Public Health & Human Rights

Images of Public Health: Community health and primary care are the answer

 

(Source: WHO World Health Report 2008.  This is Monica Korir an outreach worker visiting a home in Kenya)

For many, the allure of curative medicine seems like the answer to public health.  However, while curative medicine has an important role in health, true advances in the health of the public will come most significantly through preventive community-based primary care.

The newly published World Health Report 2008 focuses on primary care and is an important document with a wealth of information.  Describing some of the key current pitfalls in health trends, the report notes three areas of concern:

1) Approaches to health that are focused on specialized curative care

2) Approaches to health that focus on short-term disease control

3) Approaches to health that encourage unregulated commercialization of health

As the report states, "these trends fly in the face of a comprehensive and balanced response to health needs."

What is needed?  According to the report, approaches to health that 1) contribute to equity and social justice, 2) reorganize services around people's needs and expectations, 3) contribute to healthy communities through integration with various services, and 4) replace short-term control with inclusive, participatory, negotiation-based leadership.

The report is well worth the read, and is full of a lot of practical evidence and guidance.

http://www.who.int/whr/2008/en/index.html

 

Images of Public Health: World's largest smoking ban begins on October 2

 

The world's largest ban on smoking in public places begins on October 2 throughout India.  Images similar to those found above will soon begin appearring on cigarette boxes in that country as a way to inform people of all literacy levels of the dangers of smoking.

Similar images are used on tobacco products in Australia, Canada, and several other countries and studies have shown them to be effective at motivating people to quit smoking.

How well the smoking ban in India is followed or enforced is another matter, but there is no question that the new rules have the potential to save millions of lives.

Images of Public Health: Celebrating Alma Ata and Jamkhed, India

 (image source: Comprehensive Rural Health Project)

This post is categorized both under "images of public health" and as part of the "change-makers" series.  While I did not plan to post another in the "change-maker" series so soon, it seemed inappropriate to let this important day pass without this post.

The women in the above image are volunteer village health workers trained through the Jamkhed Model at the Comprehensive Rural Health Project in India.  This project was one of only a handful of community health projects specifically highlighted at Alma Ata 30 years ago today (September 12, 1978).  The lessons learned from this project, and several others, guided the writers of the final Alma Ata Declaration, a declaration that is still hailed today and is being celebrated and re-energized worldwide and with a special issue of the Lancet. 

Mabelle and Raj Arole were physicians who graduated from the Vellore Christian Medical College in 1959 and who then went to work at a rural missions hospital.  Disappointed by the lack of impact they were making in peoples' health through their hospital work, they decided, in 1970, to start a public health program.  Looking for an area to build, they were invited to Jamkhed in the state of Maharashtra, India where they settled and began building their center. 

From a modest center drilling water wells for nearby villages, they later began village health surveys and health education.  Later, they expanded into many other areas of development such as promoting reforestation and improving environmental conditions.  Over a period of 25 years, 250,000 men and women who previously had been marginalized had been empowered to change and improve their lives and the health of their villages.  Infant mortality dropped from 175 per 1000 births to 18 per 1000 births during that time period.

Mabelle and Raj Arole deserve much more text than I am providing here and I urge you to visit the site of the Comprehensive Rural Health Project to learn more about the model and what they have done.

As I mentioned earlier, their work and the lessons learned guided the development of the Alma Ata Declaration.  Later, in the early 1980's, officials from WHO and UNICEF visited Jamkhed to learn how to adapt the model to other parts of the world.  In 1989, Drs Mabelle and Raj were invited as visiting professors to the Johns Hopkins School of Public Health.  And, in 1995, Dr. Mabelle became a senior advisor for UNICEF.  Dr. Mabelle passed away in 1999.

In 2005, Dr. Raj Arole received the Mother Teresa Award for Social Justice, and his work and the exemplary work of the Comprehensive Rural Health Project continues today.  As stated in their vision, "We envision communities where families are healthy and enjoy fulfilling lives....We are called to facilitate and empower the poor and marginalized and enable them to achieve their full potential through a value-based approach with equity and justice."

See here for much more: http://www.jamkhed.org/index.htm

Images of Public Health: Pondering Climate and Health

The map above, obtained from Worldmapper.org (a site I recommend), shows the proportion of carbon dioxide, methane, and nitrous oxide (commonly referred to as "greenhouse gases") emitted from each country in 2000. The map below shows the proportion of childhood deaths from diarrhea in 2002.

What's the connection between climate and health? More on that in an upcoming post, but it is widely acknowledged that the increasing release of carbon dioxide, methane, and nitrous oxide into the atmosphere is having a noticeable and negative affect on health, especially malnutrition and diarrhea.

April 7 is World Health Day and the theme is "Protecting Health from Climate Change." For now, suffice it to say that this theme certainly bring together issues of health, rights, and faith. And the maps above are a thought-provoking contrast.

Images of Public Health - The Broad Street pump

"Death's Dispensary" 1866 by George Pinwell. A cartoon depicting the dangers of drinking water.

John Snow (1813-1858) is frequently cited as one of the early heroes and pioneers of public health for his work at identifying the source of a cholera outbreak in London in 1854. After careful investigation, which included plotting cholera cases on a map, he identified a waterpump on Broad Street as the source of the disease. The pump handle was soon removed preventing further cholera outbreaks.