Women’s health and well-being are influenced by a multitude of factors, ranging from access to healthcare to social, economic, and political determinants. The most pressing issue is often access to healthcare: is it safe and timely for all women? Equally important is the acceptability of these services — how women are treated within the healthcare sector, the respect and information they receive, and the education provided about common diseases and screenings.

Health-e News’ Ina Skosana spoke with Professor Salome Maswime, Head of the Global Surgery Division at the University of Cape Town, an obstetrician and gynaecologist, and advocate for women’s health rights, about how politics impact on women’s health and overall well-being. 

What are the major issues affecting women’s health and well-being?  

The most obvious issue that affects women’s health and well-being is access to healthcare. Is safe and timely access to health services available to all? 

Another factor that affects women’s health and well being is the acceptability of such services. This looks at how we treat women in the healthcare sector: are we as healthcare workers respectful, approachable, informative, do we educate them about common diseases and screening? 

The acceptability of the services that we provide depends largely on how we interact and engage with women, and the information that we give so that women are able to seek these services out timeously.  

Unfortunately we see a lot of delayed access to health services in South Africa.

These are women, for example, who may choose not to start antenatal care timeously, or women not screening for cervical cancer or breast cancer and presenting late. The ripple effect is that you end up with high mortality rates in this country from diseases that are preventable because of delays in accessing care.

What drives these delays in accessing care?

It has a lot  to do with how people view their healthcare system.
The high mortality rates for diseases that are preventable are a reflection of how accessible healthcare really is. It raises questions around how we’ve integrated healthcare into people’s normal and daily lives. 

For example, do women know that at the earliest that they fall pregnant or suspect that they’re pregnant, they need to start seeking antenatal care services.

Do women know at what age they need to go for their pap smears, or breast screening? Are we living in communities where these things are being discussed and women know where to go when they’ve got health concerns?

Do women trust the health system and that they will find the full range of quality health services wherever and whenever they need it.

These factors are known as social and economic determinants of health. 

What are the social and economic determinants of health? 

The socioeconomic determinants of health are factors that influence how people interact with the health system or access health services. These include issues like the education levels in particular communities. Research shows that people with a higher level of education live longer and are generally healthier than those with lower education levels. Employment is also a key determinant of health. The relationship between poverty and poor health is well-established.

All these factors are directly related to whether people are going to ultimately be able to seek and access healthcare.

If the country as a whole is not looking at addressing issues around employment, education, poverty and the wide inequality gap, then these will have a domino effect on the healthcare that people are able to access. More and more we are accepting and recognising that access to healthcare is dependent on socioeconomic factors and not just the availability of health services.

What are the political determinants of health? 

Political determinants of health refer to the health system. The state of the health system is determined by the resources, the infrastructure, and the investment in healthcare services that governments make. 

Political determinants also refer to the policies that are put in place that are either going to enable better healthcare or become a barrier. A simple example would be, at what age do we start screening women for cervical cancer? That’s a political decision. It’s not a clinical decision and in each country it is different, because such decisions are determined by the priorities set by each country, and the value that is placed on a woman and their health in their country.

So in countries where the health policies don’t favour women, you will find that women are not able to access healthcare, or are not able to access the highest quality of healthcare attainable because there are political barriers that stop them from receiving the healthcare that they should.

In South Africa, the national government is responsible for policy. Provinces are responsible for the healthcare services, and the local governments are often responsible for primary healthcare.

If you don’t have a functioning primary healthcare system then people, ultimately, are not able to access all of the care they’re supposed to get.

If clinics are not accessible, functional or efficient, then there will be a disconnect even between what is expected at policy level and what is available at primary healthcare level.

If you don’t invest in specialised and tertiary healthcare, the health system will have a high number of preventable deaths. An example would be a woman who has caesarean section complications, who needs to be admitted to an intensive care unit.

How does political leadership influence socioeconomic these drivers?

We know that health is dependent on so many other things. 

And so when you think about healthcare, you want to know that you are voting for a political party that understands primarily what the healthcare challenges are. A party that’s got a vision to improve access to healthcare. At the same time the party can’t be looking at  healthcare in isolation because of all the many other things that affect health.

And so the policies around education and other things should also speak to healthcare ultimately. And so you want to see that they are able to make those linkages and are not simply making promises.

Having a healthier society is also addressing other issues that lead to inequality that are ultimately going to improve or affect access to healthcare. – Health-e News