Agua para todos - Water for all

Luo

With the humanitarian aid given by Solidaarisuus there has been distribiuted water almost to 10 000 house holds in Somaliland which suffrers from bad droughts. Nevertheless, famine, incrising prices of water and  infant mortality are going to treathen if the draught is continuing for much longer. (Solidaarisuus 2008.) 

Inequality in access to natural resources is shockingly large between the developing and the developed countries and communities. The most of the natural resources are in hands of the richest people and the poor are left with almost nothing. In the last decades the actions of the industrialized countries have led the world in the verge of destruction and the poorest are the ones to suffer the most of the consequences. Natural hazards, draught, floods, loss of crop and insecurity in life are just some o the examples that Global warming is causing in several countries. The WHO estimates that the over quarter of health problems is due to air, water, soil and food and that the biggest burden of these goes to the poor and vulnerable communities. (McMichael A.J et al. 2008.)

Sustainability is the word in the lips of all: How to provide sustainable development, healthy, more equal and better life for all without risking the economic growth and the future of the globe. Unfortunately many of the policies  mainly concentrate on assuring the sustainability of economical development and leave aside the policy making that would better facilitate sustainable progress of nation (such as education, gender equality, health services, evenly divided access to resources and equal opportunities for all). 


If you wish to read more about NGO's and sustainable development projects, here are some very interesting link by BBC. This challenge shows a different kind of way of influencing people and making them to participate. BBC chose 10 countries which has had successful development projects ran by small NGO's and people have been able to vote their favourite among them. There are projects from almost all the continents and each project has a video. Also Peru is involved in this competition by a successful rural agriculture project. Also rain water harvesting project in Mexico City, development project with the Maya population in Guatemala, project of protecting Coral reefs in Madagascar or generating ecological electricity in Rwanda are included in the challenge

 World Challenge 10 - Pass it On. BBC's challenge for sustainable development

Picture by: BBC News, 2007a.

Peru is not one of the countries that is suffering of bad droughts due to the global warming., however the country is an urgent need of water. The country is known for the Andean mountains and glaciers, which have a huge importance for the country's water supplies and ecology. Peru has the largest number of tropical glaciers in the world and these water towers are crucial for slowly releasing water, particularly in the dry season. Peru desperately needs the water all year round. Al Gore's film about global warming "An Inconvenient Truth" revealed this side of the Peruvian water sheds and rang an alarm in that could not be ignored by to authorities. The capital of Peru, Lima is built in a desert and hardly ever recieves any rainfall. The city has a large deficit between  supply and demand. Most fo the people live in the Pacific coast with only 2% of the water supply on the country. Andes have the 98% of the water supply, but only quarter of the population live in the Andean mountains. Now this water flow in being treathened by the  global warmiang and the shrinking glaciers. (BBC News, 2007a)   

In Peru also 3,3 million people living in rural areas don't have access to potable water and 6,2 million people are lack of proper sanitation and water in their house holds. This is not so much because of the  lack of water, but due to the bad distribution of water. In the outskirts of Lima many people live in shantytowns, without proper housing or potable water. Most of the people living in these areas were forced to move from the "sierra", the Andean mountains due to the heavy terrorism in the 80's and 90's. In these areas people most  of the family's have a bucket of water to use for all together, just the tiny bit of the amount that we use in the daily basis. (BBC News, 2007b)  In the reasent years the Peruvian state has launched a programme to help this situation especially in the rural areas - "Agua para todos rural".  This programme is trying to decrease the effects of the bad water quality and lack of sanitation which causes illnesses and diarrhea for many people living in rural areas or shanty towns by creating better water distribution policies and by building a proper infrastructure for water distribution. The programme has been estimated to benefit about 34 993 people living in Lima, 39 640 people living in Amazonas, 65 759 living in Piura (among many other states or cities). (Agua para todos, 2010.)  

Zona I, Huaycán, Shanty town in Peru, Lima. Picture by Chascona 

The problems in the governmental development projects  often seem to be the top-down approach, the corruption,  the lack of knowledge by the policymakers to identify themselves with the populations that have got less opportunities. The politicians build stairways to facilitate people to climb up to the mountainous areas in shantytowns and big fuzz is made about the act.  But are the stairways really the most important thing that people need? Would it not be better to concentrate in creating jobs, giving quality education and empowering people? That way more opportunities would be created and people would have more influence on their own lives. Building stairways and expecting people to be grateful for that seems to be under-re-estimating people. A down-top or participatory approach would be necessary, as well as grass root empowerment so that people would feel that they have a say about their lives and that they can influence on their futures. It should be necessary also finally to start appreciating the native populations, since they are mostly excluded from the policy making. Does the country really not understand how much potential the people would have as long as indigenous populations and women would be better respected and empowered?      

Picture by: BBC News 2007b.

Sources: 

• Agua para todos, 2010. Programa nacional para agua y saneamento. URL:  http://www.vivienda.gob.pe/pronasar/
• BBC News, 2007a. Peru's Alarming water truth. URL: http://news.bbc.co.uk/2/hi/americas/6412351.stm
• BBC Nws, 2007b. Perú: glaciares en peligro de extinción. URL: http://news.bbc.co.uk/hi/spanish/specials/2007/clima/newsid_7071000/7071780.stm
• McMichael, A.J., Friel, S., Nyong, A. & Corvalan, C. 2008. Global environmental change and health: impacts, inequalities, and the health sector. British Medical Journal 336, 191-194.
• Melnick, 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.
• The World Bank. 2003. Environmental Health

Pictures: 

• Solidaarisuus, 2008. URL: http://solidaarisuus.fi/x43=25467 
• BBC News, 2007a. Peru's Alarming water truth. URL: http://news.bbc.co.uk/2/hi/americas/6412351.stm
• BBC Nws, 2007b. Perú: glaciares en peligro de extinción. URL: http://news.bbc.co.uk/hi/spanish/specials/2007/clima/newsid_7071000/7071780.stm

Infectious deseases

Picture by: Doctors Without Borders



Fighting Malaria is the sixth Millennium Development Goal of UN.  Malaria is an infectious disease transmitted by the mosquitoes. Malaria causes more than 1 million deaths every year mainly among children who are under five years old. Malaria affects specially people’s lives in tropical Africa, where many people don’t have the necessary income to prevent the infection. (Ruxin, J., Paluzzi, J., Wilson, P., Tosan, Y., Kruk, M. & Teklehaimanot, A. 2005.) The typical symptom of malaria is a violent fever lasting 6 - 8 hours, recurring every two or three days. Malaria is the world's worst health problem; at the moment more people are ill with malaria than with any other disease.  (WHO.) In the risk group are specially children who suffer of undernourishment or other disease. Also pregnant women, people infected by HIV/AIDS and people suffering from other illnesses are in a risk group. People who live in rural areas  without an access to health services and are very poor are the most likely to be effected by the illness. Malaria does not only cause deaths, but also influences on the economy and income of families and nations. The question is: why is there not a vaccine for malaria?  Is it because it does not influence on the lives of the people living in industrialized world, but the  people living in poor countries which do not have the influence in world's economy neither the capital to start large-scale actions? Malaria is also very bad problem in countries that suffer of ongoing armed conflicts  or corruption and that often use more money on arms than on the health care.         

Picture by: WHO.

The main actions to prevent malaria are:

• Bed nets to prevent mosquito bites in tropical areas.
• Indoor residual spraying.
• Presumptive treatment during pregnancy.
• Early diagnosis and effective interventions.
• Treatment with antimalarials.
• Management of the environment to control mosquitoes.
• Health education to population who is in risk to malaria infection.
• Policy making toward better health care in regional and national level. 

(Ruxin, J. et al. 2005.)

Almost 40 million people are infected by HIV/AIDS. Sub-Saharan Africa is the region that bears the worst consequences of the disease. Millions of people die every year, millions of children get infected by HIV/AIDS and many children remain orphans as a result of the illness.The disease also influences on the socio-economical part of people's lives and nations remain without strong work force because of the high level of HIV positive patients among the young population. HIV infections are rapidly growing also in Russia, China and India. (Ruxin, J. et al. 2005.)  

Tuberculosis is a leading killer of people with HIV/AIDS. Approximately 2 million people died of tuberculosis in 2004 and 4 million was infected. Tuberculosis influences the hardest of the poorest populations lives and up to 80% of the people infected by tuberculosis are HIV/AIDS patients. The global control of tuberculosis has failed and new actions should be taken.

One of the main reasons that the epidemics have grown so rapidly and are mainly affecting the people  in  developing countries is the reason that almost two billion people have inadequate access to life-saving medicine. (Ruxin, J. et al. 2005.)

The most effective ways to prevent HIV/AIDS are to use the condoms and campaigns to change the behaviors of people. Investing in health systems would also be required, qualified health staff and access to quality health care are essential as also access to affordable medical care. As we discussed earlier in section about the Poverty and Health  in Ruanda and Haiti there have been some successes with the community based support system to HIV/AIDS patients, where the health personnel goes to people's homes in rural areas and  support person in chosen among the community. 

Also changing peoples cultural related behavior is very important. In some countries. In Malawi, for instance, some women get infected by the reproductive rituals after they have lost their husband. Furthermore, mother's infected by HIV do not  always take the necessary actions to prevent their children from the infection, because they would be stigmatized by the community. Furthermore, by preventing HIV/AIDS infections also the number of people infected by tuberculosis. There is a crucial interconnection between these two illnesses.

To conclude the necessary actions are:    

• HIV testing and counselling.
• Antiretroviral therapy.  
• Invest on human resources (such as pharmacist and qualified health care).
• Create safety nets for people with HIV/AIDS.
• Improve the basic health care system and train community health workers.
• Improve access to education and promotion of gender equality.
• Fighting poverty and corruption.
• Better health policies and global cooperation to fight HIV/AIDS.
• Long term planning in global, in national and in local level.   

(Ruxin, J. et al. 2005.)   

 

Sources:

• Ruxin, J., Paluzzi, J., Wilson, P., Tosan, Y., Kruk, M. & Teklehaimanot, A. 2005. URL: Emerging consensus in HIV/AIDS, malaria, tuberculosis, and access to essential medicines 
• WHO. URL:  http://www.emro.who.int/rbm/AboutMalaria-QuickOverview.htm
• WHO Fact sheets: Malaria, 10 Facts on Malaria.
• WHO Fact sheets: Tuberculosis, 10 Facts about Tuberculosis.
• WHO Health Topics: HIV/AIDS.

Pictures:

• Doctors Without Borders 2010. URL:  www.doctorswithoutborders.org
• WHO 2010. URL: http://www.emro.who.int/rbm/AboutMalaria-QuickOverview.htm

Maternal and Child health

• Maternal mortality: the women who die during their pregnancy for reasons related to maternal health or women who die because of complications occurred during child birth (such as severe bleeding, infections, or unsafe abortion.) Many women also stay stigmatized by birth related illnesses such as fistula. (WHO 2008a)

• Child mortality: the children who die under the age of five. In order to have good chances to live a child would need a quality care during pregnancy and birth. After the birth the crucial things for children´s survival are sanitation, potable water and nutrition. (WTO 2008b)




Mother and Child. Picture by: Bixby center, University of California.

The key fact in maternal and child mortality is not the diarrhea, AIDS or the under qualified health personnel. The key is the importance that the societies give to women and children to their survival. The key is that the societies will decide that saving women´s lives is beneficial enough and by that saving women´s lives also millions of children´s lives will be saved. Some specialists of the public health field state that, if as many men (as women) would die each year for easily avoided causes, the societies and the field of international development cooperation would make much more actions and put much more money in order to solve this injustice. Around 99% of the deaths of women dying giving birth occurred in developing countries (and most of them in Africa). In 2005 WTO estimated that 536 000 women died during pregnancy or giving birth. While child mortality has dropped during the last years the estimation of women dying for pregnancy or child birth has been the same almost for 30 years. (Nicholas D. Kristoff & Sheryl WuDunn 2010)

In 2008 8.8 million children born alive died before their fifth birthday. Most of the children die for illnesses that could easily be prevented by good care, suitable living conditions and proper care. Mainly the reason for under-five deaths is poverty; the families cannot simply afford medicine, healthcare and proper alimentation. The gap in maternal and child mortality is huge between the rich and the poor countries. Some estimations state that 75% of the under-five deaths occurred only in 18 countries, among them India, Nigeria, The Democratic Republic of Congo, Pakistan and China. (Childinfo 2008a) Some of the countries in the list have suffered or still suffer from ongoing armed conflicts which do not favor child protection. (WTO 2008c)

Some of the main reasons for maternal and child mortality in developing countries:

• The lack of basic education and gender equality. As it was discussed in our last task; too many girls don´t have access to education or they are not allowed to attend school. Education as also very much linked to health issues and to the number of children women want to have. Lack of gender equality on the other hand also does not allow the women´s voice to be heard in some societies and people justify this inequality by tradition or cultural reasons. But can deaths really be justified by tradition?

• Lack of access to quality health care and the lack of skilled health personnel, especially in the rural areas. Many of the pregnant women in rural areas in Sub-Saharan Africa and South Asia don´t get medical care during their pregnancy and or maternal education. This means lower chances for the mother´s and child´s survival.

• HIV/AIDS is also an important factor, especially in Sub-Saharan Africa. Most of the children living with HIV are infected by mother-to-child transmission and more than half of them die before their second birthday. (WHO 2008b) If HIV positive women don´t get appropriate health care and maternal education during their pregnancy the risk of infecting your child is much bigger. (WHO 2008a)

• Water, alimentation, environment and sanitation can cause illnesses that influence especially on child health. Most of the under-five deaths are caused by easily prevented illnesses such as pneumonia, diarrhea, malnutrition, malaria and measles. These illnesses could easily be avoided by proper care and good living condition, only that many families in developing countries living in poverty cannot afford proper care for their children. (WTO 2008b)

• Girls get married too young.  Also one of the reasons for high maternal mortality in Africa can also be the fact that many girls have to get married before their body is ready for pregnancy and child birth. Young wives and pregnant girls suffer more child birth related complications and die more often giving birth then adult women. (Nicholas D. Kristoff & Sheryl WuDunn 2010)

Some countries have put emphasis on the maternal and child health and have received good results. One of these countries is Sri Lanka that has managed to make a crucial change in the maternal mortality rates since 1935. Also Nepal has had very good results by giving vitamin-A to pregnant women. Vitamin-A lowered the risk of undernourished women to suffer for infections during their pregnancy. Also iodine has been shown to have an important role in the development of fetus, and in some developing countries the pregnant women have been given iodine during their pregnancy. These examples only show that sometimes the means can be often quite simple and cheap. (Nicholas D. Kristoff & Sheryl WuDunn 2010) Nevertheless, these examples don´t mean that access to education, good health care and fighting poverty would not be the most important steps in improving maternal and child health

As the UN states in one of their videos: “Maternal and child health is a question of priorities”. These priorities should start to be given right now. The lives of women and children are essential.

Sources:

•  Childinfo 2008a. Monitoring the situation of children and women. UNICEF  - Statistics by area / Child Survival and Health

 - Statistics by area / Maternal Healt. URL: http://www.childinfo.org/maternal_mortality.html
 - Statistics by area / Child Survival and Health. URL: http://www.childinfo.org/mortality_challenge.html

•  UNICEF 2008. Why are millions of children and women dying? URL: http://www.unicef.org/health/index_problem.html
•  WHO 2008b. 10 Facts on child health. URL: http://www.who.int/features/factfiles/child_health2/photo_story/en/index.html
•  WHO 2008a. 10 Facts on maternal health. URL: http://www.who.int/features/factfiles/maternal_health/maternal_health_facts/en/index.html
•  WHO 2008. 10 Facts about women's health. URL: http://www.who.int/features/factfiles/women_health/en/index.html
•  WHO 2008c. What are the key health dangers for children? URL: http://www.who.int/features/qa/13/en/index.html
•  Nicholas D. Kristoff & Sheryl WuDunn 2010, Puolikas Taivasta. Otavan kirjapaino Oy, (Julkaistu yhteistyossa Suomen UNIFEMin kanssa).

Picture:

• Bixby center, University of California, Berkeley. URL:  http://bixby.berkeley.edu/research/maternal-health/

Half the sky - Puolikas taivasta

I'm reading right now a very interestiong book about gender issues (also shockingly horrible with many facts and details) and it has also some chapters about the neglected field of maternal health, and that that women die mostly because the societies have not decided that their lives would be worth saving. I recommend the book for everybody who is interested in Gender & Development and in Public health.

The name of the book is: "Half the Sky. Turning Oppression into Opportunity for women Worldwide" 2009. By: Nicholas D. Kristof and Sheryl WuDunn.

Teos on  myös suomennettu nimellä: "Puolikas taivasta" 2010. Otavan kirjapaino Oy, Keuruu.

http://www.like.fi/kirjat/puolikas-taivasta

Education and health

Women participating a self-esteem workshop in Huaycán, Peru.

Education is considered to be the most powerful tool in reducing poverty, gender inequality and unequal social structures in the world. Education empowers and offers people tools for a brighter future. Education gives hope and helps people to live in peace with each other. Education is especially considered to have a greater influence amongst women as educating a girl or a woman can mean educating the whole village, reducing illnesses, child mortality rates and increasing participation in the society. No one can deny the great influence that education has got in people’s health and quality of life. However, there is also a lot of discussion that education should be culture sensitive, that the same western models should not be directly adapted to other continents, and that education should not only mean literacy and numeracy, since it can be quite a limited perspective to education. I think that non-formal education is also something that should also be seriously considered in developing processes, given that for many people living in developing countries it might be more accessible than the formal education. Non-formal education is many times offered by non-profits and NGO’s and which include in their educational policies the real needs of the individuals, when the formal education is many times strictly tied with the national policies. Nevertheless, also the formal education has immense influence on the individuals and nations wellbeing, at least when it is accessible for everybody. The table that I am going to analyse is based on the formal education process; the primary/secondary school attendance and literacy rates. (UNICEF 2008a).

Women participating a self-esteem workshop in Huaycán, Peru.

I also choose to do my analyse by exploring the differences within countries of each continent, since I think that because of the local realities; because of the historical, social and cultural reasons it’s more meaningful to analyse the table between countries that share similar kind of reality than for instance an African country compared with a country from another continent. I will not be able to analyse all the countries, so I choose just few countries and write about them briefly. In order to make some limitations I will also leave out the so called "North" and consentrate more on the "Southern" countries. However, I do not deny that there would be many things to improve in Europe or in the USA.

Asia

Asia shares such disparities within the continent that it makes it quite difficult to understand the differences in the access of education. On the other hand the differences can also help in explaining the varieties; some of these varieties can be ethnical, cultural, religious or political ones. In the table the first country is Afghanistan which of course shows very large gender inequality. Only 51% of the boys are literate, but the number of girls is shockingly low: 18%. In the case of Afghanistan the Taleban regime oppresses women very strongly and the rates can be explained by that. On the other hand Bangladesh doesn’t show such inequality between the boys and girls, even if it considered being one of the poorest countries of the world. However, the rates in general are low. China is a country with a strong economy and military power, at the same time the freedom of speech is very limited. Independently of that, the literacy and schooling rates are very good and show very little difference between men and women. Surprising after the education rates the number of internet users is very low, even if it could be explained by the lack of freedom of speech which is controlled by the nation. Nepal has a large difference between the genders and women’s literacy rate in 20% lower then men’s. In the last years there has been, however, positive change in under-five mortality rates, infant mortality rates and in reproductive health as a result of education process. (Unicef, 2010.) India in general shows quite a good young male literacy rates, but also there girls have a lot less access to education. India has got the fastest growing population in the world, so educating girls would be extremely important for the future. However, it seems difficult (but not impossible) to brake the tradition of the importance of the male in the society.

Latin America

Latin America is known for male chauvinism, discrimination against the indigenous populations and for the very large gap between the rich and the poor. Despite of that, some of the countries share almost the same living standards as the countries of the “North” (Chile being one example of that). Guatemala and Bolivia are one of the poorest countries in Latin America, but still the literacy rates seem to be fairly high. Guatemala has the biggest gap between the male and female literacy rates and in all the lowest of Latin America. Surprisingly, the disparity between the girls and boys does not show in the overall rates of the continent. However, the internet user rates seem to be fairly low compared to the literacy rates that is because many people just not have a possibility to use it or does not know how to do it. Guatemala and Bolivia also have the highest indigenous populations among the Latin American countries and that causes difficulties in the schooling process. The indigenous languages are often not taken into consideration in the formal school system; the children need to study in their second language and that may also lead into loosing their traditional culture and being ashamed of their roots. There is also another thing to take into consideration; as I mentioned before we should not only watch the literacy rates and the statistics, but also the quality of the education. In many countries which have high rates, the quality is still lacking and the disparities between the social classes are large. In Peru, for example, the literacy rates are high for both genders, but according the Worldfund in year 2007 Peru’s educational system was ranked 133rd out of 134 countries. Peru also spends less than three percent of its GDP on education and many of the teachers are not qualified. (Wordfund, 2010.)

Africa

According to the table Africa is the continent that in overall has the lowest rates in literacy, schooling and internet and mobile phone usage. Nonetheless, the difference between the Northern Africa and Sub-Saharan Africa is very large. As we all know Sub-Saharan Africa is many times referred as the area which most needs action in fighting the poverty, hunger and inequality. Many African countries gained their independence much later than many of the other colonized nations and has the continent suffered decades of wars, political restlessness and exploitation as ex-colonies of European countries. Not to mention the challenge of fighting the present HIV/Aids epidemic. Among the Sub-Saharan Africa Zimbabwe and South-Africa seem to have the highest literacy rates and almost no difference between the men and the women; however, compared to many other countries the use of mobile phone seems to be much higher in South Africa. The literacy rates are very low in Mali, Niger, Sierra Leone and Ethiopia (etc.) and also the access to education between boys and girls is extremely high. In some countries as Ethiopia the reason not to go to school for many children can be the infrastructure or the income of the family: the schools can be very far away and parents need their children to work for the living. Nevertheless, the gender issue is to be taken seriously and cannot only be explained by cultural issues. Uganda is often mentioned as an example of developing their school system. In year 1996 the president decided to remove the primary school fees for up to four children of one family (amongst them two were aught be girls). This is how the key obstacle was removed and the families were sent an important message. Since then the primary school attendance has increased by 20%, even if the attendance of the girls is still 10% lower. However, at the same time the quality of the education has suffered. (The World Bank, 2002.)

Pictures by Chascona


Sources:

• Worldfund 2010. URL: http://www.worldfund.org/Peru.html
• The World Bank 2002. URL: http://siteresources.worldbank.org/EDUCATION/Resources/Education-Notes/EduNotesUganda.pdf
• UNICEF 2010. URL: http://www.unicef.org/infobycountry/nepal_nepal_statistics.html
• UNICEF 2008. URL: http://www.unicef.org/sowc08/docs/sowc08_table_5.pdf 
• UNICEF 2008. Basic education and gender equality.
• - Education for all
• - The big picture
• The World Bank 2008. Education and Development.
• The World Bank 2008. Girls' education.

Poverty and Health

Poverty and ill-health are inseparable. (Dying for change, 2001) For centuries poverty has been connected to income, and it still remains in the core of the definition; a good health means the physical and mental well-being of a person, and poverty, when connected to health, is presented as a vicious-cycle of material lack/poverty, insecurity, bad social relations, physical weakness/illness and powerlessness. (Robert Chambers, 2002) Also lack of education, bad living conditions and political instability can be added to this list of root causes which easily leads to poor health. Poor heal causes medical costs, lowers the strength to work and the level of income. People loose their hope. I can only imagine how horrible it must be to see your children suffer because of something as essential and simple as malnutrition - lack of decent food and potable water. I can easily get medical help for the tiniest reasons, I can choose whether I want to have meat or fish for a lunch and I can choose between bottled or tap water, I can choose whether to deliver my child in a hospital or at home, but the poor have not been given any of these choices in their lives, the least of all to take care and to protect their basic needs and to take care of their families. A woman from Vietnam condenses the essence poverty and health:  

“Poor people cannot improve their health status because they live day by day, and if they get sick they are in trouble because they have to borrow money and pay interests.”

(Dying for change, 2001)   

And a man from Togo says: “We are all poor here because we have no school and no health centre… There is nobody who can help, that’s why we are poor here.”

(Dying for change, 2001)

This structure certainly includes also other types of forms then only poverty and good health connected to the income, but also to a more deepened understanding of the social structures such as access to education, the role of gender and ethnicity and whether your voice is at all heard in the society because you are a poor.     

Structural Violence is a term that goes back to 1960’s and it was defined by Johan Galtung to describe social structures that are violent and injure people not only physically but also influences on people's minds. Some of these structures have already been mentioned and described above. They can be economical, political, legal, religious or cultural structures that deny the access of many people to lead a healthy life and to have equal opportunities. Racism is one of the examples f structural violence, whether it is addressd towards an ethnic group or is gender related, it can cause ill-health in many ways. Structural violence is not a clinical disease, but it is a reason that causes clinical diseases. Structural violence is interconnected to many levels of society, it would need the cooperation of multiple fields and policy making together with health professionals in a global level. More medical professionals will also have to be trained to make structural interventions. (Farmer, P., Nizeye, B., Stulac, S. & Keshavjee, S. 2006)          

Structural Interventions are the actions that make it possible address Structural violence.  Some of the interventions that can have a positive impact are vaccinations, improved water and housing quality or training more qualified midwifes. The Structural intervention example that I will present here is the PIH model (Partners in Health) that have been implemented in Rwanda and in Rural Haiti in AIDS and TB care. In the PIH model the clinical and the community barriers are removed, the treatment is made free of change for the HIV/Aids patients and the care is also delivered with in the villages. Each one of the patients is chosen to have an accompagneteur who is trained to deliver drugs and other supportive care to the patient’s home. This has been a way of removing structural violence, to giving quality care and creating jobs in rural regions. The PIH model is a bottom-up model instead of the traditional scale-up model. The challenges in Haiti and Rwanda have been diverse, because of some social and cultural differences. When the program was implemented in Rwanda the country was recovering from war. The mothers with HIV/Aids were presented a medication during the pregnancy, al well as formula-feeding and close follow-up of infants. Also potable water projects were launched. The lessons of the both countries were that this kind of structural interventions increase the agency of the poor, prevent the illnesses and decreases the inequalities. However, the biggest resistance to the PIH model came from the local and global health policy makers. (Farmer, P., Nizeye, B., Stulac, S. & Keshavjee, S. 2006)

The value that these concepts bring to the discussion is that the structural root-reasons of ill-health are recognized, the concept is deepened as it is; an essential problem of the ill-structure of the whole society. These structures do exist and they are part of the whole interconnection of the globalized world. The article also brings up the question that why do they exists? What can we do in order to decrease structural violence and ensure a good health for everybody? The article also shows that many times these changes start from grass root level, from the actions of people who understand the reality of people who live in poverty and powerlessness. That is what the worls needs, more professionals who really understand the reality of the poor. It also shows that the change can be made, it is possible as long an there is good will, knowledge and understanding.  But when do the policy makers understand that and really start acting instead of talking?    

         

Sources:

• Robert Chambers, 2005 in Dying for change. Poor people's experience of health and ill-health. WHO & The World Bank. Complete report. (to the appropriate extent) You can also choose applicable parts in this Dying for change.
• Farmer, P., Nizeye, B., Stulac, S. & Keshavjee, S. 2006. Structural Violence and Clinical Medicine. PLoS Medicine, Vol. 3(10).
• Poverty in Focus 2006. What is poverty? Concepts and measures. Sanchez, P. & Swaminathan, M.S. 2005.
• Hunger in Africa: the link between unhealthy people and unhealthy soils. (pdf) The Lancet, Vol. 365, 442-444.

Why it is important to consider health at the global level?

In the globalized world everything is interlinked with each other. A drought in some part of the world can influence as a migration fluid. An epidemic which starts as local, can spread quickly and becomes international and global. None of us lives in an isolated island and can think that things that happen in the world would not influence in our lives. We live in a so called "global village" and there for health in a global level is not only important because of the reason that the health risks can influence on our own lives, but because it can influence on others lives as well.


Health in a global level is also more profound and an ethical question. There is a huge gap in health issues between the rich and the poor. The fact is that the most if the health risks are confronted in the developing countries, where there is a lack of infrastructure, knowledge, social services, medicines, professionals and financial shortage. Also the cultural and social issues are important factors to take into consideration when reflecting the facts of the health in a global level.


So what can we in the western countries make in order to ensure that everybody in the world would have a basic health care? Pressuring the policy makers, reducing our carbon dioxide gases or donating money to the organisations like the Red Cross? Either way each one of us with our actions and decisions can influence for a change and for a better life for many people in this Earth.


Global or public health is not so much a medicine discipline, but more like collective of interdisciplinary methods, sciences and policies. In the global level it is important to consider the facts like: how do we ensure basic health care for everybody and how do we prevent that natural events and epidemics do not manipulate people’s lives? And because of this health in a global level needs policy making in the national and in the international level. The most important organisations in the global health issues are the WHO and the World Bank. However, the importance of the WTO and the NGO’s or non-profits should not be neglected.


In the research made by Huynen, Martens and Hilderink some of the key issues mentioned were the trade, migration, conflicts, social equity, knowledge, ecosystems, social environment, lifestyle, food and water (Huynen, M., Martens, P. & Hilderink, H. 2005.) All these things are a very much present in our daily lives, there for they are global and have to be considered as a factors that influence on health in a global level. Also the new technologies allow people to be in connection with each other all over the world. Facebook, Twitter, Google, all kinds of groups and blogs, not to mention the ever faster ways of travel. On the other hand people say that this connection increases the gap between people's lives, but still it can also give them an easier tool to search all kind of information, create cultural and social understanding or look for people who confront same kind of problems or ideologies.


Unfortunately the gap between the poor and the rich result that many of the factors that influence the health in a global level affect more into the lives of the poor living in the Global South. And this, I think is a fact, that should be further considered and taken even more seriously in the future.


Sources:

• Huynen, M., Martens, P. & Hilderink, H. 2005. The health impacts of globalisation: a conceptual framework. Globalization and Health 1:14.
• Kickbusch, I. 2002. Global Health - A definition. 
• Pan American Health Organization (PAHO) 2002.Public Health: What's it really about?
  

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• Office of Global Health, Tulane University.URL: http://www.sph.tulane.edu/FGH/collaborators.htm