May 27-29, 2006. Dave Hilton, MD You may end up somewhere else! If you don’t know where you are going...

May 27-29, 2006

Dave Hilton, MD

You may end up somewhere else!

If you don’t know where you are going...

1. Stand up

2. Join two persons you don’t know

3. Complete the sentence:

“Health is . . . . . .”

Health is a dynamic Health is a dynamic state of complete state of complete physical, mental, physical, mental, spiritual, and social spiritual, and social well being and not well being and not merely the absence of merely the absence of disease or infirmity.disease or infirmity.

WorldHealth

Organization,1998

Medical science has no vocabulary or framework to deal with the concept of well being.

Jonathan Mann, 1994

But the Christian community does:

Shalom , n., well being

I have come that they may have life, and have it to the full. John 10:10

Be perfect, (NIV) therefore, as your heavenly Father is perfect.

Matthew 5:48 (NIV)

complete

Be all you can be!

Health is a dynamic Health is a dynamic state of complete state of complete physical, mental, physical, mental, spiritual, and social spiritual, and social well being and not well being and not merely the absence of merely the absence of disease or infirmity.disease or infirmity.

WorldHealth

Organization,1998

After ten years of doing all the

“jungle doctor” heroics at a

mission hospital in northern

Nigeria, seeing this cartoon

changed my life.

1. Describe the picture.2. What is the problem?

3. Where does this happen in real life?

4. Why?5. What to do?

1010millionmillion

77millionmillion

33millionmillion

Tobacco is the worst human disaster of the century. WHO, 1990

Annual Deaths Globally

1970

1999

2010predicted

Why do we allow tobacco companies to continue to entice our children and grandchildren to use their deadly product?

$$Tobacco is not a medical issue!

Continuing thousands of deaths daily from tobacco are an issue of justice.

De

at

h R

at

e (

pe

r M

illi

on

Ch

ild

re

n)

Whooping Cough Measles

Immunization Generally Available

1400

1200

1000

800

600

400

200

1850 1860 1870 1880 1890 1900 1910 1920 1930 1940 1950 1960

Death Rates of Children under 15, England and Wales

De

at

h R

at

e (

pe

r M

illi

on

Ch

ild

re

n)

1970

From T. McKeown, The Modern Rise of Population, New York Academic Press, 1976

McKeown, T., Lowe, C.R. An Introduction to Social Medicine, Oxford 1974, p 237

Standard of Living

No effective medical intervention

medical services17.5

15.0

12.5

10.0

5.0

13.5

12.5

11.5

10.5

9.5

8.5

7.5

6.5

5.5

4.5

3.5

1900 1920 1940 1960 1980

7.

11

12

13

10

9

8

7

6

5

4

3

17.5

15

12.5

10

5

Mortalityrate

% GDP formedicalservices

UNITED STATES

1900 1920 1940 1960 1980 2000

7.5

Source: National Center for Health Statistics

hundreds

%13

14

“DISEASES OF POVERTY”

TuberculosisAIDSMalaria

Poverty suppresses the immune system.

Côte d’Ivoire DHS, 1994; Bolivia DHS, 1998; Kyrgyz Rep. DHS 1997; Burkina Faso DHS 1992/3; Colombia DHS, 1995; India National Family Health Survey 1992/3; Indonesia DHS 1997. Source: WORLD BANK

Infant Mortality and Poverty

+ Low prices for natural resources

+ So called aid

- High prices for imports

- High interest on external debt

= Billions in capital drain

Hemorrhage of Hemorrhage of capital from capital from

AfricaAfrica

FREE FREE MARKET?MARKET?FREE FREE TRADE?TRADE?

The most The most

important important

determinant of determinant of

health is health is

social justice.social justice.

“Woe to you Pharisees, because you give God a tenth of your mint, rue and other garden herbs, but you neglect justice and the love of God.” Jesus (Luke 11:42)

May 27-29, 2006

May 27-29, 2006

We pray, “Thy will be We pray, “Thy will be

done on earth as it is done on earth as it is

in heaven.”in heaven.”

It seems clear that the It seems clear that the

minority in the world with minority in the world with

power and money will not power and money will not

voluntarily use it to voluntarily use it to

change significantly the change significantly the

plight of the poor.plight of the poor.Dave Hilton, Contact 106, December 1988

$

$

$$$

$ $

$ = white men from wealthiest nations= white men from wealthiest nations

$

FEUDALISM

DEMOCRACY ?

$

$

$$$

$ $

DEMOCRACY

$ = white men from wealthiest nations= white men from wealthiest nations

= women of color from poorest nations= women of color from poorest nations

$

What to do about tobacco?

Letter writing campaign to the chosen leaders of your national community:

a. Ban all advertising of tobacco products.

b. Remove tobacco from the Free Trade Act list

c. Require the same warnings on exported tobacco as in the U.S.

Economic and social Economic and social

development, based on development, based on

a new economic order, a new economic order,

is of basic importance is of basic importance

for the attainment of for the attainment of

health for all.health for all.WHO, Declaration of Alma Ata, 1978

The people have the right The people have the right

and duty to participate and duty to participate

individually and individually and

collectively in the collectively in the

planning and planning and

implementation of their implementation of their

health care.health care.WHO, Declaration of Alma Ata, 1978

Go to the people.Go to the people.Live among them.Live among them.Learn from them.Learn from them.

Begin with what they have.Begin with what they have.Build on what they know.Build on what they know.And of the best of leaders,And of the best of leaders,

when the task is donewhen the task is donethe people will saythe people will say

““We have done it ourselves.”We have done it ourselves.”

Lao Tsu 300 BCE

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

MAKE SURE THAT YOUR HELP IS

HELPFUL

ALWAYS COMBINE RELIEF WITH

EMPOWERMENT

Paulo FreirePedagogy of the Oppressed

Training for Transformation by Ann Hope & Sally Timmel

LISTEN

strong feelings

reflect back

input

Paulo Freire as described in Training for Transformation by Hope & Timmel

think decide

actassess

The Role of the FacilitatorThe Role of the Facilitator

Isaiah 65: 17-35

“For I am about to create new heavens and a new earth; the former things shall not be remembered or come to mind. But be glad and rejoice forever in what I am creating; for I am about to create Jerusalem as a joy, and its people as a delight. “I will rejoice in Jerusalem, and delight in my people; no more shall the sound of weeping be heard in it, or the cry of distress. No more shall there be in it an infant that lives but a few days, or an old person who does not live out a lifetime; for one who dies at a hundred years

will be considered a youth, and one who falls short of a hundred will be considered accursed. They shall build houses and inhabit them; they shall plant vineyards and eat their fruit. They shall not build and another inhabit; they shall not plant and another eat; for like the days of a tree shall the days of my people be, and my chosen shall long enjoy the work of their hands. They shall not labor in vain, or bear children for calamity; for they shall be offspring blessed by the LORD--and their descendants as well.

Isaiah 65:17-23

Health is a dynamic Health is a dynamic state of complete state of complete physical, mental, physical, mental, spiritual, and social spiritual, and social well being and not well being and not merely the absence of merely the absence of disease or infirmity.disease or infirmity.

WorldHealth

Organization,1998