Health and vulnerability: Economic development in Ugandan pastoralist communities

In sub-Saharan Africa, economic development strategies increasingly involve the privatization of environmental resources and services. In the late 1980s, southwestern Ugandan pastoralist communities experienced dramatic decreases in access to land and water through privatization and conservation policies aimed at promoting economic development. This project's ultimate goal was to understand the health implications of these policies which redistributed land and water resource and re-shaped material and social conditions. Using longitudinal morbidity histories, themes from semi-structured interviews and demographic survey data collected in three communities (n=100 households) bordering Lake Mburo National Park, a vulnerability index was developed to quantitatively test relationships between health outcomes and both objective and subjective measures of material and social conditions. Linear regression and stepwise elimination models were fitted to examine associations between percent time ill and these conditions, at various levels of confounder control. The central categories arising from the qualitative analysis were: (1) historical context of access to environmental resources; (2) the interplay between social circumstances, contentment in community and ownership of land; (3) the complex array of coping strategies employed during times of scarcity (land, food and water); and (4) the consequences of failing to access resources necessary for life. A statistically significant negative association was found whereby as level of peace declined, percent time ill increased. These findings provide evidence that even in communities where environmental conditions are poor, a social gradient in health exists where feeling trust, a sense of belonging, and a sense of permanence in place is important to health. Since health outcomes are related to level of peace in a community, which was dramatically re-shaped as a result of privatization and conservation policies, economic development and conservation strategies must engage with the ways in which everyday lives are altered, not just materially but also socially, and the important implications for the health and well-being of those impacted. Examination of the factors that make people and places vulnerable can guide policy and improve current efforts to increase access to safe drinking water and reduce environmental infections, while bearing implications for the push to develop through privatization and individualism.