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OUR WORLD’S POPULATION
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THINK GLOBALLY – ACT LOCALLY
INEQUITY, SOCIAL JUSTICE, EMPOWERMENT UNIVERSITY OF GEORGIA; JANUARY 26, 2010 STANLEY O. FOSTER MD, MPH THINK GLOBALLY – ACT LOCALLY
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INEQUITY IN URBAN AMERICA RESIDENCE & INCOME – LOUISVILLE KY
Median Income 1000 Dollars Infant Deaths Births Median Age of Death
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WHY is poverty the number one cause of death in the richest nation on earth?
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Poverty suppresses the immune system.
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Infant & Under 1-4 Mortality Clarke County, NE GA, Africa, World
Deaths per 1000 Births Deaths/1000 Births
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10 Million Children (0-4) Deaths-2000 Each Dot Represents 5000 Deaths
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POVERTY <5 Mortality in Deaths per 1000 Births 9
Victora Lancet 2003:362:234
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WHERE WERE YOU BORN? CONDUCIVE TO LIVING STRESSED CLIMATE Sun Rain
Monsoons Malaria Drought POLITICAL Peace War GOVERNANCE Responsive Indifferent EDUCATION Available Absent
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WHO WAS YOUR MOTHER? Status Married Single/Raped Income Adequate Poor Education Yes No Birth Interval =>4 Years <4 Years Obstetrical Care
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EFFECT OF BIRTH INTERVAL INFANT MORTALITY PREBIRTH-POSTBIRTH
13 Hobcraft Pop Index, 1983, 49,602
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WHERE DO YOU LIVE? AFRICAN HOMES
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What do children die of? Green areas due to under-nutrition
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ACCESS TO HEALTH CARE BY WALKING DISTANCE IN HOURS
PERCENT USING HEALTH FACILITY IN LAST 6 MONTHS
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DVD - Ethiopia
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QUALITY OF MEDICAL CARE
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GLOBAL PROGRESS 0-4 Mortality : 10 Million in 2000 to 7 Million in 1998 Smallpox 15 million cases 2 million death in 1965 Zero cases since 1978 Iodine Deficiency 1 billion IQ points lost annually in 1990 75% reduction in iodine deficiency Poliomyelitis 350,000 polio cases in 1988; 1579 in 2009 HIV/AIDS 4 million cases treated for AIDS in 2009
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HOWEVER OUR WORLD – OUR VILLAGE1
1.4 of nearly 7 BILLION live below poverty line <$2/day 1 BILLION undernourished (calories, protein, micronutrients) Lack of food stunts growth, slows thinking, saps energy, hinders fetal development & contributes to mental retardation 1.
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Hemorrhage of capital from Africa
+ Low prices for natural resources + So called aid - High prices for imports - High interest on external debt = Billions in capital drain
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FREE MARKET? FREE TRADE?
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Why? Why? Global Distribution of Income % of total world income 82.7
Richest 11.7 Why? Why? 2.3 1.9 Poorest 1.4 World Bank, 1993
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It seems clear that the minority in the world with power and money will not voluntarily use it to change significantly the plight of the poor. Hilton, D., Contact 106, December 1988
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AID PER CAPITA 1961: $61; : $67
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Assistance doubled
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The most important determinant of health is
social justice.
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“A human rights framework describes the essential preconditions for health better than any other medical or public health model. If human rights are promoted and protected and human dignity is respected you will have a “healthy society” in which people can best achieve physical, mental, social and spiritual well-being.” Dr. Jonathan Mann
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UNIVERSAL DECLARATION OF HUMAN RIGHTS - 1948
All human beings are born free and equal in dignity and rights. Article 1 Everyone has a right to education. Article 26-1 Marriage shall be entered into only with the free and full consent of the intending spouses. Article 16-2 Everyone, without any discrimination, has the right to equal pay for equal work. Article 23-2 Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family. Article 25-1
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WHO IS PAULO FREIRE Born Brazil 1921 Suffered through great depression
Lived and played football with the poor Lost 4 years of school Educated in Law, Philosophy, Phenomenology
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SUPPRESSION, POVERTY, APATHY
Poverty was widespread Poor were apathetic Apathy is not natural Apathy only occurs when human needs are blocked by oppression
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APPOINTED DIRECTOR OF CULTURE AND EDUCATION
Non-literates could not vote Literacy was a development priority
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FREIRE LISTENED & WATCHED
Words that were common in everyday conversation Words the evoke emotion on the faces of the speakers Used these words to teach literacy Taught 300 sugar workers to read in 45 days
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(mobilize individual and community resources) Dependence
HELP LISTEN Give to, Do for, Facilitate thinking, Tell speaking & acting (mobilize individual and community resources) Dependence Empowerment Status Quo Change Health (well-being) for all
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The people have the right and duty to participate individually and collectively in the planning and implementation of their health care. WHO, Declaration of Alma Ata, 1978
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Carroll Behrhorst Guatemala
Year 0: farmed and met his neighbors Year 1: meeting to set priorities- soccer field Year 2: meeting to set priorities – lights for the soccer field Year 3- meeting to set priorities-diarrhea; “I am a doctor”
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“Genuine development requires creative, participatory processes that encourage self-reliance and a balanced sharing of available resources. Again, the fundamental goal is empowering the poor."
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CHEPE ROMERO No school in village High School - late 20s
Training in Forestry Listened to communities till they were ready (1-7 Years) Formed committee Provided technical guidance Mobilize funds for materials Developed Chepina Smoke Free Stove 30 Spring Fed Community Water Supplies
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LAS BARRANCAS
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ROSARIO DIAZ Nurse, Midwife, Social Worker Maternal Deaths per 100,000
US Guatemalan Spanish - 70 Guatemalan Indians - 211 Trained 30 Community Midwives No transport for emergencies Cell Phones Ambulance
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I AM HOUVITA A MIDWIFE IN LAS BARRANCAS
Now that I run the clinic, I use a map to identify pregnant women especially those at high risk During a training course, I learned to draw a map of my community
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ROSARIO WORKED WITH WOMEN TO ESTABLISH THEIR OWN SELF HELP GROUPS
WHO – WOMEN’S GROUPS IN 12 VILLAGES WHERE – Guatemala, Quezaltenango, Rural Villages in Highlands – 8000 Feet. WHY – Address the spiritual, development, and health needs of poor people
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TIPPING THE BALANCE WITH INCOME GENERATION
Lack of Education Under – Nutrition Disease Males in US Non-Functional Family Self Esteem Hope Faith Education Ability to Earn Community Support TIPPING THE BALANCE WITH INCOME GENERATION POVERTY HEALTH
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Small Loans To Women Average $300 In 2008 -280 Loans In 2008 - 279 Repaid
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HAND WEAVING
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ANIMAL HUSBANDRY
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Agriculture Carrots Potatoes TriCropping- Corn, Squash, Bean
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ONE YEAR COURSE IN SEWING
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Saturday Schools To Enable Adults to Complete Education 120 Students
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TRAINING COURSES Development - 2001 Community Planning 2002
Maternal Health & Family Planning 2004, 2006 Child Health – ORS for Diarrhea2003
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WHAT DO YOU SEE? “WE ARE LOCKED IN OUR HOUSES” WHY?
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WHY ARE WE LOCKED IN OUR HOUSES?
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REASONS FOR BEING LOCKED IN THEIR HOUSES
Poverty Lack of education Cost of education Urban teachers not showing up at rural schools Alcoholism and Spousal Violence Husbands in US Rising cost of food
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HOW DO WE GET OUT? Education Meet together as Sisters
Identify and solve our problems together Income Generation Quotes “I am a widow, without my project I would be a beggar” “My pigs sent my four children to high school”
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HOW A COMMUNITY SOLVED ITS PROBLEM
Problem – our teacher lives in town and frequently does not show up to school Our Action Discussed our problem in our group Appointed one of us to monitor teacher’s attendance Told teacher that if she didn’t show up, we would get her fired Problem solved
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Begin with what they have. Build on what they know.
“Go to the people. Live among them. Learn from them. Begin with what they have. Build on what they know. And of the best of leaders, when the task is done the people will say - We have done it ourselves.” Tao Te Ching, Chapter 17, written by Lao Tse three thousand years ago
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