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OUR WORLD’S POPULATION

http://opr.princeton.edu/popclock/popupclock.html

http://math.berkeley.edu/~galen/popclk.html

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INEQUITY, SOCIAL JUSTICE, EMPOWERMENTUNIVERSITY OF GEORGIA; JANUARY 26, 2010

STANLEY O. FOSTER MD, MPH

THINK GLOBALLY – ACT LOCALLY

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INEQUITY IN URBAN AMERICARESIDENCE & INCOME – LOUISVILLE KY

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20

30

40

50

60

70

80

90

District 5District 21District 24District 16

Median Income 1000 Dollars

Infant Deaths 1000 Births

Median Age of Death

http://www.unnaturalcauses.org/assets/uploads/file/louisvillemap.pdf

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Underlying causes of death

Poverty17%

Tobacco17%

Diet & SL12%

All others50%

Alcohol4%

Hahn, RA, et al; (CDC) Epidemiology 6(5) 490-7, 1995

USA, 1991, ages 25-74

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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 MortalityClarke County, NE GA, Africa, World

Clarke NE GA Africa World0

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20

30

40

50

60

70

80

90

100

Infant 1-4 Years

Deaths per 1000 Births Deaths/1000 Births

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

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POVERTY

0

20

40

60

80

100

120

140

Low Income Lower Middle Upper Middle High

<5 Mortality in Deaths per 1000 Births

Victora Lancet 2003:362:234

WHERE WERE YOU BORN?

CONDUCIVE TO LIVING

STRESSED

CLIMATE SunRain

MonsoonsMalariaDrought

POLITICAL Peace War

GOVERNANCE Responsive Indifferent

EDUCATION Available Absent10

WHO WAS YOUR MOTHER?

Status Married Single/Raped

Income Adequate Poor

Education Yes No

Birth Interval

=>4 Years

<4 Years

Obstetrical Care

Yes No11

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EFFECT OF BIRTH INTERVAL INFANT MORTALITY PREBIRTH-POSTBIRTH

0

50

100

150

200

250

300

350

Long-Long Long-Short Short-Long Short-Short

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

66.759.5

4246.5

30.2 31.625 21.1

0

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20

30

40

50

60

70

80

0 1 2 3 4 5 6 =>7

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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HOWEVEROUR 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

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+ 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

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FREE MARKET?

FREE TRADE?

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Global Distribution of Income

Richest

Poorest 1.4

1.9

2.3

11.7

82.7

Why?Why?

World Bank, 1993

% of total world income

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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 CAPITA1961: $61; 2002: $67

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Assistance doubled

1999-2007

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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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HELP

Empowerment

LISTEN

Facilitate thinking,speaking & acting

(mobilize individual andcommunity resources)

Change

Dependence

Status Quo

Health (well-being) for all

Give to,Do for,

Tell

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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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CarrollBehrhorstGuatemala

• 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 WorkerMaternal Deaths per 100,000

US - 13Guatemalan Spanish - 70Guatemalan Indians - 211

Trained 30 Community MidwivesNo transport for emergencies

Cell Phones

Ambulance

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I AM HOUVITAA 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

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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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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

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Small LoansTo Women

Average $300In 2008 -280 Loans In

2008 - 279 Repaid

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HAND WEAVING

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ANIMAL HUSBANDRY

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Agriculture

Potatoes

TriCropping- Corn, Squash, Bean

Carrots

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ONE YEAR COURSE IN

SEWING

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Saturday Schools ToEnable Adults to

Complete Education120 Students

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TRAINING COURSES

Development - 2001

Child Health – ORS for Diarrhea2003

Maternal Health & Family Planning

2004, 2006

Community Planning

2002

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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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“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 donethe 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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