Water and its Social Determinants of Health

This essay explores the impact of water as a social determinant of health on the target population of children in Afghanistan. It discusses the lack of access to clean and safe water, its impact on health, and possible interventions to address the issue.

Running head: WATER AND ITS SOCIAL DETERMINANTS OF HEALTH
Water and its social determinants of health
Name of the student:
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WATER AND ITS SOCIAL DETERMINANTS OF HEALTH
Introduction:
The health status of a population depends on a variety of different factors, and each of
these factors has a significant and unique impact on the health status and living conditions of a
community. By definition, health is not just the mere absence of disease, but it can be defined as
the state of absolute physical emotional and mental wellbeing is an individual. Hence, the health
of a particular individual can be recognized as a multifaceted phenomenon that transcends the
idea of mere absence of illness in an individual (Shahraz et al., 2014). Undoubtedly, with so
many factors associated with it, the impact of the different social, economic and physical
environment on health cannot be ignored; and the external and internal factors associated with
the above mentioned aspects of health are known as the determinants of health.
The determinants of health can be defined as the social, physical, and economic
environment where the individuals are born, live, work and age in, and the impact of these
conditions on the access to health care services. Hence, these determinants can be defined as the
socio-economic variables that have the potential to influence the individual and group
differences in health status of a community. Among the various different kinds of socio-
economic determinants of health, water can be considered a significantly important one. Many
under-developed countries have a variety of different communities that have very limited access
to the clean and hygienic water. According to Maguen, Luxton, Skopp and Madden (2012), the
lack of access to clean and hygienic water is the fundamental factor leading to a variety of
different water-borne communicable diseases; and adds to the burden of mortality and shorter
life expectancy in communities. Hence, it can be easily stated that the water is a considerably
important determinant of health and the lack of access to it or the socioeconomic impact on the

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access to clean and hygienic water can be considered as an imperative public health priority for
certain populations. One such population that has been burdened by the diseases and reduced
health status due to the lack of clean water is the population of children in Afghanistan (Elyan,
Monestersky, Wasfy, Noormal & Oyofo, 2014). This assignment will attempt to explore water as
a social determinant of health, its impact on the target population, and the possible intervention
or recommendations to address the issues.
Social determinants of health:
In order to better understand the impact of social determinants of health and its
association with clean and hygienic water for populations, it is important to understand what
social determinants are and how they impact the health status of populations. According to the
definition provided by www.who.int (2018), social determinants of health can be defined as the
conditions in which people are born, live, work, grow and age. On a more elaborative note, the
circumstances that contribute to the social determinants of health in a certain population are
shaped by the unequal distribution of money, power, and global, local, or national level
resources. According to Shahraz et al. (2014), among different types of determinants of health,
the social determinants of health contribute mainly to the inequality in health status across socio-
economic stratifications based on unfair and avoidable disparities in the health status across
different SES statuses.
According to the www.who.int (2018), the economic condition or employment status is
one of the greatest social determinants of health, which has a significant impact on the living
condition and in turn the health status of the key populations. Different type of professional roles
and responsibilities or even the lack of any employment, which leads to a crucial threat to

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financial sustainability and the ability to avail basic necessities of life, can deteriorate the health
conditions of a population significantly. Another very important social determinant of health is
the discrimination in the society leading to social exclusion, based on gender, race,
socioeconomic status, and even cultural background. The public health programs and policies
addressing the different inequities and disparities in health status across populations is another
very important social determinant of health. According to Madani (2014), it is very important for
the health policies and schemes to understand and address the particular health needs of different
underprivileged populations in order to restore equal distribution of health resources in the
society. Lastly, early child development is a new addition to the social determinants of health
and it is intricately linked with the concept we are exploring in this essay. As per Chellaney
(2012), the lack of resource availability necessary for optimal growth and development of the
children can lead to persistent and multifaceted health issues in the children as they grow.
Among these basic necessities, access to nutritional food, clean and hygienic water,
immunization, and hygienic living conditions are the most imperative. Hence, as the target
population selected for the assignment is the children in Afghanistan, the social determinant that
will be discussed in the essay is selected as water, which is a key requirement for sustaining life
and optimal growth and development, especially in the childhood.
Water as a social determinant of health:
According to Ikram et al. (2014), water is a basic commodity which plays a fundamental
role in nurturing and maintaining the health of a particular individual. Now, it has started to
receive adequate attention from the healthcare industry as well. It has been discussed by the
research that water can be considered as a powerful underlying dynamic which can affect a
particular individual at different levels and in various degrees. As the human body is made up of

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WATER AND ITS SOCIAL DETERMINANTS OF HEALTH
two-third of water, the basic functioning of a body system can easily be disrupted and improved
by water. Hence, it can be stated that water is a significant factor in deteriorating the health of an
individual, whether it is by infectious waterborne disease or dehydration due to low consumption
of water. This basic commodity plays a fundamental role as a significant determinant of health
across different populations (Elyan, Monestersky, Wasfy, Noormal & Oyofo, 2014).
Researchers are of the opinion that an environment that has guaranteed access to clean
and hygienic water has been reported to improve the living conditions in the health status of the
people living in the environment on a large scale. Potable water does not just ensure protection
from certain water-borne infections or communicable outbreaks, but can also uplift satisfaction
and preserve the dignity of the residents. Considering the target population, the war conflict in
Afghanistan has resulted in many casualties in the nation and the water crisis that is going on in
the country is one of the most significant consequences of the same. According to the research,
one of the casualties of the war conflict going on in the country for decades is the destruction of
the infrastructure that used to supply the residents of Afghanistan with clean and safe water
(Elyan, Monestersky, Wasfy, Noormal & Oyofo, 2014). Hence, the lack of clean and safe
drinking water has become one of the greatest public health priorities in Afghanistan and the
children in Afghanistan are the most affected population due to this crisis. This crisis has led to
80% of the residents having no access to safe drinking water and 60 among 100 children born in
Afghanistan dying from water-borne infections before the age of 5. Hence, the selected social
determinant of health for the target population of children in Afghanistan is the lack of access to
clean and safe water.

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Impact of social determinant on the target population
The current assignment focuses upon the social determinants of Health and how the
effect upon the target population. For the current assignment, the target population chosen is
children in Afghanistan. Afghanistan was once victimized by the terrorist group of Taliban
which greatly affected the social life of people. The oppression by the terrorist groups affected
the well being and progress of the Afghans as a society. One of the most tormented social
groups in this regard is the women and the children. As mentioned by Overbo et al. (2016), due
to the terrorist activities the women and the children were confined within the four walls of their
homes or would often keep on travelling from one place to the next like a nomad and had no
permanent residence. This often affected their living conditions as they had no access to safe
drinking water and food. Therefore, the inequitable distribution of resources along with lack of
safe drinking water often made the children suffer from health issues such as jaundice and
cholera. As mentioned by Schwendicke, Doost, Hopfenmüller, Meyer, Lueckel and Paris (2015),
such situation would often changed into epidemic where a large segment of the population would
be affected at the same time. Additionally, the situation of political unrest further deteriorated the
medical resources required to treat the population or cope up with the burden of diseases. This in
particular worsened the situation of the children and women recuperating from a disease.
Afghanistan has been home to many world refugees particularly the ones who have been residing
in the war-stricken areas of Pakistan, Bangladesh and China. The lack of concern from the
Government and the rampant terrorist activities such as testing and launching of missiles further
deteriorates the local water bodies. Additionally, the pressure exerted by the refugees over the
limited resources further leads to contamination of the water bodies. The poor living conditions
also mean that people are using the water bodies for performing all sorts of basic living

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activities. For example, washing of clothes, cleaning of dishes, passing faeces, they are all done
close to the water bodies. Moreover, this same source of water is also used for consumption
purposes. The polluted river water also causes a number of health issues within the population
such as gastritis, dysentery, diarrhoea etc.
The problem could be represented with reference to official figures and statistics.
Between 2003 and 2015, Afghanistan experienced a 29% decline in the mortality rates of
children below the age of 5 years (who.int, 2018). The problem lies with respect to the childhood
vaccination rates which are very low for Afghanistan. As mentioned by Lassi et al. (2015), the
equitable access to healthcare resources remains a challenge, as the present delivery models have
high transactional cost.
It had been seen in Afghanistan that more than 257 children per 1000 births would not
survive will the age of 5 years as they would be contracted with health issues mostly diarrhoea,
jaundice, cholera form the consumption of polluted and unclear water (Akseer et al., 2016).
Additionally, the unequal access to vaccination programs further made the problem worse. As
reported, among 60% children below the age of 5 years were acutely malnourished, whereas
50% children aged between 6-24 months were anaemic, while three-fourths of school-aged
children were iodine deficient (who.int, 2018).
In this respect, some of the diseases with their exact figures could be provided over here
such as there were 144605 annual cases of diarrhoea reported from Afghanistan alone. Out of
this 25 % of the diarrhoea was accounted to children alone (who.int, 2018). It pointed towards
the lack of safe drinking water. A camp in Darfur recorded 50% weekly attack rates of diarrhoea
(Bain, Cronk, Wright, Yang, Slaymaker & Bartram, 2014). As reported by Cabada et al. (2016),
2 out of the 3 infant deaths could be attributed to infectious diseases. Hence, there was a lack of

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adequate access to safe drinking water, which enhanced the problem of the community manifold
times. The acts of terrorism along with the pressure of inhibition put by the refugees made the
water bodies insufficient to meet with the large-scale demands. As mentioned by Schwendicke et
al. (2015), the improper use of the scarce water resources further made the problem worse.
Though , there have been a number of initiatives taken on the part of the government which
aimed to supply clean drinking water to the children living in the marginalized areas, the
efforts have not been distributed equally which worsened the problem. Additionally, the health
workers had been sceptical in travelling to the war-stricken areas.
Recommendations:
The lack of clean drinking water has undoubtedly become a significant crisis for the
population of Afghanistan especially for the children who are dying at an alarming rate due to
different water-borne infectious diseases. Along with that, their developmental pattern is also
being affected significantly due to the lack of this basic necessity. Hence, it is very important for
the global and national authorities to address the present water crisis with strategic
recommendations so that the target population can be relieved from the water crisis and can have
the privilege of a commodity as basic for sustaining life as water.
 The first recommendations that can address the present water crisis needs in Afghanistan
is a global initiative taken by World Health Organization and the United Nations to
provide clean and sanitary bottled drinking water to the residents at free of cost. It has to
be mentioned that the climatic changes and the destruction of infrastructure providing
clean and safe water due to the war has made it nearly impossible for the local water
bodies to be immediately used for delivering clean and hygienic water to the residents
(Unicef for every child, 2018). Hence packaged drinking water supplied to the families,

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especially with children under the age of 12 regularly and periodically at free of cost can
be the first initiative towards the people in Afghanistan having the access to the privilege
of clean drinking water without any hassle.
 The second recommendation for improving the water crisis and the associated health
problems in the selected population is the initiation of awareness campaigns (Dehgan,
Palmer-Moloney & Mirzaee, 2014). It has to be mentioned that the level of awareness or
health literacy is more or less negligible in the target population and their families which
have led to extensive unhygienic practices regarding acquiring water from contaminated
water bodies. This has significantly added to the burden of infectious waterborne diseases
in the country, and the children are the most affected by it. Hence it is crucial for the
families and the children to be educated and made aware about the importance of
consuming clean and sanitary water and the health consequences of consuming
contaminated unhygienic water (Chellaney, 2013).
 Another very important recommendation that can improve the water crisis going on in
Afghanistan in a long-term basis is initiative from global not-for-profit organizations
investing in improving the water supply infrastructure in the country (Zolnikov, 2013).
However, it has to be mentioned that it is a long-term goal and will be a time-consuming
procedure. Although, if successful, it can rid the country of the water crisis it is facing.
 The fourth recommendation is advocacy strategy for the needs of the target population
towards the local and global government bodies by different non-for-profit organization
which can facilitate implementing different treaties and policies for both clean water
supply without any cost and infrastructure development for improving water supply
facilities in the country (Habib et al., 2013).

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 Lastly, it is very important for the children to be screened and assessed in a periodic
manner to help recognize and manage infectious waterborne diseases or different health
consequences resulting from consuming water that has been exposed to pollutants and
radiation waste due to the war (Granit et al., 2012). Hence, quarterly medical camps
organized by the national and local authorities and with the help of World Health
Organization can help in preventing and recognizing the health consequences in the
children of Afghanistan due to consuming and hygienic water at an early stage and
reduce the rate of mortality in the target population effectively.
Conclusion
The study over here focuses upon the social determinants of health and the effect of the
same over the children in Afghanistan. It had been mentioned already that Afghanistan is a war-
stricken area and hence it is central to a lot of terrorist activities and terrorist attacks. The testing
of the explosives or the explosives dropped amidst a war situation often pollute the water bodies.
This water, in turn, is consumed by the poor and the marginalized population resulting in stunted
growth and poor health in children. The war conditions have disrupted the social life of
Afghanistan, as they do not have proper access to a lot of healthcare resources. The inequitable
distribution of healthcare resources further results in problems such as inadequate vaccination.
The improper vaccination deteriorates the natural immunity standard within the children.
Additionally, the pressure over the limited and peaceful residential dwelling areas further limits
the access to adequate resources. In most of the cases , it has been seen that the people coming
from refugee areas do not lack proper education upon maintaining effective hygiene standards
which are reflected in the manner in which they handle the limited resources such as littering

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around the water bodies which makes the problem such as maintaining overall well being of
children worse.
In this respect, a number of steps have been undertaken by the World Health
Organization and United Nations. These aim to package drinking water free of cost to children in
the marginalized area. However, the healthcare workers most often do not want to travel or
relocate to the remote areas. Therefore, effective push and involvement from the government is
required along with providing education to the local inhabitants over the just use of drinking
water can reduce the propensity of the problem

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