Global Health Promotion

My name is Brooke Guerrini, I am a third year Health Studies student and this is my GHP learning ePortfolio.

Aid Effectiveness in Ghana

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Figure 1 - Germany in Ghana: financing free primary education for all. Oxfam. n.d. This artifact describes an example of foreign economic aid and with further examination, demonstrates aid effectiveness. http://www.oxfam.org/en/about/issues/aid-effectiveness/aid-works/germany-ghana-education?utm_source=oxf.am&utm_medium=ZhN&utm_content=redirect

     Despite controversy surrounding foreign aid, it can be critical for the lives for impoverished people around the globe who greatly benefit, especially health-wise. Seear (2012) argued that, “the fact that the aid industry is easily criticized or that foreign aid has often been done badly in the past is not a valid argument against the concept of aid; it is an argument in favour of doing it properly” (p. 267). It is important that donor countries ensure that aid is as efficient as possible, providing appropriate support rather than solely charity. It is also important that it is untied aid that benefits the recipient over the donor. Oxfam (n.d.) claimed that foreign aid from Germany that is financing free primary education for all in Ghana is an example of aid effectiveness. Between 2004 and 2006, Germany has provided 19.6 million euros to the government of Ghana which has helped them dedicate over one-fifth of their national budget to education (Oxfam, n.d.). Providing free education without the economic means to do so as country is troubling as it may encourage dependence on foreign economic aid. However, Ghana is actually taking strides towards independence, so economic aid is being used well. Thomas et al. (2011) revealed that aid dependency in Ghana has fallen from 47% to 27% in the last decade. 

     In this case, Germany’s economic aid may be considered effective aid. Aid effectiveness has five essential obligations that are defined in the Paris Declaration (Seear, 2012). First, ownership requires that developing countries take the lead on projects and ensures that all levels of society participate, not just elites (Seear, 2012). It is evident that the government of Ghana, as well as the people are invested in free primary education. Also, Ghana now has its first aid policy and strategy published. “It sets objectives of reducing aid dependence, ensuring aid supports national priorities, and setting a donor performance assessment framework” (Thomas et al., 2011, p. 38). Secondly, alignment depends on aid policies that align with the needs of recipients and untied aid that uses local systems when possible (Seear, 2012). It appears to be untied aid because it is being provided directly to the government’s national budget to be used to build schools, provide teachers’ salaries and finance student grants (Oxfam, n.d.). It is unclear whether Germany require schools to built by German companies, but if so Ghana is working towards correcting this. Ghana’s aid policy clearly states that budget support is their preferred method of aid and that changes must be made to ensure alignment with government priorities and systems (Thomas et al., 2011). Inoue and Oketch (2008) argued that public subsidies of education are important for Ghana’s communities as they relate to health and poverty by lessening inequities of opportunity for education and therefore incomes. Free primary education for all aligns well with Ghana’s needs. Thirdly, harmonization signifies that, “donors should avoid overlap by joining forces to fund particular broad segments, identified by the recipient, such as supporting a national education plan” (Seear, 2012, p. 277). This is exactly what Germany, along with other countries are doing for Ghana to avoid aid fragmentation.The fourth requirement is results-based management which highlights the need to measure results as it helps allocate funds, detect problems and improve future project design (Seear, 2012). The artifact demonstrates successful results and their accountability models require a measurement of progress. The last requirement is mutual accountability between donor and recipient, as well as between recipient government and citizens (Seear, 2012). Ghana is becoming more accountable to citizens, rather than just donors as it tracks school budgets and supports national audit institutions, community monitoring organizations and free independent media (Thomas et al., 2011). Also, Germany’s aid is monitored to provide transparency and accountability. After careful review it is clear that this is a case of relatively effective aid and that Ghana is on the right track regarding education. Germany’s aid is not hindering the pathway to further success and independence. 

References

Inoue, K., & Oketch, M. (2008). Implementing free primary education

     policy in Malawi and Ghana: equity and efficiency analysis. Peabody

     Journal of Education, 83(1), 41-70. 

Oxfam. (n.d.). Germany in Ghana: financing free primary education for all.

     Retrieved from http://www.oxfam.org/en/about/issues/aid-

     effectiveness/aid-works/germany-ghana-education?

     utm_source=oxf.am&utm_medium=ZhN&utm_content=redirect

Seear, M. (2012). An introduction to health. Toronto, Canada: Canadian

     Scholars’ Press Inc.

Thomas, A., Viciani, I., Tench, J., Sharpe, R., Hall, M., Martin, M., & Watts,

     R. (2011). Real aid: ending aid dependency (3rd ed.). London, United

     Kingdom: ActionAid. 

Anti-Gay Laws

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Figure 1 - Antigay Laws Gain Global Attention; Countering Them Remains Challenge. Somini Sengupta. March 1 2014. This newspaper article highlights a global issue regarding gender equity that can have a major impact on health and well-being. It requires an intersectionality perspective to understand the entirety of the problem. http://www.nytimes.com/2014/03/02/world/africa/antigay-laws-gain-global-attention-countering-them-remains-challenge.html?_r=0     

     There has been growing awareness concerning global injustices in relation to sexual orientation, particularly homosexuality. People are more aware or no longer find it acceptable that it is banned in several parts of the world. A recent article in The New York Times, highlighted in figure 1, examined various antigay laws and their impact on other countries and the United Nations. Sengupta (2014) revealed that homosexuality is banned in an estimated seventy-eight countries and seven of those allow the death penalty. The article fails to clearly mention how there is discrimination and prejudice in countries without anti-gay laws that need to be addressed as well. A growing number of people are aware of this human rights violation, but small group discussion in class made it evident that some are not and many do not make the connection with gender equity. Men may be persecuted if they do not fit gender roles expected of them. In some countries, such as Jamaica, same-sex acts are tolerated among women, but not men (Cowell, 2011). Gender equity was explained in class to ensure fairness to men and women and compensate for social disadvantages. The lesson in class further clarified that it meant an equal opportunity to realize full human rights and the potential to contribute to society. This is not the case for the LGBT community in countries such as Uganda, Russia and Nigeria (Sengupta, 2014). It is imperative to ensure that gender identities of any kind do not hinder one’s ability to participate in society. 

     This a complex issue that cannot be seen as one-sided. It is critical to look at how sexual orientation intersects with other determinants of health as this intersection creates conditions of health. Shields (2008) explained that the principle of intersectionality involves mutually fundamental relations among social identities such as gender, race, class, ethnicity and sexual orientation. It challenges the homogenization of gender and demonstrates how intersections can create oppression or opportunity (Shields, 2008). In class a video was shown of a woman who experienced a cross hatch of discrimination because of her gender, race and sexuality as she was a black lesbian. She mentioned the difficulty of understanding how this all worked together. Her experiences and understanding of her own gender might change and further complicate if she lived in a community with anti-gay laws. 

     It is important to think about intersectionality when tackling global health issues such as homosexuality and HIV. Shields (2008) illustrated that, “the very meaning of manhood may vary when applied to one’s own racial group as compared to another group” (p. 303) This applies to the experience of homosexuality in different cultures. Rates of HIV are disproportionately high among men who have sex with men (MSM) compared to other groups (Beyrer et al., 2013). Therefore in some parts of the world gay men are considered a group to be targeted for prevention and intervention of HIV and AIDS, providing them with more opportunities. However, in other parts of the world they are mistreated on multiple levels because of these characteristics. In countries with anti-gay laws, the prevalence of HIV among gay men remains, but they do not have equal access to treatment (Ireland, 2013). It was discussed in class that medics and teachers in Uganda must report same-sex acts, so in order for these men to receive treatment and education without penalty, they must be dishonest. Their education and health is at risk because of unnecessary laws. Gays rights associations in Burundi that raise awareness about HIV and provide support are closing down for fear of arrest due to anti-gay laws (“AIDS activists,” 2009). These laws are causing many to lose needed social support and health services. Gay men with HIV are experiencing this cross-hatch of discrimination, but on a dangerous level. 

     Social class and socioeconomic status are other factors that come into play. A striking example is the constant persecution of Jamaican homeless LGBT youth. They have been thrown out of their homes by their families and consistently arrested and abused by police who will not let them take shelter in any public or abandoned locations (Stewart, 2014). Their age and ableness affects their ability to handle the discrimination towards their sexual orientation which intersects with their homelessness. Their health is at risk because they are discriminated in such a tangled way that makes it almost impossible to escape poverty. Shields (2008) argued that intersectionality is, “an effort to see things from the worldview of others and not simply from our own standpoints” (p. 309). This reflects the topic of cultural humility that has been discussed in class in terms of global health. It takes into account the power imbalances and requires ongoing reflection from practitioners. Those who wish to eradicate the discrimination of these vulnerable groups must take into account the intersections of their social identities. 

     The response to anti-gay laws by world leaders has been powerful, but not ideal to make legitimate change. Countries are cutting off bits of aid and sternly warning discriminatory governments, but some feel as though countries are free to enact their own laws (Sengupta, 2014). The warnings are inadequate and cutting off small amounts of aid does not create a sufficient impact. However, the aid that has been cut would have been funding and promoting HIV/AIDS prevention and treatment (Sengupta, 2014). This action will only put the marginalized individuals at a further disadvantage as they make up an at risk population. Therefore, it misses its target and hurts those that are supposed to be supported. Hildebrandt (2014) argued that external intervention may be seen as an extension of colonial politics and that decriminalization of homosexuality will come with culture change. Although external intervention might be necessary as it has been successful in decriminalization, it must respect citizens of other countries. The emphasis should be on support for positive political leaders and victims of discrimination, especially those that ask for help. The conversation around anti-gay laws should also include the intersecting social identities that must all be addressed in order to understand the entire problem. 

References

AIDS activists condemn new anti-gay law in Burundi. (2009). Reproductive

     Health Matters, 17(33), 191-192.

Beyrer, C., Sullivan, P., Sanchez, J., Baral, S. D., Collins, C., Wirtz, A. L.,

     Altman, D., Trapence, G., & Mayer, K. (2013). The increase in global

     HIV epidemics in MSM. AIDS, 27(17), 2665-2678.

Cowell, N. M. (2011). Public discourse, popular culture and attitudes

     towards homosexuals in Jamaica. Social and Economic Studies, 60(1),

     31-60.

Hildebrandt, A. (2014). Routes to decriminalization: a comparative analysis

     of the legalization of same-sex sexual acts. Sexualities, 17(1/2), 230-

     253. 

Ireland, P. R. (2013). A macro-level analysis of the scope, causes, and

     consequences of homophobia in Africa. African Studies Review, 56(2),

     47-66. 

Sengupta, S. (2014, March 1). Antigay laws gain global attention;

     countering them remains challenge. The New York Times. Retrieved

     from http://www.nytimes.com/2014/03/02/world/ africa/antigay-laws-

     gain-global-attention-countering-them-remains-challenge.html?_r=2

Shields, S. A. (2008). Gender: an intersectionality perspective. Sex Roles,

     59(5), 301-311. 

Stewart, C. (2014, March 12). Judge rules for LGBT youths living in

     Jamaican sewers. Huffington Post. Retrieved from

     http://www.huffingtonpost.com/2014/03/12/jamacian-lgbt-

     sewers_n_4948676.html

End FGM

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Figure 1 - End Female Genital Mutilation. Eric Ravelo. February 2014. This is the logo for the Guardian’s End FGM campaign. It is meant to capture the horror and make people uncomfortable without causing them to turn their heads away. The cut up razor blade cannot be used anymore, signifying the end of FGM.

     The globe has seen improvements in injustice and discrimination, but significant inequities remain and in particular, gender inequities. “The United Nations defines violence against women as any act of gender-based violence that will likely result in physical, sexual, or psychological harm” (Seear, 2012, p. 157). This definition includes the misogynistic practice of female genital mutilation, FGM, which is a leading example of violence against women and children. It is typically performed between infancy and adolescence. Seear (2012) described that the mutilating forms of female circumcision often involve damaging or completely removing external female genitalia with no hygiene or anesthesia. It is a virtually universal practice in Africa, Guinea, Egypt, Mali and Eritrea with over a million carried out each year and affecting 100 to 104 million women worldwide (Seear, 2012). The UN has contradictory views as Article 24 depicts that traditional practices detrimental to children’s health will be terminated while Article 29 commands respect for parents, the child’s cultural identity and values of their country (Seear, 2012). In this case, the values are inferiority and ownership of women which should not be respected in any country or culture. It is an unnecessary procedure that has no benefits besides attracting a husband as uncircumcised women in some countries cannot find one. Seear (2012) outlines examples of perceived benefits as women having reduced sexual arousal and less premarital intercourse or adultery. Complications include hemorrhage, painful scars, infection, sexual dysfunction, depression and many more side effects (Seear, 2012). This gender inequity oppresses women and promotes the belief that women cannot be sexual beings like men. There should be no debate on whether this is a human rights issue as it clearly is. Article 29 of the UN Convention on the Rights of the Child displays aspects of cultural relativism which supports the continuation of FGM. The decision whether to intervene in another’s culture is difficult and this deliberation has been debated in class. Assimilation must be avoided as the values and beliefs of others should be respected and kept in tact. FGM is sometimes justified by culture, religion and tradition. This unnecessary practice is not an element of religion or culture, but instead explicit abuse making it an easier decision. When values and beliefs cause harm then intervention is necessary from whoever can make a positive change. 

Video - Time to step in now: schoolgirls ask for FGM education. The Guardian. February 2014. This artifact illustrates the feelings of the girls of Integrate Bristol and expresses the importance of the Guardian’s campaign.

     The British newspaper, The Guardian, is running a campaign called End FGM and they teamed up with the girls of the charity, Integrate Bristol. Female genital mutilation is often thought to occur only in developing countries, specifically Africa. Unfortunately, it is happening all over the world and its prevalence in the United Kingdom has recently been on the center stage globally. Topping (2014) revealed an estimated 66, 000 women of the United Kingdom are living with the effects of this procedure and 24, 000 girls under 15 are at risk. The campaign also highlights how schoolgirls are experiencing this tradition in Britain or often unknowingly sent abroad during their summer holidays, the cutting season (Topping, 2014). Integrate Bristol accomplished their goal as Education Secretary, Michael Gove, has agreed to send letters to primary and secondary school teachers that will include information about the issue, risks and warning signs and reminders of the protective duties of education staff (Topping, 2014). Mainstream and widespread awareness is crucial so that the appropriate and influential individuals will take serious action. However, it is also important to be cautious in how the issue is approached. Cultural humility should always be practiced by innovators in global health. Examining risk factors should not allow the promotion of stereotypes towards immigrants and marginalized groups. Also, those at risk should be integrated into the existing child protection framework. This campaign has gained a lot of attention, but now that it has reached its goal, it is important that the underlying issues do not fall back into the shadows. The media and the public must realize that the battle against this harmful tradition will be a lengthy process that does not end with the Education Secretary.  

     Female Genital Mutilation is already banned in the UK, but that has not made a significant difference. Topping (2014) reported that there have been no prosecutions in the UK despite decades of legislation. The justice system must take this issue more seriously, but banning this procedure and implementing legal regulations is clearly not the solitary solution. It will only continue, remaining unsanitary and unregulated, until the attitudes and practices of the people change. Education is only the first step. Changing the attitudes of this generation and promoting gender equity will ensure that the next generation will not feel the need to participate in this gruesome tradition. FGM can be seen as a coming of age tradition therefore it is important to highlight other customs that can be shared instead. Seear (2012) explained that, “programs based on community advocacy by religious and community leaders, plus the substitution of an alternative rite that does not involve cutting, have been successful in Kenya, Senegal and even Sudan” (p. 163). The failure of imposing outsider programs have been extensively discussed in class. The residents themselves must want to actively participate in the program and transformation of their lives. Foldes, Cuzin and Andro (2012) worked with over 2000 willing participants from various countries to reconstruct their sexual organs. The work of Foldes and his colleagues demonstrates that these oppressed women are willing to take action to better their own lives and the status of women. People are making advancements in their own communities. Therefore we must support them and partner with them to generate change. Instead of imposing outsider ideas, it is more appropriate and advantageous to work with the ideas of the target population. FGM has been forced underground in Kenya where it has been outlawed and now occurs without ceremonies which causes male elders to argue that their culture has been criminalized (Howden, 2014). However, alternatively it shows that the ceremony is not the important part as the abuse continues without them. Daughters remain property or wealth of families that are sold to husbands with a dowry from the groom’s family. Uncut girls will not receive dowries and are ostracized as the community claims these girls are stealing from their families (Howden, 2014). One teacher, Joseph Kapkurere, offers a sanctuary at school during the cutting season and a priest, Christopher Chochoi, established the Cana girls’ rescue centre (Howden, 2014). These are just a few examples of leaders in the movement of the eradication of FGM. Those who wish to help the cause can support such centres or provide medical help to those in need. Micro-financing has been discussed in previous class topics, but it would be beneficial for ostracized women and former circumcisers so that they could start a new profession. 

     Gender inequities remain and they arise globally. FGM is just one example of violence towards women and children and the power imbalance between men and women. Class discussion involved the different levels of gender-based violence and this form of discrimination is present at all levels. At the family level, the girls are considered a form of wealth and are controlled by the decision-makers in their family who are encouraging this practice. At the community level, leaders and elders are encouraging and insisting on this norm as girls will be be rejected by family and the community if they do not conform. This condones and legitimizes the violence. There is isolation and a lack of social support for uncut girls. Gender roles and the level of women empowerment on a global level enforces and perpetuates female genital mutilation. This is a complex problem that must have a multifaceted solution that is guided by changing attitudes towards women. 

References

Foldes, P., Cuzin, B., & Andro, A. (2012). Reconstructive surgery after

   female genital mutilation: a prospective cohort study. The Lancet,

   380(9837), 134-141.

Howden, D. (2014). Kenyan ‘cutter’ says female genital mutilation is her

   livelihood. The Guardian. Retrieved from

   http://www.theguardian.com/society/2014/feb/07/female-genital-  

   mutilation-kenya-daughters-fgmlivepage.apple.com

Seear, M. (2012). An introduction to health. Toronto, Canada: Canadian

   Scholars’ Press Inc. 

Topping, A. (2014) British girl leads Guardian campaign to end female

   genital mutilation. The Guardian. Retrieved from

   http://www.theguardian.com/society/2014/feb/05/british-girl-guardian-

   campaign-end-female-genital-mutilation-fgm

Topping, A. (2014). Michael Gove agrees to write to schools over female

   genital mutilation. The Guardian. Retrieved from

   http://www.theguardian.com/society/2014/feb/25/michael-gove-

   schools-female-genital-mutilation

Poverty and Celebrity Aid

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Figure 1 - Rooney Mara’s Inspirational Work in Kenya. Oxfam. March 2, 2014. This photo highlights Rooney Mara as a contributor to celebrity aid. It can also demonstrate how people often focus more on celebrities instead of the cause or aid recipients, as people will probably focus on Rooney Mara instead of thinking about the context of the photo.

     When people scroll through their tumblr dashboard, they might come across the picture shown above. They will probably recognize the familiar face, but they might have to look up who she is. This might lead to an investigation of which movies she has been in and how many of those they have seen. For some, it may even go as far as searching who she has dated and what she wore to the oscars. The first thought is unlikely to be concerning the context of the picture and many will not undergo extensive research into the work she was doing while the picture was taken. This demonstrates the obsession with celebrities and celebrity aid flourishes because of this obsession. There is nothing wrong with using their popularity or excess income to support a good cause or make positive change. However, sometimes the focus is more on the celebrity than the cause or aid recipients themselves. Davis (2010) demonstrated how during the famine relief movement of the 1980s, the media focused more on the aesthetically pleasing celebrities and charity merchandise than upon those suffering. The ethical dilemma of who is benefiting from the campaign is also a concern. Davis (2010) outlined how, “organizers, celebrity participants, corporate sponsors, event planners and providers of event equipment and locations, ethical consumers, and, to some extent, the intended recipients of aid have all gained in ways inconceivable without the help of the 1984-5 famine relief movement” (p. 114). The recipient of aid may not be the top priority as various players try and take advantage of the opportunity and publicity. The public becomes aware of a cause because of the celebrities and must trust that it is a legitimate cause that is worth their time and resources. Many fans will blindly support any cause that a beloved celebrity supports when that person may know little about the initiative they are promoting. Celebrity aid can create awareness and momentum like nothing else can, but campaigns must use the powerful momentum to continue advancing when interest potentially fades. 

     The woman in the photo is academy award nominated, Rooney Mara. She was in Kenya in this photo, visiting an orphanage for young girls. Unlike other celebrity aid, she is making significant impacts in the lives of those in poverty. Some celebrities will only donate money which does not address the root of the problem. Seear (2012) explained that poverty is a lack of money, but also has connections with social or cultural isolation, absence of power, marginalization and lack of eduction. Mara founded Faces of Kibera and worked closing with Uweza, driving the two organizations to merge together and form the Uweza Aid Foundation of which she is now President and member of the board of directors (Cruz, 2014). This displays her legitimate role in the aid programs. This registered NGO claims to fight the cycle of poverty in the Kenyan city of Kibera, but does not define poverty. In small groups in class, the importance of defining poverty was discussed. A problem cannot be addressed and solved until the issue is explicitly defined and understood. Each person experiences poverty differently and context is necessary in order for poverty alleviation to be effective. Seear (2012) explained that there are different types of poverty and it is important to understand this because they may need different solutions. The Uweza Aid Foundation (n.d.), based in the largest slum in Kenya, mentioned that often a family’s income is not enough to cover the cost of an education, so they offer a sponsorship program. This indicates the presence of economic poverty. They also mentioned high unemployment rates, high rates of AIDS, unstable structures, poor sanitation and the need for emotional and social support among other characteristics (Uweza Aid Foundation, n.d.). There is absolute poverty with people deprived of all basic elements for healthy living, but also hidden poverty where people may have a home without heating or health care (Seear, 2012). The Uweza Aid Foundations caters to people experiencing both absolute and hidden poverty. A multidimensional analysis of poverty consists of various components measuring standards of living including educational attainment, access to clean water and longevity (Seear, 2012). It appears as though the foundation uses such an analysis because they provide more than income support which is appropriate for poverty alleviation. 

     The Uweza Aid Foundation (n.d.) demonstrated that they are a community-based organization that evolves to express needs of the community and sponsorships are offered because they are the most commonly requested service by their community. Community members are actively involved and all Uweza staff are residents. They have a community centre that offers various programs that allow creative expression, educational support, income generating opportunities, life skills training and community collaboration among much more (Uweza Aid Foundation, n.d.). The programs work in a grassroots approach and allow the Kibera population to generate sustainable and empowering change. The initiative’s slogan is, “we nurture and build upon the already-existing capabilities and resourcefulness of Kenyans through community-based empowerment programs” (Uweza Aid Foundation, n.d.). The NGO also facilitates micro-financing which was discussed in class to be a solution for poor people without access to financial services. Littlefield, Morduch and Hashemi (2003) clarified that the poor use micro-finance to invest in their micro-enterprises, health and education with loans, transfer payments and a range of other services. This allows them to build assets, reduce vulnerability and experience improved health outcomes and nutrition (Littlefield et al., 2003). Micro-finance members in the Uweza Aid Foundation pay a membership fee so that they progressively receive higher loans after each loan repayment and receive aid when a loved one is sick (Musanga, 2013). Musanga is a member of the journalism club which is a refreshing example of the prosperity of these programs. The website is transparent and consistent, backing up all claims made by the foundation. This is a case of celebrity aid that demonstrates a positive and significant contribution to poverty alleviation. 

 

References 

Cruz, L. (2014). Rooney Mara - New York, NY. Retrieved from

   http://www.oxfamamerica.org/take-action/your-stories/rooney-mara-

   new-york-ny/

Davis, H. L. (2010). Feeding the world a line?: celebrity activism and

   ethical consumer practices from live aid to product red. Nordic Journal

   of English Studies, 9(3), 89-118. 

Littlefield, E., Morduch, J., & Hashemi, S. (2003). Is microfinance an

   effective strategy to reach the millenium development goals?

   Washington, DC: Institute for Financial Management and Research. 

Musanga, R. (2013). Kibera Arise. Retrieved from      

   http://www.uwezakenya.org/category/kibera-agenda-4-business-  

   savings/

Seear, M. (2012). An introduction to health. Toronto, Canada: Canadian

  Scholars’ Press Inc. 

Uweza Aid Foundation. (n.d.). Retrieved from http://www.uwezakenya.org

Maternal Health

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Figure 1 - Maternal Health. Unicef. November 26, 2012. This artifact provides factual information about maternal health and introduces the importance of family planning to prevent harm to women. 

      Maternal health applies to the mother’s health during pregnancy, childbirth and postpartum. It requires safe motherhood and a universal access to reproductive health services, especially family planning (Habumuremyi & Zenawi, 2012). Figure 1 demonstrates that the fifth Millennium Goal of improving maternal health is a relevant goal, but that much more progress must be made. Family planning is the key aspect of maternal health and it also relates to poverty reduction as there is a connection between high fertility and standard of living. The World Health Organization established family planning as allowing desired family size and spacing of births. Access to health care, contraception and safe abortions are all involved. It also encompasses HIV prevention and control. Annual reductions of 79 000 maternal deaths, 600 000 newborn deaths, 26 million induced abortions and 21 million unplanned births would be the result of universal access to family planning (Carr, Gates, Mitchell & Shah, 2012).

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Figure 2 - We Can End Poverty. United Nations. 2001. This image lists the eight millennium goals. 

     We were asked in class to rank elements of primary health care that included education, medical care, nutrition, immunization, etc. After income and poverty, maternal and child health services are the most important. Seear (2012) explained that a mother who has health resources and cares for her child can protect them against a variety of infectious and environmental dangers. Protecting the child against these dangers is preventative and better than dealing with health concerns later. Seear (2012) expanded that, “no serious advances in child mortality can be made until equivalent attention is paid to female health, particularly education, gender equality and pregnancy-related medical care” (p. 236). This is why there is the tendency to group their health concerns together. The element of maternal and child health services is directly related to four of the Millennium Development Goals, numbers three to six in the picture to the left, but the connection goes further than that. Sinding (2009) described several research studies that demonstrated how family planning must be available for individuals in developing countries before any of the other MDGs can be fulfilled.

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     Family planning controls fertility and increases quality of life. The World Health Organization (WHO) named six benefits of family planning, listed above. Allen (2007) explained that spacing pregnancies lowers the lifetime risk of disability and death of the mother which decreases the likelihood of poor healthcare and early death of the child. Allen (2007) expanded that the lowered birth rates from less pregnancies that are further apart helps health systems manage and provide skilled workers knowledgeable in hygiene and feeding that would not be available in overwhelmed institutions with inexperienced attendants. Smaller families will lower the rates of stunted growth, malnutrition and low birth weights in children (Allen, 2007). Carr et al. (2012) justified that this also contributes to a larger investment in children’s’ health and education, particularly for daughters. Using family planning to avoid adolescent pregnancies, pregnancy in a woman’s forties and closely spaced births will lower infant mortality rates (Allen, 2007). Even with modern contraceptives unintended pregnancies occur, requiring the need for safe abortions which are crucial for maternal health. Contraception as a reproductive choice or having a desired pregnancy will also empower women, giving them more decision-making at home and in society (Allen, 2007). In addition, family planning will increase the likelihood of women getting an education and joining the workforce which provides more financial security for the whole family.

     Family planning has its critics as a feasible solution, but they have been proven wrong on several occasions as it has so many benefits. Sinding (2009) explained that population policies and reproductive health programs have been successful and well-received in countries such as Kenya and Rwanda. This was also addressed in the Navrgono field experiment in Ghana where fertility decreased by 15% despite extreme poverty and poor living conditions (Sinding, 2009). However, in terms of family planning promotion, more research must be done to illuminate the most appropriate and culturally relevant approaches. We discussed cultural competence and humility in class. In this case, cultural humility is especially important because we would need to think about power imbalances, mutually respectful partnerships and ongoing engagement in order to succeed with family planning. Maternal health is important all over the world and although it requires a lot of extensive improvement in some countries, that doesn’t mean there is not room for improvement in all countries.

References

Allen, R. H. (2007). The role of family planning in poverty reduction.

     Obstetrics & Gynecology, 110(5), 999-1002.

Carr, B., Gates, M. F., Mitchell, A., & Shah, R. (2012). Giving women the

     power to plan their families. The Lancet, 380(9837), 80-82. 

Habumuremyi, P. D., & Zenawi, M. (2012). Making family planning a

     national development priority. The Lancet, 380(9837), 78-80.

Half The Sky. (2013, January 17). Turning oppression into opportunity for

      women worldwide. Retrieved from    

      http://halftheskymovement.tumblr.com/post/40781569819

Jnvsackles. (2013, September). Millennium development goals: because

     together we can end poverty. Retrieved from

     http://itsajensenthing.tumblr.com/post/58693108934/millennium-

     development-goals-because-together-we 

Seear, M. (2012). An Introduction to International Health. Toronto, Canada:

     Canadian Scholars’ Press Inc. 

Sinding, S.W. (2009). Population, poverty and economic development.

     Philosophical Transactions of the Royal Society, 364(1532), 3023-3030.

World Health Organization. (2013, May). Family planning. Retrieved from

     http://www.who.int/mediacentre/factsheets/fs351/en/

Looking Beyond Infectious Disease

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Figure 1 - Myth #2: NCDs are a disease of the rich? NCDFREE. Jan 23, 2014. This artifact is powerful in changing the way someone may think about disease globally. 

     Non-communicable disease (NCD) is generally thought to be a problem of the rich when in fact this is not the case. The impact of infectious disease on the developing countries cannot be denied. However, one tends to look at the data and mortality rates, only seeing infectious disease as the health issue and westernized medicine or vaccinations as the all-encompassing cure. NCDFREE tackles non-communicable diseases such as diabetes, heart disease and cancer as a global social movement. Figure 1 was posted on their website with the description stating that, “80% of NCDs globally occur in the world’s poorest nations… NCDs are caused by, result in and perpetuate poverty - locally and worldwide”. In order to significantly improve health in developing countries, it is not appropriate to focus on only on curative measures impacting infectious disease because the problem is not that simple. The National Institute on Aging (NIA, 2007) clarified that, “noncommunicable diseases already account for as much of the burden of disease in low- and middle-income countries as communicable disease, maternal and perinatal conditions, and nutritional conditions” (p.12). Projections show that the burden of chronic disease is expected to increase which can be seen in figure 2. 

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Figure 2 - The Increasing Burden of Chronic Noncommunicable Disease: 2002-2030. NIA. March 2007. This artifact lays out the reality of communicable and non-communicable diseases, showing the burden of chronic disease. It also helps support the fact that infectious disease is not the only health issue in the developing world.

      Accepting the importance of non-communicable disease as a global problem and not just a problem of the affluent, is only the first step. It is a common misconception that chronic illness is caused solely by individual health behaviours. Dr. Demaio discussed this in his NCDFREE video provided below where he shatters myths about NCDs in a global perspective. Messages from the media and governments are monopolized by information telling individuals to exercise, maintain a balanced diet and avoid risky behaviours such as smoking or unsafe sex. It is made to seem like such a simple pathway to health and conveniently masks any blame on the big players who are responsible as well. This is the issue of victim blaming. Telling an impoverished individual with little to no resources, in any part of the world, to get vaccinated, exercise and eat healthy is obviously not a successful method. It is wrong to blame individuals for their poor health if they have little control over their personal determinants of health. Also, the social determinants of health are often forgotten. The concept of choice vs. chance comes up a lot in class which re-enforces the need to stop victim-blaming. People don’t always have the choice to go to the gym or the choice to have stressful lives with little control that put them at risk for both infectious and chronic diseases. It is extremely difficult for individuals to overcome these barriers, so it should be governments that take action. In class we discussed equality vs equity. We focused on equity and equalizing health outcomes of advantaged and disadvantaged groups. Braveman and Gruskin (2003) revealed that, “equity in health means equal opportunity to be healthy, for all population groups” (p. 257). This is sadly not the case in today’s world as many people do not have adequate resources.   

Video - NCD Mythbusting with Dr Alessandro Demaio. NCDFREE. October 2013. This artifact highlights NCDs as a global issue and discusses the social determinants of health. 

     We need to explore the social determinants of health in order to overcome both infectious disease and chronic disease. Preventative measures and action not only directly related to health but also socially and politically are necessary. Marmot (2005) explained that this action will, “address not only the major infectious diseases linked with poverty of material conditions but also non-communicable diseases—both physical and mental—and violent deaths that form the major burden of disease and death in every region of the world outside Africa and add substantially to the burden of communicable disease in sub-Saharan Africa” (p. 1099). In class we discussed how the Lalonde Report addressed human biology, environment, lifestyle and health care organization as determinants of health, but the government and society began promoting change in lifestyle alone. There has been progress in going beyond services related only to lifestyle with help from the Ottawa Charter and the Bangkok Charter that promote the importance of all twelve of the determinants of health. Marmot (2005) argued that action on the social determinants is possible and necessary. Sweden has worked to provide social conditions conducive to health with policies relating to healthier environments and work life as well participation in society. Columbia will provide money to impoverished families as long as their children are attending school classes and receiving preventive health care. Therefore internationally, all countries should and can take action.

     We tend to separate the world into us vs them. The developing countries are seen as separate and less developed than the western world which brings up feelings of superiority. In every day discourse, even in our classroom, there is a tendency to hear statements claiming the need for developing countries to follow our lead and overcome diseases like we have. There should be no us and them, only we and we should be a global community that works together to achieve optimal health for all. This way of thinking does not mean we are all alike and should follow a standardized path of development. The context of health issues may vary not only from one country to the next, but from one community or home to the next. If we go past the data of health issues and exploring the context to adopt appropriate policies the world can overcome disease.

References 

Braveman, P., & Gruskin, S. (2003). Defining equity in health. Journal of Epidemiology 

     and Community Health, 57(4), 254-258.

Marmot, M. (2005). Social determinants of health inequalities. Lancet, 365(9464), 1099-

     1104. 

National Institute on Aging. (2007). Why population aging matters: a global perspective.

     (DHHS Publication. ADM  07-6134). Washington, DC: U.S. Government Printing

     Office. 

NCDFREE. (2014, Jan 23). Myth #2: NCDs are a disease of the rich? Retrieved from

     http://ncdfree.org/iceberg/

NCDFREE. (2013, October). NCD mythbusting with Dr Alessandro Demaio (video file).

     Retrieved from http://vimeo.com/79153602