenya as a whole.

That assumes that Kenya has an integrated social and economic life. So you can be marginalised because you want to or because you are too far away from Nairobi or you just have not had enough children over time.

Much of the time spent crafting these definitions are about political power distribution, which no surprise are meant to lead to individual accumulation of wealth rather than community because at the end of the day benefits of society accrue primarily to individuals through communities.

Within public health there exists the discipline of community health, which is the field of study concerned with the study and improvement of the health of biological communities. For practical purposes ‘community’ is often defined as a geographical area, where people share resources rather than as people with shared characteristics.

This simple definition works especially in rural areas where a geographical area is likely to populated by ethnically related persons. But when it comes to urban areas, and where urban areas are growing twice as fast as the general population, the definition begins to breakdown. Many people maintain rural links despite living all their lives in the city. They may know a few of their neighbours, but not feel a strong sense of affinity with them.

Yet among the major determinants of disease, the social and economic environment; the physical environment; and the person’s individual characteristics and behaviours all play a role.

Among these determinants the environment plays a much bigger role in determining how healthy you are compared to your ethnicity.

Further do not imagine that good healthcare is the solution to improving health. In 1963, Kenya’s life expectancy was 48 years compared to 61 years in 2012, an improvement of 13 years. The comparative figure for Cuba was 66 years and 79 years, while for the United Kingdom it was 71 years and 82 years, an improvement of 13 years and 11 years respectively. Not only are we still behind what other countries were 50 years ago, but we are not really catching up. Part of the problem can be seen in where we invest our money. Only about 17.5 per cent of the increase in life expectancy can be attributed to improvement in disease care, such as cancer, malaria treatment and so on. Over 80 per cent is due to improved public health prevention such as immunization.

Doing so effectively requires the collective efforts of communities to organize themselves and have a sense of purpose. Providing clean water, sanitation, immunising children is done through communities but it is the individual who receives the benefit. Our constitution and the way we interpret it, while seeming to protect the rights of some also goes someway to entrench ill health in the wider society by not promoting environments, where people are free to make choices and support one another to develop to their fullest potential.

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