‘Social determinants of health’ are the circumstances and surroundings that influence an individual’s health outcomes.
Researchers have focused on social determinants of health for decades and there is now a general consensus that higher socioeconomic status predicts better odds of future health and well-being. While this notion is scientifically accepted, it prompts the question: what creates these social determinants of health? This has brought much needed attention to the ways in which politics affect health – both directly and indirectly.
‘Political determinants of health’ are the factors that shape the social determinants of health. This is a relatively new concept and is of particular significance for women. An example of the link between politics and health can be found in Sudan.
In Sudan, the political climate is shaped by religion and the constitution is based on teachings of Sharia Law. Currently, many communities face extreme financial strain as a result of failed past politics and/or war and insecurity. This has increased pre-existing and vast social inequities, including gaps in financial and educational opportunities.
The political situation in Sudan has had inevitable consequences for health.
Social disadvantage falls heavier on women. Until recently, girls have been denied the same education as their male counterparts. Lack of education leads to limited knowledge of health, which affects an individual’s ability to improve their own health outcomes.
One example is the issue of sexual and reproductive health. Sexuality and sexual behaviour are sensitive topics rarely discussed in conservative, religious cultures like Sudan’s. Sexual and reproductive health and rights do not enjoy a high-priority status among political agendas, either, and there has been very little consideration of introducing sexual education into classrooms. However, many educators and health officials have started to support sex education in schools, resulting in increasing support by legislators.
Another example is the high prevalence of female genital mutilation (FGM) in Sudan, at a prevalence of approximately 89% countrywide. The harmful practice continues to affect many areas of the country, and although it is legally banned, it is well-known to continue with the open support of many religious leaders. This is a clear example of failed implementation of legislation that has allowed FGM to remain prevalent despite wide-spread efforts by campaigns and NGO peer-education programs.
Under Sudanese constitution, child marriage, forced marriage or marital rape are not against the law.
Much of the country’s legislation does not provide any protection for women’s rights. As a result, many Sudanese women fear persecution.
One case that struck the international community was that of Noura Hussein in 2018. The 19-year-old was sentenced to death for fatally stabbing her husband – who she had allegedly been forced to marry – after he attempted to rape her. In the eyes of the law, marital rape does not exist, and so Hussein had no claims to self-defence as she was viewed as a belonging of her husband. The ruling was thankfully overturned after increasing international pressure on the Sudanese government. Hussein received a reduced sentence of 5 years in prison.
Historically, women in Sudan have been forced to be subordinate to men. Although this is changing and vast improvements have been made, drastic changes to the country’s politics and constitution are needed to ensure full protection of women’s rights – especially their rights to health and wellbeing.