Analytical summary - Social determinants
The social and economic environment is a major determinant of health. It includes factors such as the demographic situation and trends, income and socio-economic status, education and literacy, employment and working conditions.
Demographic situation and trends
The population of Zambia has rapidly grown from about 3 million people in 1964, to 13.2 Million in 2010 . The average life expectancy at birth has also increased from 40.5 years in 1998 to 51.3 years in 2010. This rapid population growth, places an increasing burden on the national economy, particularly the country’s capacity to keep pace with the health needs of a rapidly increasing population and its dynamics.
Education and Literacy
Education is the gateway to better employment and improved household income, while literacy is an important tool for accessing health information and education. Zambia has recorded major improvements in education and literacy.
According to the Economic Report for 2009, net enrolment of children in primary education (Grade 1 – 7) and completion rates have increased from 80% and 64% in 1990 to 101.4% and 93% in 2009, respectively. However, the completion rate for girls at secondary school level remained low, at 17.4% in 2009. It is estimated that 64% of women and 82% of men are literate, with urban areas having higher literacy levels than rural areas. Literacy rates among men are fairly high across all provinces, ranging from 71% in Eastern to 90% in Copperbelt province.
Social and cultural environments: Zambia is among the most politically stable countries in Africa, and has continued to experience uninterrupted peace since its independence in 1964. The country has a multi-cultural society, characterized by different racial and ethnic groups, religious and traditional groupings, urbanization, and increasing access to the internet and other sources of information, with significant potential for promoting good health. However, there are some social, cultural and religious beliefs and practices that negatively affect health. These include cultural practices, such as sexual cleansing of surviving spouses, unsafe traditional male circumcision procedures, early marriages for the girl child, gender discrimination in favour of males, and risky traditional health practices.
The family and community: The families and communities have an important role in shaping the character and behaviours of the people. Peer pressure also has potential to mislead people, particularly the adolescents, into practices that are risky to health, such as alcohol and substance abuse, smoking, sexual abuse, and violence. These could lead to severe consequences on health, including the risks of contracting HIV and other Sexually Transmitted Infections (STIs), trauma, teenage pregnancies and mental illnesses.
Income and socio-economic Status: The country is experiencing high levels of unemployment and weak socio-economic status of the population, which have implications on the health status of the population. Income inequity among the population has remained high, with the Gini Coefficient at 0.57 in 2004 (a drop from 0.66 in 1998). High poverty levels (67% in 2006) and poor access to safe water and sanitation also remain serious factors on health.
In 2009, Zambia ranked at 163 out of 182 countries on the 2009 United Nations Human Development Index (HDI). The standard of living is low while per capita annual incomes are currently much below their levels at independence in 1964, and that of the African average. Figure xxx presents the trends in GDP Per Capita for Zambia, from 1962 to 2006.
Economic Status: Zambia has, however, realized strong economic performance in recent years. Over the past 5 years, average Real Gross Domestic Product (GDP) growth has been above 5%, and reached 6.3% in 2009. This economic growth has been led by increased mining output, thanks to the large investment in the mining sector, construction, agriculture and a growing tourism sector. Inflation has declined to single digits since 2009 and has continued to drop in 2010. The external position has strengthened, as the recovery of copper prices and a weak Kwacha have helped to reduce the current account deficit.
However, these achievements have not yet significantly impacted on the socio-economic status of the majority of the population, most of whom have continued to face poverty and socio-economic deprivation.
The situation is further compounded by the inequities in the distribution of wealth and socio-economic infrastructure across the country, which currently favours the urban areas and adversely impacts on the provision of social services, such as health and education in rural hard-to-reach areas.
Table xxx below presents a summary of selected demographic and socio-economic indicators for Zambia. More socio-economic data on Zambia could be accessed at www.zamstats.gov.zm and www.boz.zm).