1. OUR WORLD’S POPULATION

2. THINK GLOBALLY – ACT LOCALLY
INEQUITY, SOCIAL JUSTICE, EMPOWERMENT UNIVERSITY OF GEORGIA; JANUARY 26, 2010 STANLEY O. FOSTER MD, MPH
THINK GLOBALLY – ACT LOCALLY

3. INEQUITY IN URBAN AMERICA RESIDENCE & INCOME – LOUISVILLE KY
Median Income 1000 Dollars
Infant Deaths Births
Median Age of Death

5. WHY
is poverty the number one cause of death in the richest nation on earth?

6. Poverty suppresses the immune system.

7. Infant & Under 1-4 Mortality Clarke County, NE GA, Africa, World
Deaths per 1000 Births Deaths/1000 Births

8. 10 Million Children (0-4) Deaths-2000 Each Dot Represents 5000 Deaths

9. POVERTY <5 Mortality in Deaths per 1000 Births 9
Victora Lancet 2003:362:234

10. WHERE WERE YOU BORN? CONDUCIVE TO LIVING STRESSED CLIMATE Sun Rain
Monsoons
Malaria
Drought
POLITICAL
Peace
War
GOVERNANCE
Responsive
Indifferent
EDUCATION
Available
Absent

11. WHO WAS YOUR MOTHER?
Status
Married
Single/Raped
Income
Adequate
Poor
Education
Yes No
Birth Interval
=>4 Years
<4 Years
Obstetrical Care

12. 12

13. EFFECT OF BIRTH INTERVAL INFANT MORTALITY PREBIRTH-POSTBIRTH13
Hobcraft Pop Index, 1983, 49,602

14. WHERE DO YOU LIVE? AFRICAN HOMES

15. What do children die of? Green areas due to under-nutrition

17. ACCESS TO HEALTH CARE BY WALKING DISTANCE IN HOURS
PERCENT USING HEALTH FACILITY IN LAST 6 MONTHS

18. DVD - Ethiopia

19. QUALITY OF MEDICAL CARE

20. 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

21. 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.

22. 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

24. FREE MARKET?
FREE TRADE?

25. 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

26. 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

27. AID PER CAPITA 1961: $61; : $67

28. Assistance doubled

29. The most important determinant of health is
social justice.

31. “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

32. 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

33. 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

34. SUPPRESSION, POVERTY, APATHY
Poverty was widespread
Poor were apathetic
Apathy is not natural
Apathy only occurs when human needs are blocked by oppression

35. APPOINTED DIRECTOR OF CULTURE AND EDUCATION
Non-literates could not vote
Literacy was a development priority

36. 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

37. (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

38. 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

39. 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”

40. “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."

41. 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

42. LAS BARRANCAS

43. ROSARIO DIAZ Nurse, Midwife, Social Worker Maternal Deaths per 100,000US
Guatemalan Spanish - 70
Guatemalan Indians - 211
Trained 30 Community Midwives
No transport for emergencies
Cell Phones
Ambulance

44. 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

45. 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

46. 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

47. Small Loans To Women Average $300 In 2008 -280 Loans In 2008 - 279 Repaid

48. HAND WEAVING

49. ANIMAL HUSBANDRY

50. Agriculture
Carrots
Potatoes
TriCropping- Corn, Squash, Bean

51. ONE YEAR COURSE IN SEWING

52. Saturday Schools To Enable Adults to Complete Education 120 Students

53. TRAINING COURSES Development - 2001 Community Planning 2002
Maternal Health & Family Planning
2004, 2006
Child Health – ORS for Diarrhea2003

54. WHAT DO YOU SEE? “WE ARE LOCKED IN OUR HOUSES” WHY?

55. WHY ARE WE LOCKED IN OUR HOUSES?

56. 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

57. 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”

58. 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

59. 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