Social Determinants of Health

Custom Student Mr. Teacher ENG 1001-04 28 March 2016

Social Determinants of Health

Sociocultural perspective of health tells us stories of social contexts worldwide. From the developed countries to the developing countries, one can see that health status for this country can be very different from the other. The poor with low or no income often has more health problems than the rich with better income (Kawachi, Adler et al, 2010). Comparing a developed country versus a developing country, the developing countries are seeing more health problems. Through globalization, awareness was formed. Many were concerned over the increasing health inequities, “the unfair and avoidable differences in health status seen within and between countries” (WHO, 2011). Comparing between countries, one country might have high life expectancy, the other might not (CSDH, 2008). The difference is fortunately recognised. In the name of social justice, the need to close the gap is heard globally. In 2005, a commissioning on social determinants of health was set up by World Health Organisation (WHO) to curb health inequities. Social determinants of health, “the circumstances, in which people are born, grow up, live, work, and age, as well as the systems put in place to deal with illness” (WHO, 2011). One example of social determinants could be the availability of employment in a specific country. When a country does not have enough jobs, there will be no income. When a person has no income, food source is a problem. When a person does not have adequate nutrition, poor health can occur. Although not all circumstances are related to the governance of the systems, a person’s behaviour and belief towards health do influence the likelihood he or she will seek treatment. Culture does influence health beliefs of individual (Vaughn, Jacquez & Raymond, 2009). A person who is from a rural area and one who is from the urban will treat fever differently. The rural area might self-treat, where else the one from urban will see a doctor. Health in social perspectives includes study of a person’s well-being, quality of life, etc. Health is “Not merely absence of disease but rather in the positive sense of well-being” (Germov, 2009, p. 15). Thus the sociocultural, behavioral and environmental factors are important in the study of social determinants of health. Discussion

In this essay, the author is interested to explore the working conditions of the foreign construction workers working in Singapore. The
author will discuss on how employment and working conditions impacts both Singaporeans and foreign construction workers. What are the social issues encountered by foreign construction workers? The impact of the foreign construction workers in Singapore will be discussed. An outline of programs to improve working conditions for foreign workers in Singapore will also be explored. The author will provide point of view from a health care professional perspective. . A survey conducted by Ministry of Manpower foreign worker study (2011), reported that foreign workers interviewed expressed high levels of satisfaction working in Singapore. Why have they chosen to work in Singapore? In developing country such as Bangladesh, many could not find employment, forcing workers to look for jobs aboard. Many of the young Bangladeshi men sought working experience in a foreign country even though there are risks of fraud. They need to fork out a sum of money for labour migration; some even sell their houses to obtain loans. Despite the negative elements, the Bangladeshi workers flock to Singapore for employment (Rahman, 2004).

The Bangladeshi who had the chance of working overseas were looked upon highly, especially on migrating to Singapore for employment, to them is an opportunity that dignify them as a complete man (Rahman, 2004). The bulk of Singapore’s construction workforce was from migrant workers because for many Singaporeans the working conditions make the industry an unattractive sector due to relatively low wages, long hours and harsh working conditions. Foreign workers take up to more than 85 per cent of the construction workforce in Singapore (Debrah and Ofori, 2001). Singapore is an island surrounded by sea. The only “natural” resource is its own people. The population of Singapore has increased to 5 million and almost half of them are non-residents (Singapore statistics, 2012). In order to create more revenues for the economic growth, the government needed to build more houses thus increasing the need for more foreign construction workers. This too created problems for Singaporean. Many of the local felt that Singapore does not belong to the locals anymore. It is invaded by foreign workers. An extract from Tomorrow, Bulletin of Singapore Bloggers ( in 2007, Mr Biao wrote “Too many foreign workers in Singapore!” The buses are filled with them. They are gathering around open space eating and drinking. Leaving without clearing debris. They are affecting the lives of
Singaporeans causing social problems to the locals. According to Khadimul research paper (2010), it was citied in “The New Paper” (Local newspaper) on 22 March 2010, that employment agencies were overcharging each foreign worker thousands of dollars for work in Singapore. They were also not paid according to the contract that they had signed. Some cases reported that they were asked to sign a new contract when they have reached Singapore. This could be an example for social injustice. The foreign workers had no choice but to sign the contract since they have already step foot in Singapore. The Ministry of Manpower in Singapore requires all foreign workers to attend medical examination once they reached Singapore.

They have to go for health checks within 14 days of arrival and will be repeated 6th monthly. If they were to be diagnosed with HIV or PTB, they will be repatriated. This is to safe guide public health and preventing spread of disease. The environment in which the foreign workers live in are usually near construction sites, it predispose them to dengue fever. Dengue fever is an infectious disease that spreads through Aedes mosquito bites (WHO, 2012). Aedes mosquito grows in stagnant water and construction sites are one of the high risks for stagnant water due to the Singapore’s topical climate. This could create health problems to the workers. They will need time to recover from the illness thus productivity will be affected. Although there is law on employee’s health in Singapore, there is no legalised standard requirement for living conditions of foreign workers. Often the foreign workers will be sharing toilets facilities and bunks as space is limited in Singapore. Meals are not provided for the workers after work and living conditions are not adequate. It was reported in (“Have you ever seen the inside of a foreign worker’s dorm?”, 2009), that at least 16 of the foreign workers were lodged in a congested room with 8 double decker’s bed. The room was so clutter and messy. The reporter reported that it was not the worst condition, he had seen quarters worse than this. This encourages disease transmission in a poor ventilated, sanitised environment. That is also the place that they will cook, eat and wash their laundry. One might felt that this could not be happening in a meritocratic society in Singapore, a developed country, unfortunately it does. Does the employer have a choice to make things better? Sometimes is it not a choice, people are forced to behaviour this way due to the way society is constructed.
Greed of a human makes one go out of his humanity. There are also cases whereby workers were abandoned. Such cases usually happen when small companies facing cash flow problems or loss of contract on construction tenders (HOME, 2011). Employers are still liable for the welfare of the workers. The employer will be fined for breach of contract. The foreign workers have no choice but to find other employers or to be repatriated home. Programs

In 2009, a task force was set up by Ministry of Manpower to curb companies abusing foreign workers. It is a requirement for the employer to furnish S$5000 security bond for the employee. If the employer failed to pay or house them in satisfactory condition, legal actions will be taken against them (HOME, 2011). This reflects Singapore’s effort in responding to WHO’s calling for fair employment, to protect all foreign workers through standardised policies. Foreign workers working in construction industries are often at risk for occupational disease. The book Workplace Safety and Health Guidelines (2011, p. 3.) defines occupational disease as “any disease contracted as a result of an exposure to risk factors arising from work activity”. Risk factors include chemical, biological, physical and physiological hazards. The construction workers are exposed to harsh chemical such as asbestos which is a common agent used in construction industry is predisposing them to carcinogen agent. This is an example of working conditions that could lead to workplace illnesses. In Singapore, Workplace Safety and Health Council aim to promote safety and health culture at work. The Workplace Safety and Health Act is an important framework to encourage good safety habits in workers. Based on (“Recognising the contributions of foreign workers in Singapore”, 2012), the government in Singapore has been constantly reviewing employment laws. Both local and foreign workers are protected by the Employment Act and the Employment of Foreign Manpower Act (EFMA). Employers will have to pay the full cost of hiring foreign workers. This also helps to curb abuse against foreign workers. Public views and suggestions were taken into consideration to improve working conditions of workers. Ministry of Manpower (MOM) has partnered with newly formed Dormitory Association of Singapore Ltd aiming to educate foreign workers with goals to promote better standards in industry.
To tackle issues on working conditions of foreign workers, MOM has standardized basic foreign worker housing requirements to be implemented in EFMA. MOM had also conducted roadshows and publishing of regular newsletters to educate foreign workers on their rights. Conclusion

In this essay, the author has discussed on the reasons why foreign workers chose to migrate to Singapore despite the poor working condition that they faced. Some of the risk for health hazards were identified and the author has reflected on the governments affords to improve working conditions of the foreign workers. From the author point of view, working in a foreign environment can significantly influences one’s health and wellbeing. Frequently, the foreign workers hunger for a better living condition thus, they travel to countries far from their hometown leaving their loves ones. It must be a culture shock to them to be treated this way. Not knowing what is ahead of them. The social structure in which they live in challenged them to behavior this way. By studying social determinants of health, it helps to broaden the knowledge of healthcare professionals; they will have a better understanding of how the society infleuence people’s behavior thus able to reflect on why the person will behave in this manner.

CSDH (2008). Closing the gap in a generation: health equity through action on the social
determinants of health. Final Report of the Commission on Social Determinants of Health.
Geneva, World Health Organization.

Debrah, Y. A. and Ofori, G. (2001). Subcontracting, Foreign Workers and Job Safety in the Singapore Construction Industry. Asia Pacific Business Review 8, 1, 149.

Germov, J. (Ed) (2009) Second Opinion. An introduction to health sociology. (4th edition) Melbourne. Oxford University Press.


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  • University/College: University of Arkansas System

  • Type of paper: Thesis/Dissertation Chapter

  • Date: 28 March 2016

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