Nida, a success story: Addressing social determinants of health to improve health equity

Nida came to us, at Samir Malik Heart Care Foundation Fund, in 2014, with complaints of breathlessness on exertion. She was born with an atrial septal defect (ASD), which had been diagnosed four years back during a routine health checkup in school. Her parents took her to a hospital, where she was advised open heart surgery to correct the condition at an estimated cost of around Rs 1.5 lakh. Her father, a welder, was the sole earning member of his family, which had six dependent family members. He had no insurance cover, ESI or CGHS. So, clearly, he could not afford the surgery.

He was then referred to us by the doctor who had first diagnosed the child.

When Nida came to us in 2014, she was 9 years old; after reviewing her condition, the Samir Malik Heart Care Foundation Fund decided to adopt her. In September 2014, she underwent ASD device closure by Dr Smita Mishra through the fund. An open heart surgery was avoided. 

Since then, Nida has been regularly coming to us for follow up care.

She is now 14 years old and a student of class 9. She has friends and participates enthusiastically in all school extracurricular activities – drawing, poem recitations etc.; she enjoys sports like Kho Kho, Kabaddi and above all, she is doing very well academically.

Nida is another success story of the Samir Malik Heart Care Foundation Fund.

Using the device closure method avoided the trauma of open heart surgery, a more invasive procedure, to correct the congenital heart defect. It also meant a shorter hospital stay, quicker recovery. Undergoing the device closure also helped to remove the social stigma of living with a scar on the chest. 

Social gradient has been identified as one of the 10 social determinants of health. The others are: Stress, early life, social exclusion, work, unemployment, social support, addiction, food and transport. Social gradient means “people who are less advantaged in terms of socioeconomic position have worse health (and shorter lives) than those who are more advantaged”. 

Social gradient needs to be addressed to eliminate the inequalities in health in the society.

To see Nida as a healthy and active child today only helps us to stay committed to our cause, which is to provide assistance to needy heart patients, young and old, so that they can live a healthy and productive life – “no person should die of a heart disease just because he/she cannot afford treatment”. 

Since it was first established in 2014, the Fund has successfully sponsored 279 heart surgeries such as valvular heart surgery, pacemaker implantation, surgeries for congenital heart diseases, bypass surgery and stents. It has also helped more than 1788 patients, both children and adults.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

Social determinants of health: How social factors determine health in the elderly

Social factors are increasingly being recognized as important determinants of health for the young and the old alike. These factors relate to the conditions of life and occupation and are therefore called social determinants of health. According to the World Health Organization (WHO), social determinants of health are the conditions in which people are born, grow, live, work and age.

The elderly or senior citizens have their unique social needs. These are people who have led active productive lives until their retirement, following which their social circle tends to decrease. Some people may perceive retired life as loss of status and respect in the society.

Loneliness, neglect, loss of self-esteem, loss of control, fear, abuse, financial insecurity, food insecurity, decreased mobility due to either disability or physical illness or lack of suitable transportation are some of the factors tied in to their health, which can lead to mental and physical illnesses and also worsen health outcomes. They increase non-compliance to treatment; consequently, the patient may present to the doctor’s clinic very frequently for chronic complaints that don’t seem to resolve.

Social isolation or exclusion is a very important problem in this age group, because of which they feel rejected by the society and sometimes, unfortunately by their own family.

Herein lies the significance of a good support system. While a good social support or a positive social environment has a beneficial effect on health and enhances quality of life acting as a ‘stress-buffer’, the effect can be quite the opposite when social support is either present but the quality of support is poor or support is totally lacking.

All these factors add on to each other and the net result is a poor quality of life as well as poor mental and physical health.

Loneliness and social isolation have been recognized as risk factors for coronary heart disease and stroke. So, while the doctor may be treating the heart disease and stroke with medicines, he/she could be missing out on these underlying ‘causes’ that caused the disease – “the causes of the causes”.

In a recent judgement, the Bombay High Court has ruled that elderly parents can take back property gifted to a son if he fails to look after them or harasses them. Citing the special law for the maintenance of senior citizens ‘The Maintenance and Welfare of Parents and Senior Citizens Act, 2007’, a division bench of Justices Ranjit More and Anuja Prabhudesai upheld a tribunal's order that had cancelled a gift deed given by an elderly Andheri resident by which he had granted 50% share in his flat to his son, reports TOI.

The Maintenance and Welfare of Parents and Senior Citizens Act, 2007 provides for the maintenance and welfare of parents and senior citizens. Maintenance includes provisions for food, clothing, residence and medical attendance and treatment. As per this Act, any senior citizen, after 2007, who have “transferred by way of gift or otherwise, his property, subject to the condition that the transferee shall provide the basic amenities and basic physical needs to the transferor and such transferee refuses or fails to provide such amenities and physical needs, the said transfer of property shall be deemed to have been made by fraud or coercion or under undue influence and shall at the option of the transferor be declared void by the Tribunal.”

It is therefore important for the treating doctor to be aware of the unmet social needs of the elderly, beyond their immediate presenting complaint, when they seek help and identify them and address them. This is important for healthy aging. They should also help the elderly patients be aware of their rights.

Dr KK Aggarwal

Padma Shri Awardee

Vice President CMAAO

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA