OUR WORLD’S POPULATION
http://opr.princeton.edu/popclock/pop
upclock.html
http://math.berkeley.edu/~galen/popcl
k.html
1
INEQUITY, SOCIAL JUSTICE, EMPOWERMENT
UNIVERSITY OF GEORGIA; JANUARY 26, 2010
STANLEY O. FOSTER MD, MPH
THINK GLOBALLY – ACT
LOCALLY
2
INEQUITY IN URBAN AMERICA
RESIDENCE & INCOME – LOUISVILLE KY
Median Income
1000 Dollars
Infant Deaths
1000 Births
Median Age
of Death
3
http://www.unnaturalcauses.org/assets/uploads/file/louisvillemap.pdf
Underlying causes of death
USA, 1991, ages 25-74
Alcohol
4%
All others
50%
Diet & SL
12%
Tobacco
17%
Poverty
17%
Hahn, RA, et al; (CDC) Epidemiology 6(5) 490-7, 1995
4
is poverty the number
one cause of death in the
richest nation on earth?
5
Poverty
suppresses the
immune system.
6
Infant & Under 1-4 Mortality
Clarke County, NE GA, Africa, World
Deaths per 1000 Births
Deaths/1000 Births
7
10 Million Children (0-4) Deaths-2000
Each Dot Represents 5000 Deaths
8
POVERTY
<5 Mortality in Deaths per 1000 Births
140
120
100
80
60
40
20
0
Low Income
Lower Middle
Upper Middle
High
9 9
Victora Lancet 2003:362:234
WHERE WERE YOU BORN?
CLIMATE
CONDUCIVE TO STRESSED
LIVING
Sun
Monsoons
Rain
Malaria
Drought
POLITICAL
Peace
War
GOVERNANCE
Responsive
Indifferent
EDUCATION
Available
Absent
10
WHO WAS YOUR MOTHER?
Status
Married
Single/Raped
Income
Adequate
Poor
Education
Yes
No
Birth Interval =>4 Years
<4 Years
Obstetrical
Care
No
Yes
11
12 12
EFFECT OF BIRTH INTERVAL
INFANT MORTALITY PREBIRTH-POSTBIRTH
350
300
250
200
150
100
50
0
Long-Long
Hobcraft Pop Index, 1983, 49,602
Long-Short
Short-Long
Short-Short
13 13
WHERE DO YOU LIVE? AFRICAN HOMES
14
What do
children
die of?
Green
areas due
to undernutrition
15
16
ACCESS TO HEALTH CARE BY
WALKING DISTANCE IN HOURS
PERCENT USING HEALTH FACILITY IN LAST 6 MONTHS
80
70
66.7
59.5
60
42
50
46.5
40
30.2
31.6
30
25
21.1
6
=>7
20
10
0
0
1
2
3
4
5
WALKING DISTANCE IN HOURS
17
DVD - Ethiopia
18
QUALITY OF MEDICAL CARE
19
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
20
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. www.fao.org/es/ess/faostat/foodsecurity/index_en.htm
21
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
22
23
FREE MARKET?
FREE TRADE?
24
Global Distribution of Income
% of total world income
Richest
82.7
11.7
2.3
Why?
1.9
Poorest
1.4
World Bank, 1993 25
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
26
AID PER CAPITA
1961: $61;
2002: $67
27
Assistance
doubled
1999-2007
28
The most important
determinant of health
is
social justice.
29
30
“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
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
32
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
SUPPRESSION, POVERTY,
APATHY
• Poverty was widespread
• Poor were apathetic
• Apathy is not natural
• Apathy only occurs when human needs
are blocked by oppression
34
APPOINTED DIRECTOR OF
CULTURE AND EDUCATION
• Non-literates could not vote
• Literacy was a development
priority
35
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
HELP
LISTEN
Facilitate thinking,
speaking & acting
(mobilize individual and
community resources)
Empowerment
Give to,
Do for,
Tell
Dependence
Status Quo
Change
Health (well-being) for all
37
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
38
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
“Genuine
development
requires creative,
participatory
processes that
encourage selfreliance and a
balanced sharing
of available
resources. Again,
the fundamental
goal is empowering
the poor."
40
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
42
ROSARIO DIAZ
¾Nurse, Midwife, Social
Worker
¾Maternal Deaths per 100,000
¾US
- 13
¾Guatemalan Spanish - 70
¾Guatemalan Indians - 211
¾Trained 30 Community
Midwives
¾No transport for emergencies
Cell Phones
Ambulance
43
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
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 45
needs of poor people
1. Lack of
Education
1. Self Esteem
2. Under –
Nutrition
2. Hope
3. Disease
4. Males in US
5. NonFunctional
Family
TIPPING THE
BALANCE
WITH INCOME
GENERATION
3. Faith
4. Education
5. Ability to Earn
6. Community
Support
POVERTY
HEALTH
46
Small Loans
To Women
Average $300
In 2008 -280 Loans In
2008 - 279 Repaid
47
HAND WEAVING
48
ANIMAL
HUSBANDRY
49
Agriculture
Carrots
Potatoes
50
TriCropping- Corn, Squash,
B
ONE YEAR
COURSE IN
SEWING
51
Saturday Schools To
Enable Adults to
Complete Education
120 Students
52
TRAINING COURSES
Development - 2001
Community
Planning
2002
Child
Health –
ORS for
Diarrhea
2003
Maternal
Health &
Family
Planning
2004,
200653
WHAT DO
YOU SEE?
“WE ARE
LOCKED
IN OUR
HOUSES”
WHY?
54
WHY ARE WE
LOCKED IN
OUR HOUSES?
55
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
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
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
58
– Problem solved
“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 years59 ago
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