Background to Liberia
Looking at Liberia’s background, the country has suffered an immense amount of trauma from 1985 when there was oppression, mass killings and rapes by all the militant and rebel elements that were present at the time. Children were kidnapped, abused, drugged and made to become soldiers. This continued from 1989 to 2003 and unfortunately the consequences of this relentless abuse and trauma has not just impacted that generation but has now been manifested into the next generation.
Many communities have suffered a loss of purpose and been rendered powerless and hopeless. For some women their self esteem is an issue. One of the root causes of this is the gender inequality that is a cultural norm, leading to a loss of respect and dignity for the women. Another root cause is the trauma they have endured or witnessed in the past. Often in the young men there is confusion regarding their identity and purpose because of the high unemployment and a lack of good role models present in their life. The societal norms have greatly changed due to the previous long term conflict and ongoing poverty.
Background – Civil War
Liberia was in civil war between 1989 and 1996 and then again in 1999 and 2003. At least 250,000 people were murdered, 50,000 of them children, 1/3 of the population fled. Child soldiers were widely used and Nimba County is where many children were kidnapped, raped, drugged and trained up to be soldiers. Many of these former soldiers are in Monrovia and re-integration back into their original communities has yet to take place. Current stats show that life expectancy in Liberia is the age of 57. 51% of the population under the age of 18 that are orphans and 40% of children under the age of 5 are suffering malnutrition.
Infrastructure was badly damaged during the war years with both roads and access bridges blown up. There are few roads with tarmac and conditions during the rainy season can be hazardous and some communities become cut off. This creates a situation where petrol, food and transport become expensive. Running water, sewage systems and access to electricity is limited even in the capital city of Monrovia and less in the interior.
Background – Health Statistics in Liberia
Rebuilding started not long before the Ebola virus outbreak in 2014/15. Ebola infected 10,672 and 5,000 died in Liberia. Neighboring countries leaving many families to care for orphans in their community.
The social determinants of health reflect the social and physical conditions of the environment people are born into. Although complex and interrelated they are important factors that determine the health status of not just individuals, but families and the wider community. Cited in the Social Determinants of Health there are complex modifiable factors that impact on health outcomes. Our lifestyle factors, social and community networks, living and working conditions and the general socio-economic cultural and environment conditions contribute to our health and well-being. Liberia’s infrastructure has been decimated by the effects of war. This was compounded during the outbreak of Ebola when the lack of resources had devastating consequences not only for individuals, families but the wider community. Liberia continues to struggle to recover with providing such basic resources such as; roads, transport, water, sewage, waste disposal, electricity, healthcare and education.
Education is viewed as many things, however at its most powerful it has the ability to empower participants with skills, which can be life changing. Nelson Mandala believed it could transform a nation. It can enable people to make informed choices, reducing health risk behavior. Lynch and Barry  stated that education can be viewed as a ‘weapon against disease and ill health, remove the ignorance and you minimize the risk’. However accessing quality education in Liberia can be both challenging and expensive to the majority of families who exist on very little or no reliable income. High unemployment and slow economic growth combined with high inflation continues to cause both health and social inequalities.
Background – Health and Social Welfare
The government is addressing those key issues through the implementation of their Health and Social Welfare Strategy. The statistics are improving, however some are at a very slow rate. Below outline some of the key issues in a population of 4,808,768.
Infant mortality is an important indicator of population health and can be a gauge for the wider ‘socioeconomic determinants of health’. Lynch and Barry further state that, “there is a direct correlation between countries wealth and its health outcomes”.  This is clearly visible through the health inequalities that exist in Liberia and are reflected by the statistics. There is a large gap economically between those in the minority population who have a higher income and those in the majority population who are living in absolute poverty.
Background – Mortality Statistics
The following statistics show the high infant mortality rate 50.6 deaths/1,000 live births and the high rate of maternal death; 725 deaths/100,000 live births. Liberians National Health and Social Welfare plan highlights maternal and child mortality as one of the highest killers. In 2015/16 the government requested that all expectant mothers must attend a clinical setting for the birth of their child.
Liberia has a young population and a lower life expectancy compared to a developed country. This is reflected with 60% of the population under 25 with only 3.43% of the population between 55 and 64 and 2.85% of the population over 65. Life expectancy is 61.6 years for males and 66 years for females. This type of population pyramid poses its own problems both economically and socially especially with such a high rate of unemployment among the youth.
Despite significant improvements in terms of access to clean water, access to sanitation is still low. Actions through various developmental aid organizations have improved this situation.
Background – Other issues
Other pressing issues include a prevalence of HIV and AIDS with 40,000 people living with HIV/AIDS and 2,500 recorded deaths. Both of these statistics have increased from previous data counts. The degree of risk from other infectious diseases is also very high in Liberia leading to chronic illnesses or death. The lack of Doctors is a serious issue, 0.02 physicians/1,000 population. This statistic is improving with more doctors graduating in recent years but it is still very low with fewer than 300 doctors for the whole population.
 Dahlgren and Whitehead (1991) The Social Determinants of Health
 Lynch and Barry (2008) , p158
 All Ireland Traveler Health Study Team. (2011) All Ireland Traveler Health Study: The Birth Cohort Follow up Study, University College Dublin, Dublin.
 Lynch, U. and Barry, J. (2008) The Development Reader; ‘Public Health Governance in Cuba: Makes Health For All a Reality’, The Centre of Global Education.
 (2018, February 01). Retrieved from https://www.cia.gov/library/publications/the-world-factbook/