James T. Pfeiffer, PhD, MPH, Department of Anthropology, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106-7125, 216-368-2631, jtp8@po.cwru.edu

Most of the public health literature on the health effects of World Bank/IMF-sponsored structural adjustment programs (SAPs) in developing countries focuses on service quality, financing, and access concerns. There is less in this literature on how growing social and economic inequality often generated by SAP-promoted market reforms affects health-related behavior and status. As recent epidemiologic evidence suggests, growth in inequality can impact the social environment in dramatic ways that affect stress levels, health behaviors, and health outcomes. This paper examines how Mozambique’s SAP experience, and attendant growth in inequality, occurred simultaneously with the rapid expansion of African Independent Churches (AICs) and Pentecostals that recruited new members through faith healing in poor populations. Drawing on recent survey research (2002) in central Mozambique that used Likert scales to measure social attitudes, this paper examines the relationship between local perceptions of increasing inequality during the SAP period and changes in health-seeking behavior. Complemented by in-depth ethnography and collection of illness narratives, the research suggests that rapidly growing inequality has led to changing interpretations of illness causation. Many persistent health problems are believed to emanate from social conflicts with co-workers, neighbors, and family that find expression in illness causing spirits within a social environment marked by deepening competition and status insecurity. Health seekers increasingly avoid expensive traditional healers or biomedical services and consult church healers instead to provide broad spiritual protection. This health-seeking shift may be linked to declining service utilization and suggests that new approaches to health education are needed in these communities.

Learning Objectives: At the conclusion of the session, the participant will be able to

• Recognize the value of Likert scales in measuring perceptions of inequality.
• Describe how increases in social inequality are changing health seeking behavior and fueling the growth in faith-healing African Independent Churches in Mozambique
• Assess how the growth in church popularity may affect primary health care delivery to poor populations in the region.
• Discuss how the church growth may affect both AIDS prevention campaigns and AIDS care in Mozambique.

Keywords: International Health, Social Inequalities

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.