Researchers find definite link between preventable deaths and social inequality in Seychelles

A typical day at the Victoria market, with people shopping for fresh fish, vegetables and fruits. A new study carried out has found that people with lower incomes and positions in society in the small island nation of 90,000 people are at a much higher risk for preventable deaths from diseases. (Gerard Larose, STB)

(Seychelles News Agency) - Researchers conducting a 15-year-long population-based study have discovered a definite link between mortality in Seychelles and socio-economic status. Their findings show that people with lower incomes and positions in society in the small island nation of 90,000 people are at a much higher risk for preventable deaths from diseases such as cardio-vascular disease (CVD).

In high income countries, the link between low socio-economic status (SES) and most causes of death are well-established, but studies conducted in low and middle-income countries (LMIC), particularly in Africa are sparse, due to unreliable mortality data, and the few that have been conducted often paint an uncertain picture with large differences in conclusions.

The researchers, from the Institute of Social and Preventive Medicine, Lausanne University Hospital in Switzerland together with three officials from the Ministry of Health in Seychelles, sought to examine differences in mortality rates among various SES groups in the small island state off the eastern coast of Africa. According to them, Seychelles’ small population and status as a higher middle income country made it a good place for the population-based surveys to be conducted effectively.

Mortality has ‘little to do with healthcare’

As Seychellois citizens enjoy free universal healthcare, many might wonder why lower socio-economic status increases the risk of mortality, but it appears that the provision of healthcare has very little to do with the root causes of all types of preventable diseases.

In an email interview with one of the researchers, Dr Jude Gedeon, who is the Public Health Commissioner at the Ministry of Health in Seychelles, believes that differing lifestyles between wealthy and poor often play a key role in developing risk factors that could lead to death, such as obesity, hypertension and heavy drinking and smoking, with wealthier people often tending to lead much healthier lifestyles.

Gedeon notes that even in the most equalitarian healthcare systems in the world, such as those in Scandinavia, inequalities in health there are even more pronounced than in Seychelles.

“The contribution of health care to SES-related disease and mortality is usually low in all countries, including in middle income countries such as Seychelles,” he explained. “Although the existence of universal health system certainly contributes to attenuate SES differences in mortality, impact of health care is limited because it intervenes at a late stage, that is, when a disease is already developed.”

The public health commissioner believes that the main reason for socio-economic status-related inequalities in health stem from the existence of social inequalities in the distribution of resources, such as education, income, coping capacities and stress.

Many of these differences in health, he says, are also related to socio-economic differences in the prevalence of major risk factors such as smoking, alcohol, unhealthy diet and obesity, upon which the health care system has little influence.

Effective prevention starts with policy

Gedeon said that effective reduction in the mortality rate for lower SES groups would lie with structural measures ranging from higher taxes on tobacco, government subsidies on fresh healthy foods such as fruit and vegetables, stricter regulations for food composition (e.g. the elimination of trans fats in foods).

He added that some measures, such as taxes on tobacco and alcohol were already in place in Seychelles, and said that the impact of health education was often very limited, as people with lower socio-economic status often tend to ignore health education due to a lack of personal and financial resources.

“Structural measures are the cornerstone, including high taxes on tobacco, alcohol and possibly sugar and fatty foods,” he said. “This is already largely implemented in Seychelles but there is room for strengthening. Of note, these measures lay largely outside of the health care sector: that is, they involve other sectors: finance, agriculture, transports, etc.

“Measures should also be taken to encourage physical activity, such as sidewalks on streets, bus lanes, bike lanes, mandatory 2-3 hours of physical activity per week in schools, etc.”

At the health care level, Gedeon believes a few more important measures should be implemented which would make a measurable impact on social health patterns, in addition to the free health care and medication that is already being provided by the government.

In most countries, preventative measures such as screening for cancers, CVD and other treatable diseases are met with cultural barriers, and Gedeon says Seychelles is no exception to this trend. Low SES groups tend not to participate in these preventative drives and strict adherence to medication instructions from doctors is also a challenge among the low SES groups.

“These barriers cannot be easily overcome at the health are level because they are deeply ingrained at the individual level and difficult to change,” added the public health commissioner.

Smoking, alcohol consumption figures down

According to recent research addressing the trends of risk factors that contribute to cardiovascular disease in Seychelles, smoking and drinking have both decreased, although differences in SES groups have become more pronounced, as they have in most countries around the world.

Among men, smoking and heavy drinking are now more prevalent in the low SES group, although obesity is less prevalent. Interestingly, during the study period, diabetes among men went from being more prevalent in the high SES group to being more prevalent in the low SES group.

Among women, the SES gradient in smoking reversed over time from higher prevalence in the high SES group to higher prevalence in the low SES group. Obesity and diabetes among women were more common in the low versus the high SES group throughout the study period. Heavy drinking, hypertension and hypercholesterolemia did not appear to be socially patterned among women.

“Our data also shows a marked decrease in overall alcohol consumption, particularly because of the very large decrease in homebrews over time, but high consumption of alcohol still tends to concentrate among low SES persons,” said Gedeon.

“On the negative side, obesity is markedly increasing in Seychelles, and diabetes that comes with obesity, as in other countries worldwide,” he added. “Obesity is, interestingly, more frequent among low SES women than high SES women, but more frequent among high SES men than low SES men.”

But according to the doctor, the news is not all negative – he says it is important to bear in mind that overall levels of health in Seychelles, is improving across the board, even though it may seem that the higher socio-economic status groups are improving faster.

“The improvement in health is particularly large in Seychelles with a decrease of approximately 50 percent in the age-adjusted mortality over the past 25 years,” said Gedeon. “Although this decrease was not examined according to SES group in this [research] article, such a large decrease in mortality must have occurred in the entire population, including low SES persons.”