Global Health Begins Locally
by Kolya Braun-Greiner
We live in a time when technology and healing have joined forces to create incredible advances in health care. From heart transplants to laser surgery, life expectancy is being pushed beyond the imaginations of our ancestors. It seems modern medicine is answering our prayers for long and healthy lives.
But this is a skewed view of health care around the world. High-tech medicine is not even a remote possibility for most people. Lives end in infancy because prenatal care is not available. Getting to a local clinic or doctor is difficult or impossible for many people.
United Methodist Missionaries Sylvia and Marvin Reimer, who serve in Mutambara, Zimbabwe, tell the story of a woman whose husband walked 8 kilometers to a rural hospital to get her help in delivering their baby. But help came too late. The baby died.
The North-South gap
In recent decades, more children have been immunized against preventable diseases such as polio, tuberculosis and measles. Access to basic health services has increased in some areas. Yet there remains a significant gap in the availability of health care between industrialized nations and developing nations, between the North –- North America and Europe –- and the South –- South America, Africa and much of Asia. Questions to ask when making this analysis include:
The United Nations provides several reports that explain the status of global health care. The "Human Development Report," published annually, answers the above questions by presenting data from member nations to create a "Health Profile" for each country. These profiles show that countries of the South lag far behind those of the North.
Among 45 countries that fall into the category of "low human development," 26 are in Africa with Sierra Leone ranking last –- No. 174. While access to clean water has improved in Sierra Leone, life expectancy is still less than half that of a person born in the United States. Fifty percent of all Sierra Leoneans are not expected to survive to age 40. A pregnant woman is at high risk of maternal death, 89 percent of the population lives without sanitation, nearly 30 percent of children under age five are underweight, and one in five children do not live to age five. Many of these deaths would be preventable if adequate prenatal care was available.
The gender gap
Women from developing countries share a double burden in terms of health care. They suffer the North-South gap and are subjected to gender inequalities. Worldwide, women’s health care get less attention and funding than men’s. Gender inequalities include:
A second U.N. report, "The State of the World’s Population 2000: Lives Together, Worlds Apart," shows that where unequal power relations exist between women and men, women’s and girls’ health is compromised.
Girls’ health is threatened by being pressed into sexual activity too early because of poverty, child marriage and prostitution. The health and human rights of girls are violated where female genital mutilation is practiced resulting in life-threatening infection or permanent damage to their childbearing capacity.
When girls’ and women’s control over sexual activity or their choices about protection from unwanted pregnancies are limited, they are also more vulnerable to sexually-transmitted diseases including HIV/AIDS. According to UNICEF, girls and young women are more than 50 percent more likely to contract HIV than boys or men.
Reproductive-health services are critical to women’s survival and long-term health care. Such access was championed as "Women’s Health: A Human Right" at the International Conference on Population and Development in Cairo, Egypt, in 1994 and the Fourth World Conference on Women in Beijing, China, in 1995. Where access to contraceptives is limited, unwanted pregnancies result and women seek abortions. According to the U.N. Development Fund, nearly 80,000 women die every year from unsafe abortions.
Increased access to family planning and education is the most effective way to reduce abortions. Recent action by the Bush Administration to prohibit U.S. funding of international health services, such as family-planning clinics, that mention abortion as an option in the range of reproductive-health choices, will make it increasingly difficult for women to have safe alternatives to pregnancy and childbearing.
Studies show that when resources are designated for the improvement of women’s lives, through medical treatments, literacy training and increased economic opportunities, children benefit as well. The reverse is also true: when prenatal care is provided maternal health improves.
The State of the World’s Children Report 2001 says:
"Women’s education and literacy tend to reduce the mortality rates of children."
Health for children, youth
The health and well-being of children is mandated by the U.N. Convention on the Rights of the Child, yet to be ratified by the United States. The convention recognizes "the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health."
Cynthia Anne Girton, a United Methodist missionary in Liberia, described the needs of children there:
"Children are not always able to eat lunch because there are not enough funds to buy food....but slowly, The United Methodist Church is making a difference. A fortified rice meal funded by the United Methodist Committee on Relief arrived in a Operation Classroom container."
The early years of a child’s life are critical for emotional health and healthy development of brain function. Conditions during the prenatal months and the first three years affect children for the rest of their lives. The absence of care during these critical years because of poverty, war or famine violates children’s rights to healthy lives. These will be among rights of children examined at the U.N. Special Session on Children in September 2001.
When children and youth are forced to work in slave-like conditions as cheap labor, their health and their lives are in jeopardy. Abusive child labor is an issue in such places as Pakistan, India and parts of Southeast Asia. Children are given meager food, housed in cramped unsanitary quarters, and are forced to work long hours with no time for education or play.
International attention to child labor is leading to labor and trade policies to eliminate abusive forms of child labor.
The resolution, "Eradicating Abusive Child Labor," page 178 in the 2000 United Methodist Book of Resolutions explains the denomination’s opposition to child labor and support of efforts to eliminate it.
In 1999, the International Labor Organization adopted the "Convention Concerning the Prohibition and Immediate Action For the Elimination of the Worst Forms of Child Labor." The worst forms of child labor include "all forms of slavery or practices similar to slavery, such as the sale and trafficking of children, debt bondage and serfdom, and forced or compulsory labour, including forced or compulsory recruitment of children for use in armed conflict."
HIV/AIDS is among the most devastating health threats to children and youth worldwide. According to UNICEF, about half of all new infections occur in youth ages 15-24. The youngest children contract the virus in the womb. Seventy percent of the world’s HIV-infected people live in Africa. In African countries, nearly 10 percent of children under 15 are AIDS orphans. Around the world, nearly 250,000 children and youth are infected every month.
A constellation of factors is needed to address AIDS. Preventive education is key, especially among youth as they become sexually active. The most effective and innovative programs are those in which the youth act as peer educators.
The North-South disparity is clearly apparent in the HIV/AIDS crisis. Medical treatment to prolong the lives of those who are HIV positive is limited or nonexistent in the South. Drugs available in developed countries of the North are too expensive for people in developing countries. Tight controls by the pharmaceutical industry, which are supported by World Trade Organization rules, are prohibiting production of more affordable, generic drugs in the South.
A health worker in Zambia expressed her view on the HIV/AIDS pandemic in the State of the World’s Children 2000 report: "We can’t deal with the root problem, which is poverty."
She shared an example of a family in which a sex worker brought in the only source of income. Finding a cure for HIV/AIDS is not the only answer. Poverty must be reduced.
Violence as health issue
Children’s and women’s health are inextricably connected to and impacted by violence in society. Children suffer emotionally and physically in families where mothers are abused. Girls sold into the sex trade are at high risk of HIV infection. Where there is war, children and women are displaced, injured and killed. They are often maimed by land mines in the aftermath of war.
Kathy and Bruce Griffith, United Methodist missionaries serving in Central Asia, shared their experience:
"Civil war continues. Schools are closed to girls. Women can’t work. Health care is extremely poor, and the infrastructure is nonexistent." The United States is not immune to the impact of violence. The availability of guns, insufficient restrictions on the buying and selling of guns, and inadequate safety regulations lead to deaths of children, youth and women. According to The Children’s Defense Fund, nearly a classroom of children is killed by gunfire every two days. The State of the World’s Children report says, "Violence is a public-health issue in almost every industrialized and developing country in the world."
Environmental issues
Even where sufficient food, immunization and access to medical care are available, the lack of clean drinking water, poor sanitation and environmental pollution threaten health. Diseases born by rats, lead paint, and pathogens in the air and water are health hazards. Other hazards come from industrial wastes, such as radioactive leaks from nuclear-power plants and sulfur dioxide from coal-powered plants. Pesticides used in agriculture leave residue on food at levels unsafe for children’s developing bodies, and pesticides leach into the groundwater.
Deforestation poses a health threat where soil erosion leads to decreased food supply and degradation of the natural environment. At the global level, global warming and ozone depletion pose threats such as rising rates of skin cancers, respiratory diseases, and irrevocable damage to the web of life because of extinction of species sensitive to slight changes in the environment.
Actions for reducing emissions that contribute to global warming were mandated at both the United Nations’ World Summit on the Environment and Development in Rio de Janeiro, Brazil, in 1992, and the third session of the Conference of the Parties to the U.N. Framework Convention on Climate Change -- known as the Global Warming Conference -- in Kyoto, Japan, in 1997. Those actions remain to be implemented. The United States no longer supports the treaty. The Bush Administration announced in March it would abandon the treaty and related efforts because they would raise costs.
Holistic health
For the vast majority of the world’s people, training community-based health workers is more effective than the high-tech approach to medicine. Village residents benefit directly from people trained in prevention and basic health-care skills.
United Methodist Missionary Ester Galima Mabry who served in Cambodia discussed the reception of such workers there:
"They welcomed our offer of health services and were glad that we would train women to work especially with women, children and the poor."
The community-based approach takes the whole person into account, including family environment and economic status. Multiple factors that contribute to health, are seen as interrelated.
Extreme poverty leaves communities without resources to support adequate health facilities and families without access to health insurance. Too often, low-income families come up short on adequate nutrition. Where nutrition is deficient, children are more susceptible to mental and physical illnesses.
If war is ravaging a nation, medical care may be impossible to reach. Economic policies and structural-adjustment programs have a ripple effect on people’s health at the local level. Miguel Mairena of San Francisco Libre, Nicaragua, explained:
"Because of structural-adjustment programs, which ensure each country can pay interest on its debt to the North, millions go hungry and die before their time."
As we look at health, we see that a host of issues must be addressed. A simple medical approach is not the only answer. Health cannot be adequately examined in isolation from economics, education, poverty, violence, the status of women and the environment.
Kolya Braun-Greiner, a writer and consultant, is author of the leader’s guide for the 2001-2002 youth mission study book, Youth Chat on Global Health and Christian Response-Ability. She is former Women’s Division staff and lives on Long Island, N.Y.