ENVIRONMENT FOR HEALTH

CASE: Uranium mining in Namibia (1)

Uranium mining has been a good source of income for the Namibian government since 1976. Therefore, it’s not a surprise that the Uranium mining industry has a strong government support in the south-western African country. According to World Nuclear Association, Namibia has the capability to produce 10 per cent of the world mining output with only two significant mines (2). Overall there are about eight big Uranium mines in Namibia – and there are more to be approved if nothing is done.

Namibia doesn’t even have the use for its Uranium. According to SOMO, 100 per cent of the Uranium mined in Namibia is exported to Europe, the United States, South Africa and China, where it’s been mainly used in nuclear power-plants.

Uranium

As we know, Uranium can become very leathal when used in atom bombs. However, a person can be exposed to uranium – or its radioactive cousins such as radon – by inhaling dust in air or by ingesting contaminated water and food. People who live or work near government facilities that made or tested nuclear weapons, a modern battlefield where depleted uranium weapons have been used, or coal-fired power plants, facilities that mine or process uranium ore, or enrich uranium for reactor fuel, may have increased exposure to uranium (3).

According to World Health Organization, being exposed to Uranium may have impact on people’s health. In bad work conditions inhaling dust containing Uranium may have a relation to increased amount of lung cancer (4). It may also have impact on other organs, but according to WHO these have not been examined enough.

Hidden health information

According to SOMO, the Uranium miners in Namibia are not well enough informed about the health threatening possibilities Uranium can have. Namibian research Institute LaRRI did a research on environmental, labour and human rights conditions at Namibia’s largest uranium mine: Rössing Uranium. The LaRRI director Hilma Shindondola told that:

“During the time we conducted the study, employees claimed that Rössing does not explain what health problems can arise from exposure to uranium. Workers of the company raised concern that although they are tested annually, the results are never revealed until such a time when they leave the company.”

Severe health problems, such as cancer, will remain unknown until the workers leave the company. They probably have to leave when they’re too sick to work. This leads to socio-economic problems later on, when the families loose their main source of income. In order to prevent such tragedies, SOMO has been trying to raise the knowledge among the miners and their communities in cooperation with LaRRI. Together they will continue to investigate the environmental health and safety conditions among workers in Uranium mines in Namibia, as well as examining the links between multinational uranium mining companies and the governments they sign mining deals with.

Solutions?

First of all, the impact of Uranium to miners should be further examined to find out how it really impacts the health of the people.

Secondly, the health information should not be hidden from the workers. They should have the right to know their health status before it gets too severe. I doubt there is very much social security money at hand in Namibia, especially when it comes to companies paying the workers. That’s why I doubt the knowledge would not make a lot of difference – if you get sick, you can’t work. But of course, if you know you’re getting sick, you potentially have a better choice to choose whether to continue (or start at all) or to do something different.

1) http://somo.nl/news-en/uranium-workers-namibia-unaware-of-severe-health-risks/

2) http://www.world-nuclear.org/info/inf111.html

3) http://en.wikipedia.org/wiki/Uranium#Precautions

4) http://www.who.int/mediacentre/factsheets/fs257/en/

INFECTIOUS BUT NOT UNBEARABLE

The curable curse of Malaria

A net thick enough to keep the insects away costs US$10 on average. That’s how much it would cost to keep Malaria away. According to Global Malaria Action Plan, an average US$ 1.5 billion is used annually to prevent Malaria (1). With this money some 150 million nets could be bought for those in need. Yet about 3.3 billion people – half of the world’s population – are at risk of Malaria. According to World Health Organization WHO, every year, it leads to about 250 million malaria cases and nearly one million deaths. Every fufth child in Africa dies because of Malaria (2).

The deadly circle of Malaria could very easily be treated and even prevented. Infections can be prevented either by spraying insecticides indoors or by sleeping under long-lasting insecticide-treated bed nets.

Bed nets work by creating a protective barrier against deadly-malaria carrying mosquitoes that bite at night. According to Nothing But Nets organization, a family of four can sleep under an insecticide-treated bed net, safe from malaria, for four to five years (3).

US$ 10 for a bed net may not sound like much, but yet it is enough to keep the nets away from those in the greatest need – the poorest, surviving with less than US$ 1 per day. They are often the ones dying because of Malaria and suffering the most because of the lack of proper drugs.

Preventing Tuberculosis and HIV

I was very overwhelmed after hearing what economist Emily Oster had to say about Aids in Africa (4). I could buy the theory of miscalculation and how the statistics could have been misunderstood or collected even. From what I have understood about the success story of Uganda is, that the fact raported cases of HIV/Aids have diminished could in fact be due to the fact that most of the people with Aids are now dead and not infecting new people. Also the free spread of anti-retroviral drugs since 2004 may have stalled the HIV from developing to Aids (5).

What could be done globally is, to give out information and change the attitudes towards HIV. It’s not an instant dead sentence anymore to have HIV but it’s problematic. It may need a bigger attitude change than just “being faithful” and using condom. As Oster states, in countries where the life expectancy is about 40-50 years, people don’t see a virus like HIV as an instant threat in a world full of faster killing problems. And I’m not saying it’s just a problem in developing countries. It may become a problem in developed world too, where the anti-retroviral drugs are at hand of more people – thanks to the better salaries.

What comes to TB, vaccinating might easily solve the problem. Vaccinating can prevent up to 80 per cent of infections.  For some reasons there have been problems in vaccinating children in Africa. And the major vaccination programme in Finland was stopped in 2006. At the same time, WHO expects one billion new TB infections between 2000 and 2020 and has declared Tuberculosis as an emergency situation (6).

1) http://www.rollbackmalaria.org/gmap/1-4.html

2) http://www.who.int/features/factfiles/malaria/malaria_facts/en/index1.html

3) http://www.nothingbutnets.net/malaria-kills/

4) http://www.ted.com/talks/lang/eng/emily_oster_flips_our_thinking_on_aids_in_africa.html

5) http://www.avert.org/aids-uganda.htm

6) http://www.who.int/immunization/topics/tuberculosis/en/index.html

FROM MOTHER TO CHILDREN

There are various problems and circumstances that cause maternal and child mortality in developing countries.

Education

First of all, the lack of education and educated doctors and midwives kills both mothers and children. Even though giving birth to a child should be the most natural thing there is, in sub-Saharan Africa the lifetime risk of maternal death is 1 in 16. Every 16th woman dies because of having a child. In developed nations only 1 in 2 800.

Hygiene and complications

Secondly, inadequate hygiene and conditions cause deaths. According to World Health Organization ( WHO), every minute, at least one woman dies from complications related to pregnancy or childbirth – that means 529 000 women a year. In addition, for every woman who dies in childbirth, around 20 more suffer injury, infection or disease – approximately 10 million women each year. Most of this could be prevented by having more proper clinics, more professionally educated people to assist in child birth and in prenatal maternal care. Having more professionals and knowledge also diminishes the mortality of newborns.

The five most common complications that account for more than 70% of maternal deaths are (1):

1) haemorrhage (25%)

2) infection (15%)

3) unsafe abortion (13%)

4) eclampsia (very high blood pressure leading to seizures – 12%)

5) obstructed labour (8%)

Children left without their mother are 10 times more likely to die within two years of the mother’s death than those who have a mother to care of them.

Malaria and HIV

Two illnesses that put mothers and children in serious risk in especially Africa, are malaria and HIV/Aids. Both of the diseases are basically pretty easy to prevent. Malaria with mosquito nets and HIV/Aids by using condom (+ getting tested and staying faithfull).

Pregnancy makes women more vulnerable to malaria and for the unborn child, it increases the risk of spontaneous abortion, stillbirth, premature delivery and low birth weight – a leading cause of child mortality (2). As for HIV, an estimated 420 000 children were newly infected with HIV in 2007, the vast majority of them caught the virus from their mother during the pregnancy, labor or breast feeding. With anti-retroviral drugs, most of the infections could be prevented (3).

(1) http://www.who.int/features/qa/12/en/index.html

(2) http://www.who.int/features/2003/04b/en/index.html

(3) http://www.who.int/hiv/topics/mtct/en/

EQUALITY MATTERS

I wanted to share a comment I made to another student’s blog in my own blog because it seemed like an interesting point of view:

Last night I read a part of an interesting book online. The book was Iina Soiri’s The Radical Motherhood – Namibian Women’s Independence Struggle. Christianity has made an impact in Namibia when it comes to equality and the rights of women. Even in those UN charts we got to read last week, it seemed like it is the girls getting better educated now than the boys.

But it isn’t how it used to be. Namibia was, before Christianity and all, pretty patriarcal society. What was an interesting point to me is, the Christianity made the patriarcal system even stronger at the beginning. Well, God is male, Jesus is male etc… And the patriarcal system still exists pretty strongly, even though the women have gained more equality.

It is just a random point, but worth thinking I guess. To me it seems like, our western civilization has, in this matter, been unsuccesfull. We all know by now what a great impact it has to societies, if women are ’empowered’ .

(I found the part of Iina Soiri’s book/or article from Google books. In case you’re interested in reading the whole of it. I reccon it was written in 1996.)

EDUCATION & HEALTH

Literacy

Literacy makes a huge difference in life. If you can’t read, you pretty much depend on what the others are telling you. There is a way to learn about life by doing, but without literacy you can’t really get accurate and objective information of the world you’re living in.

Take a look at Afghanistan for example. Al-Qaeda pretty much crushed the school system among the other things. Going to school and getting educated has been made especially difficult for women. Literacy is a strong weapon. If most people in Afghanistan could read, they would probably object Al-Qaeda more because they could read from Koran themselves that what they’ve been told is not the truth about Koran. In Afghanistan, only half of young males aged 15-24 can read. With young women, it is even more sad – only 18 per cent of the young women in Afghanistan can read. This doesn’t give them a very strong stand in the world. Uneducated, illiterate people can’t help themselves. They can’t search information, about how to keep healthy for example. They are not fully in charge with their own lives.

Illiteracy is a huge problem all around Africa, too, where the poorest countries are. Illiterate, uneducated people can’t fix their own society. The majority of people is dependent on foreign aid and their own government. No matter what kind of government it is.

How long will you study – what will you become?

The school attendance is another thing. If about half of the kids drop out of school before the fifth grade, like in Chad (69%), Equatorial Guinea (67%), Rwanda (56%) and Nicaragua (46 %) for example, what are the chances of an entire population making a difference in their own society once they’re adults? How many doctors, lawyers and teachers will there be in the future?

Another thing with kids not going to school, is if they’re not in school, where are they?

A little too often, the answer is: they’re working. They’re working to get money for they families. They’re working to stay alive. And when they’re investing all their energy to working, they’re too exhausted to go to school. Many times, the parents need the kids to work so that the younger siblings will have food and can attend to school a couple of years, maybe. Sometimes, kids no more than 10 years old are taken into guerilla armies. If they’re lucky, they may learn to stay alive, but at what cost.

Working too much (not to meantion fighting) too young can cause a lot of health problems, too. The work may be dangerous, the physical work may injure bones, joints and organs and there may be toxic chemicals involved etc. (1) It preceeds unhealthy generations.

It may also be that they’re out on the streets sniffing glue and stealing.

Why are they not in school then?

I think it has all to do with the society. In more developed societies, education is deeply valued. Where there’s money, kids stay at school and most of them study a proper profession.

Public free basic education is another key factor. In most European and North American countries, basic education is mostly free. The higher the level, more likely it’ll need to be fed with money. In many African countries though, it’ll cost from day one. It’s a problem.

1) http://www.continuetolearn.uiowa.edu/laborctr/child_labor/about/health_issues.html

Condemned by the structures

The social determinants – racism, gender inequality, poverty, political violence and war – often play a huge role in the game of who falls ill and who has the access to care. In fact, these social factors may even have a greater influence to public health than viruses and microbes themselves. This is why the article by Farmer et al (2006) suggests the structural side of health to be considered even before the molecule level of diseases.

Structural violence

The important concept Farmer et al use to understand the problem is called ‘structural violence’. Johan Galtung, a Norwegian sociologist and a principal founder of the discipline of Peace and conflict studies, was the first to come up with the term structural violence in the 1960’s. Galtung describes social structures that stop individuals, groups and societies from reaching their full potential. These structures can as well be economic, political, legal, religious or cultural. (1) Racism and sexism are good example of these.

Think of apartheid in South Africa for example. Apartheid, meaning segregation in Afrikaans, was a system of legal racial segregation enforced by the National Party government in South Africa from 1948 to 1994. (2) It separated colored people from whites in every level of life – in schools, hospitals and common human rights. Such segregation also meant that the whites, who were the ones leading the country, had better schools, better hospitals and healthcare – better human rights. They had better rights to work in better places and to own their land and goods, which means, they had better chances to live a better and healthier life.

Which brings us to the latter part of the concept – violence. The violence hides is but physical, also hiding in the structures that cause injury to people. It is typical though, the injury is not awaiting for those responsible for perpetuating such inequalities but the less well-off.

For example, in countries where women have very little rights and the men are the only ones making the policy, it is the women who suffer the most. It is the women who are being injured or die because of prohibition of abortion or malfunction and bad hygiene in maternal clinics. It is the women who carry the consequences if they raped and pregnant. Or if their infidel husband becomes HIV positive and passes it on to their wife only by having the right to demand sex and refuse to wear a condom.

Biosocial

I think another important concept in the article by Farmer et al is the concept of ‘biosocial’. The term refers to the fact that not only germs cause illness but also the social factors discussed before.

The article states that:

“Biosocial understandings of medical phenomena are urgently needed and all those involved in public health sense this, especially when they serve populations living in poverty.” (3)

If the social factor of the disease cannot be understood or altered, there is very little hope it can be treated for good. Venereal diseases for example are a very good example of the social roots a disease can have. Venereal diseases are born in a culture of ignorant and active sexual behaviour. Most often carried out by men who had the means to act more responsibly but they don’t because in the culture it might lessen their status as a man. Another thing is the diseases caused by bad hygiene and pollution, frequent in such communities and policies not handling their waste properly.

The link between poverty and health

I find it difficult to think there would not be a link between poverty and health. It can even be seen in a northern social wellfare state like Finland. If you are less well-off, student or retired, or have a large family, you are very often standing in the queuing up for the public health care and sometimes lacking the best treatment and testing. If you have the money and the opportunity, you’ll be taken care of in a private clinic, but it costs extra money.

However, money also decides the social factors of healt, such as where you live, what you eat and what kind of medicine or operations you afford to have – or do you.  The division between the wealth and poverty is visible even in countries usually not associated with poverty, like the United States.

In the US, it is a web of bad options if you don’t have the money. You don’t have the money to live in a better neighborhood, you don’t have the money to buy better food (fastfood and other unhealthy stuff is more inexpensive than vegetables, fruits and whole meat), you don’t have the money to get treatment and medicine if you can’t afford a proper insurance… It is a cykle very likely to lead to bad, unhealthy options.

Keep this in mind and think of the developing countries having even a greater gap between the extreme poverty and wealth…

(1)   Galtung J. (1969) Violence, peace and peace research. J Peace Res 6:167–191.

(2)   http://en.wikipedia.org/wiki/South_Africa_under_apartheid

(3) E. Farmer, Bruce Nizeye, Sara Stulac, Salmaan Keshavjee (2006) Structural Violence and Clinical Medicine

THE GLOBAL LEVEL OF HEALTH

What is the one thing all people have in common in a world full of cultural, religious and genealogical diversity? What is the one thing even the richest half of us can’t buy?

It is the same thing that can be the most valuable possession of the poorest half – health.

Once lost, it will impact not only the person him or herself, but the whole community. Even the whole country and continent – the world.

I will give an example. We could examine this global impact of lost health easily just by looking at the sub-Saharan Africa.

AIDS kills societies

One tenth of the world’s population lives in the area of sub-Saharan Africa, 60 percent of them are infected by HIV. An estimated 1.9 million people were newly infected with HIV in sub-Saharan Africa in 2007, adding up 22 million to the number of people living with HIV. (1)

It can’t be just a local problem. It is a good example of a huge global problem. A global reason to care.

Global spreading of the disease is just one side of the problem. We tend to think “it happens somewhere far away. I’ll be careful and it doesn’t become my problem.”

What makes it a catastrophe, to me too, is the fact that it seriously hurts the societies living in the area. The virus kills mothers and fathers. Children are left behind to take care of themselves. Their education suffers which hurts the society eventually.

Also, sick people are not able to make a living. Poverty spreads. Poverty causes hunger and people have no money to buy medicine – they will get more sick, weaker. So, what happens is, the virus tears down entire communities and countries that can no longer take care of their own infrastructure. And when people are only interested in where they can find their next meal, they’re not able to preserve nature or prevent pollution. Crimes and alcohol and drug problems occur.

The sick infected societies become dependent on the other countries, Western ones. This is how it moves from local to global level. It also increases the gap between the developed and the developing world.

Pandemics travel the world

Global world is a new smaller world. Tourism and tight neighborhoods make it easier for pandemics, such H1N1 aka Swine flu, Avian flu, Cholera and Severe Acute Respiratory Syndrome (SARS) to spread around. Globalization is a paradise for pandemics.

An aggressive virus for example can infect millions of people in a relatively short period of time and cause more devastation than ever, such as in the case of HIV for example.

(1) http://www.unaids.org/en/CountryResponses/Regions/SubSaharanAfrica.asp