What social determinants will cause ethical challenges in geriatric care? Comments from South Africa
Accepted: 10 August 2022
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Background. Social determinants are defined as those nonmedical factors that influence health. Their influence is especially evident in vulnerable communities, such as the geriatric one. However, which social determinants will cause ethical challenges in geriatric healthcare in South Africa are not yet confirmed. Objective. This study first identified which social determinants influence geriatric care. The study then established which of these social determinants raises ethical challenges in geriatric care. Methods. Twenty statements were identified from the literature review and were grouped into 3 indexes, focusing respectively on i) a general view on public health and social determinants; ii) social determinants influencing geriatric people’s health; iii) the consequences of social determinants on geriatric people’s health. The rating was based on presenting the statements employing a 5- point Likert scale. Results. The rating of statements confirmed the generally accepted view that social determinants impact geriatric people’s health. The responses to the statements were an additional confirmation that the quality and access to healthcare services influence geriatric care and lead to ethical challenges. Matters such as corruption, limited resources, and the COVID-19 pandemic contribute to the influence of social determinants and the expected but failed ethical behavior toward the geriatric community. Conclusion. The geriatric community is vulnerable because of the ongoing social factors that have a negative impact on health, of which healthcare quality and provision are significant contributing factors. These factors contribute to ethical challenges in healthcare for the geriatric community.
Chan M. Ten years in public health, 2007–2017: Report by Dr Margaret Chan, Director-General, World Health Organization. Geneva: WHO, 2017. https://creativecommons.org/licenses/by-nc-sa/3.0/igo.
Berridge V. Public health. A very short introduction. Oxford: Oxford University Press, 2016. DOI: https://doi.org/10.1093/actrade/9780199688463.001.0001
Braveman P, Gottlieb, L. The Social Determinants of Health: It’s time to consider the causes of the causes. Public Health Reports. Supplement 2014; 129:19-31. https://doi:10.1177/00333549141291S206. DOI: https://doi.org/10.1177/00333549141291S206
Braveman P, Egerter S, Williams DR. The Social Determinants of Health: Coming of Age. Annu. Rev. Public Health 2011; 32:381–398. https://doi:10.1146/annurev-publhealth-031210-101218. DOI: https://doi.org/10.1146/annurev-publhealth-031210-101218
Wilkinson R, Marmot M. Social determinants of health. (2nd Edition). Geneva: WHO, 2003. https://www.euro.who.int/data/assets/pdf.file/0005/98438/e81384.pdf.
World Health Organization (WHO). World Report on Ageing and Health. Geneva: WHO Press,2015. https://apps.who.int/iris/bitstream/handle/10665/186463/9789240694811.
World Health Organization (WHO). Developing an ethical framework for health ageing: report of a WHO meeting. Tübingen, Germany, 18 March 2017. Geneva: WHO, 2017. https://apps.who.int/iris/handle/10665/259932.
World Health Organization (WHO). Ageism leads to poorer health, social isolation, earlier deaths and cost economies millions. WHO Newsletter. 18 March 2021. https://www.who.int/news/item/18-03-2021-ageism-is-a-global-challenge-un.
Republic of South Africa (RSA). Mid-year Estimates Report. Stats SA, 2020 http://www.statssa.gov.za/?p=13453.
Republic of South Africa (RSA). Press release: Mid-year Estimates Report. Stats SA, 2020. (http://www.statssa.gov.za/?p=13453.
Republic of South Africa (RSA). If South Africa’s provinces were independent states, 2018. http://www.statssa.gov.za/?p=11092.
Marshall MN. Sampling for qualitative research. Family Practice 1996; 13(6): 522-525. DOI: https://doi.org/10.1093/fampra/13.6.522
Palinkas LA, Horwitz SM, Green CA, Wisdom JP, Duan N, Hoagwood, K. Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Administration and Policy in Mental Health 2015 42(5): 533-544. http://DOI:10.1007/s10488-013-0528-y. DOI: https://doi.org/10.1007/s10488-013-0528-y
Moore E. Old age grants hold together many a household. Daily Maverick, 15 April 2020. https://www.dailymaverick.co.za/article/2020-04-15-old-age-grants-hold-together-many-a-household/.
Republic of South Africa (RSA). Strategic Plan 2020-2025. Department of Health, 2020. htpp://www.depthealthstrategicplanfinal2020-21to2024-25.
South African Lancet National Commission Report. Confronting the right to ethical and accountable quality healthcare in South Africa. Pretoria: National Department of Health, 2018. http://rhap.org.za/wp-content/uploads/2019/01/SA-Lancet-Report-Synopsis-South-Africa_Confronting-the-Right-to-Ethical-Accountable-Healthcare.
Kececi A, Serap, B. Health Education for the elderly, 2012: e1-26. Retrieved on January 18, 2021, from DOI 10.5772/33472 DOI: https://doi.org/10.5772/33472
Mallmann D G, Neto N M G, Sousa J, Vasconcelos E M R. Health education as the main alternative to promote the health of the elderly. Ciênc. saúde coletiva, 2015; 20(6). https//scielo.br/scielo.php?script=sci_arttext&pid=S141381232015000601763&lng=en&nrm=iso DOI: https://doi.org/10.1590/1413-81232015206.02382014
Sigasana, L. Opinion: are the elderly in South Africa invisible? Business Report. 1 October 2017. https://www.iol.co.za/business-report/opinion-are-the-elderly-in-south-africa-invisible-11427253.
Zikali Z. No suitable care for SA’s elderly population. Health-e news, 2018. https://www.health-eorg.za.
Weber LJ. Business ethics in healthcare: beyond compliance. Bloomington: Indiana University Press, 2001.
Republic of South Africa (RSA). Constitution of the Republic of South Africa, 1996 Pretoria. (Act No. 108 of 1996.)
Republic of South Africa (RSA). COVID-19 Coronavirus vaccine strategy, 2021. https://www.gov.za/covid-19/vaccine/strategy.
Farham B. Editorial: Vaccine hesitancy? No, government failure. S Afr Med J. Published online 16 August 2021. https://doi.org/10.7196/SAMJ.2021.v111i9.16039. DOI: https://doi.org/10.7196/SAMJ.2021.v111i9.16039
Copyright (c) 2023 the Authors
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.