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Since 1950, 7th April has come to commemorate World Health Day. Each year the day is themed, presenting the World Health Organisation (WHO) with an opportunity in which to spread global health awareness. This year’s theme, “building a fairer, healthier world for everyone”, places focus on the health inequities that result from the social stratification of people, encouraging us to take a closer look at the health disparities that exist between and within countries.
As we continue to grapple with COVID-19 globally, we have come to realise that the virus has been anything but proportionate, in more ways than one. Firstly, as is the case with all illnesses, conditions and diseases, researchers have pointed towards the influence that socio-economic factors have on health outcomes. This means that our experiences of the virus, within society, are not identical. Secondly, inconsistencies in rates of infection and virus-related deaths from one country to another are striking. While the virus continues to devastate certain parts of the world, there are many counties that, for all intents and purposes, remain unscathed. This certainly appears to be the case for Timor-Leste which has, to date, seen no COVID-19 related deaths. This contrasts sharply with the number of deaths suffered in the U.K. which, as of 2nd April 2021, had a COVID-19 death rate of 188.7, having lost over 120,000 lives to the virus. The virus appears to have had minimal impact in Timor-Leste, however, that is not to say that the country is free from the health concerns and health inequities that affect marginalised groups the world over. Like all countries, health inequities exist in Timor-Leste, derived from societal and economic imbalances that can only, fully, be understood within the context of the country.
Nestled away from mainland South-East Asia, Timor is set amongst a cluster of islands administered by Indonesia. Political borders divide the island; the western portion forms part of the East Nusa Tenggara province of Indonesia, while the eastern part constitutes the obscure country of Timor-Leste. After gaining independence from Portugal in 1975, the country enjoyed freedom for all of 9 days, before it was invaded by neighbouring Indonesia. Upon securing independence from Indonesia in 2002, the country emerged wounded from the decades-long civil war which had, by then, plunged the country and the overall health of its population into a deep pit of despair. As the nation arose from independence in 2002, life expectancy was dismal, hovering around 57 years, compared to a world average of 68 years at the time.
At the turn of the twenty-first century, one of the biggest threats to the island nation’s health security was malnutrition. This was particularly endemic amongst children and led to high levels of stunting. In response to the health concerns facing the country, the Timorese government set out its commitment to health equity, stressing the need for a health system that addressed issues relating to women, children and other vulnerable groups.
By 2009, it seemed as though the government had, in some respects, failed to live up to its promises as malnutrition and stunting still hadn’t budged from the list of national health concerns. From the outside looking in, it appeared as though little headway had been made as stunting continued to affect an exceptionally high proportion of Timorese children, especially when comparing the country to its international counterparts. Behind the scenes, however, the government embarked on a mission to collect, interpret and analyse data relating to the country’s social determinants of health. For example, upon closer inspection of health concerns like child stunting, links were drawn between levels of educational attainment and rates of child malnutrition; 63 percent of children born to mothers who had not been formally educated were stunted, compared to 53 percent of children whose mothers had, at least, achieved a secondary education.
Given that slightly over 50 percent of Timorese children under the age of 5 showed signs of stunting in Timor-Leste as recently as 2020, a data-driven approach could be forgiven for surmising that attempts to reduce rates of malnutrition and stunting in the country have been trivial. Whereas, an analytical approach would consider not only figures, but the Timorese government’s methods too.
There is no doubt that Timor-Leste, through its demographic and health survey, has gone to great lengths to identify and understand the social and economic factors underpinning the country’s most pressing health concerns. Establishing causal relationships between socio-economic factors and health concerns are key to understanding the determinants of health outcomes. Correlations of this nature allow for targeted, tailored and specific approaches that consider the cultural intricacies of a country. Therefore, as long as the government continues in its efforts to comprehend the most significant determinants of health within the country, there is every eventuality that health inequities can, one day, be eradicated in Timor-Leste.
By Adjoa Osafo-Binfoh
Adjoa is a graduate and postgraduate of Law and International Relations, respectively. She has previously engaged in human rights and international development placements in Ghana, Ethiopia and the U.K.
Although all blog posts are reviewed by an editorial team, our blog authors all write in a personal capacity and the views expressed are not necessarily those of HART.