Instead of choosing one specific source of information of environmental factors, I wanted to concentrate on one specific subject: air quality. Air pollution is one of the most common threats to our health and still one of those that we often forget. It is always present - but we rarely see it.
What is causing air pollution in this planet? Outdoor air pollution is most often caused by energy production, industrial sources and transport and traffic. (1,2,3) For example soot or black carbon has been used as energy resources for centuries, but the health and climate effects of black carbon have been neglected almost as long time. In addition, agriculture may also release substances (such as pesticides) that are affecting air quality and are toxic compounds. (1,2) Air pollution is certainly a global concern, it is not only present in developed Western countries nowadays, but big industrial countries, such as India and China, are struggling with this same problem. In addition, at the same time than people in developed countries have woken to see the problem and tried to improve facilities and invested in cleaner tehnologies for better air quality, in developing countries industrial systems, increasing traffic and energy production are causing great amounts of release of air pollutants. The oudoor air pollutants are affecting also the quality of indoor air. Nevertheless, indoor air pollution is caused also by many other reasons, for example tobacco use, using unhealthy fuels and unsatisfactory stoves and cooking practices, (3)
In addition to thinking what is causing air pollution, as important is to think what is air pollution causing to individuals. The effects of air pollution on human health range from mild changes in respiratory function, through increased respiratory and cardiovascular morbidity, to increased mortality. (1) In children, outdoor air pollution is increasing the incidence of acute lower respiratory tract infections, asthma, low birth weight, and impaired lung function.(1) It is also assumed that small particles (PM10 and PM2.5) in air pollution are largely responsible for these adverse health impacts and excess deaths.(1) In addition, epidemiological studies have shown that daily exposure to ozone both increases mortality and the occurrence of respiratory diseases.(1)
Outdoor air pollution as well as other toxic substances are causing polymorphic symptoms. COPD and cancer incidences are increasing, there might be different kinds of other respiratory symptoms. Especially exposure to lead may cause IQ impairment.(3) Children may have respiratory problems when there is high levels of air pollution in and around their homes and schools. (4) Exposure to indoor air pollution may cause similar symptoms. It is assumed that indoor air pollution causes number of child deaths due to respiratory illnesses. Lung cancer and COPD are also common among adults exposed to high amounts of indoor air pollutants.
What could we do to prevent these environmental health problems of air pollution, are there any solutions? We should also think about other possibilities, if we are not able to stop air pollution but we don`t want to exposure ourselves to it. Siting home buildings, schools, play and recreation areas away from traffic, noise, industrial and waste sites reduces people`s exposure to air pollution.(4) Nevertheless, the most important thing is to try to stop pollution of the air. Associated sectors have lot more possibilities than a single human being, for example factors related to energy production and industrial processes may use cleaner fuels and improve their facilities. It is vital to follow up different barometers that may have information of air pollution, for example annual mean levels of PM10 (ug/m3), annual ambient concentrations of lead in the atmosphere (ug/m3), lead level in blood (particularly children (ug/dl)) and waste management codes.(3) International protocols are needed for recording and reporting emissions of pollutants from industrial and traffic sources. Especially inside European Union they have recently concentrated on the sources of air pollution and European Pollutant Release and Transfer Register (PRTR) has a new protocol, which ensures that firms are required to report annually the amount of certain pollutants they release to the environment. (1)In addition, at homes we have still some possibilities to affect. For example ensuring access to safe and cleaner household fuels for cooking and heating especially in developing countries, reduces air pollution inside home and makes the quality of air much healthier to breathe. (4)
The happy news is that actions that reduce the exposure to toxic chemicals and child mortality caused by indoor air pollution give us a double benefit of addressing the Millenium Development Goal 4 on child mortality and Millenium Development Goal 7 on environmental sustainability. (2) Once again, we need lots of education and training of safe chemical management and good environmental practices. The involvement of different sectors of society, including legislation, is needed.(2) Public awareness of health effects that air pollution is causing us in everyday life is important. And in developing countries, each country should take air pollution seriously and take responsibility for the problem locally.
The following video tells us more about the consequences that air pollution is evoking in the Arctic areas and those are really affecting us all. We see climate change often as disaster to our nature, but understand far too less about the consequences to our health. Everything is affecting everything and if we are not taking care of the entireness, we will see the systemic crisis. It really counts, what kind of air we are breathing.
References:
(1) Health and Environment Alliance.”Putting health at the centre of environmental issues.” http://www.env-health.org/r/90
(2) Melnick, M., McNeely, J., Kakabadse-Navarro, Y., Schmidt-Traub, G. & Sears, R. 2005a. Environment and human well-being: a practical strategy.(pdf) UN MIllenium Project. Task Force on Environmental Sustainability 2005. Earthscan. (sivu 89/109 Air pollution)
(3) The World Bank. 2003. Environmental Health.
(4) WHO 2003. Protecting our children.
maanantai 23. marraskuuta 2009
tiistai 10. marraskuuta 2009
Infectious diseases - and how to prevent those?
Malaria is an infectious disease that is widely concentrated on the specific geographical areas. Nevertheless, it affects more than 50 % of the world’s population and in the area of tropical Africa there can be found 90% of the global malaria burden. (1) Let’s start with the good news: malaria can be prevented. Actually the main expedient in prevention is very simple; an insecticide-treated net can prevent the mosquitos that are exposing to malaria.(2) Other aids in prevention are indoor residual spraying and intermittent presumptive treatment during pregnancy, management of the environment to control mosquitos and health education.(1) Unfortunately, malaria is one of the most woeful diseases, because the prevention of it is possible, relatively cheap and easy and still millions of children are exposed to malaria because of the lack of education, funding and nets. Yes, education – the tiny vital word – is present here again. Without information people do not know the ways for prevention. In addition, when the nets are available, they need education of how to hang and use the nets.(2) With proper use malaria can be prevented.
I hope I could say that is all. But malaria is only one piece of the story of infectious diseases spreading in the world, concentrating on the developing countries, again. Other main infectious diseases, such as tuberculosis and HIV/AIDS, have at least as wide influences as malaria on the individuals and communities. (1) Together these infectious diseases caused an estimated 6 million deaths worldwide in 2004. (1)
HIV is affecting also the risk of other infectious diseases, for it causes an infection and as the infection progresses, the immune system becomes weaker, and the person becomes more susceptible to other infections. (3) So a person is more vulnerable for example for malaria.(4) Prevention of HIV/AIDS is one of the most demanding tasks, for it needs not only education but also the change of attitudes and cultural environment and legal and policy changes in many parts of the world. The methods for prevention are effective and mostly available: condoms and campaigns of behavioural change, harm reduction measures to limit spread in injecting drug users and antiretroviral protocols to reduce mother-to-child-contamination. (1) When we talk about HIV; we meet the inequality of sexes; in some cultures men have got the right to the have relationships with plenty of partners and thus they are prone to spread the infection to many partners. So, we could briefly just say that use of condoms and refusal of varying partners can prevent HIV/AIDS but it is clearly not so simple.
Tuberculosis is a disease that affects mostly to the poor and vulnerable populations and individuals. (1) Tuberculosis is connected to HIV, for it kills people with HIV and is more common among the populations having high prevalence of HIV. There is also a growing concern of multidrug resistant tuberculosis in the world. (1) WHO recommends directly observed therapy strategy (DOTS) that should be available for every patients with standard care. One necessary step in prevention of these diseases is strengthening of health systems at local and national level. In addition, increasing the number of health care specialists, including pharmacists and pharmacy technicians, is necessary. We should also be able to guarantee public funding as well as the strategies for prevention of each disease at the local level, each country should be leading the process inside the country. (1) These are wide and demanding actions. But definitely worth it.
Anu
References:
(1) 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. (pdf) The Lancet, Vol. 365 (12), 618-621.
(2) Red Cross and Red Crescent 2008: Malaria Prevention Campaign.
(3) WHO Health Topics: HIV/AIDS
(4) UN Millenium Campaign, Goal 6: Combat HIV/AIDS.
I hope I could say that is all. But malaria is only one piece of the story of infectious diseases spreading in the world, concentrating on the developing countries, again. Other main infectious diseases, such as tuberculosis and HIV/AIDS, have at least as wide influences as malaria on the individuals and communities. (1) Together these infectious diseases caused an estimated 6 million deaths worldwide in 2004. (1)
HIV is affecting also the risk of other infectious diseases, for it causes an infection and as the infection progresses, the immune system becomes weaker, and the person becomes more susceptible to other infections. (3) So a person is more vulnerable for example for malaria.(4) Prevention of HIV/AIDS is one of the most demanding tasks, for it needs not only education but also the change of attitudes and cultural environment and legal and policy changes in many parts of the world. The methods for prevention are effective and mostly available: condoms and campaigns of behavioural change, harm reduction measures to limit spread in injecting drug users and antiretroviral protocols to reduce mother-to-child-contamination. (1) When we talk about HIV; we meet the inequality of sexes; in some cultures men have got the right to the have relationships with plenty of partners and thus they are prone to spread the infection to many partners. So, we could briefly just say that use of condoms and refusal of varying partners can prevent HIV/AIDS but it is clearly not so simple.
Tuberculosis is a disease that affects mostly to the poor and vulnerable populations and individuals. (1) Tuberculosis is connected to HIV, for it kills people with HIV and is more common among the populations having high prevalence of HIV. There is also a growing concern of multidrug resistant tuberculosis in the world. (1) WHO recommends directly observed therapy strategy (DOTS) that should be available for every patients with standard care. One necessary step in prevention of these diseases is strengthening of health systems at local and national level. In addition, increasing the number of health care specialists, including pharmacists and pharmacy technicians, is necessary. We should also be able to guarantee public funding as well as the strategies for prevention of each disease at the local level, each country should be leading the process inside the country. (1) These are wide and demanding actions. But definitely worth it.
Anu
References:
(1) 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. (pdf) The Lancet, Vol. 365 (12), 618-621.
(2) Red Cross and Red Crescent 2008: Malaria Prevention Campaign.
(3) WHO Health Topics: HIV/AIDS
(4) UN Millenium Campaign, Goal 6: Combat HIV/AIDS.
torstai 5. marraskuuta 2009
Maternal and child mortality
Maternal mortality is such a rare term in Western countries that we often forgot that it even exists. It is remarkable, that worldwide, a woman dies every minute due to complications during pregnancy and childbirth , which makes more than 500 000 women per year (1). In developing countries, pregnancy and childbirth are actually the second leading causes of death among women of reproductive age after HIV and AIDS. (1). Factors associated more often with maternal mortality are usually preventable: severe bleeding, infections, hypertensive disorders (pre-eclampsia and eclampsia), unsafe abortion, and obstructed labour. (1) If health care system had enough facilities, most of these problems could be avoided. After childbirth mother can get fever, anaemia, fistula, incontinence, infertility or depression (1) and these factors increase the risk of other diseases and death. Adolescent pregnancies are a risk factor, too. Even the fact that there could be a trained midwife, nurse or doctor during childbirth available, could reduce the risk of maternal and new born baby deaths.
Maternal health also influences the health of a child, but there are also other threats for children, both environmental, social and many of these are connected with the conditions. Nearly 10 million children under the age of five die each year (2) and this is enormous amount of living years lost. The main reasons for the child mortality are pneumonia, diarrhoea, malaria, measles and HIV (2,3). In addition, malnutrition contributes to more than half of all child deaths (3). At first we shall concentrate on malnutrition, for approximately 20 million children under five year old worldwide are severely malnourished and malnutrition is connected with so many diseases. (3) Malnutrition may increase the risk of many diseases and lead to child death. In developing countries around three-quarters of malnourished children could be treated with "ready-to-use therapeutic foods" (3), which would be ideal food and also ideal for the conditions where hygienic level is not so good.
For many of these diseases causing child mortality the prevention and treatment could be even easy if the society had enough facilities and funding. For example, in pneumonia, antibiotics and oxygen treatment are essential (2,3) and still not available in many parts of the world. Diarrhoeal diseases are a leading cause of sickness in many developing countries and these could be prevented/treated with, for example, exclusive breastfeeding and use of oral rehydration salts (ORS).(3) For malaria, vaccinations are pretty uncommon in developing countries, but the use of insecticide nets and treatment with anti-malaria medication may be essential. (3) It is also surprising that even 90% of children with HIV are infected through mother-to-child transmission (3). This could also be prevented by certain manners and antiretroviral drugs. New born babies are most fragile: almost 40 per cent of all under-five deaths occur during the neonatal period, the first month of life, from a variety of complications. (3) Frequent check-ups after delivery and good hygienic condition could prevent or to help get faster treatment for inflammation diseases that are common in new born babies in developing countries.
Are there any similarities in reduction of child and maternal mortality? There certainly are. For example poverty increases the risk of both.(1, 3) Living in rural areas is a risk factor for both, respectively. (3) It is interesting to see that here we meet the familiar term, education, again. It is assumed that maternal education is a very important factor for child`s health, while an educated mother is more likely to know, for example, the benefits of breastfeeding, things concerning malnutrition and treatment of diarrhea and the importance of family planning.(4) In countries, where the maternal mortality rate is high, child mortality rate is also high so these deaths accumulate into same areas in the world. In addition, the same efforts could prevent both. Education, as already mentioned, better functioning health care systems, elimination of poverty, better hygienic conditions, clean drinking water, check-ups for a mother during pregnancy and for a child during early age, enough qualified health workers - the list is endless. There certainly are things that could be done to eliminate this huge problem in developing countries.
References:
1.WHO 2008. 10 Facts on maternal health.
2.WHO 2008. What are the key health dangers for children?
3.WHO 2008. 10 Facts on child health.
4.UNICEF 2008. Why are millions of children and women dying?
Maternal health also influences the health of a child, but there are also other threats for children, both environmental, social and many of these are connected with the conditions. Nearly 10 million children under the age of five die each year (2) and this is enormous amount of living years lost. The main reasons for the child mortality are pneumonia, diarrhoea, malaria, measles and HIV (2,3). In addition, malnutrition contributes to more than half of all child deaths (3). At first we shall concentrate on malnutrition, for approximately 20 million children under five year old worldwide are severely malnourished and malnutrition is connected with so many diseases. (3) Malnutrition may increase the risk of many diseases and lead to child death. In developing countries around three-quarters of malnourished children could be treated with "ready-to-use therapeutic foods" (3), which would be ideal food and also ideal for the conditions where hygienic level is not so good.
For many of these diseases causing child mortality the prevention and treatment could be even easy if the society had enough facilities and funding. For example, in pneumonia, antibiotics and oxygen treatment are essential (2,3) and still not available in many parts of the world. Diarrhoeal diseases are a leading cause of sickness in many developing countries and these could be prevented/treated with, for example, exclusive breastfeeding and use of oral rehydration salts (ORS).(3) For malaria, vaccinations are pretty uncommon in developing countries, but the use of insecticide nets and treatment with anti-malaria medication may be essential. (3) It is also surprising that even 90% of children with HIV are infected through mother-to-child transmission (3). This could also be prevented by certain manners and antiretroviral drugs. New born babies are most fragile: almost 40 per cent of all under-five deaths occur during the neonatal period, the first month of life, from a variety of complications. (3) Frequent check-ups after delivery and good hygienic condition could prevent or to help get faster treatment for inflammation diseases that are common in new born babies in developing countries.
Are there any similarities in reduction of child and maternal mortality? There certainly are. For example poverty increases the risk of both.(1, 3) Living in rural areas is a risk factor for both, respectively. (3) It is interesting to see that here we meet the familiar term, education, again. It is assumed that maternal education is a very important factor for child`s health, while an educated mother is more likely to know, for example, the benefits of breastfeeding, things concerning malnutrition and treatment of diarrhea and the importance of family planning.(4) In countries, where the maternal mortality rate is high, child mortality rate is also high so these deaths accumulate into same areas in the world. In addition, the same efforts could prevent both. Education, as already mentioned, better functioning health care systems, elimination of poverty, better hygienic conditions, clean drinking water, check-ups for a mother during pregnancy and for a child during early age, enough qualified health workers - the list is endless. There certainly are things that could be done to eliminate this huge problem in developing countries.
References:
1.WHO 2008. 10 Facts on maternal health.
2.WHO 2008. What are the key health dangers for children?
3.WHO 2008. 10 Facts on child health.
4.UNICEF 2008. Why are millions of children and women dying?
keskiviikko 28. lokakuuta 2009
Education – does it really save the World?
Education is a privilege that we in developed countries easily keep as a matter of course our duty. Well, it is a duty, too, but when we dissect the situation for example in literacy and primary school attendance worldwide, we find that it certainly is a privilege. There are millions of children in our world who have no possibilities to study, no possibilities to learn to read or go even to primary school, to have an education. There are also remarkable differences in education between countries. Briefly you could say that the poorer the country, the worse are the possibilities to study and have an education. That is naturally because the lack of facilities in school system and logistical problems, but also because poor families have to use their children as labour and thus they are prevented to study. This is one of the vicious circles that poverty is causing: when you do not study, you will never be able to catch higher social status and that encourages the poverty to blossom.
Nevertheless, I think investing in education is also a matter of system and cultural habits. In some countries, even though the lack of funding is present, the will to maintain good education and an attitude that education makes our future is saving a lot. For example in former Soviet Union countries, Kazakhstan and Tajikistan, the literacy rate of youth is 100, even though the countries are not very wealthy (Unisef 2008). So when there is a will, there is a way, I guess. And when there is already education about the importance of education, people are possible to maintain good education regardless of lack of funding. The battle goes on.
Table of the state of world`s children (Unisef 2008) clearly presents the differences between countries in our world. It is surprising, that the problems of education are partly clustered into some continents. For example African countries, excluding the North Africa, show to have much lower literacy rate of youth and also the enrolment rate of primary school. On the other hand, if you compare the state of poverty in African countries to the one in former Soviet Union countries, it is natural that situation is much more difficult in Africa. There are more wars, starving, worse agricultural possibilities, larger families and rare poverty. For example in Somalia only 24 % of boys and 20 % of girls are attending primary school and under 8 % and 4 % are attending secondary school, respectively. The table shows also that especially in African countries and in South Asia there is a great difference in literacy rate between genders (Unisef 2008). Boys have better chances to study, even in the 21th century. We cannot see this same phenomenon between Latin America and Caribbean, Europe, East Asia or Pacific; the gender differences in education do not luckily exist. Is it the culture or religion or prejudices? And more interestingly; what to do to change this climate? It is funny to notice that the answer to the problem is the same as the problem: education.
The same table (Unisef 2008) also shows the number of phones and internet-users on each country. The differences are remarkable: industrialized countries predictably are shining in the top place. This can be a sign of positive vicious circle: the more you have equipment to study and find information, the easier it is for you to study and maintain good education and general knowledge. How to share education to everybody? How to guarantee the equal possibilities to have an education? Should we first eliminate poverty or which comes first? I don`t know - meanwhile we at least need to educate.
References:
Unicef. The state of the world´d children; table; 2008.
Education is a privilege that we in developed countries easily keep as a matter of course our duty. Well, it is a duty, too, but when we dissect the situation for example in literacy and primary school attendance worldwide, we find that it certainly is a privilege. There are millions of children in our world who have no possibilities to study, no possibilities to learn to read or go even to primary school, to have an education. There are also remarkable differences in education between countries. Briefly you could say that the poorer the country, the worse are the possibilities to study and have an education. That is naturally because the lack of facilities in school system and logistical problems, but also because poor families have to use their children as labour and thus they are prevented to study. This is one of the vicious circles that poverty is causing: when you do not study, you will never be able to catch higher social status and that encourages the poverty to blossom.
Nevertheless, I think investing in education is also a matter of system and cultural habits. In some countries, even though the lack of funding is present, the will to maintain good education and an attitude that education makes our future is saving a lot. For example in former Soviet Union countries, Kazakhstan and Tajikistan, the literacy rate of youth is 100, even though the countries are not very wealthy (Unisef 2008). So when there is a will, there is a way, I guess. And when there is already education about the importance of education, people are possible to maintain good education regardless of lack of funding. The battle goes on.
Table of the state of world`s children (Unisef 2008) clearly presents the differences between countries in our world. It is surprising, that the problems of education are partly clustered into some continents. For example African countries, excluding the North Africa, show to have much lower literacy rate of youth and also the enrolment rate of primary school. On the other hand, if you compare the state of poverty in African countries to the one in former Soviet Union countries, it is natural that situation is much more difficult in Africa. There are more wars, starving, worse agricultural possibilities, larger families and rare poverty. For example in Somalia only 24 % of boys and 20 % of girls are attending primary school and under 8 % and 4 % are attending secondary school, respectively. The table shows also that especially in African countries and in South Asia there is a great difference in literacy rate between genders (Unisef 2008). Boys have better chances to study, even in the 21th century. We cannot see this same phenomenon between Latin America and Caribbean, Europe, East Asia or Pacific; the gender differences in education do not luckily exist. Is it the culture or religion or prejudices? And more interestingly; what to do to change this climate? It is funny to notice that the answer to the problem is the same as the problem: education.
The same table (Unisef 2008) also shows the number of phones and internet-users on each country. The differences are remarkable: industrialized countries predictably are shining in the top place. This can be a sign of positive vicious circle: the more you have equipment to study and find information, the easier it is for you to study and maintain good education and general knowledge. How to share education to everybody? How to guarantee the equal possibilities to have an education? Should we first eliminate poverty or which comes first? I don`t know - meanwhile we at least need to educate.
References:
Unicef. The state of the world´d children; table; 2008.
keskiviikko 14. lokakuuta 2009
Poverty and health - what they have to do with other?
“Structural violence” – a brilliant fresh term to the phenomenon I have understood earlier but never really thought about its consequences through before. Farmer et al (2006) introduced this term to me and enlightened how structural violence is connected to both public health and clinical medicine. Structural violence is not a new discovery, not even a new concept, though it has been developed already in 1960s by Johan Galtung and liberation theologians. They described structural violence as social structures, including every field of our life – that eliminate individuals, groups and societies from reaching their full potential. (Galtung et al. 1969). These structures are acting as supporting things in our everyday life but actually they work as a social machinery of oppression to some of us – who usually are not the richest and self-supporting ones. Poverty is one manifestation of structural violence. I have always known that poverty causes diseases through unfavorable living conditions and makes it more difficult to treat diseases especially because of the high costs of modern medicines. But I have never before really thought about how deep and wide-ranging the effects really are. The article by Farmer et al (2006) enlightened the phenomenon really clearly: if we want to affect the structural violence and poverty, we really have to go to the grassroots. We have to bring the health services close to the patients or at least facilitate the patients to come to the treatment (paying for transportation costs, for example), we need to answer to the social and economical need of them, we need to educate people in their own level and courage to achieve their own links and support nets (accompagneteurs, for example). In a word: we have to make sure that nothing within the medical system or the surrounding community stops poor people from getting the standard of care. That is struggling against structural violence about.
The other fascinating concept I want to introduce here and which is highly connected to structural violence is “social disease”. Good example of social diseases is AIDS. AIDS is considered as a social disease – it is just highly varying why clinicians and people in health care think it is a social disease. As Farmer (2006) describes, many doctors thinks AIDS is a social disease due to the behaviors and lifestyle that influence the disease or the risk of it. But could it be that the social background of this disease and its consequences is also wider? It has been found that when a person gets HIV the course and outcome of that disease varies a lot according to the social factors, such as poverty. Actually in many cases the social factors have such a great effect that the course and prognosis of the disease has got only a little do with the universal pathophysiology of that disease (Farmer et al 2006). If we could change the direction of those social factors, we may be able to affect the disease itself. A huge possibility!
Well, what stops us, why do we not utilize the effects of social factors? At first, we people in medical area and health care are not used to the idea that we could affect this kind of things. Also, even though we would, there could be some external moderators. As Farmer (2006) also demonstrated, the greatest opposition against struggling with structural violence is does not come from the patients – not the rich or the poor ones – but from the structure itself. For example, if we want to prevent mothers from contaminating their babies with HIV, we need to educate them with proper manners. Nevertheless, in Rwanda, where the local intervention took place, these local and global health policy makers were the most difficult to get co-operate and get rid of the old, harm-causing manners (Farmer et al. 2006).
Poverty has got so strong roots concerning health. Poverty causes hunger, hunger makes people sick, sickness steals their working ability, they become unemployed, they do not get education, and these factors fortifies poverty. A vicious circle that is hard to cut down. Everything is about inequality. In Finland we may not even see the real meaning of structural violence, for we have such a functional health care system which is not based on the insurances as in many other countries. Nevertheless, we can also see the inequality here and notice that health problems are gathered to the people in the lower socio-economic status – even though we cannot really talk about poverty here. Social diseases have social root. And social diseases should also have social treatments, I think.
References:
Farmer PE, Nizeye BN, Stulac S, Keshavjee S. Structural Violence and Clinical Medicine. PLoS Medicine 2006;3(10):0001-0005.
Galtung J. Violence, peace and peace research. J Peace Res. 1969;6:167-191.
The other fascinating concept I want to introduce here and which is highly connected to structural violence is “social disease”. Good example of social diseases is AIDS. AIDS is considered as a social disease – it is just highly varying why clinicians and people in health care think it is a social disease. As Farmer (2006) describes, many doctors thinks AIDS is a social disease due to the behaviors and lifestyle that influence the disease or the risk of it. But could it be that the social background of this disease and its consequences is also wider? It has been found that when a person gets HIV the course and outcome of that disease varies a lot according to the social factors, such as poverty. Actually in many cases the social factors have such a great effect that the course and prognosis of the disease has got only a little do with the universal pathophysiology of that disease (Farmer et al 2006). If we could change the direction of those social factors, we may be able to affect the disease itself. A huge possibility!
Well, what stops us, why do we not utilize the effects of social factors? At first, we people in medical area and health care are not used to the idea that we could affect this kind of things. Also, even though we would, there could be some external moderators. As Farmer (2006) also demonstrated, the greatest opposition against struggling with structural violence is does not come from the patients – not the rich or the poor ones – but from the structure itself. For example, if we want to prevent mothers from contaminating their babies with HIV, we need to educate them with proper manners. Nevertheless, in Rwanda, where the local intervention took place, these local and global health policy makers were the most difficult to get co-operate and get rid of the old, harm-causing manners (Farmer et al. 2006).
Poverty has got so strong roots concerning health. Poverty causes hunger, hunger makes people sick, sickness steals their working ability, they become unemployed, they do not get education, and these factors fortifies poverty. A vicious circle that is hard to cut down. Everything is about inequality. In Finland we may not even see the real meaning of structural violence, for we have such a functional health care system which is not based on the insurances as in many other countries. Nevertheless, we can also see the inequality here and notice that health problems are gathered to the people in the lower socio-economic status – even though we cannot really talk about poverty here. Social diseases have social root. And social diseases should also have social treatments, I think.
References:
Farmer PE, Nizeye BN, Stulac S, Keshavjee S. Structural Violence and Clinical Medicine. PLoS Medicine 2006;3(10):0001-0005.
Galtung J. Violence, peace and peace research. J Peace Res. 1969;6:167-191.
torstai 8. lokakuuta 2009
Why it is important to consider health at the global level?
Straight to the question: I see that health is a basic human right and every time when we talk about human rights we have to take the whole global context into account. Human rights are the basic elements of humanity and wellbeing. Nevertheless, as well as regarding to other human rights, certain health difficulties have focused into certain areas and possibilities to maintain health are very unequal in different global areas.
Thus, I see this is mainly an ethical question. We here in developed countries have a responsibility to chare those financial, equipmental and information sources to balance the gab between countries and areas. As Ilona Kickbusch (2002) is saying: "Its (meaning global health) goal is the equitable access to health in all regions of the globe".
While I see this mainly as an ethical thing, I often think it is so sad that we in Westerns countries really do not understand the truth of global world untill it is seen as a threat to us. For example pollution problem, toxic substances and unsafe goods and products seems to be no problem to us as long as they stay on the other side of the world. Somehow it is so sad that we see a swine flu as a huge global threat now when it is really affecting Western countries, even though the death rates show that disease is really a tinpot in a global point of view. Contrary, we have not done our best to prevent diarrhea in children of developoing countries, even though the death rates of this disease are certainly higher. Idea of global health demands motivation to come out of the own dear nest and see more widely and more open-hearted. For the best of all of us.
Health should bee seen as a global issue also because alone we are unable to achieve anything, not even the local good, for this world is already globalized. We need reorientation in policy and strategy, as well as massive political and financial commitment in both developed and developing countries (Kickbusch 2002). But I hope that the great source of motivation for this would not be the self-indulgent one but the one that sees that we all need health, even though we have unequal possibilities fot that in global context.
Thus, I see this is mainly an ethical question. We here in developed countries have a responsibility to chare those financial, equipmental and information sources to balance the gab between countries and areas. As Ilona Kickbusch (2002) is saying: "Its (meaning global health) goal is the equitable access to health in all regions of the globe".
While I see this mainly as an ethical thing, I often think it is so sad that we in Westerns countries really do not understand the truth of global world untill it is seen as a threat to us. For example pollution problem, toxic substances and unsafe goods and products seems to be no problem to us as long as they stay on the other side of the world. Somehow it is so sad that we see a swine flu as a huge global threat now when it is really affecting Western countries, even though the death rates show that disease is really a tinpot in a global point of view. Contrary, we have not done our best to prevent diarrhea in children of developoing countries, even though the death rates of this disease are certainly higher. Idea of global health demands motivation to come out of the own dear nest and see more widely and more open-hearted. For the best of all of us.
Health should bee seen as a global issue also because alone we are unable to achieve anything, not even the local good, for this world is already globalized. We need reorientation in policy and strategy, as well as massive political and financial commitment in both developed and developing countries (Kickbusch 2002). But I hope that the great source of motivation for this would not be the self-indulgent one but the one that sees that we all need health, even though we have unequal possibilities fot that in global context.
It is always a cool feeling to learn something new...
Hello, you all. My nime is Anu Ruusunen and I will share with you this fabulous trip to the world full of global health issues. Let`s have an interesting trip.
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