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University of Waterloo (2019)

Exploring Health and Wellbeing in a Low-to-Middle Income Country : A Case Study of Kenya

Onyango, Elizabeth

Titre : Exploring Health and Wellbeing in a Low-to-Middle Income Country : A Case Study of Kenya

Auteur : Onyango, Elizabeth

Université de soutenance : University of Waterloo

Grade : Doctor of Philosophy in Geography 2019

Résumé partiel
The recent past has witnessed an increased interest in the concept of wellbeing both in academia and public policy. Governments and international organizations have developed a policy agenda with the broad goal of improving individual and collective wellbeing ; positioning it as the desired outcome of, and the benchmark with which to evaluate social and economic progress, and the effectiveness of governments and their policies. The majority of such efforts have been conducted in Euro-American nations with limited efforts in developing countries. In the low-to-middle income countries where such efforts exist, they are based on experiences and indicators from the high-income western countries. As such, limited initiatives that aim to understand how wellbeing is conceptualized in time and place exist in low-to-middle income countries (LMICs) as societal progress in these resource-constrained areas are persistently assessed by econometric measures such as Gross Domestic Product (GDP). To address this gap, the present thesis explored indicators for constructing a healthy population index, an important domain of societal wellbeing in the context of LMICs. As part of the global index of wellbeing project, this thesis set out to understand how Kenyans socially construct their health and wellbeing across place, socio-demographic characteristics, and over their life-course. Using an explorative study design, the thesis employs the social constructionists’ perspectives and the eco-social theory to answer three specific research questions. First, the thesis responds to the question, what are the perceptions, meanings and determinants of societal health and wellbeing that matter most to Kenyans and are there differences and similarities by gender and region ? Second, how do the youth (15-24 years), the middle-aged (25-49) and the seniors (≥50 years) in Kenya socially construct their health and wellbeing ? Third and lastly, what are the indicators of a healthy population domain of wellbeing that matter in the context of Kenya and are there potential secondary data sets that could be used to evaluate progress in health over the past years and into the future ? In answering these questions, this thesis adopted qualitative research methodologies – including in-depth interviews (IDIs) and focus group discussions (FGDs). The IDIs with representatives of youth groups (male and female), women, and men groups, representatives of Community-Based Organizations (CBO), and with policy makers (i.e., Member of County Assembly) were conducted to explore their work and lived experiences of health and wellbeing in their respective communities. Focus group discussions (FGDs) with lay participants were conducted to understand their perceptions, meanings, determinants and the social construction of societal health and wellbeing and to determine similarities and differences by gender and across place. The thesis also highlights the indicators of the healthy population domain that matter to Kenyans as revealed in the collected data and suggest potential data sources for evaluating progress. Using the constructs of embodiment and pathways of embodiment of the eco-social theory, the thesis provides a framework with which to map population health indicators for wellbeing assessment in the context of LMICs.


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