Understanding poverty-related diseases in Cameroon from a salutogenic perspective

Abstract

Poverty-related diseases (PRDs) assume poverty as a determinant in catching disease and an obstacle for cure and recovery. In Cameroon, over 48 % of the population lives below the poverty line. This dissertation starts from the premise that the relation between poverty and disease is mediated by a person’s capacity to cope with the challenges posed by the natural and social environment. The central problem addressed is that in (inter)national health promotion, disease eradication is overemphasized whereas strengthening the capacity of people to cope with harsh conditions is disregarded. Research efforts show a similar division in emphasis, resulting in a limited understanding of the way people deal with health challenges in conditions of poverty. This dissertation is based on the salutogenic model of health that emphasizes the combined effects of (natural) disease conditions, mental conditions and social factors as determinants of health. This implies an emphasis on health as a positive strategy to deal with stressors and also an emphasis on the agency of people to respond to challenges that hamper their health and wellbeing. The study is carried out among two different groups of people in Cameroon. These are workers including dependants of workers of the Cameroon Development Corporation (CDC) and students from the universities of Buea and Yaoundé. The overall aim of this dissertation is to understand how conditions of poverty impact the health of people and how they manage these challenges. Specifically, the study aims to unravel the interlinkages between poverty and health by creating a deeper understanding of the social and material dynamics which enable people’s capacity to preserve health, anticipate health risks, and mitigate or recover from stressors such as PRDs. The main research question addressed is: What factors underlie the maintenance of good health and overcoming stressors in the face of PRDs in Cameroon?

Different research methods were used to collect data. Interviews were carried out with respondents from both groups addressing PRDs, other stressors and coping strategies. General surveys were carried out to identify perceptions as well as health behaviour patterns across the two groups. Standardised surveys were carried out to measure individual factors such as sense of coherence, resilience, self-efficacy, subjective well-being and self-rated health. Results presented in different empirical chapters of the thesis each respond to a specific research question. In Chapters 2 and 3 are presented surveys with 272 students and 237 camp-dwellers respectively. Perceptions, attributed causes of, and responses towards PRDs are explored as well as motivations for given responses to health challenges. In chapter 4, a qualitative study with 21 camp-dwellers and 21 students is presented in which the dynamics of health-seeking behaviour is highlighted. In this chapter also, factors which are influential in seeking formal healthcare are indicated. Chapter 5 elaborates on what people experience as stressors and the mechanisms they put in place to cope with the stressors. In this chapter, not only is the diversity of stressors outlined for both groups, but also presented are the different identified coping mechanisms put in place by respondents. Chapter 6 which is the last empirical chapter presents coping with PRDs through an analysis of individual, demographic and environmental factors.

Based on the studies carried out, this thesis concludes that the two groups investigated are very aware of what PRDs are and can differentiate them from common diseases. Major PRDs listed by the two groups of respondents were malaria, cholera and diarrhoea. This classification is different from what is considered major PRDs by (inter)national health bodies such as the World Health Organisation and the Ministry of Public Health in Cameroon. Also, organisations such as CDC and Universities, offer limited contributions towards better health for camp-dwellers and students respectively. This is experienced relative to the living conditions, quality of the healthcare system and poor work or study conditions. That notwithstanding, people play an active role in maintaining their health through diverse coping mechanisms. Coping was most strongly related to enabling individual factors such as sense of coherence and subjective health, perceptions of effective strategies to respond to diseases as well as social factors such as the meaningful activities in the social groups to which they belong. The results presented in this thesis are intended to contribute to sustainable and effective response strategies towards PRDs.