Applying an ecosystem approach to community health research in rural northern Ghana.

摘要

The purpose of this thesis is two-fold. First, I seek to demonstrate that health problems facing rural communities in northern Ghana cannot be fully understood and resolved without situating them in their broader historical, political and socioeconomic contexts. Many reports point to the increasing spatial and social health disparities throughout the country. In particular, rural communities in the northern regions have persistently fared worse in many health dimensions including infant, child and maternal mortality rates. Efforts by Ghana's health sector to curb these growing health disparities have been less successful. The questions posed by this thesis then are: (1) why does poor health seem to persist in rural northern Ghanaian communities, (2) why has public health research and intervention been less successful in reversing these poor health trends, and (3) what alternative health interventions can be used to improve rural community health and reduce the existing health disparities?;Methodologically, I worked jointly with an interdepartmental research team and two groups of community participants, men and women. We explored people's perceptions of health, ill health, major health concerns and their underlying causes. A strategic planning process was used to map out a vision for a 'healthy community'. The study reveals that most of the underlying causes of poor rural health lie outside the purview of the health sector and suggest the need for concerted efforts amongst various stakeholders. The study also demonstrates that local people understand these causes and if given the space, can contribute to finding solutions that are meaningful to them both culturally and ecologically. From an ecosystem perspective, this study constitutes one of the first in rural northern Ghana, and provides a foundation for similar studies to be conducted in other parts of the country and elsewhere.;The study makes use of a community-based ecosystems approach to health research in a village in the Upper West Region of Ghana. It integrates three theoretical frameworks: political ecology of health, ecosystems approaches to human health, and community-based participatory action research. Political ecology of health examines rural northern Ghanaian health problems by situating them within Ghana's colonial, postcolonial and structural adjustment policies. Participatory action research advocates people-centred health development and provides space for indigenous and subjective views.