Abstract
BackgroundStreet-connected children and youth (SCY) in Kenya disproportionately experience preventable morbidities and premature mortality. We theorize these health inequities are socially produced and result from systemic discrimination and a lack of human rights attainment. Therefore, we sought to identify and understand how SCY’s social and health inequities in Kenya are produced, maintained, and shaped by structural and social determinants of health using the WHO conceptual framework on social determinants of health (SDH) and the Convention on the Rights of the Child (CRC) General Comment no. 17.MethodsThis qualitative study was conducted from May 2017 to September 2018 using multiple methods including focus group discussions, in-depth interviews, archival review of newspaper articles, and analysis of a government policy document. We purposively sampled 100 participants including community leaders, government officials, vendors, police officers, general community residents, parents of SCY, and stakeholders in 5 counties across Kenya to participate in focus group discussions and in-depth interviews. We conducted a thematic analysis situated in the conceptual framework on SDH and the CRC.ResultsOur findings indicate that SCY’s social and health disparities arise as a result of structural and social determinants stemming from a socioeconomic and political environment that produces systemic discrimination, breaches human rights, and influences their unequal socioeconomic position in society. These social determinants influence SCY’s intermediary determinants of health resulting in a lack of basic material needs, being precariously housed or homeless, engaging in substance use and misuse, and experiencing several psychosocial stressors, all of which shape health outcomes and equity for this population.ConclusionsSCY in Kenya experience social and health inequities that are avoidable and unjust. These social and health disparities arise as a result of structural and social determinants of health inequities stemming from the socioeconomic and political context in Kenya that produces systemic discrimination and influences SCYs’ unequal socioeconomic position in society. Remedial action to reverse human rights contraventions and to advance health equity through action on SDH for SCY in Kenya is urgently needed.
Highlights
Street-connected children and youth (SCY) in Kenya disproportionately experience preventable morbidities and premature mortality
Despite the robust evidence of social and health inequities experienced by SCY, to our knowledge no studies have been conducted to date that explore how the social and health inequities experienced by SCY in Kenya are produced, maintained, and shaped by structural and social determinants of health (SDH) in this context
We theorize that the extensive social and health inequities experienced by SCY in Kenya are socially produced and result from systemic discrimination and a lack of human rights attainment for this marginalized population
Summary
Street-connected children and youth (SCY) in Kenya disproportionately experience preventable morbidities and premature mortality We theorize these health inequities are socially produced and result from systemic discrimination and a lack of human rights attainment. Known by the public as chokoraa (garbage pickers), these children and youth are subject to human rights violations and experience tremendous stigmatization, social exclusion and discrimination, all of which have an impact on their health and wellbeing [6, 10, 12,13,14] This marginalized group disproportionately experiences preventable morbidities including but not limited to: a heightened prevalence of human immunodeficiency virus (HIV) and sexually transmitted infections, posttraumatic stress disorder, substance use and misuse, and negative sexual and reproductive health outcomes [9, 15,16,17,18,19,20,21,22,23]. We theorize that the extensive social and health inequities experienced by SCY in Kenya are socially produced and result from systemic discrimination and a lack of human rights attainment for this marginalized population
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