Social Determinant of Health (Khat in Yemen)
How do I explain that one plant became so important that it helped dry up a country’s water, affected its economy, reduced how much work people got done every day, and is still loved by millions of people?
You’d probably think I’m talking about cocaine, tobacco, or maybe alcohol. No, it’s not. It’s called khat. Khat comes from a plant called Catha edulis, which grows mainly in East Africa and parts of the Arabian Peninsula. People pick the fresh leaves and chew them for hours. The leaves don’t taste particularly good, but they contain a natural chemical called cathinone. This chemical acts as a stimulant, meaning it makes people feel more awake, energetic, confident, and talkative. It can also create a temporary feeling of happiness. For many people, chewing khat becomes part of their everyday routine.
To understand why khat became such a big issue in Yemen, you first have to understand that it is more than something people chew. It is part of the country’s culture. Think of it this way. In some countries, people meet after work at a bar or a café. In Yemen, many people meet to chew khat. Friends spend time together over it, families gather to chew it, business meetings, political discussions, weddings, and even community gatherings often happen while people are chewing khat. This tradition has existed for generations, because almost everyone around you chews it, not joining in can make you feel like an outsider. That makes it very difficult to reduce its use.
What Does Khat Do to the Body?
The chemical in khat, cathinone, works on the brain by increasing chemicals that make people feel alert and energetic. In the short term, many users experience more energy, better concentration, less tiredness, feeling happier, becoming more talkative, and feeling more confident. But these effects don’t last forever.
People who chew khat regularly are more likely to develop health problems such as difficulty sleeping, high blood pressure, faster heartbeat, anxiety, depression, stomach pain, constipation, poor appetite, and dental problems. Although khat is not considered as dangerous as drugs like cocaine or methamphetamine, people can become dependent on it. Many regular users say they struggle to work or even enjoy their day without chewing it.
The Problem Didn’t Stop at People’s Health
One of the biggest problems caused by khat wasn’t actually inside people’s bodies. It happened on farms. Farmers realized they could make much more money growing khat than growing food like vegetables, fruits, grains, or coffee. Naturally, many of them switched.
Today, around one-third to almost 40% of Yemen’s irrigated farmland is used to grow khat instead of food crops. The result is that less land is available to grow food, forcing Yemen to import much of what its people eat. This makes the country more vulnerable to food shortages and rising food prices.
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Yemen is already one of the driest countries in the world. Water is scarce, and many communities depend on underground water stored in aquifers. Unfortunately, khat needs a lot of water to grow. Farmers pump huge amounts of groundwater to keep their khat farms alive. Some estimates suggest that 30 to 40 percent of all groundwater extracted in Yemen is used for growing khat.
Over time, this has caused underground water levels to fall. Many wells have dried up, while others have become deeper and more expensive to use. Although khat is not the only reason Yemen faces water shortages — climate change, population growth, poor water management, and years of conflict have also contributed, and has made the problem much worse.
Chewing khat is not something people do for five or ten minutes. A typical chewing session lasts between three and six hours. Every afternoon, millions of people spend hours chewing khat instead of working. Businesses slow down, government offices become less productive, and valuable working hours are lost.
Families also spend a surprising amount of money buying khat. Some studies show that households spend 10 to 30 percent of their disposable income on it. Imagine if that money were instead spent on nutritious food, children’s education, healthcare, or savings. For many families, khat becomes an expensive daily habit that leaves less money for essential needs.
Why Don’t People Just Stop?
The answer is simple but complicated. Khat is deeply connected to people’s culture, daily life, and livelihoods. Millions of farmers depend on growing it to earn a living. Millions of traders make money selling it. Millions of people have chewed it for years, and many see it as a normal part of life. That means solving the problem isn’t as easy as banning the plant.
Governments would have to help farmers grow other profitable crops, improve water management, create new jobs, educate people about the health risks, and gradually change social attitudes. That takes time.
Gilson’s Take Home
Many people think public health is only about hospitals, vaccines, or treating diseases. But public health is much bigger than that. It is about understanding how people’s habits, culture, environment, and economy affect the health of an entire population. The story of khat is a perfect example. One plant didn’t just affect the people who chewed it. It affected farming, food security, water supply, household income, mental health, productivity, and even the country’s economy.
This is what public health professionals call the social determinants of health — the idea that health is influenced by where people live, how they earn money, what they eat, the environment around them, and the traditions they grow up with. Khat is a reminder that a public health problem is not always caused by a deadly disease. Sometimes, it starts with a cultural habit that slowly affects millions of people, their environment, and their economy.
In the end, the biggest lesson is that the health of a nation is not only determined by its hospitals or medicines. It is also shaped by the everyday choices people make, the policies governments adopt, and the resources they protect.
