BMJ Case Reports 2016; doi:10.1136/bcr-2016-215670

Social determinants of health: poverty, national infrastructure and investment

  1. Haimanot Kasahun Alemu2
  1. 1Medical School for International Health, Ben Gurion University, Be'er Sheva, Israel
  2. 2Department of Oncology, Addis Ababa University Tinkur Abessa Hospital, Addis Ababa, Ethiopia
  1. Correspondence to Dr Nathan T Douthit, ntdouthit{at}
  • Accepted 7 June 2016
  • Published 22 June 2016


This case presentation of a 19-year-old Ethiopian woman diagnosed with nasopharyngeal carcinoma reveals the barriers the patient has to medical treatment, including poverty and a lack of national infrastructure. The patient lives a life of poverty, and the outcome of her illness is a result of her being unable to overcome barriers to accessing health care due to inability to afford transport, lodging and treatment. In this case, the patient's vulnerability to disease due to her poverty is not overcome because of lack of infrastructure. The infrastructure fails to develop because of inadequate investment and other delays in building. The end result is that the patient is vulnerable to disease. Her disease process impacts her family and their contribution to Ethiopia's development.

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