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Citation Information

Type Journal Article - International Journal for Equity in Health
Title The social determinants of health and health service access: an in depth study in four poor communities in Phnom Penh Cambodia
Author(s)
Publication (Day/Month/Year) 2012
URL http://www.biomedcentral.com/content/pdf/1475-9276-11-46.pdf
Abstract
Background: Increasing urbanization and population density, and persisting inequities in health outcomes across
socioeconomic groupings have raised concerns internationally regarding the health of the urban poor. These
concerns are also evident in Cambodia, which prompted the design of a study to identify and describe the main
barriers to access to health services by the poor in the capital city, Phnom Penh.
Sources and Methods: Main sources of data were through a household survey, followed by in-depth qualitative
interviews with mothers, local authorities and health centre workers in four very poor communities in Phnom Penh.
Main findings: Despite low incomes and education levels, the study communities have moderate levels of access
to services for curative and preventive care. However, qualitative findings demonstrate that households
contextualize poor health and health access in terms of their daily living conditions, particularly in relation to
environmental conditions and social insecurity. The interactions of low education, poor living conditions and high
food costs in the context of low and irregular incomes reinforce a pattern of “living from moment to moment” and
results in a cycle of disadvantage and ill health in these communities. There were three main factors that put poor
communities at a health disadvantage; these are the everyday living conditions of communities, social and
economic inequality and the extent to which a society assesses and acts on inequities in their health care access.
Conclusions: In order to improve access to health and health services for the urban poor, expansion of public
health functions and capacities will be required, including building partnerships between health providers,
municipal authorities and civil society.

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