Leadership as a determinant of health: A Reflection

By Mezie Okolo

Health has been defined as a state of “complete physical, mental and social well-being and not merely the absence of disease or infirmity."(WHO, 1948). This definition will be the basis of our discussion.

Health is considered a state of ‘complete...’, that sets the bar high right there. If indeed ‘complete’ is important to that definition, then we must look hard to find persons who are ‘healthy’ in most economic systems, in the right sense of that word. If one interprets that definition as a state of complete physical well-being, complete mental well-being, and complete social well-being...now we begin to see the challenges not only in achieving a state of health but in maintaining it on an ongoing basis, given the present economic realities.

Someone may have complete physical well-being, but incomplete mental well-being and one may have complete physical and mental well-being but incomplete social well-being. Look at it differently, most times the physical and mental well-being are affected and determined by the social environment and social factors within the individual’s ecosystem. So instead of looking at health today through the physical and mental lenses (micro-level), we would look at it from the social (macro-level) perspective, but more definitively, through all of them taken as a composite measure. The social (or sociological) aspect of health appears to be a major determinant of the physical and mental states of health in modern day society, and this is where the effect of leadership on health is most pronounced, because it goes beyond the individual and extends to the community. Public health is about the health of human populations in their communities.

If an individual has physical Ill-health, a doctor or a team of doctors would try to definitively determine, by way of diagnosis, using modern technologies, the causes of the ill-health, the prognosis, and the treatment regimen. This is typical and depending on the diagnosis, the illness could be medically addressed. Maybe the individual recovers in time, disease is cured, and life continues uninterrupted. This is a simplified scenario for health and health care. He is considered healthy because there is now absence of physically noticeable illness. right? Let us say this individual suffered from a highly stigmatized ill-health or has a mental health issue which may have been caused by the disease or by myriads of other determinants of health. Now he is no longer experiencing a state of complete mental well-being, and we see lots of this scenario in society today. Remember, mental health is a person’s condition with regards to his psychological and emotional well-being. These are conditions that affect mood, thinking and behavior. Mental health takes into consideration the emotional and behavioral adjustment of an individual as he goes about his daily activities. If any of these cognitive aspects of human life and living situation is off, mental illness is queried, and then maybe clinically diagnosed.

Some of these are cases like anxiety (worry, ‘idiopathic’ fear), depression (low mood or loss of interest in activities) and bipolar (mood swings from high to low), or a combination of these to mention but a few. We see that to be in a state of complete mental well-being is a big deal, especially at such a time like this when the USA has been jokingly referred to as the United States of Anxiety. Imagine what the situation is in Africa even though strangely, Africans are an incredibly happy people, maybe due to what we already referred to as “leprosy”. An individual who is mentally healthy is adequately able to cope with the demands of daily activities while someone who is mentally unhealthy is unable to do so.

That takes us to the third part of that definition, a state of social well-being. This is broad and more encompassing. It refers to the achievement of balance (equilibrium) of the interplay between the individual’s health (physical and mental) and his physical, social/sociological, economic, ecological, or geographical environment. It means that ill-health is not just about physical and mental impairment but also socioeconomic impairment. This leads us to what has been described as “the social determinants of health”. These are environmental conditions in which people are born, live, learn, work, play, age, worship; and which expose them to health risks, certain quality of life and certain health outcomes. The social determinants of “physical” health are not very different from the social determinants of “mental” health which also include racial discrimination and social exclusion, adverse early life experiences, poor education, unemployment, underemployment and job insecurity, poverty, income inequality, and neighborhood deprivation; poor access to enough healthy food; poor housing quality, and the list goes on. Can you see how any of these can impact your health status and health behavior?

So, leadership affects health directly and indirectly through its effects on the determinants of health. Leadership and leadership policies affect your health behavior too. For example, a leadership policy in place can determine how you seek help and who dies or survives from COVID-19. A directive from the leadership could make all the difference between life and death for you and your loved ones. The way health care is organized, accessed, delivered, paid for, or utilized can make all the difference in the life of a given community, especially those who are disproportionately unable to overcome the barriers. Where you were born, where you live, where you work, even your zip code can be determining factors of the quality and “quantity” of your life. Think about air quality, water quality and environmental pollution from oil spillage and their effects on quality of life, both for man and for livestock. As mild as it is, in Andrews Texas, the water in certain areas is known to discolor the teeth of persons that have lived in that city long enough. Imagine what lead or asbestos does to people in the construction industry. How about ordinary allergic reaction to pollen in certain places of West Texas. Those can alter the quality of your life.

Can you imagine the impact of poverty on health status and access to care among the poor people of the world? In my study of certain African countries (Burkina Faso, Mali, Chad, Ghana, Cote D’Ivoire) using the principal components analysis to categorize study samples into quintiles of wealth, it was consistently shown that the poor suffer more from diseases of poverty and live with unmet health needs. Let us consider the effect of poor education on health or on health care. We need to make a quick clarification here on the differences between health and health care. Health is a state of general well-being (physical, mental, psychological, emotional, socioeconomic) while health care is the maintenance, restoration, and improvement of general well-being through medical and ancillary interventions.

Looking at the inter-connectedness of these things in the communities helps us to see how bad road is connected to health; how poor education is connected to health; how pollution is connected to health; how lack of basic amenities in the neighborhood is connected to health; how job insecurity is connected to health; how unemployment affects your health; how income inequality is related to health; how racial discrimination is related to health and how all the above are related to health behavior. Then do you see how leadership is related to all these factors that determine health? When next you vote, you have to vote for good health by voting only for people who would prioritize education, jobs, social equality, green energy, poverty alleviation, good roads, and social networks, especially among the minority populations.

Mezie Okolo is a Pharmacist, an Epidemiologist, a Public Health Advocate and a Leadership Analyst

@ www.mezieokolo.com

05/26/2020.