An exploration of social determinants of health amongst internally displaced persons in northern Uganda

Abstract

Social determinants of health describe the conditions in which people are born, grow, live, work and age and their influence on health. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels, which are themselves influenced by policy choices. Armed conflict and forced displacement are important influences on the social determinants of health. There is limited evidence on the social determinants of health of internally displaced persons (IDPs) who have been forced from their homes due to armed conflict but remain within the borders of their country. The aim of this study was to explore the social determinants of overall physical and mental health of IDPs, including the response strategies used by IDPs to support their health needs. Northern Uganda was chosen as a case-study, and 21 face-to-face semi-structured interviews with IDPs were conducted in fifteen IDP camps between November and December 2006.The findings indicated a number of key social determinants. Experiencing traumatic events could cause "over thinking" which in turn could lead to "madness" and physical ailments. Respondents also attributed "over thinking" to the spirit (cen) of a killed person returning to disturb its killer. Other social determinants included overcrowding which affected physical health and contributed to an emotional sense of loss of freedom; and poverty and loss of land which affected physical health from lack of food and income, and mental health because of worry and uncertainty. Respondents also commented on how the conflict and displacement and led to changes in social and cultural norms such as increased "adultery", "defilement", and "thieving". Response strategies included a combination of biopsychosocial health services, traditional practices, religion, family and friends, and isolating.This study supports work exploring the political, environmental, economic, and socio-cultural determinants of health of IDPs. Addressing these determinants is essential to fundamentally improving the overall physical and mental health of IDPs.

The role of social support on HIV testing and treatment adherence: A qualitative study of HIV-infected refugees in southwestern Uganda

“…Displaced from their native land, refugees are sometimes described as having fractured social connections, including disrupted social structures, broken social norms, and isolation from traditional communities (Muhwezi et al, 2011; Roberts et al, 2009; UNAIDS & UNHCR 2007). Given this context, it was not clear prior to our study whether the benefits of social support observed in non-refugee populations would also be seen among refugees.…”

“…Refugees displaced by conflict are uniquely vulnerable to economic, medical, and social hardships. Normal social networks are disrupted by war and displacement (Muhwezi et al, 2011; Roberts et al, 2009; UNAIDS & UNHCR 2007; Wood, 2008), and can be re-formed and re-broken as multiple traumas and displacements affect a population. Changes in social structure and support increase vulnerability to mental health problems, sexual violence, and sexual exploitation (Muhwezi et al, 2011; Spiegel, 2004; UNHCR 2013a; UNHCR 1999).…”

Local Actors’ Frames of the Role of Living Conditions in Shaping Hypertension Risk and Disparities in a Colombian Municipality

“…Forced displacement has multiple negative social, economic, and health consequences. [29][30][31][32] Generally speaking, people flee toward areas where they expect better conditions when their integrity is threatened. For many, the displacement is the continuation or even the accentuation of an already poor and vulnerable condition.…”

Is maternal education a social vaccine for childhood malaria infection? A cross-sectional study from war-torn Democratic Republic of Congo

“…Social determinants of health are factors, such as gender, age, living conditions, socioeconomic status, and education, that influence health and risk of disease [2,3]. Unequal access to healthcare, education, sanitation, and adequate shelter all have an impact on the health disparities that impact disadvantaged populations [4].…”