Chagas disease and the health-disease process
The so-called neglected diseases, like Chagas disease, are a clear example of how the health-disease process largely exceeds the strictly biological dimension.
The demonstration of the complex structure that supports the health-disease process has been exposed since the beginnings of public health. While it is difficult to identify the origin of public health, the devastating effects of several epidemics undoubtedly contributed to the understanding of the need for joint action to protect the health of the population. England was the leader in this field; the Black Death in the 14th century and the Great Plague of London in the 17th century were driving factors for the development of public health in that country as well as in the rest of the world. In England, public health became more precisely defined during the 19th century, and it is interesting to analyse the characteristics of the universal healthcare system and the implications of the law passed in 1875, which covered environmental sanitation, protection of the population against unsafe food and infectious diseases, creation of hospitals, among others.
The multiple factors involved in the health-disease process, termed social determinants, have become increasingly relevant over time. The World Health Organization defines social determinants of health (SDH) as the "conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life."1 The burden and the effects of inequity and inequality on health have been brilliantly studied by Professor Sir Michael Gideon Marmot2, professor of Epidemiology and Public Health, University College London, who has led research teams on these topics for the last 30 years.
Based on scientific evidence, Sir Michael G. Marmot has demonstrated that health inequalities require political action in six domains:
- Give every child the best start in life
- Enable all children, young people and adults to maximise their capabilities and have control of their lives
- Create fair employment and good work for all
- Ensure a healthy standard of living for all
- Create and develop healthy and sustainable places and communities
- Strengthen the role and impact of ill health prevention.
The new report published in 2020 resolves a paradox about the fact that, after a century of continuous improvements in life expectancy, since 2011 a decrease in life expectancy has been detected in England, affecting women in the most deprived areas outside London and men in other areas. Although the scope of the report is limited to England, the method can be applied to other countries and regions. The report reveals the different opportunities that individuals have according to their social condition and ethnicity, and their residence “zip code”.
As can be inferred from his works, there are several “extra medical” actions and scopes that have an effect and that need our interventions in order to change the direction of healthcare outcomes.
However, why should we review these concepts? Because it is in this context in which we need to think when we design a program or project oriented to reduce the impact of Chagas disease on people and communities, or when we evaluate its outcomes.
In more than forty years of professional practice, I have seen how a more comprehensive and multidisciplinary approach gradually gains ground and presence in the public healthcare field.
Several years ago, attempts to include elements in programmes or projects to mitigate some of the numerous barriers to healthcare access encountered by the most socioeconomically deprived populations implied having to give several explanations and very often not obtaining the necessary resources to face those challenges.
Today, we no longer need to explain why sometimes we need funds for people transport, or for the incorporation of an accompanying person and treatment supervisors, or for house improvements and safe water supply. We also no longer need to explain why, despite considerable efforts made by the entire project teamwork in the field, sometimes the expected results are not achieved.
The comprehensive view of such a complex reality has always been the hallmark of Mundo Sano Foundation, which is reflected in the thorough analysis of the ongoing projects. Each project has been designed considering the identified needs and weaknesses, i.e., they are “tailor-made” for each territory. Probably, most of the achieved success lies in this comprehensive approach, as well as in the motivation generated by knowing that we have tools to face the permanent challenges posed by Chagas disease.
References
- https://www.paho.org/es/temas/determinantes-sociales-salud
- https://www.instituteofhealthequity.org/resources-reports/fair-society-healthy-lives-the-marmot-review
- https://www.instituteofhealthequity.org/resources-reports/marmot-review-10-years-on