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1 OUR WORLD’S POPULATION upclock.html k.html 1

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

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

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

6 Poverty suppresses the immune system. 6

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

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

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

10 WHERE WERE YOU BORN? CONDUCIVE TO LIVING STRESSED CLIMATESun Rain Monsoons Malaria Drought POLITICALPeaceWar GOVERNANCEResponsiveIndifferent EDUCATIONAvailableAbsent 10

11 WHO WAS YOUR MOTHER? StatusMarriedSingle/Raped IncomeAdequatePoor EducationYesNo Birth Interval =>4 Years<4 Years Obstetrical Care YesNo 11

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

14 WHERE DO YOU LIVE? AFRICAN HOMES 14

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

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

18 DVD - Ethiopia 18

19 QUALITY OF MEDICAL CARE 19

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

21 HOWEVER OUR WORLD – OUR VILLAGE 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

22 + Low prices for natural resources + So called aid - High prices for imports - High interest on external debt = Billions in capital drain Hemorrhage of capital from Africa 22

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24 FREE MARKET? FREE TRADE? 24

25 Global Distribution of Income Richest Poorest Why? World Bank, 1993 % of total world income 25

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

27 AID PER CAPITA 1961: $61; 2002: $67 27

28 Assistance doubled

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

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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 31

32 UNIVERSAL DECLARATION OF HUMAN RIGHTS 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

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 33

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

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

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 36

37 HELP Empowerment LISTEN Facilitate thinking, speaking & acting (mobilize individual and community resources) Change Dependence Status Quo Health (well-being) for all Give to, Do for, Tell 37

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,

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” 39

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." 40

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 41

42 LAS BARRANCAS 42

43 ROSARIO DIAZ  Nurse, Midwife, Social Worker  Maternal Deaths per 100,000  US - 13  Guatemalan Spanish - 70  Guatemalan Indians  Trained 30 Community Midwives  No transport for emergencies Cell Phones Ambulance 43

44 I AM HOUVITA A MIDWIFE IN LAS BARRANCAS During a training course, I learned to draw a map of my community Now that I run the clinic, I use a map to identify pregnant women especially those at high risk 44

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 45

46 POVERTY 1.Lack of Education 2.Under – Nutrition 3.Disease 4.Males in US 5.Non- Functional Family 1.Self Esteem 2.Hope 3.Faith 4.Education 5.Ability to Earn 6.Community Support HEALTH TIPPING THE BALANCE WITH INCOME GENERATION 46

47 Small Loans To Women Average $300 In Loans In Repaid 47

48 HAND WEAVING 48

49 ANIMAL HUSBANDRY 49

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

51 ONE YEAR COURSE IN SEWING 51

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

53 TRAINING COURSES Development Child Health – ORS for Diarrhea 2003 Maternal Health & Family Planning 2004, 2006 Community Planning

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

55 WHY ARE WE LOCKED IN OUR HOUSES? 55

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 56

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” 57

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 58

59 “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 17Tao Te Ching, Chapter 17, written by Lao Tse three thousand years ago 59

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