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?
  

Picture:

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