PU335 Unit 4 Determinants of Health Paper Example

Plantations, Remittances and Sugary Drinks: A Unit 4 Paper on the Social and Commercial Determinants Dividing Health on Hispaniola

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Purdue University Global

PU335: Global Health

Unit 4 Determinants of Health Paper

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[Date]

The analysis is the student's; the frameworks, history and studies cited are real, and specific figures should be checked against current sources.

Why Determinants Matter

Marmot (2005) argued that most of the differences in health between and within countries arise from the circumstances of everyday life, from childhood housing and schooling to adult work and old age, and from the distribution of power and resources that shapes those conditions. Medical care matters, but it acts late, after the conditions that cause illness have done their work. The World Health Organization's commission on the social determinants of health made the same case, calling for action on daily living conditions and on the structural drivers of inequity.

History as a Determinant

The two countries' paths diverged long before modern health care. Haiti won independence from France in 1804 after a revolution of enslaved people and was later forced to pay France a large indemnity for its own freedom, a debt that drained public resources for generations. The Dominican Republic's history included Spanish rule, Haitian occupation and a long dictatorship, but its economy developed differently, later expanding through tourism, free-trade zones and remittances. Sen et al. (2022), examining the context of global health policies, argue that post-colonial legacies continue to shape health service systems, and Hispaniola illustrates that argument starkly.

Social Determinants Compared

Income and poverty. Haiti is the poorest country in the Americas by income per person, while the Dominican Republic has grown into an upper-middle-income economy. Income shapes almost everything else on this list.

Education. School enrollment and literacy are lower in Haiti, and many schools are private and fee-charging. Many Haitian families pay fees for primary school, so a bad harvest or a lost job can pull children out of class, and girls are often the first withdrawn. Children of mothers who stayed longer in school are more likely to reach their fifth birthday.

Water and sanitation. Safe water and improved sanitation are far less available in Haiti, which helps explain its higher burden of diarrheal disease and its cholera epidemic.

Housing and environment. Much of Port-au-Prince's population lives in dense informal settlements, vulnerable to earthquakes, floods and disease.

Political stability and security. Repeated political crises, and in recent years armed gangs controlling parts of the capital, have displaced hundreds of thousands of Haitians and closed clinics, cutting people off from care. The Dominican Republic has been comparatively stable.

Haiti's health disadvantage begins with its history and its water, long before a patient reaches a clinic.

A Closer Look: Water in Two Capitals

The contrast is visible in daily routines. In many neighborhoods of Port-au-Prince, households buy water by the bucket from private kiosks or trucks, paying more per liter than wealthier homes with piped connections, and store it in open containers where it can be contaminated. In Santo Domingo, most households have piped water, although service can be intermittent and many families still buy bottled water for drinking. A Haitian mother who spends part of each day finding and paying for water has less time and money for food, school fees and clinic visits, so one determinant drags down several others at once. This is why the cholera epidemic examined in Unit 2 spread so quickly in Haiti and so slowly across the border.

Commercial Determinants

Kickbusch et al. (2016) used the term commercial determinants for the ways firms market and sell goods, and shape choices, in ways that damage health. They are increasingly important on both sides of the island. In the Dominican Republic, rising consumption of sugary drinks, processed foods and alcohol contributes to the chronic disease burden described in Unit 3, and the country's high road traffic death rate is linked to the rapid growth of motorcycles as cheap transport. In Haiti, commercial determinants appear in the high cost of imported food, which makes cheap processed products attractive, and in the dependence of water supply on private vendors and trucked water of uncertain quality.

Commercial actors also shape health positively. Remittances sent home by migrants, a large share of household income in both countries, pay for food, school fees and medical care.

Migration as a Determinant

Migration links the two countries' determinants. Hundreds of thousands of Haitians work in Dominican agriculture, construction and domestic service, sending money home that pays for food and school. Their work is often informal, without contracts or health insurance, and many live in bateyes or urban settlements with poor services. Migration therefore improves the determinants of health for families in Haiti while exposing the migrants themselves to unsafe work and exclusion in the Dominican Republic, a double effect that national statistics on either side of the border rarely capture.

Determinants Within Countries

The determinants also explain inequities inside each country. In the Dominican Republic, Haitian migrant workers and Dominicans of Haitian descent living in bateyes, the settlements built for sugar plantation workers, have historically faced poor housing, limited water and sanitation and barriers to legal documents, which in turn limit access to health insurance and services. In Haiti, rural residents in mountainous areas face long distances to care, while residents of gang-controlled neighborhoods in the capital face violence that blocks access entirely.

What the Analysis Implies

If determinants drive most of the gap, health care alone cannot close it. For Haiti, investment in water and sanitation, education and security would likely save more healthy years than new hospitals. For the Dominican Republic, action on commercial determinants, sugary drinks and road safety, and on the exclusion of migrants and their descendants, would address its largest remaining burdens and its sharpest inequities. Neither government can act alone on the determinants that cross the border. Migration, trade in food and the shared watershed of the Artibonite River all connect them, so some of the most useful policies, such as protecting migrant workers and coordinating water and sanitation along the border, require cooperation.

Limits

Determinants interact, so attributing a share of the gap to any one is difficult. Historical explanations risk oversimplification; each country's history is contested and complex. Data on migrants and informal settlements are especially incomplete.

Conclusion

The health gap on Hispaniola is rooted in history, income, education, water, housing and political stability, with commercial determinants shaping a growing chronic disease burden, especially in the Dominican Republic. The worst outcomes in each country fall on the most excluded: rural and displaced Haitians, and Haitian migrants and their descendants in the Dominican Republic. Closing the gap requires action on these conditions, not only on health care.

References

Kickbusch, I., Allen, L., & Franz, C. (2016). The commercial determinants of health. The Lancet Global Health, 4(12), e895-e896. https://doi.org/10.1016/S2214-109X(16)30217-0

Marmot, M. (2005). Social determinants of health inequalities. The Lancet, 365(9464), 1099-1104. https://doi.org/10.1016/S0140-6736(05)71146-6

Sen, K., Qadeer, I., & Missoni, E. (2022). Understanding the context of global health policies: Their post-colonial legacies and impacts on health service systems. World Review of Political Economy, 13(3). https://doi.org/10.13169/worlrevipoliecon.13.3.0322