WHO AND NGO COLLABORATION

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WHO AND NGO COLLABORATION
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RF_COM_H_81_SUDHA

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NGOs at WHA: We can fight
Health risks Together!
NGO Briefing at the World Health Assembly
• ^e^the ***.

Pekka Puska, WHO
Out of the Worlds

The new WHO

DG, Dr. Lee mentioned just a
few minutes ago that we have
tremendous burdens of
infectious diseases which arc
k still major challenges. Public
health depends however mojo
and more on the few chronic '
non communicable diseases
which cause a big burden to
countries and a double burden
to many developing ountries.
Behind this arc many other
transitions, in behaviours, life
styles and in particular in diet,
physical activity, and tobacco.
There are demographic
changes and changes which
‘can be related to globalisation,
{global trade communication
land urbanisation.
Lets look at global
mortality. Of course we
know that mortality is only the
tip of the iceberg but it shows
the transition. 60’% of all
deaths in the world arc
already caused by a few non
communicable diseases and
half of that are cardio vascular
diseases. Every third death in
the world is now cardio
vascular and this transition is
rapidly going on

six WHO regions we see that
not only in this continent but
also in the American continent
and in Western Pactific, public
health is prcdomincntly
dependent on what happens with
a few chronic diseases.

But even in S.E.
Asia and the Eastern
Mediterranean also those
diseases are the greatest killers
now. It is only in Sub Saharan
Africa where the infections and
traditional picture is still the
major one But even there the
transition is very rapid. So at
the same time we have to
continue our work concerning
the more traditional diseases,
there is a tremendous burden of
a few chronic diseases. And
the transitions continue rapidly.
This is the reality already in
most parts of the developing
world which means that, unlike
twenty years ago the
overwhelming majority of the
non communicable disease
burden is now in the developing
world in India and China alone
more than in all industrialised
countries together Twenty or

thirty years ago, when I
started my work in
Northern Europe these
diseases were called the
diseases of affluence
Those times have gone.
These diseases are

now going to poorer and poorer
countries and within the
countries they are going to
poorer and poorer parts of the
population and becoming the
major contributor to ill health in
the world.

People arc sick because they arc
poor. And when they get the
diseases they become poorer.
This is a vicious circle.

The bad news arc
that there is a growing epidemic
of non- communmicablc
diseases in most parts of the
world., not just human
suffering but an enormous
burden to health services.

See page 4

Traditional Practices on Health risks
Dr. Morissandra Kouyate:
Traditional Practices
arc beliefs, attitudes and
behaviours which a social group
applies for various reasons, for
cultural, health or religious
reasons. There arc two major
categories of traditional
practices which we arc going to
present here. First 1 want to talk
about beneficial traditional

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1/014-0

practices because we often
think that all traditional
practices arc bad. Obviously
this is not a condcmination of
our traditions or cultures so I
want to recall that there arc
good traditional practices. What
are they? There arc many and
in the interests of time I have
chosen just a few.

The collective

responsibility for children is a
very widespread practice in
Africa. This means that a child
is considered the child of the
society, of the collective society.
So each member considers
himself in the parental role to
the child. Its a collective
See page 2

J Jx

Dr. Morissandra Kouyate (from page 1)
towards the child. Obviously this involves
civil, moral and health education and im­
provement in health can also be a result.

Oocial aid and sharing of troubles
is another area. The African social system is
not just words. Its not money which we put
into national and social security but a sys­
tem of helping one another and sharing bur­
dens and troubles
and it begins with
the family. We
often have three or
five generations
living together which
means that the older
people are not mar­
ginalised, they are
not abandoned they
are taken care of by
their children and
their grandchildren
which creates a very
good atmosphere
within the family.
There is also the
collective responsibility for problems which
means that when there is a problem in the
society this is dealt with collectively. We
don't have an individual response to prob­
lems it is more or less worked out when
there are illnesses, disasters or deaths it is
collective. If there is someone ill in the fam­
ily, everybody in the family is concerned.
Everybody in the house takes responsibility
for caring for the person until he has recov­
ered. When there is a death, people come
together to cry with their friends and their
neighbours Maybe sometimes it is simulated
but still that collective bereavement is sup­
port. This collective responsibility for our
problems is not a new thing. It has a long
tradition of thousands of years and we want
these traditions to be respected.

As an NGO we do everything we
can to ensure that these beneficial practices
do not cease but we must also be aware that
there are some traditional practices which
are genuinely dangerous or harmful. So we
mustn’t be complex we cannot pretend that
everything is fine when it isn’t. So we have
to deal with this. As the Inter African Com­
mittee we particularly fight against FGM .
I don’t think I need to tell you a lot that you
don’t know about this practice. FGM is a
problem for the whole society. Unfortu­
nately it is presented as a woman’s or little
girl’s problem and that’s why we have a
slow response or a solution because the
problem has been marginalised by calling it

a woman’s or girl problem. But it is a prob­
lem of the whole society. You see there are
many harmful consequences. The major
complication such as haemorrhages, infec­
tion, fistula, the risk of Hl V/A1DS as and
don't forget this - we use one knife for eve­
rybody during the ceremony and perhaps ten
girls are all operated on at once, so that if
one of them has HIV then perhaps all the
others could risk catching it from that same
dirty knife. There are also later complica­
tions,
such as
sterility
of the
adult
woman,
psycho­
logical
effect,
and in our
society
Those
complica­
tion could
be diffi­
cult preg­
nancy,
death in childbirth. Often when we have a
difficult job in Africa when we see that a
woman is having a difficult labour there are
traditional attitudes that this is a punish­
ment on her. Perhaps she has been unfaith­
ful to her husband or there is some other
reason why she is suffering. So instead of
helping her, or taking her to the hospital, she
is surrounded by people accusing her of
adultery and obviously this is all linked to
the physical problems which is the difficult
birth and which could have been caused by
FGM at a much earlier age.

There are some taboos to do with

food as well in Africa. These taboos are
myths or beliefs when people believe that
certain foods should not be consumed . by a
certain part of the population. Often these
are food items which are rare, and are often
very good to eat so if there is not enough of
this food to go around the whole population,
discrimination on the basis of these tradi­
tional practices means that women and
children are prevented from eating these
particular foods and obviously this causes
health consequences as these people cannot
eat a balanced diet. Obviously these taboos
vary from region to region and country to
country Another thing we have noted is that
colostrums the first milk that comes after the
baby is bom is the richest milk Unfortu­
nately there are certain populations which
consider this is impure milk and women are

not permitted to feed their baby with the
colostrums , and have to wait until the full
milk comes after a couple of days. This
means that the babies are deprived of this
and if we don’t receive vaccination they are
then totally deprived of the immunity they
would have received through the colostrums
which they were prevented from taking.
Eggs are another item which are sometimes
not permitted. People believe that they can
cause a child to become deaf and dumb, I
don’t know why but it is quite a widespread
belief. Women believe that eating meat can
cause heavy periods and painful labour.
Some people believe that fish should not be
given to babies because it will give them
scales on their skin. And even giving water
to a child can diminish their intelligence.
Children are often prevented from having
vegetables because it is believed that they
will cause blindness. Fruit which is not fully
ripe is considered to be bad for children be­
cause it could cause lockjaw. We often see
anaemia in pregnant women and children; (
we see difficult and dangerous pregnancies;
and maternal and child mortality at birth;
haemorrhages during and post partum.

we are trying to promote and

sustain good and beneficial practices, and to

when we see that a woman is

having a difficult labour there

are traditional attitudes that
this is a punishment on her

stamp out harmful practices. We are devel­
oping campaigns of raising awareness and J
of advocacy. We are mobilising traditional
leaders, community leaders and local or­
ganisations. We have activities with some of
the traditional practicants, training them for
other activities. We are carrying out lobby­
ing campaigns, multidisciplinary ap­
proaches. As a result we have achieved a
demystification of traditional practices, par­
ticularly FGM. We see commitment of
communities and many political leaders.
Among the 28 countries which continue
with FGM. There has been a vote in 14 of
them to stamp it out. Recently we had a new
declaration that the 6th February will be the
International Day of Zero Tolerance of
FGM.

Let me just conclude my presen­

tation with this African proverb. If you can­
not take all your luggage with you, take the
luggage which is the most useful and forget
that you owned the rest of it.

Lets luuk at the suiiniitiiy pictute.1

Page 3

Berhane Ras-Work,
The NGO Ad Hoc Advisory Group on Health Promotion:

We are receiving more

and more recognition for this effort.
And it is with this objective that the
Group has initiated this afternoon's
briefing. We are grateful for the
help and support that we receive
from the Non-Communicable Dis­
ease Prevention Department. We
are grateful for the excellent col­
laboration and support that we re­
ceive from Dr. Desmond O'Byrne
who has been with us all along.
This afternoon we are

privileged to have distinguished
personalities with us to present the
introduction to the Briefing. Dr.
Pekka Puska, Director of NonCommunicable Disease Prevention
and Health Promotion,
Dr. Morissandra Kouyate,

Director of Field Operations for the
Inter African Committee He is a
Guinean and has a distinguished
career in the area of health promo­
tion.

He is a com­

mitted campaigner
against harmful tradi­
tional practices and
gender equality. He
combines rare quali­
ties of professionalism
and human value. He
has an excellent qual­
ity of communication;
he reaches the grass roots as well as
the decision makers. We are privi­
leged to have you Dr. Kouyate with
us. He came to Geneva specifically
for this meeting.

Then we have Ruth Kobia,
representative of the World YWCA
who is going to share her experi­
ences with us. I must say before I
end that a great part of the credit for
the existence and operation of the
Ad Hoc Group goes to my friends
and colleagues Joanna Koch and
Mats Ahnlund. We are all grateful
to you the members of the Ad Hoc
Group.

“The NGO Ad Hoc
Group has exerted

sustained efforts to
strengthen its working

relationship with WHO,

following the spirit of the
Jakarta Declaration. “

Page 4

Pekka Puska (from Page 1):

The good news are that the
medical evidence for prevention is strong.
We don’t know everything. but very much.
Of course it is important to try to treat pa­
tients as well, but resources for expensive
coronary care, cancer, renal diabetic
treatment are limited. Prevention should
have the priority and prevention is possi­
ble. We have strong evidence on the few
factors that relate to most of these dis­
eases, those common risk factors are,
unlike with old infectious diseases, aspects
of our behaviours.

Behind the risk related behav­

iours there are realities in the society and
in the community, social and economic and
environmental factors that determine be­
haviours. Already in the world there are
more obese people than people with under­
weight and if we take overweight, the crite­
ria ratio it is even greater. Obesity is in­
creasing all over, so is unbalanced nutrition
and physical inactivity. Much of this is
shown in the latest WHO reports which
look not only now at the disease burden,
but at the risks to health, which are beyond
the disease burden.

trials, China, Finland and USA, the Group
that made some changes in the diet and
physical activity had 60% less new cases of
diabetes

At the population level in the
country where I come from, which had the
highest mortality in the world from cardio
vascular disease thirty years ago we launched
a project to change diets. This message was
taken in collaboration with NGOs, public
services, government and media. Gradually
diets were changed, people stopped smoking
and physical activity increased. In 25 years
the number of heart disease deaths in this
population was 75% less. With reduced
smoking there was a 70% reduction in lung
cancer and health improved, not just preven­
tion of disease, but better health.
So finally a few words what WHO is doing
and how are we responding. The basis for
our work to curb the epidemic of non com­
municable diseases a global strategy was
decided by the WHA three years ago. In­
stead of going to vertical disease pro­
grammes we go to integrated prevention,
targeting the main risk factors where the
evidence is strong and effective interven­
tions are available, and results are measur­
able.

Let's look at the summary pic­

Last year the WHA said that the

ture. Out of the well recognised risk fac­
tors high blood pressure is number one
killer in the world. Number 2 is tobacco,
Nr. 3 is high blood cholesterol, under­
weight, unsafe sex, low fruit and vegetable
high body mass index, physical activity,
alcohol. Out of the ten top risk factors
for the mortality in the world already seven
relate to non communicable diseases This
is not surprising as they are the biggest
killers. Tobacco is the one that the Frame­
work Convention is now hopefully ad­
dressing in a big way. Most of the other
risk factors relate to what we eat, drink and
move. This concerns especially coronary
heart disease, type 2 diabetes and even 1/3
of the cancers. We have increasing evi­
dence that prevention is possible. Lets take
first classical trials. We have three major
diabetes trials where high risk people have
been randomised into a group which was
advised to make some sensible changes in
diet and increase the physical activity and
control group. In a short time, in all these

WHO-work with tobacco is very important
but what about the other risks diet, physical
activity ? We should start work on that too.
So, the WHA asked us to prepare a global
strategy The message is clear. We have an
expert report about certain aspects of diet and
physical activity. It is not just a question to
individuals, it is very much a question of
making the healthy choices affordable and
possible in our societies. It means that the
emphasis is on policies and environment and
on the underlying factors, and in trying to
identify certain priority actions. The basis
is the WHO non communicable disease strat­
egy, but now we have mandate from the
WHA to prepare a global strategy on diet
and physical activity for next year’s Assem­
bly.

We have just completed the first
phase which was this report by WHO and
FAO and which gives the science base onhealthy diet and physical activity for NCD
prevention.

This is the report that the sugar industry
attacked very heavily, but we are very
confident about this unanimous report by
scientists from different parts of the
world. We are now having a large series
of consultations with Member States in
different parts of the world, with UN
agencies, civil society and private sector,
to arrive at the strategy which we will
present to the Executive Board and the
WHA 2004.

I cannot help stressing the
importance of civil society and NGOs.
The example of the Framework Conven­
tion shows how important NGO support
is, for implementation.

“I cannot help stressing the
importance of civil society and
NGOs. We are very much
counting on a partnership “

we are very much counting on a

partnership, strong collaboration with
NGOs for this very complex but im­
portant task. We feel that enormous
health gains are at stake and even
modest success can bring very great
gains. Even if we say that informa­
tion is cheap, we do need resources
for this kind of work, We are identify­
ing resources for this type of work,
from tobacco and alcohol tax, maybe
a soft drink tax. Prevention is
cheaper than expensive treatment,
but we need the resources

Prevention is better than
cure both for individuals and for the
society We have the evidence, how
to work for the health of the people.
WHO cannot do it alone, govern­
ments cannot it alone, we have to
work together, the role of NGOs is
very important. This great day has
shown us how important this
collaboration is.

Page 5

Dr. Ruth Kobia,
Young Women's Christian Association:
I will talk to you about a few
risks on health. I should say that luckily in
my community where 1 come from, it is men
who are not allow ed to eat vegetables be­
cause it is considered they would become
weak so women have the privilege to eat all
the green leaves.

lot of middle class people and even high
class people pretend to be over weight. It is
not accidental. It is because people have
been told eating an egg is good , eating meat
is good so they end up eating if they can
afford it, eggs five or seven days a week. In
my town in Nairobi there are some men
mostly because they have the money, w'ho
have meat for lunch every day of the week.
Of course this is unhealthy. Women on the

do not have the right information on breast
cancer. For example someone did a survey
in a group and they found out most of the
Chinese women in that particular group
believed that cancer is always fatal, which is
not necessarily so. The Italian women
believed once you get breast cancer there is
no treatment, and there is. In the African
women’s group they believed you could not
control how you get cancer, so we try to
educate people in good habits and try to
remove these myths.
There is also the problem of stig­
matisation not only of AIDS but also of
breast cancer And this is true especially in
the developing world. We know that
women have done a very good job. Women
survivors have been leading campaigns to
educate others, to encourage others, and this
has been quite a good example w-hich is
catching up in the third world. In Nairobi a

“In war situations women and
children are the ones who

We recognise the effort that
WHO has made to eradicate very many
diseases especially the communicable dis­
eases like leprosy, diphtheria, polio and
many more. However new diseases have
now come and they are a dread to our world.
MTV AIDS we all have heard about it and
"oiv of course even SARS and diseases like
cancer which have been with the human
being from time immemorial. Cardiovascular
diseases, obesity, malnutrition these are still
a dread to our health. Sometimes we won­
der why we still have so many health risks
despite the many meetings WHO has held,
despite all the programmes that governments
have held but certainly we see there are ma­
jor problems that prevent the implementa­
tion of all the programmes that we have.

We know that poverty is a major
obstacle to health. In most situations pov­
erty leads to ignorance and here let me say
that ignorance is not necessarily with the
illiterate people. Ignorance in developing
countries we know some of the things could
also be called myths, things like gaining
weight is considered a privilege in well to
do communities , especially in developing
countries, like those in Africa. So you find a

contrary, because they don’t have money
cannot

afford to eat much, so they end up being
malnourished and being anaemic and having
such diseases.

Political instability leading to
wars that damage our ecosystem, destroy the
infrastructure and remove people out of their
dwelling places. In war situations women
and children are the ones who suffer because
they lack good food and good nutrition, and
all the problems that result. People are
forced to move from their usual places, they
move to towns, and of course not neces­
sarily to the best part of towns, the slum
parts. In these places we know there is not
enough water, basic hygiene is not available,
and they are exposed to bad health habits like
drugs and alcoholism.

Another problem that we have
been trying to overcome is cancer, espe­
cially breast cancer. We know this can be
avoided by good practices, like good nutri­
tion, exercise, avoiding smoking, but we
think there are many communities who are
not aware that these practices can help.
There are also communities not necessarily
in Africa but in other parts of the world, who

suffer because they lack good
food and good nutrition, and
all the problems that result"
centre has been opened, the Kenya Breast
Healthy Programme, started by a lady who
got cancer while she was in the US for her
further studies. She decided that as a Chris­
tian probably God had a purpose in making
her have this illness. She became a cam­
paigner for breast cancer which in most de­
veloping countries women don’t talk about
because of its association with sexual matters
and feminity, but she started this programme
and now women are encouraged to come out
and talk about it and to encourage one an­
other. Unfortunately this woman passed
away last month. The programme she
started still exists and I think this was a very
good effort.

The YWCA has observed that
when we all team up, governments, NGOs
we can really make a difference in combat­
ing illnesses especially in the way of creating
awareness and many experts believe that
global cooperation and trust are vital to the
success of disease control

TXT

Members of the NGO Ad
Hoc Advisory Group on
Health Promotion

•
•
•

•

Associated Country
Women of the
World

Global Alliance for
Women’s Health
(New York)

Inter African
Committee on
Traditional
Practices
International
Baccalaureate
Organisation

•

International
Council of Nurses

•

International
Council of Social
Welfare

•
•

International Health
Co-operative
Organisation
International Union
for Health
Promotion and
Education

•

AMREF-African
Medical& Research
Foundation

•

International AIDS
Society

We

are an informal group of international NGOs which all attended

the WHO 4th International Conference on Health Promotion in Jakarta, in July
1997. We saw the need to implement the Jakarta Declaration, and to work in
partnership to involve NGOs in the WHO work for Health Promotion

We come from widely different areas of activity •

health promotion & education,

•

international education,

•

health co-operatives,

•

traditional practices,

•

nursing,

•

rural women,

•

social welfare,

•

women’s health.

•

HIV/A1DS

Our wide diversity of interests, international structures and grass
root involvement give the NGO Ad Hoc Group its richness of approach,
experience and expertise.Together we represent many millions of members
around the world.

Working together and individually, and in close liaison with the
Health Promotion, Non Communicable Diseases, and Surveillance Unit at the
WHO headquarters, we have endeavoured to keep the Jakarta and Mexico
agendas in the forefront of the NGO community. As a group we held six
successful lunchtime briefings at the 1998, 1999, 2000, 2001,2002 and 2003
World Health Assemblies on NGOs and government partnerships in the follow
up to Jakarta and Mexico. As an individual NGO this would nothave been possible.
We hope that this example of partnership will encourage others to become involved

in health promotion, and that it will serve as an example for NGO Groups in other

areas and disciplines.
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