The state of worlds’ children education(unicef report) October 24, 2009

LITERACY DIFFERENCES AND ITS IMPLICATIONS (UNICEF, 2006 REPORT)

Education is a fundamental human right and very critical to development. it a source of power, wealth, knowledge, opportunities, gender equality, a weapon to poverty and a foundation to development. However all the above also are dependent on the quality of education we attain and the factors that facilitate access to education.

In reference to the UNICEF report, countries with lowest female literacy and least female attendance like Afghanistan, Mali, Niger, girls are almost denied the right to enrol even at the lowest level of primary as well as secondary. The implication is that education is only a right only if enforced. Others include girls in Yemen, Iraq, Pakistan etc countries characterised by Islam as a factor that shows more numbers of boys preference to get education as compared to more Christian ones like Philippine with more girls attending school that boys, others include Ukraine, Venezuela.

 Generally least developed countries indicate the lowest literacy levels especially at secondary levels while the developed countries show the highest literacy levels. The developed countries also show high levels of technology and communication. The implication is that children in developed countries have more access to research, skills, electricity associated with internet and phone operations etc. Their world is more technologically advanced as compared to poor African countries like Mali Ethiopia etc were internet as main medium of communication in the global world is zero. Lack of these services have also increased the education gap between the developed and poor countries.

 The statistics also show that the most developed countries have more gender equality in enrolment of boys and girls at all levels so is the attendance. While in most poor countries it indicates children preference in education where the boys are enrolled more than the girls at all levels of education. Discrimination of girls from enrolment especially in Moslem countries like Afghanistan and Pakistan have the lowest girls enrolment. This  can be associated with either religion or cultures that see girls only as mothers in the making and therefore do not require to go to school.

 Reasons for the differences:

Poverty is one of the reasons why not all children go to school especially girls. For instance in Uganda were primary education is free for all and Secondary education, but still the enrolment is higher at the primary level with high attendance but it decreases at higher levels. This is because children at earlier age are not so required to provide labour than when they grow. This is influenced by culture which socialise girls for domestic work and early marriage than others.

The reason for high rates of low attendance in poor countries is due to lack of enough resources and labour for subsistence. While in developed countries child policies on education and enforcement may be more realistic than in less developed countries were child labour if forbidden.

 The other reason could be the advancement in technology in the developed countries where information and education is supported by technology. In most countries with low literacy also have no internet, this in itself goes beyond technology to suggest that there may not be electricity to support computers and phones. There fore low literacy have factors that go beyond attendance.

 We also note that although enrolment is important at the primary level, retainance is another big issue coupled with inconsistent attendance. This in the end affects performance and quality of education. In comparing mostly East African levels of enrolment and retainance, there is a lot of drop outs of children as compared to developed countries which retain their children in the schools to the end.

 This implies that unless children are enrolled, retained and attend lessons can not gain from the education like getting any qualifications to earn a job to eradicate poverty. Because education is an assurance for better wellbeing and critical for one’s own health living and others,  employment is also possible. For example the UNIPID courses are only done on line, this implies that without the internet you can not have the right to study these courses or if you are computer illiterate. This is the true situation of our friends who don’t have internet and no technology in their countries like Ethiopia the table shows zero internet( UNICEF , 2008)

 

Reference

UNICEF(2006) The state of the world’s children 2007. Table 5

Available at  www.unicef.org

linking gender to poverty & health October 17, 2009

 

POVERTY AND HEALTH:

a) How is Gender inequality linked to poverty and Health In reference to Farmers’ article (2008)?

Summary of the article: Farmer in his article, explores the relationship of poverty and poor health or diseases by looking beyond curative approaches to diseases. He explains the relationship between socially constructed forces which he calls structural violence to the actual effects it has on the spread, treatment, poverty and prematurely death. Some of these social constraints to health access especially are economic, race, social violence gendered, religious and political. These constraints directly or indirectly affect especially the third world population in impairing their normal lives by lowering the possibilities by which they would be accessible.

The relationships arise when these social constrain limit the possible means of earning like lack of education, unemployment, structural violence  which often shape the course of the diseases or the spread. To the poor, some of these diseases have been normalised like malnutrition, natural breast feeding with no supplement, poor sanitation, poor housing, etc all of which in the long run affect their health in terms of immunity, hastening diseases which would otherwise be healed, illnesses resulting from poor water sources, poor environment and providing for other opportunist diseases like typhoid, diathermia etc.

To farmer it is unfortunate that even the medical professions, public health providers do not consider social factors as a contributory factor to most of these diseases. And yet he reports that indeed most of these illnesses are so prevalent because of social factors. Social factors are agencies to these illness, affect the diagnosis of drugs, administration and cure. He insists that indeed social factors determine variable risk of infections. He gives an example of how race affected black Americans from accessing HIV treatment as priority according to race.

He explains that to eradicate poverty is to start by improving health of the poor and ensuring access to health services. however he warns of the tradition that making medicines alone can not realise the goals but rather waste time, because the diseases lies beyond medicine.

Suggests that improvement of social constrains may not in themselves heal diseases but rather lessen the chances of persistent and re-occurrences. Although research indicated that structural violence increases the chances of illness, it is really discussed as an approach to addressing the poverty or health problems. Condemns the distal health approaches which don’t understand the structural violence embodied at the individual, community. And therefore their solutions do not address the cause.

 General Comments: I do agree with Farmers’ observations that vitally , it is very important to examine social factors as well as medical causes of disease especially in poor countries where illness seem to be related to poverty or other shortages of basic needs. Also agree that unless measures are undertaken to include in the medical investigations the social, economic reasons, efforts of cure may indeed be futile. This is because most of the diseases have underlying factors that can either affect the patient psychologically, recovery, accessing the services, or physical and religious constraints.

However, to suggest that medical providers investigate beyond medical causes implies that they be also trained to handle structural violence in treating or providing health care. This would be ideal but unfortunately in poor countries the ratio of doctor to patient is so alarming that if this procedure is considered, then very few people world access such services and it is also very expensive for instance for poor countries to provide social public services for free, free insurance without collapsing the entire economy. Especially where there is a high dependency on donor tired funding and its consequences and terms on where to invest or whom to benefit.

In most poor African countries, the poorest will prefer to take alcohol which is like a drug to make them forget at least their poverty for a day than stay sober in poverty((WHO, 2001). In Uganda for instance, the poor people have many sorts of local brew and spirits where especially the HIV infected would prefer to drink from morning to late in the night just to forget that they are sick. This however does not only affect their health but also their families. Usually these people become so drunk and violent and often fail to think of food or any other basic needs for themselves and families. They become poor because of spending on liquor which is a danger to health and savings. This is a behavioural trend that is accepted in some societies as normal. Increased earning implies increased consumption of alcohol, and increased violence and increased vulnerability to illnesses.

 He suggests that there is no good way to tackle the health crisis in Africa without using both distal and proximal tools. This sound so generalised and portrays Africa as one country with same structural violence problems and require same solutions. Africa is however a big continent with varying social structures and different problems that have affected their health and wellbeing. To one it is genocide, the other drought, floods, wars, race is almost not there apart from few countries like South Africa. All these require a diversity of skills and resources.

The inequalities rather are of class, tribal, political affiliations, language, location, corruption etc These in one way or another affect the end results of health and poverty. The PIH model for instance could not take off especially in countries were corruption is “almost” legalised. What kind of system would Farmer suggest in such a country were peoples’ lives are shaped by forces of corruption and the befits are diverted away from the patients? The case in reference is about the Global fund where millions of Dollars were sent to facilitate HIV patients, provide mosquito nets to prevent malaria, reduce maternal mortality etc but all this money was diverted by a few entrusted people to carry out exactly what farmer suggested, but unfortunately it was all diverted into their private usage. What would farmer suggest in the circumstances?

Farmer’s solutions seem to be more politically achievable, for instance, improving quality of water, education, insurance, security, etc are more of public goods that require state provision or legislation as a check to structural violence. This is true, but there are also their underlying factors that require to be addressed before structural violence is addressed. For instance land reform, trained personnel, functional legal system, political stability, accountability, infrastructures like roads etc

 HOW GENDER INEQUALITY LINK TO POVERTY AND HEALTH? Gender refers to the socially constructed roles, behaviours, activities, attributes that a given society considers appropriate for men and women (WHO).It includes the rights, roles, responsibilities and resource distribution. This is particularly true in the developing world where women are often systematically deprived from having equal access to social services as well as to physical and social capital(Phipps, 3003). Women are allocated roles that are often unpaid for while men are assumed to have more rights than women. women are more domesticated in the private space while the men dominate the public space. Each of these social constructs are dictated by culture, religion or general socialisation and have a negative impact on women.

To farmer, even disease is gendered, as well as poverty. Because women are not as mobile as men affects their access to health facilities. They are not only sick but also have no facilitating resources like transport or formulae for the infants. because women are denied access and control over resources, they can not make strategic life decisions or participate as much as men. Because women have been socialised to be child bearers and home care taker, they spend time taking care of others thus suffer time poverty and forget their own health. As a result, they are disempowered economically causing income poverty (Chamber, 2006), material poverty and capability poverty (laderchi et al, 2006)all of which are linked to poor health or wellbeing.

From the definition we note that these social constructions create inequalities between men and women by influencing who has access over what and why, who is supposed to do what in society. As a result, men and women are allocated duties which affect women and men’s health positively or negatively. In reference to the definition of poverty by UN (1995) gender plays a role by putting constraints in labour markets by making it hard for women to get paid jobs than men and or limiting certain jobs to men like police, night jobs, piloting etc because of the socialisation that women are the week, home takers while the men are tough and bread winners so entitled to pay and work. In the process, women become poorer and can not afford to access health

 Gender related constraints in labour market make it more difficult for women to escape poverty through employment or paid labour as a result they suffer more poverty constrained because they can not afford the basics of wellbeing and as such their health is affected in the long run.

It is evident that Countries with low levels of gender inequality report higher levels of economic growth, while those with high inequality gap levels report high poverty rates (Ehrenprel(2008) In essence there fore the higher the gender inequality the higher the poverty and the lower the health levels.

Because of gender inequality, men are the key decision makers and holders of economic and organisational power and public resources. They may not represent the needs of the women as well as the women would if there was gender equality to make decisions as well. This affects women in that gender-related-priorities-health-needs of women like maternal health, sexual health and reproductive health related services may be ignored. This can lead to maternal mortality, reproductive related diseases and complications as well as infant mortality. Because women already suffer from income and material poverty, lacking these resources could lead to absolute poverty and poor health

Gender also is responsible for the unequal distribution of resource in any society. Women have the responsibility of taking care of others especially when sick but no body takes care of them((Kern, 2001). This makes their own health poorer given the factor that even if they wanted to access medication they may not afford because of lack of resources.

It is also noted that due to reproduction, women especially the poor can not afford to access the basic health services were transport is required. As a result of poverty, their health is compromised. This can not be compared to men as a gender because they are mobile and have lesser domestic reproductive related obligations like taking care of the children and the aged, the sick, breast feeding etc.

Health is however worsened when they are HIV infected. Farmer (2006) reports that these women require ART to be given to the expecting mothers before birth but because of the distance, most of them miss this opportunity putting the life of the new born and that of the mother at a high risk. Because these women are poor, they can not afford formula for their new borne as a requirement to protect the infant from being infected but because they are poor, they end up breast feeding these babies and increasing the chances of making others sick because they are too poor to afford health measures.

Structural Violence therefore makes the victims vulnerable to poverty and forces them to live in unsatisfactory environment without the basic needs by either influencing access to resources, control over, behavioural changes, wellbeing etc directly or indirectly. However not all poor countries suffer the same structural problems although they may all suffer from poverty and ill health. This therefore requires a diversity of approaches in addressing health and poverty issues and support by the poor countries themselves and the victims or communities affected.

 Reffernces:

Ehrenprel D (2008) Poverty in focus: gender Equality. International Poverty Centre Brazil. Available at www.undp.povertycentre.org

Farmer PE, Nizeye, Stulac, Kashavjee S( 2006) Structural Violence and Clinical medicine. PLoS medicine Vol 3(4) at www.plosmedicine.org.Vol

Kern A, (2002) Dying for change: Poor people’s experiences of health and ill health. World health Organisation

 Laderchi C R, Stewart F, Ruhi S (2006) Does the definition of poverty matter: comparing four approaches. UNDP

 Phipps S(2003) The impact of poverty on health: A scan of research literature.  Canadian Institute for Health, Ottawa. Canada.

United Nations (1995) Copenhagen declaration and programme for Action: World Summit for Social Development.

 UNDP (2006) Poverty in Focus. International poverty centre poverty in focus. Brazil. At

www.undp-povertycentre.org

 

 

                POSTED ON 15^TH OCTOBER 2009

 

                 https://hart2009.wordpress.com

why is it important to consider health at global level October 11, 2009

                                       

               WHY IS IT IMPORTANT TO CONSIDER HEALTH AT THE GLOBAL LEVEL?

      INRODUCTION: Health is a concept with varying interpretations depending on the standpoint and knowledge of the one defining. But whatever the definition, determining its importance in global sense depends on how you define it. In this work the WHO(1946) definition has been adopted as well as some aspects of human rights perspectives. This work therefore explores the concept of health, its significance within and beyond boarders and the need for it to be addressed as a globally concern. It addresses the questions of why health should be recognised as important to the whole population, why there is need to  be protection measures against other effects of globalisation, why there is need to promote health living.  How it serves to preserve and provide the benefits to the next generation. Finally concludes with caution about the possibility of dominating the less developed countries and the consequences of dependence on the developed world than the intended interdependence.

 Health:

Health is a broad term defined differently in different disciplines and application. In science it is limited to being free from disease, from the human rights perspective health is a fundamental human right, to the UN millennium declaration (2000), it is an indicator of development, to others it is social wellbeing, to an environmentalist is living in a certain physical environment, and to WHO( Constitution 1946, Dickens et al,2004) it is “a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity”. Implying that health is shaped by a variety of factors ranging from individual factors, physical, social-cultural, economic and political context in which people live (smith et al, 2006). it goes beyond individual wellbeing to the environment one lives in that must be free not only from disease to be health but in terms of factors that influence health through relation with others or the surrounding one lives in which is also dependent on other influencing factors.

Although health is basic to everyone’s wellbeing, it is not enjoyed equally as a right in terms of access or distribution, due to a number of factors that go beyond an individual and national ability to provide, protect, and promote equally to the entire population. This is because health is like any other good with value and cost but least invested into because it does not generate direct profits to attract private investment. It therefore leaves the burden often on the state as the main provider or the victims. Health however is becoming increasingly expensive especially in this globalisation era, where focus is mainly on economic and political security.

Good health per se, has been acknowledged as very important to economic development  and achieving the MDGs (Huynen et al, 2005), but to achieve it requires a diversity of innervations in order to give a more central role to pro poor growth considerations

 by providing the necessary poverty reduction strategies through promoting good health, protecting populations against diverse health effects of globalisation. This is what has been referred to as public health.

Public health:

Public health is a broad and dynamic science, practice, an attitude taken to ensure that basics are met. It is politics, a principle and art of protecting and improving the health of people or communities and preventing disease as well as promoting health through organised and systematic efforts such as education, research, promoting healthy life styles, injury(Kauhanen, 2008, Brown et al, 2006) etc. Public health is more than medicine and more practical system and or infrastructure aimed at ensuring prevention of disease or injury, and protection of the most vulnerable populations for instance from epidemics and affections were individual initiatives can not provide sufficient solutions. It is a field which recognises that health needs can be addressed at multiple level such as interpersonal, community, environmental, political level, while at the same time being informed by a range of disciplines such as epidemiological studies, ethnographic studies, sociological research as well as historical studies, and economic research(Smith et al, 2006). It is characterised with prevention measures rather than curative aspects of health at a population level not individual.

Although public health is essential, it is often very expensive to under take due to the fact that it is a common good and often does not attract private profit motivated organisations neither does it affect only a group of individuals but also across boarders to impact on the globe directly and indirectly.

WHY IT IS IMPORTANT TO CONSIDER HEALTH AT A GLOBAL LEVEL

Basing on the UN Millennium Declaration(2000) and MDGs (2005), it was declared as a principle and the responsibility of all the member sates to uphold human dignity, equality and equity at the global level. It was an obligation of states to fight injustices including ill health as an indicator of under-development at the global level in order to ensure peace, security and a just world (WHO, 2005). This there fore is not a debate as to whether or not to consider health at global level but rather an unprecedented commitment by world leaders and requirement/ duty to bring justice especially to the most vulnerable groups.

From the development point of view, health is the heart/centre of the realisation of  MDGs to reduce poverty, as well as enhance important measures of well being. Out of the eight goals, health is directly represented as central to the realisation of gender equality, eradication of extreme poverty, education and hunger. Therefore from this point of view, it requires health diverse strategies to respond to the diverse health needs of different countries worldwide hence consideration of health at global level for the purpose would be ideal.

From Kickbusch’s(2002) arguments, globalisation  has largely contributed to transfer of health risks changes in nature due to the increased speed and reduced distance and cultural transfer brought about by modern transport and communication as well as economic dependence and interdependence. The implication therefore is that disease travels faster  than ever, harmful cultural practices, pollution, toxic substances and unsafe products. Health at a global level becomes important in such circumstances to provide guidelines, carry out research to establish the impact of such risks to human health and provide measures of prevention, protect the population at risk and to hold those responsible accountable for  their actions for the good of humankind.

 Since calamity or disaster  does not give notice as to when and where to strike, for instance floods, influenza, air borne diseases, earthquakes, wars etc,  implies that any body anywhere can fall victim and usually in such circumstances, there is little or no preparedness to protect such population from heath disaster that comes a long with such calamity. It is therefore important to consider health at global level to address human health needs especially in emergencies.

 From the definition, public health is so broad that it require a lot of diversity of specialisation in its planning and service providence and even advocacy which is easier if done collectively or globally in terms of resource requirement especially in research, education, prevention to ensure responsibility of all and to avoid similar crisis the WHO went through while being financed by individual states than globally(Brown et al, 2006).

 In order to prevent spread of infectious deceases resulting from factors of globalisation process, requires global campaigns through media, professionalism, diversity of appeals which have an economic implication to focus on health education, encouraging people to make health choices , demands , statistical evidence to show the gravity of the matter and the effects  on health to promote health life styles. All require global cooperation and organised system to combat such problems, makes health at global level ideal.

 While for administrative purposes, it is important for instance in creating policies for health, having standard of measure  of improvements  or decline( health indicators) , checking the politics of health, business and science of private health providers in managing fiscal resources needed to deliver effective acceptable services free from exploitation. This could be effective in controlling illegal trade of drugs, restricting production of scientifically proven dangerous products at an agreed global level health standards.

It also creates a link of different nations to one another, this also could lead to accountability of all to the improvement or degradation of health related factor and a collective effort to prevent the reoccurrence and provide a head way to better living for all as a developmental factor as well as checking the health challenges that go beyond national boundary

At global level specialisation is possible in addressing complex emergencies and promoting public health benefits such as public nutrition, food security, research, evaluation etc which would otherwise be expensive for an individual nation to address its problems. It Can ensure accessibility to health services especially of the vulnerable populations, given the fact that there are development inequalities among nations especially the less developed countries who often fall victims of poor health. By focusing on the entire population than individual health, enhances health equity.

Economically, health is a public good with value but has been ignored as a good in the expansion of trade and commerce in global institutions ( Kickbusch, 2004). Because it is a common good with often no profits attached, investment in it is left for those who do not want to make profits and some times it leads to exploitation of others or depletion of the environment. It there fore necessitates the creation of public health models that can take radical approaches to question the very premise of what a private good is at the global level. As well as addressing health issues and challenges beyond national boarders

Health is central to wellbeing as well as an important contributor to development and progress. This is based on the argument that healthier population is more productive in that people who live longer are more productive in terms of human resource and provide market , while poor health population drain the countries resources in terms of providing for social services and providing poor human resource and its associated effects.

Public health as a public good and or service has high demand at national level but limited supply which requires subsidising especially among the poorer nations who are not only indebted to donor countries but also can not afford to provide these goods and services to all their population among others include preventing HIV spread, child mortality, improving maternal health, carrying out research etc. This therefore necessitates global intervention.

Unlike before were states were able to produce what is sufficient for their population, with time, globalisation seem to be the only option to expand markets, commerce, there by creating interdependence between countries in terms of trade, technology, differences in endowment and many other resulting relationships. However this comes along with its own health impacts due to mobility of goods, people and more exploitation of the environment. Generally , global activities creates the need for an overall global body to monitor these activities in relation to the health of the general population.

Addressing health issues at global level enhances social networks of information, knowledge, research, social support thereby inducing changes in social cohesion, integration and interaction to influence social support in a population(Huynen et al, 2005)

This leads to enhancement of knowledge , technology to improve surveillance of the infectious diseases , monitoring , increased speed of response  especially in emergencies  like rapid spreading infections, by using global alerts , specific advisories and monitoring can prevent the spread there by saving the costs of treatment and loss of lives.

Conclusion:

Although there may be many reasons for considering health at global level, this program like any other, comes along with its own global negative impact especially on the poorer nations. For instance, given the big gap of inequality, there is a high possibility of dependence rather than interdependence. However on the other hand, we should ponder on how global is health at that level? What does it take to close the global health gap? Who sets the standards and terms of operation? How sustainable? How participatory are the poor developing countries? How independent is the organisation from the main- founders or funders of the program? Who takes decisions? What are the safety nets to this program? Who determines the beneficiaries? Why do we need global health when we already have the world health organisation?

 References:

Brown TM, Marcos C, Fee E, The world Health Organisation  and the Transition from International to Global Public Health.(2006). American Journal of Public Health 96(1): 62-72.

Dickens BM, Cook RJ and Fathalla MF(2004) Reproductive Health and Human Rights : Integrating Medicine , Ethics and Law. New York, Oxford University press.

Hynen MM, Marten P, Hilderink HBM, The health impacts of globalisation: a conceptual frame-work (2005) Globalisation and health 1 (14) 1-12. health.com/content/1/1/14.Last accessed on 6^th/10/09. available at http://www.globalisationand

Kauhanen J (2008) Introduction to Public Health. Video available at http://www.oppi.uku.fi/opk/video/kansanterveystiede/kauh

 Kickbusch I,(2004) From Charity to Rights: Proposal for five Action areas of Global Health. Journal of epidemiology  and community  health 58 ; 630 – 631. At http://www.ilonakickbusch.com/global-health/global-health.pdf

 Lee JW (2005) Health and the Millennium Development Goals: Keeping the promise. World Health Organisation.

Smith BJ, Cho tang Kwok and Nutbeam D, WHO Health Promotion Glossary: new terms. Oxford University Press ( 2006), 21 (4) 340 -345.

United Nations Millenium Declaration. NewYork, NY United Nations(2000) A/RES/55/2

Available at  http://www2.ohch.org/english/law/millenium.htm . accessed on the 8^th/10/09.

 World Health Organisation Constitution 1946

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