Safe environment

WHO 2003 ,Healthy environments for children.

Photo gallery available at http://www.who.int/features/2003/04_gallery_8_en.html

This link provides an eye-opening opportunity to see environment by the eyes of children. Most of the ten photos present everyday life situations that can cause threat to children’s health. And many of them can be easily prevented. Sometimes simply education and skills training could help adults to change environment to be more safety to their children.

Photo series starts with a picture of a child under a mosquito net. Malaria is one of the greatest threats to children’s health especially in Africa. Malaria is one of the environmentally related disease. Not only by providing insecticide-nets but protecting forests and supporting research there is hope to find tools to decrease this vector related problem. Second photo reminds how important is to look out dangers in our environment. 50 000 children dies yearly because of poisoning. It is adult’s responsibility to store poisonous items away from children that they cannot reach them. Simple thing is to lock e.g. medicines in a separate cupboard or use child proof containers. There is also a danger to environment if we destroy or store harmful fuels, liquids etc. irresponsible way. Two pictures remind that every child should have clean air to breath. Not to smoke where there are children and there is a need to create possibilities for better indoor air. Small children suffer easily from respiratory diseases. Reducing these things are healthy for the environment too.

One picture tells the fact that water is source of life in many ways. Not only providing safe drinking water is necessary, but clean water improves also general household hygiene. Teaching to use water in a wise way, storing it clean and not wasting water too much, we can protect this environmentally important source as well. Good hygiene and proper use of latrines are key things in preventing transmittable diseases. At the same time this photo reminds us that well built latrines can be useful for the soil as fertilizer and on the other hand not harmful for the water sources. There is a reminder to wash hands carefully, and one photo reminds about food safety. Storing food right, cooking it carefully, having clean products and good hand hygiene are vital in prevention of disease transmission. Diarrhoea is one of the most killing diseases among children.

Photos remind that traffic is also a great danger to children. Traffic and roads should be planned to be safer to children, and children should learn to move in traffic carefully, use belts in cars or special seats. Unintentional injuries can be prevented by such a small things, but these can be life saving.

Are there solutions to have safe environment for our children?

One old song says that children are the future, but what kind of future there will be or they will have if there is not safe and healthy environment to grow up?

Those places where children spend most of their time should be safe and built so that threats for health could be minimized. Schools, housing, playgrounds, communities need to be looked in a new way. There is a need to find development challenges to have better environment for the children, and this is quite easy. Most of the environmentally related diseases could be prevented. These include for example diarrhoea, malaria and respiratory diseases. More than five million deaths of children could be prevented if there was an availability to clean water, sanitation, fresh air, unpolluted indoor air and safe non hazardous ground to play. These should be right to every child in this world (WHO 2003. Healthy environments for children).

Urban development, transportation, waste, and waste pollution are also issues that need to be planned safe for the children. Traffic accidents come straight after infectious diseases as a cause of children’s deaths or disabilities.(World Bank 2003) More than ever environmental education needs to become part of the school programmes, starting from primary schools. Awareness raising is vital for parents, and in general in community level (Melnick et al 2005).Politicians need to be influenced by facts and research. There is a need to show impressive data about facts how these things affect children’s health. Households and communities should have access to cheaper but healthier heating systems. Once again work in all level needs to be done, from micro to macro level. Individuals can choose to have e.g. clean surroundings for children to play and live, but communities should provide e.g. place to collect and safely destroy waste, so that air and water resources are not contaminated. Lots of problems can be avoided by grass root level actions, like by teaching people to build environmentally sound sanitation systems. Often these things are not too expensive to do either. Without a political will there is no success, all levels must co-operate towards same vision and goal. People need to be empowered to work for their own health.

 

Wars and other emergencies cause challenges to environment as well. One environmental problem is landmines.  Landmines are hidden in fields and footpaths, and often it is children who are attracted to these curious designs. Too often these unexploded mines are where children like to play. This problem may stay years after the war itself has finished. Generation after generation suffer consequences of landmines, often they are children. Fortunately there is lot been done in this area, but international agreements to forbid these deadly mines are still needed (UNICEF: Unicef in emergencies.)

 

 

UNICEF; Unicef in emergencies. Available:http://www.unicef.org/emerg/index_landmines.html, visited 8.11.2010

WHO2003 ,Healthy environments for children,

photo gallery available at http://www.who.int/features/2003/04_gallery_8_en.html

WHO, Healthy environments for children alliance. Available: http://www.who.int/heca/en/, visited 5.11.2010

20Melnick, D., Kakabadse-Navarro, Y., McNeely, J., Schmidt-Traub, G. & Sears, R. 2005b.The MIllenium Project: the positive health implications of improved environmental sustainability. (pdf) The Lancet, Vol. 365, 723-725.

 

 

 

How to prevent Malaria

 

When thinking about this question it comes first in mind, that to get rid of malaria is to get rid off malaria bearing mosquitoes. It would be end of this problem, but life ain’t this simple. Many things cannot be avoided like having these insects. So we need to take a deeper sight to this problem.

Our learning material shows some grass root level interventions in preventing malaria. Many organisations share mosquito insecticidal nets in order to prevent this disease. Awareness raising in communities is effective way to increase peoples’ knowledge. Again women play a significant role in prevention. All pregnant and under five year old children should have these nets to prevent them from malaria which cause 20% of children’s deaths in Africa yearly.Just 5^th of November there was a big campaign called Nose Day in Finland (Nenäpäivä) which collected money to African children. One goal was to get money to buy insecticidal nets for families with children. One net costs only 5 euros.

 

Early diagnosis, treatment, and safe medicines are needed. In malaria prevention we face the fact of poverty again. Poor people need to have same right to have access to health care. There is a need for agreements to give government money for prevention and greater efforts to get new drugs, and distribute them also to rural or poor areas. Environmental issues have to be focused more, cutting down trees and human created puddles increases mosquitoes. Long term impact to nature and insects needs to be studied more(Ruxin et al. 2005).

New research about malaria vaccine is promising, and hopefully soon in use (New malaria vaccine).

And what comes to mosquitoes, harm of them can be reduced by using insecticide. Spraying of houses is effective but this needs to be done regularly(WHO, 10 Facts about Malaria). Deeper look to a question of prevention touches all infectious diseases which cause too many unnecessary deaths yearly.

 

Global aspect of prevention

Networking with international organisations can be a start in global prevention of infectious diseases. Lots of different barriers were mentioned in Ruxin et al’s (2005)article. This might not come first in mind that lack of human resource in pharmacy in developing countries is one reason for disease reducement to be so slow. There is a need for higher education that these countries could have more e.g. pharmacist and technicians. Personnel working in pharmacy need to know how to store medicines, how to use them properly and what needs to take inconsideration in transporting drugs in rough conditions. Their knowledge can be passed further.

In African countries, where the e.g. malaria cases occur most, it is necessary to influence politicians. Making sustainable and well reasoned decisions is vital, they need to have good moral and fight against corruption. This is part of the reducing often dangerous but curable infectious diseases. Sometimes it is simply lack of good will among politicians that makes prevention work hard. Developing countries need urgently to create access and better possibilities for poor to have health care. They need to assure right for every person to have proper treatment, access to medicines and care. Donor co-operations should be well planned, and equal shared to most vulnerable areas. In order to prevent effectively, get new drugs to countries in need, there is a need for international trade agreements( Ruxin et al. 2005).

 Fighting the battle with infectious diseases in developing world is a fight with poverty. This has to be faced in all levels, from grass root to macrolevel, from individuals to communities and up to politics. And as we have learned education is one key thing in this fight, training community workers can be a start in awareness raising. Inadequate treatment and poor understanding use of medicines have led to the emergence, and problem of drug resistant is growing.

There is need to develop well-managed programs with adequate screening, teach diagnostics and improve treatment facilities. More money is needed for health staff  training. Several different factors contribute to the high rates of infectious diseases. A lot more emphasis in environmental, social, poverty reducing, control and migration factors is needed. But it is good to keep in mind that in order to success, local communities and national needs have to be basis of  prevention programmes (USAID 2005).

Used references:

 

Ruxin, J., Paluzzi, J., Wilson, P., Tosan, Y., Kruk, M. & Teklehaimanot, A. 2005. Emerging consensus in HIV/AIDS, malaria, tuberculosis, and access to essential medicines. The Lancet, Vol. 365 (12), 618-621.

 

USAID, 2005. Reducing the threat of infectious diseases of major public health importance.  

available: http://www.usaid.gov/our_work/global_health/id/idstrategy.pdf

 

WHO; Health topics HIV/AIDS.

 

Science Daily. New malaria vaccine is safe and protective in children. available:http://www.sciencedaily.com/releases/2010/02/100203201425.htm visited 4.11.2010

New malaria vaccine.available: http://www.sciencedaily.com/releases/2010/02/100203201425.htm, visited 6.11.2010

 

Personally I have an interest to learn about this topic more. Our learning material provides very good picture about situation in the world concerning maternal and child mortality. It is touching to think that every second there is one child dying (some totally unnecessarily) somewhere in this globe. Unnecessarily means that most of the cases could have been prevented by early interventions.

What are the main reasons for this to happen? Most of the deaths take place in neonatal period, the first month of life and usual reason is different complications and infections. Most common reason to deaths is pneumonia, sepsis and diarrhoea. Huge amount of children, around 2 million dye from pneumonia each year. It could be prevented, e.g. by teaching mothers to count breathing of the baby could save some of them. Mothers should know better the symptoms of main infectious diseases, when to go to a doctor and not to wait too long. As well as diarrhoea, which could be treated a simple way if there were knowledge enough. All together 17% under 5 child mortality cases are caused by this preventable disease.

It would be simple and easy to describe reasons to child and maternity mortality with sentences which start with word  LACK. Lack of good water source, lack of sanitation, lack of medicines, lack of knowledge, lack of warm, lack of shelter, lack of educated health care personnel etc. An inappropriate hygiene is one cause of children’s death yearly. As I had a chance to work in developing country educating young mothers to take care of their babies and themselves, I know how much can be done only by increasing their knowledge. People are usually motivated to learn and every mother wants their children’s best.

War and emergencies create challenging situations to societies anyways not to mention to health care and possibilities to get proper care for infants. Some children are danger because their mothers have severe childbirth complications. Putting emphasis to better care during the pregnancy and childbirth lives of children as well as mothers’ can be saved.

 

“Many children may simply have lost their mothers to pregnancy and childbirth complications. The lifetime risk of a pregnant woman dying from pregnancy or childbirth in a least developed country is 1 in 13, compared to 1 in 3,900 in Northern Europe.”(UNICEF 2008). These numbers are alarming. This difference exist even many organisations have worked to reduce mortality rates for years. Millenium Development Goals present this goal one of the hardest goal to achieve. Transmission of diseases causes increasing numbers in child mortality, HIV e.g. is more or less   infected through mother-to-child transmission. This can be prevented with antiretrovirals, as well as safer delivery. About two-thirds of child deaths are preventable through practical, low-cost interventions. Malnutrition make children more vulnerable to get infections and other diseases, and risk for death increases. Malnutrition causes third of all under five deaths among children.

 

 

Mothers’ mortality rates could be reduced if there were quality care during pregnancy and delivery. Bleeding, unsafe abortion, pre-eclampsia and too high blood pressure must be taken care of during the pregnancy, but this is far away possibility for too many women in developing countries. In South Asia and in Africa some girls are married too young. Their bodies are not mature to give birth and many severe complications cause sometimes unnecessary deaths of young girls. Too many women have to give a birth without skilled personnel.

One reason to high mortality is lack of emergency care and facilities during deliveries. For many poor countries there is simple lack of specialized care, therefore e.g. situations that would need an operation may lead to death. Some women are in a higher risk because of too many pregnancies in too short time. Many developing countries cannot deliver birth control pills for free or there is simply no access to get them. Poor women simply can not afford them, or know how to use them properly. It is estimated that more than 300 000 midwives would be needed to cover the need to have safe pregnancy, education and deliveries in developing countries.

 

 

 

Unicef 2008. Why are millions of children and women dying? visited 22.10. 2010 available:http://www.unicef.org/health/index_problem.html

 

Unicef 2008, Childinfo. Monitoring the situation of children and women. Statistics by area/ Child survival and health.

WHO 2008.What are the key health dangers for children?

WHO 2008: 10 Facts on maternal health.

 

 

 

Education

 

 

The Statistic table State of the World’s children (2008) shows clearly few facts. It is obvious that Central Asia has high differences in gender equality concerning girls’ education. In Sub Saharan Africa gender equality is not good either but better than in South Asia, like in Kenya there is hardly any difference between boys and girls’ attendance in primary school. According to these indicators there is a huge difference between primary schooling and secondary school attendance ratio in Africa and in Asia. According to videos that we had as a learning material, girls’ education, especially secondary school education is vital in reducing mortality, producing better health and capacity to earn money and social status can be influenced by their further education(video;Unicef at Oxford).

Children in primary school age have higher attendance in education than secondary school aged children, and this is common to every country listed in this chart. So it seems to be quite common that small children may attend school for few years yet further education and occupational training can be just a dream for people in Sub Saharan Africa and in Central Asia, and this is especially concerning girls again.

It is quite interesting that former communist countries still have very high attendance in education and have high literacy rate. This has continued even some of these countries count as developing countries, like Mongolia and Uzbekistan. These countries may have a high literacy rate, yet access to internets and phones is fairly poor. Could we expect as a conclusion, that education is respected but countries’ social economical status is still quite low, which means that gap between poor and rich is usually very obvious and deep.

There is huge gap between least developed countries and western industrialised countries what comes to education in all level, and same difference in access to phones and internets. In least developed countries often one out of five or less has had secondary schooling. Interestingly only ten out these 200 countries in the chart had higher female primary school attendance than males. But percentage is only marginally higher. It is clear that difference an opposite way in percentages is bigger. For example in Namibia literate youth’s percentage of the total population for male is 91% and for female 94%. Difference between male and female is three percentages. The other example shows more common situation, like in Nepal 81 % of 15-24 years old male are literate but only 71% of female.

 

What can explain differences concerning educational disparities between countries?

One is gender based violence. It is too often that girls do not have same possibilities for the education due to many factors. Some are religion and cultural based factors. Like we see in a chart that is girls’ attendance in schools very low in South Asia. One reason has to do with these countries’ attitude and religion what comes to women’s right and status in society. Some countries have clear discrimination of women’s right and social injustice can be apparent. Interestingly in Namibia girls are attending more in secondary school education, and we can suppose that over one hundred years missionary work in that country has influenced positively in gender equality. Most of the development work missionaries did was education in the first years they started work in Namibia.

 

It is obvious that girls do not have same access to schools, and there are several reasons to this. Few main reasons are poverty, cultural practices, and quality of teaching and long distances to schools. One emerging challenge is HIV/AIDS causing orphan hood. (The World Bank 2008).

   Many countries lack teachers and trained personnel. Especially rural areas have difficulties to get trained teachers. Some governments do not give support and value teachers’ work, and therefore it is very hard to get people to work in these challenging areas. Many countries infrastructure can be so low, that they do not simply have any schools, not only lacking teachers, but also books and facilities overall.

   Often war and other natural emergencies cause huge difficulties for the countries to rebuild social and educational systems again. It might take years before schools are working fully again. In these situation priorities are somewhere else than in education, sadly to say, ‘cause it only will worsen these countries’ development.  If there is not educated people to work and rebuild the country situation might worsen or at least take much longer.

   Poverty itself is one reason causing low educational level. Poor people do not have possibilities to pay school fees. Poverty can require that even children have to work for the families, they are necessary work power. Especially in situations where some family members are struck with sickness it can cause that children need to stay home. If children are working for their family they might get a daily income or bread to the table, and therefore many poor people cannot see education as an investment for tomorrow (UNICEF 2008).

   It is fact that some ethnic minorities have worse access to schooling than majority of the population.

High literacy rate indicates better gender equality and better democracy in decision making. Due to this fact it is obvious that education can change attitudes and thinking of population.

There is a fact that if mothers themselves have education they are more likely motivating their children to get education as well. The importance of secondary schooling is not seen important enough. It could have so many positive impacts, like better employment, new skills and lower fertility just to mention few. If literacy rates are low, it might be in countries where gender equality is poor, and this pattern that women stay home is continuing from generation to generation. No access to information and lack of insight why it is important to get education, can be one reason to explain differences between countries. It is hard to change attitudes. Many poor hope for the better future for their children. By seeing some great examples what difference education makes, they can be motivated to send their children to school.

 

Used articles

UNICEF 2008 Education for all (http://www.unicef.org/education/index_44870.html)

The World Bank 2008, Education and development

UNICEF 2008, Basic education and gender equality

 

 

 

 Two concepts and their link to health and poverty. Value that article points out.

One main concept in Farmer et al’s article (2006) is structural violence. It’s content is broad, as it shows injustice in social system that oppress poor what comes to their access to health care and in general access to better health. This concept also includes idea that in many level culture, religion, policies, communities, social systems and structures etc can hinder individuals to reach their full potential if their vision concerning public health is not broaden. Structural violence can be invisible, but relatively easy to influence, like increasing poor people’s access to education and give possibilities to use political power.

 

The other concept is structural intervention. It can be explained as practical interventions which can influence reducing structural violence in individual and community, national and political level. Interventions can be proximal and distal. Some interventions can increase possibilities to better nutrition, clean water, medicines etc. On structural level interventions may include improvement of educational level, campaigns for the community development, agriculture policies just to name some of the practical interventions. When these interventions are succeeded they will diminish gender inequality, have excellent impact on disease control and increase public health status. (Farmer et al , 2006.)

 

Farmer et al’s (2006) article shows clearly the fact that structural violence has link to premature deaths and disabilities among people suffering from poverty. Often social determinants of health are not understood deep enough and not less among health care personnel. Studies showed that structural interventions had great impact in lowering diseases, but some doctors didn’t see this kind of work as their duty to do. This only confirms that social violence needs to be discussed and understood in broad aspect.

Article claims that poverty is not reason for the diseases but often social structures influence in better and worse, so that those who are poor suffer more if their needs are ignored. Individual’s behaviour doesn’t explain why some diseases appear, many factors influence disease course and poverty is one of them. Poor people may not be able to buy medicines, they might live in rural areas with long distances to health centres, their health status may worsen because of poor nutrition and unclean water etc. Structural violence can be addressed by effective interventions in distal and proximal level, so that poor will get appropriate sanitation, access to clean water, education, their voice is heard on political level, agriculture is supported in rural areas etc. If authorities don’t pay attention on these things the health level of poor will not be changed and poverty may only deepen the problems in several sectors already mentioned above.

Article showed also some examples how structural interventions may have direct influence on health in positive way, like in Rwanda, Haiti and Baltimore. In fight against HIV some key points were to bring health care close to people, raise awareness, make it social acceptable to get help and have easier access to medicines. In Baltimore case there was clear evidence that black people got worse care, had difficulties to get medicines and lack of medical insurance hindered them to get proper care. Racism was the main reason of the structural violence in Baltimore’s case, and until it has been solved these things will not be changed. In Rwanda education seemed to become important way of influencing on structural violence, like promoting adult literacy, gender equal legislation and improvement of housing quality. If people get education they simply have better possibilities to get jobs and fight against poverty in economical level. There was evidence that these interventions, which were grass root level actions, had instant positive impact on their health, and these interventions can lessen mortality.

 

Values that this article points out are gender equality, social justice and social and economical rights. If these things are acknowledged and addressed in high political level, public health can be influenced. Inequalities in social and health level will be diminished if reducement of poverty is taken seriously in political decision making.

 

 

Farmer, P., Nizeye, B., Stulac, S. & Keshavjee, S. 2006. Structural Violence and Clinical Medicine(pdf) PLoS Medicine, Vol. 3(10).