The economic determinants of public health are fundamental factors that significantly impact the overall well-being and health outcomes of a community. These determinants include income and socioeconomic status, as families or individuals with higher incomes and better socioeconomic conditions often have greater access to improved healthcare, nutrition, education, and housing, which in turn, positively influence their health. Additionally, employment opportunities and working conditions play a pivotal role, as job stability and a safe work environment are associated with improved health outcomes. Economic policies, such as taxation, social welfare programmes, and healthcare financing, can profoundly shape public health by either promoting equitable access to healthcare services or exacerbating health disparities. Understanding and addressing these economic determinants is essential for policymakers and public health practitioners to develop effective strategies aimed at improving the health and well-being of populations. Since the 1994 Genocide against the Tutsi, Rwanda has undergone a remarkable transformation, achieving significant economic progress that has garnered international attention. The country's recovery has been characterised by stable governance, visionary leadership, and a commitment to reconciliation and social cohesion. Under President Kagame's leadership, Rwanda has focused on fostering economic growth through strategic investments in sectors like agriculture, tourism, and technology. The government has also implemented pro-business policies and attracted foreign investments, contributing to an annual average GDP growth rate of around 7% for over a decade. Additionally, Rwanda has made substantial advancements in healthcare, education, and infrastructure, resulting in improved living standards for its citizens. This impressive post-genocide economic recovery serves as a testament to Rwanda's resilience and determination to overcome its tragic past and build a more prosperous and inclusive future. The health effects of the Genocide lasted long after the physical violence stopped that July. An estimated 250,000 women had been raped, and thus HIV become a weapon of war. One of the 20th century’s largest cholera epidemics exploded in refugee camps along Rwanda’s western border. Fewer than one in four children were fully vaccinated against measles and polio in 1994. Rwanda’s under-5 mortality rate that year was the highest in the world; life expectancy at birth would remain the lowest anywhere through the next few years. Tuberculosis control programmes were in complete disarray; for years afterward, many patients received only intermittent therapy. Moreover, most health workers had either been killed or fled the country; many who remained had been complicit in the Genocide, and trust in physicians and nurses was frayed. The destruction of health facilities and the collapse of supply chains for drugs and consumables handicapped the country for years. The capacity to respond to the new crisis of mental health trauma was as strapped as the capacity to respond to the trauma usually attended by surgical teams. Rwanda boasted neither psychiatrists nor trauma surgeons at that point. As part of its remarkable journey of economic transformation, Rwanda has also rebuilt its health system from scratch. Life expectancy has doubled, now standing at 69.6 years according to the National Institute of Statistics of Rwanda. Child mortality has fallen by more than two-thirds since 2000. In the past decade, death rates from AIDS and tuberculosis have declined at record speed. Vaccination rates for many diseases surpass those in first-world countries. And Rwanda has achieved the Millennium Development Goals for health. Rwanda prioritised healthcare financing and launched innovative programmes like the community-based health insurance scheme known as Mutuelle de Santé. This initiative aimed to increase healthcare access for all Rwandans, regardless of their socioeconomic status. Investments were made to build new healthcare facilities, train healthcare professionals, and improve the overall healthcare infrastructure. The government's commitment to the health sector was further demonstrated by allocating a significant portion of the national budget to healthcare as per the Abuja Declaration and collaborating with international organisations and partners to secure funding and technical expertise. The Rwandan government is also committed to data-driven decision-making and technology adoption and this has enabled the efficient management of healthcare resources and the development of innovative solutions like telemedicine. By tackling multiple health determinants, economic growth in Rwanda has acted as a catalyst for significant improvements in health outcomes. People frequently see increases in incomes when the economy of the nation grows, which in turn improves their access to healthcare, the capacity to buy wholesome food, and the opportunity to find safe housing. This strong economic growth has resulted in lower rates of poverty, better sanitation and hygiene, and greater access to clean water—all of which promote general health. Additionally, economic expansion has increased employment possibilities and living standards, which will reduce the prevalence of communicable diseases and maternal and infant deaths. Ultimately, economic growth in Rwanda plays a vital role in promoting better health outcomes, fostering social well-being, and breaking the cycle of poverty. Dr Vincent Mutabazi is an applied epidemiologist. X: @VkneeM
