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.

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.

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.

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.