4TH INTERNATIONAL CONFERENCE ON URBAN HEALTH TORANTO-CANADA-OCTOBER 26TH-28TH 2005
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4TH INTERNATIONAL CONFERENCE ON URBAN HEALTH
TORANTO-CANADA-OCTOBER 26TH-28TH 2005 - extracted text
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Basappanakatte Slum o-^' /^=HCXJ?£>p^ k«=«oi'--^
Visited by Mr. Rajendran on 19-5-1999; Dr. Roopa & Ms. Shylaon 7-6-1999.7
All of us visited the slum in Peenya’s industrial belt accompanied by Ms. Jyothi and had
the pleasure of interacting with the differenf^groups oT members. Some of the
information shared with us was:
c
The slum is under the Bangalore Mahanagara Palike and is an extension of
Rajagopalanagara slum.
o
There are approximately 530 families living in huts (population approximately
12,000). 80% of the people (approximately 7000) belong to the SC/ST groups.
Approximately 30% of people speak Tamil and 50% Kannada, with a smattering of
Telugu and other languages.
o
The slum is on the dried up lake. Ldust beyond this lake is the cremation ground.
Drinking water is from corporation pipes and tap connections. There is also one bore
weljjtpd bed; with very little water remaining. All the severage water drains into this
sump aud this is used for vzashinf?. r)iirmnr the mousoorij the entire slum is flooded
and water enters the houses, we were told. Amazingly, fish survive in this water. £7
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Tlie h
P, pproximately 5’ x 5’ (one or two rooms) and there are no
toilet facilities there/ There are a row of large sewerage pipes fixed vertically in a
^fow, which are supposed to be public toilets.^obviously unused as there is no water
' facility. Waste is everywhere, the people have not thought of a system to dispose of
it, nor is there any go^d facility.
The women work as casual labourers on construction sites; roll agarbathis and as
helpers in the factories and garment units nearby. Construction work pays Rs. 30/per day, 15 days average a month. Girls in garment factories earn Rs. 300/- to 600/per month. Agarbathi rolling pays Rs. 3/- for every 1000 sticks perfectly rolled; so
they earn between Rs. 9-12 per day depending on their skill. This work is adjusted to
the housework and managing young children.
The men go to the factories or work as coolies in neighbouring markets, or odd jobs
in carpentry / construction.
•
There is a balwadi school, non functional. 3% of children attend a private school in
Laggare and most are either playing or helping parents at their work.
o
There is a government clinic (one km away) with a lady doctor and ANM visiting
daily. The women we spoke to did not know the ANM or anganwadi worker. Most
women use the multiple ‘clinics’ in the nearby bus-stand area; some have 3-4 beds for
“serious” cases. The cost of a visit to the doctor is Rs. 15/- and a drug prescription of
medicines worth Rs. 40-50, which may or may not be bought. The average cost of an
‘admission’ is about Rs. 600/-. The chief problems the women have are complaints
of back ache, headaches and white discharge. The presence of the lady doctor does
not seem to enable the women to seek help.
The community organised by Ms. Jyothi / Mr. Basavaraju with the Dalit Kranti Dal /
and Mr. Samuel and their colleagues in the neighbouring belt of slums was due to
have a meeting in a local public hall on Sunday.
After visiting Peenya with Jyothi, we at CHC feel that:
1. Considering our ongoing commitments, and physical distance from Peenya, we
may not be able to get involved at direct grass root level. Also considering the
ongoing work of Jyothi and friends, we (particularly Mr. Rajendran) would be ,
happy to come in as resource people for meeting-organised-in-the-slum-.
2. On the health front, we could'involve Jyothi and any other women leaders in
training programmes in which CHC is involved eg., the W/^TprojecCThis might
help in imparting health information in a spirit of empowerment to the women.
3. CHC could use its network of contacts to put pressure / find-out-how-to help 1C5
conununity put pressure on the Slum development bbard. Also ‘Sadhana’ die
group could be put in touch with other groups,working like them'or resources particularly at government programme leveVjfiey can tap.
4. Referral links with a few hospitals such as K.C. General Hospital and St. Martha’s
Hospital (Dr. Sr. Teresita, Medical Superintendent) could be established with
Sadhana / Astha.
5. A priority issue to be addressed is provision of safe water supply and sanitation
facilities. This will need to be taken up with the concerned Government
Departments through peoples organisations such as Sadhana, supported by Astha.
vtWfi
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“ Right to health care campaign"
in India
Peoples' Health Movement (PHM) is a network
of organization and individuals concerned about
the widening gap between the rich and the poor
due the process of globalization, privatization and
liberalization, and its adverse impact on the health
of millions of the poor and the marginalized all
over the world.
People's Health movement was launched at the
first people's.Health Assembly held in Dhaka,
Bangladesh in the year 2000.
PHM is an emerging movement striving towards
achieving health for all. It is present in over 80
countries.
Governments and World Health Organization
failed to
achieve
'Health For All by 2000 AD"
PHM demands Health For All now!
www.phmovement.org
1
PHM movement in India is known as Janswasthya
Abhiyan(JSA)
One of the aims of JSA is to
establish health as fundamental
right in India.
In order to achieve this JSA in Collaboration with
the National Human Rights Commission (NHRC)
is quazi government body)
Launched a campaign called
' The Right to Health Care Campaign" during the
silver Jubilee of Alma Ata Declaration in 2003.
PROCESS
To hold regional public hearings ori Health and
Human Rights in five regions of the country
allowed by a national public hearing in New
Delhi.
’reparation of guidelines for documenting
ndividual and Health center case studies
Translation and Information Dissemination of
2ase of denial of access to health care Selection
^Documentation
Screening and short listing
Preparation for presentation
HELD PUBLIC HEARINGS IN THE FIVE
REGIONS OF THE COUNTRY
During the day-long public hearings, selected
cases or instances, wherein individuals or groups
have suffered denial of right to health care, and
have not received mandated health care from a
public health facility, were be presented before a
panel consisting of the NHRC and the state level
public health officials. Similarly, violation of
health rights due to structural deficiencies in the
heath care delivery system was also presented.
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Issues discussed at the NATIONAL PUBIC HEARING
Regional Public Hearings were
culminated with a two-day
national Public hearing held in the
capital; Health minister and senior
health officials were present to
listen and respond to the issues.
Group B
Urban health care
(Urban Health care emerged as a one of the key issues of
concern as a result of the public hearing conducted by the
state chapter of JSA in Bangalore in a slum)
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Rights
Health Policy Issues and Violation of Health
~
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Group A
KEY AREAS OF HEALTH RIGHTS VIOLATIONS
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Women's Right to Health Care
•
Children's Right to Health Care
•
Mental Health Rights
CONCLUDING SESSION OF THE HEARING
Right to essential drugs
•
Health Rights in the context of the Private
medical sector
•
Healtli rights in the context of HIV-AIDS
•
Occupational and Environmental Health
Rights
Towards a National Action Plan to Establish, Fulfill
and Monitor the Right to Health Care'.
easons for accessing health
services
Public hearing on
Urban Health in Bangalore
11 individual cases of denial and 2
health centers case
studies were presented.
Childbirth
Cancer care
Disrespect
Forced delivery
Key issues raised by the Case studies
• Incompetent and negligent care
• Delay in care
• Non-performance of postmortem
Doctor not qualified to practice allop athic
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medicine.
Not informing the patient the cond tion
Lack of attention
Bribery
• Corruption
C«
Psychological trauma
Stigma and discrimination
Refusal to provide treatment
Violation of confidentiality
Investigation apparatus not available in pubic health care
institution
Referred to a private health care institution from public
healthcare institution
Violence on a patient with mental health complications due
to worsening diabetes
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III treatment of patients
Not given free medicine
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Delay in care
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Health centers -Issues
Lack of staff
CONSEQUENCES
Five of the eleven case studies resulted in death
• Death
• Death of baby and mother
• Excessive expenditure
• Loss of time waiting for the doctor
•Harm to baby during delivery
• Loss of money
• Debt to be repaid
•Huge, unaffordable expenses for the purchase of medicines
Lack of trained staff
Unavailability of staff
i !• Lack of medicine
i’]• Lack of facility for investigations
LI* Vacancies
(.!• Surroundings of health center unclean
[!• Poor utilization
.
f ]• No community participation
• No water supply
FOLLOW UP ACTION
NHRC has given recommendations to each
state government to address on the issues
raised during the pubic hearing.
Setting up a joint monitoring committee with
JSA member to monitor the implementation
process
5
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Meetings of collaborators on Community Based Continuum of Care in an Urban
Setting
Date: 22-06-2006.
Venue: Snehadaan, Bangalore.
Members present
1
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5
6
7
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Mr. Eddie Preindas (Community Health Cell)
Mr. S.J.Chandar
(Community Health Cell)
Mr. Augustine C. Kaunds
(Society for Peoples Action for Development)
Mrs. Lissy
(SUPPORT)
Fr. Jose Thoompanal
(SUPPORT)
Fr. Mathew Perumpil
Snehadaan
Fr. Baby Naikarakudy
Snehadaan
Mr. Sunil George
Snehadaan
Mr. Abraham Mathew of SWASTI excused himself from attending this meeting due to ill
health.
The meeting began at I 1.20 and Fr. Baby who is the Director of Snehadaan welcomed all
on behalf of Snehadaan. While Snehadaan had been collaborating with all the
organisations that were present, this was the First lime that they ahd gathered to work
together on a specific programme.Fr. Baby expressed the hope that this would also help
to build a stronger bond between everyone present and ultimately prove beneficial to the
community of People living with HIV/AIDS.
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Mr. Sunil George the Community Programme Coordinator of Snehadaan then suggested
that everyone could introduced themselves along with a brief profile of the organisation
that they were representing in order to familiarise one another with the nature of the
group.
After the round of introductions, Fr. Mathew the Coordinator of Sneha Charitable Trust
gave a brief background of this initiative. The idea was conceived within the particular
context of an urban setting (Bangalore). Some of the factors that prompted this thinking
were.
I. The nature of HIV that has changed from a near fatal disease to chronic
manageable syndrome.
2.
The high rate of readmission that Snehadaan was experiencing that pointed to the
lack of systems in the community to help PLWHA to maintain their health once
they are discharged.
In a rural setting there are slightly more organised systems than what we find in an urban
setting. Some of the unique features of an urban setting that affects the sustained care for
PLWHA are. people living alone with no social support, migration... All these factors
necessitate a unique kind of response in an urban setting as opposed to a rural setting.
In July 2005 MILANA a Family Support Group for People infected and affected by
HIV&AIDS approached Snehadaan for building the capacity of their Peer Workers with
regard to providing Home based Care to their members. While discussing the issue both
Snehadaan and MILANA seemed to face a similar problem and had a common vision of
ensuring healthy productive lives to PLWHA and their families.
As a result of the various discussion that were held the Peer workers from MILANA
started making regular visits to Snehadaan to talk on positive living to the in-patients.
Because of these visits, the peer workers were able to interact with the patients and share
their own stories, struggles and successes. Many in-patients were surprised to meet
people who were HIV positive and yet leading a healthy, normal life.
In the month of December, a three-day training programme was held at Snehadaan
covering the areas of Counselling, Nutrition, Opportunistic Infections, and ARVs. After
this training it was decided that the peer workers would make home visits to in-patients
of Snehadaan who had been discharged and a Support Group would be formed for
PLWHA in Bangalore urban who had been in-patients of Snehadaan. Based on the
experiences during this trail period (Jan 2006- Mar 2006) it was decided that there was a
felt need for an Urban based Community Care programme and hence a decision was
taken to start a pilot project during this year.
After this Mr. Sunil George the Coordinator of the Programme made a presentation on
the various components of the programme. They included
1. Home Visits
A home visit to a PLWHA will be made after an initial contact has been established
during the persons stay in Snehadaan. The specific objectives of a Home Visit are as
follows
a.
To assess the situation in the person's home and the extent to which the person is
able to cope up with the status of being positive.
b.
To counsel the PLWHA and the family on positive living and coping with the
various issues arising out of stigma and discrimination from the family, relatives
and society at large.
c.
To help the family with the nutritional needs of PLWHA by teaching them about
the nutritive value of foods that is locally available as well as to teach them how
to prepare them.
d.
To help the family with regard to hygiene and precautions that needs to be
observed.
e.
To make an initial assessment of the PLWHA for referral in conjunction with the
counselling department of Snehadaan
The first Home Visit is planned even before the person is discharged and is
incorporated into the discharge procedure
2. Support Group Meetings
I he following activities will lake place in every Support Group Meetings
a. Theme-based Sessions
Theme based sessions in order to build skills of PLWHA and their families to
facilitate positive living (E.g. Session on Nutrition. Hygiene. Yoga, Meditation
etc.)
b.
Health Monitoring
A very important component of the Support Group Meeting will be this monthly
health monitoring. This will include a monthly check up by the resident physician
at Snehadaan in order to detect signs and symptoms of any Opportunistic
Infection so that prophylaxis or early treatment can be given.
c.
Diagnostic and Drug Support
Part of the health monitoring would also be diagnostic services that are available
at Snehadaan in order to ascertain the proper course of treatment required for
individual PLWHA who require it as well as supply of drugs (primarily
prophylaxis/maintenance therapy) that have been prescribed by the physician for
prophylaxis.
In addition to this the Support Group meeting will also serve as a space for newly
discharged PLWHA to share their fears and doubts with others like them as well as to
raise issues that concern them the most. The Support Groups Meetings shall also serve as
a platform to discuss with the larger body of PLWHA programmatic issues on a regular
basis. While the Support Group was currently functioning only in Snehadaan the idea was
to decentralise it and make it functional at least in a few other areas s well so that
PLWHA and their families do not have to travel all the way to Snehadaan to make use of
this.
3. Community based fund for Health Care
In order to take care of the health care needs of the PLWI-IA such as prophylaxis,
diagnostics services, referrals etc, we propose to start a community-based fund through
contributions from each family under this programme. This fund will then be used to take
care of the various health care requirements such as prophylactics, diagnostics, inpatient
admission etc. This is a long-term plan and the specifics need to be worked out. This also
takes into account the issue of long-term sustainability of the programme. Sunil also
mentioned that Mr. Abraham Mathew of SWAST1 had mentioned to him earlier that they
would be able to contribute in the design of such a scheme and the specifics of how to go
about it needs to be worked.
4. 1 raining/Advocacy and Sensitisation of Physicians in Bangalore
Building a network of physicians in Bangalore Urban District who are professionally
trained on the Management of Opportunistic Infections will be an important activity of
this programme. This training will include
a. Medical Management of Opportunistic Infections related to HIV/AIDS
b. Legal and ethical issue surrounding HIV/AIDS
c. Patents/Drug issues
d. Interactions with PLWHA in order to understand their perspectives on access to
Care and Support and the problems they face
Sunil also mentioned that this training would be an ongoing programme and not a one
time affair. Sensitisation and community monitoring of the physicians is very important.
Mere training does not serve the purpose, as knowledge alone does not seem to make a
major impact. Even if we have a good network 20 to 30 committed doctors by the end of
this year it would make a major difference in the medical management of Opportunistic
Infections in the community itself.
5.Support for Children Infected and Affected bv HIV/AIDS
One of the area that is the concern of positive families is the support and future of their
children, both infected and affected. Two specific initiatives are planned in order the
address the problem of infected and affected children. They are as follows
a. Advocacy and liasoning with schools in Bangalore in order to ensure proper
educational facilities for infected and affected children. In this regard the idea was
proposed on sensitising the principals of catholic schools in Bangalore with the
goal of adopting a policy on ensuring access to education for both infected and
affected children in these schools. This was to be a goal during the pilot year itself
and it was decided to approach the archbishop of Bangalore Most Rev. Bernard
Moras for his support for this venture.
b. Building up fund/sponsorships for infected children through local contributions.
The purpose of this would be to provide financial support to families to make sure
that infected children receive proper nutrition and care as well as educational
expenses.
Again the specifics as to what exact amount, how will the programme be implemented
etc. needs to be worked out
6. Awareness and Sensitization Programmes
Building awareness on issues relating to HIV/AIDS as well as sensitizing the public to
the rights and problems faced by PLWHA will be another important activity of this
programme. Various mediums such as street plays, meetings, awareness programmes are
planned and they will be conducted in various parts of Bangalore addressing various
classes of people such as students and teachers, high risk groups, professionals etc.
Sunil shared his experiences over the years with various groups of young people who had
expressed that they did not have any proper forum I order to know the correct
information about HIV/AIDS, sexuality etc.
1 he plan was conduct these among the youth and build up a committed team of
volunteers who would then be organised on the lines of a forum that would meet
regularly and would be guided by competent resources persons on various pertinent
issues such as life skills, sexuality, HIV/AIDS etc. This is important especially
considering the fact that a large number of the new infections happen among the young.
Following this Sunil suggested that the group could take up each component and discuss
h
in
detail.
Mr. Augustine: This programme will be limited to PLWHA who are in Bangalore Urban
district. But what about those who are admitted here from other parts of Karnataka. Do
we have a plan for hem as well?
Fr. Mathew: Community based care can happen only within a particular geographical
area. Currently Snehadaan refers people who call up from other districts to Care centres
in their own areas. In case of admission of a person who is from another district we make
sure that we put them in touch with other groups in their own areas before they are
discharged.
Chander: Why don’t we think of very NGO working in the Held of health and work out a
general networking with all so that each of their Community Health Worker can be
trained. The capacity building could be done by Snehadaan and this would ensure that
more people are available for providing care for PLWHA. Also instead of having
specialised health workers for each problem /disease we should look at developing the
skill of the general Community Health Worker who can then respond to each problem
comprehensively.
Sunil George: It's a very good suggestion. Can Q IC help us with networking with the
other NGOs in Bangalore in order to achieve this?
Chander: Definitely. It can be worked out
Augustine: Why only Health Workers or Health NGOs? Anyone can be trained for this
work. We should look at mainstreaming this response further from health to the general
group of people working in the development Held.
Augustine: What will the Peer Worker do in a Home Visit?
Sunil George: The Peer Worker makes an assessment on various parameters such as
health, socio-economic and other issues that are affecting the PLWHA and their family.
We have developed a format that is being tested in order to make sure that they are able
to get a more or less objective picture of the current situation of the PLWHA. In case
there are issues of stigma and identification by the neighbours then we do not visit the
home but meet them here. All this is worked out during the discharge procedure itself.
Pr.Mathew: The issue of identification is more relevant to a rural set up while in an urban
set up there is more anonymity.
Augustine: This is very important by this initiative we can address stigma and
discrimination effectively. If people see a PLWI-IA who gets better and leads a normal
life then it will change their attitudes and help I the fight against stigma and
discrimination
Also we should remember that economic issues are extremely important. Most people
who come to us are very poor.
Fr. Mathew: Yes this is very true.
Augustine: Asha Foundation has a very good programme. Each family is assessed and
support is provided. This is working very well to the extent that PLWHA are able to
repay the loans that they have taken. Sunil should visit them we could implement the
learning’s in this programme
Chander: What would be the approximate cost of prophylaxis for a month?
Fr.Mathew: It would be around Rs.30/- for the primary prophylaxis. These drugs
(Bactrim D.S) are supposed to be available in the taluk hospital but in most case they are
not there.
Augustine: That is true all PFICs are supposed to have STI drugs but the reality is
different.
Fr.Mathew: We need to do the work of providing the care component and also advocacy
so that these drugs are available in the government hospitals. Another issue is that they
develop fungal infections later and then the drugs required are more costly.
Augustine: When medicines are not available even in Governemtn hospitals then how can
we expect them to be available at the PHC level.
Fr. Mathew: We need to work on this as well as do advocacy so that theya re made
available.
Augustine: We will give our data to CHC may be you could formulate a letter on behalf
of all of us to the government.
Premdas: This concept of Community based Care is extremely good. I have just two
comments to make.
I. There is a flood of funds into HIV/AIDS programmes but care programmes seem
to lack sufficient resources
2.
A lot of advocacy is associated with HIV/AIDS. One wonders where this
advocacy is taking place and for what purposes? If at the PHC level there are no
basic drugs then what is the use of this entire advocacy.
Unless we work on the Public Health System and revamp it we cannot really reach
everyone. We need to do advocacy al the local level for this. For example why cannot
KSAPS, KHPT and others provide medicines for PLWI-IA at the PHC level?
Fr.Mathew: We need to really participate with the Public Health System. To break
through everything may be impossible but even if we can do this at a few places it would
be wonderful.
Chander: We should remember that the PHC is the nearest point of service for the poor in
any illness.
Augustine: And when the PHC works well the doctor is under tremendous stress. In our
work we have seen this happen in the PHC al Kengeri. When people realised that it is
w orking well they began to access the services and there was a great rush of patients.
Premdas: One component of the training of the Peer Workers should be that they should
go to the PHC for initial services. Il will be difficult initially as there will be ressitance
but there will be an eventual break though.
Chander: Every PHC is allocated a certain amount of funds. The local community should
know of this.
Augustine: may be each NGO should do an informal study of the PI ICs in their areas to
understand its functioning
Chander: We are already trying to do this. On the 25lh there is a meeting at Ashrivad on
comprehensive care at the PHC level.
Fr. Jose: Our experience on working with leprosy has been that medicines were there but
doctors did not distribute them. Hence we have an agreement wherein we are involved in
the PHCs in or area of w ork.
Premdas: Efforts shuld eb made to address the medical officers in the traiing of doctors.
Sunil George: The issue is not about training but follow up. Time and again wwe get
PLWHA from the northern districts of Karnataka. We know very well that we have
trained doctors, nurses and other health care providers in that are but there doesn't seem
to be any difference. The follow' up and monitoring of those who are trained is extremely
important if there has to be any tangible results.
Chander: For that the Peer Worker is going to be very important.
Sunil George: This book is an example of what can happen if the government system
functions. This has been prepared in Andhra Pradesh and is meant for Care givers of
PLWHA and their families. Il's very simple and uses pictures to convey important
messages about Care and Support. In fact one of our goals is to bring out a similar book
in Kannada that would have detailed information that is presented in a simple format on
various aspects such as nutrition, hygiene, ARVs, yoga etc so that it could be a reference
manual for PLWHA in their homes.
Augustine: we will also have to work around the notion that PLWHA themselves have
that once they are positive they need expensive drugs and ARVs if they are to remain
healthy.
Fr.Mathew: that is very true. The emphasis should be on preventive measure and not
drugs.
Fr. Mathew then presented the total budget for Karnataka and the various allocations for
1IIV/AIDS for the next one year
Total:
’ 2,777.22 lakhs
Prevention:
1,991.91 lakhs
(High Rish Groups, Bridge/Migrant population 392 lakhs. Mapping 23.59lakhs)
I EC
419 lakhs
Even in the Executive Committee meeting of KSAPA that was held on the previous day
there were demands that the amount allocate for IEC should be reallocated on more
priority areas such as care and 0.1. management
Even the government data of the no of PLWHA is Karnataka is 5 lakhs. Out of this
around 2 lakhs would be in need of 0.1. management. But the total allocation is 50 lakhs
which roughly works out to 50.000 per year for every taluk hospital. The entire Careand
Support/Treatment needs have been fixed at 345 lakhs. This is excluding ARVs which is
provided by the Global fund.
The National Aids Control Programme III (NACP III) was more community oriented and
focussed on treatment and care. Part of this was strengthening of Primary Health Centres
(PHC)s and Community Health Centres (CHCs). Since the states programme went in late
it will now take time for approval to come through. Il was actually supposed to begin by
April lsl this year but we are not sure when it will come. So we have in effect lost one
year of NACP III and more importantly the focus.
Sunil George: What are the expectations of this group? We need to formulate concrete
plans to move forward in every area. Two suggestion that 1 can make are.
I. Collaborate in certain specific components
2. Meet once every 3 months in order to review and assess the programme
Augustine: One suggestion would be to start an e-group for this community based
continuum of care.
Chander: We should nol duplicate but complement each other.
Sunil George: The future of all IIIV/AIDS interventions lies in community based
programmes and not vertical interventions. We are on the right track and need to move
ahead
Fr.Mathew: One possibility is that we could list out our strengths and work on those areas
thereby complementing each other’s work. And the other suggestion by Sunil to meet as
a mentoring group quarterly to review the programme
Premdas: When are you planning to launch this programme officially?
Sunil George: We will begin the programme from July 1st and have an official function to
mark it on July 15lh.
Fr. Jose: We need to have specific plans to implement and work based on each of the
components that were presented if it has to be a success.
Augustine: One advantage is that we are all Bangalore based.
Sunil George: Can the next step be as follows?
I. I shall fix up meetings in each of your offices as a follow up. In this
meeting we shall do the follwoing
a. Work out specific areas from the components and what exactly can
be done in each area by means of our collaboration.
b. This can then be further refined to have a specific timeline with
individual goals and objective to be achieved.
This programme though being initiated by Snehadaan belongs to al of us who are
working in the field of health. Unless we all come together I am afraid we will not be
able to achieve this goal of community-based continuum of care for PLWHA.
Premdas: Ultimately we need to lookat health as a right. We can use the data that we have
and will be documented through this initiative as the evidence in our campaigns.
HIV/AIDS can be used as a case to raise larger issues with the health systems 1 our
country.
Chander: We should look at this initiative as a process model and nol as a project.
With this the discussion came to an end and the group dispersed for lunch.
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Towards Urban Primary Health Care
By S.J.Chancier, Community Health Cell
In the era of globalization only the glamorous part of the cities have attracted the
attention of media. More the glamour the cities become for the rich and the elite more the
misery it adds to the poor who- constitute a significant portion in every city. Cities have
always been the economic powerhouses and the political never centers but unfortunately
neither the political power nor the economic abundance has done much to the urban poor
ever to meet the bare minimum basic needs.
It is estimated that India has more than 250 million city-dwellers. Experts predict
that this number will rise even further, and by 2020; about 50 per cent of India's
population will be living in cities. This is going to put further pressure on the already
strained basic amenities.
The widening gap between the rich and the poor accelerated by the process of
globalization has been document worldwide. The rural poor turn to cities for survival.
Those who turn to the urban areas to escape rural poverty and unemployment do not find
much solace when the land up in the urban areas. They subject themselves to double
peril: firstly they become more venerable to health problems caused undesirable living
condition secondly they become target for the politically influenced liquor barons who
aggressively sell their products among urban poor.
The key factors affecting health of the urban poor are poverty and undesirable
living conditions. Poverty is defined as lack of specific consumption or not enough to eat;
lack of command over commodities exercised by a population and capability to function
in a society. Unemployment, irregular employment opportunities or unpredictable
employment availability is key factor responsible for the inflicting poverty status. As
result the basic minimum necessities for maintaining health is under stake leading to poor
dietary intake, poor housing and illiteracy. The second major problem affecting the
health of the urban poor is their poor living condition.
While there is inadequate response to improve the key determinants such as employment,
water and sanitation and housing that can promote the health of the urban poor, the
services for managing the life crisis affecting their mental, physical and social health is
pitiable. India Family Welfare Urban Slums Project in its report admits that urban water
supply and sanitation sector in-the country is suffering from inadequate levels of service,
an increasing demand-supply gap, poor sanitary conditions and deteriorating financial
and technical performance.
India started responding to this challenge as early as 1982 by developing policy
framework for urban primary health care. A new initiative known as Urban Revamping
Scheme was started in 1984 with strong focus on improving linkages of primary health
and family planning services with other urban basic services such as clean drinking water
and sanitation. Once the externally aided project started providing services for the urban
poor, the focused changed from comprehensive primary health care to family welfare and
1
family planning. The objectives of the world bank project implemented from 1994-2002
were a) reduce fertility by improving access and demand for family planning services;
and (b) improve maternal and child health by decreasing maternal and infant mortality
rates among slum residents.
The key problems of the urban poor are inadequate housing, water, sanitation,
employment opportunities and various pollutions affecting the environment. These are
the causes of their health problems. In what way the urban family welfare and family
planning programme is justified to meet the challenges. How long the government is
going to pump in million of rupees for medicines and family welfare services? What the
urban poor need is a comprehensive primary health care.
The principles of primary health care stated in the Alma Ata declaration are as follows;
" Primary health care is a essential health care based on practical, scientifically sound
and socially acceptable methods and technology made universally accessible to
individuals and families in the community through their full participation and at a cost
that the community and country can afford to maintain at every stage of their
development in the spirit ofself-reliance and self-determination. "
The components of primary health care are:
1. Education about prevailing health problems and methods of preventing and
controlling them.
2. Promotion of food supply and proper nutrition
3. An adequate supply of safe water and basic sanitation.
4. Maternal and child health care including family planning
5. Immunization against infectious diseases
6. Prevention and control of endemic diseases
7. Appropriate treatment for common diseases and injuries
8. Provision of essential drugs.
It is not at all justified when the fourth component gets a major focus and other
component are either inadequately addressed or not addressed at all. It is time that people
are mobilized to demand health as their right and to take collective action for their own
health. They must work towards changing the focus of the government health
programme. The government run Primary Health Centers must promote holistic health
which should include preventive, promotive, curative and rehabilitate aspects. They
should not focus only of physical dimension of health but also on mental and social
dimensions
2
4TH INTERNATIONAL CONFERENCE ON URBAN HEALTH
October 26 - 28, 2005
The Wcslin Harbour Castle
Toronto, Ontario, Canada
' CONFERENCE PROGRAM
_____
Wednesday, October 26
_ ________________
9:00 am - 7:00 pm
Onsite Registration
12:00 - 4:00 pm*
Pre-Conference Workshops
2:00 - 5:00 pm
Community Tours
5:00 - 7:00 pm
Poster Session I and Opening Reception
■ L; ,",
____
Thursday, October 27
7:30 am - 5:00 pm
Onsite Registration
7:30 - 8:45 am
Poster Session 11 and Breakfast
9:00 - 10:15 am
Welcome Address & Plenary Session
Keynote Address: Dr. Gro Harlem Brundtland;
former Director-General, World Health Organization;
former Prime Minister, Norway
10:15 - 10:30 am
Break
10:30 - 12:00 noon
Breakout Session 1
A. Community Stream
HIV and Marginalized Populations
1.
II.
111.
IV.
Women Under Arrest Striving for Health Rights (C)**
A Community-Based Participatory Approach to Developing an HIV
Prevention for Severely Mentally III Latinas (C).
Community Empowerment Through Collaborative Research: The Sisters,
Mothers. Daughters & Aunties Project to Promote Equitable Access to
Future HIV Vaccines for Black Women in Canada (A)**
Committee for Accessible AIDS Treatment (C)
B. Community Stream
Community-Based Participatory Research: Barriers and Facilitators
1.
11.
111.
IV.
V.
A Survey of Community-Based Research (CBR) in Canada: From Barriers
to Solutions (A)
An Academic-Community Partnership to Build Capacity for CommunityBased Research in Immigrant Health (C)
TBA
Sustaining an Urban Community-Based Participatory Research Program
Through a National Influenza Vaccine Shortage (C)
The Art and Science of Integrating Community-Based Participatory
Research Principles and the Dismantling Racism Process to Design and
Submit a Research Application to NIH (C)
T
C. Academic Stream
Conceptualizing and Measuring Social Justice
1.
11.
III.
IV.
Health Inequity in a Network Society: A Conceptual Framework (A)
TBA
TBA
Exploring Ideological Barriers to Addressing Health Inequalities at the
Local Level (A)
D. Academic Stream
High-Risk Youth
1.
'
11.
III.
IV.
The Neighborhood Identification and Engagement Process: A Mixed
Methodological Approach for Exploring Urban Youth Violence (A)
The Emergency Department: Is it an Appropriate Venue for an
Intervention Program to Reduce Youth Violence (C)
Risky Alcohol Use and Daily Cannabis Use Differ between Low' Educated
Dutch Adolescents Living in and Outside the City of Amsterdam: A Result
of Differences in Pleasure-Seeking Behaviour? (A)
Environmental Influences on Youth Gambling: Is the Deck Stacked? (A)
E. Invited Panel: Urban Income Inequality and Health Sponsored by the Canadian
Population Health Initiative
10:30 - 12:00 noon
Community Tour
12:00 - 1:45 pm
Conference Luncheon
Dr. David Vlahov, President, International Society for Urban Health
Special Guest: Hon. George Smitherman, MPP.
Ontario Minister of Health and Long-Term Care
Guest Speaker: Commiiiiily Perspectives
Loretta Jones,
Founder and Executive Director of Healthy African American Families
1:45 - 3:15 pm
Breakout Session 2
A. Community Stream
Peer-Led Harm Reduction
1.
II.
111.
IV.
CRYSTAL CLEAR: A Peer To Peer Health Promotion Project (C)
Community and Public Health Impacts of Medically Supervised Smoking
Facilities for Crack Cocaine Users: A Peer-Led Feasibility Study (C)
The Vancouver Area Network of Drug Users (VANDU): The Evolution of
a User-run Organization in Vancouver's Downtown Eastside (C)
Community Driven, Participatory Research Projects
Toronto Harm Reduction Task Force (C)
B. Community Stream
Advocacy for Social Justice in Urban Health
1.
Improving the Post-Approval Surveillance System for Prescription Drugs
(C)
11.
III.
IV.
In Our Own Voices: Surveying Asian Pacific American lesbian, Gay,
Bisexual, and Transgender people (C)
Women in Transit: Organizing for Social Justice in Our Communities - a
PAR project of the Bus Riders Union (C)
The Development of Peer-Driven Intervention for Individuals Requiring
Assistance with Injection (C)
C. Academic Stream
Urban Neighbourhoods
1.
II.
III.
IV.
V.
Finding Good Places to Play: Exploring Social Justice and Public Park
Provision in Urban Neighbourhoods (A)
The Usefulness of Geographic Information Systems (GIS) to Reduce
inequalities in Urban Road Safety (A)
Socioeconomic Inequality of Urban Core Neighbourhood Residents in
Saskatoon (A)
Neighborhood Mapping as a Participatory Tool for Evaluating
Community-Based Urban Health Initiatives (C)
Spatial Association between Diabetes Prevalence and Neighbourhood
Characteristics and Environment for Healthy Living in Toronto, Canada
(A)
D. Academic Stream
Policies and Interventions to Promote Social Justice
1.
II.
III.
IV.
V.
Barriers to Disability Benefits for Homeless and Under-housed People (C)
Dismantling Racism: Promoting Social Justice through Individual
Awareness, Institutional Policy Change and Institutional and Community
Partnerships (C)
Is the Public Ready? Understanding Public Attitudes Toward Federal
Action to Reduce Inequalities in Healthcare - United States' Perspectives
(A)
Recognition of Sexual Diversity in Urban Health Policy (A)
Pharmacists as Health Service Linkages; Expanding Service Referrals to
Injection Drug Users through the Expanded Syringe Access Program, New
York City. 2001-2004 (A)
E. Academic Stream
Urban Crises
1.
II.'
III.
IV.
Surmortality Related to the August 2003 Heat Wave: An Ecological Study
of Socio-economic Factors in Paris (France) (A)
High-Rise Building Evacuation: Lessons Learned from the World Trade
Center Disaster (A)
TBA
TBA
1:45 -3:15 pm
Community Tour
3:15 - 3:30 pm
Break
3:30 - 5:00 pm
Breakout Session 3
A. Community Panel: Community, Professional, and Scientific Collaboration for
Environmental and Social Justice in the Southwest of Spain
B. Academic,Stream
Global Urban Health
1.
II.
III.
IV.
V.
The Urban Environment from the Health Perspective: The Case of Belo
Horizonte, Minas Gerais, Brazil (A)
Sexual Behaviors of Street Children in Lahore, Pakistan: The Risk of
Survival (A)
Reported Use of Violence among Young Men in Dar es Salaam, Tanzania
(A)
TBA
The Delayed Engagement with Healthcare: Experiences of People with
HIV/A1DS in Beijing, China (A)
C. Academic Stream
Homelessness and Housing
1.
II.
III.
IV.
V.
The Aging of the Homeless Population: Fourteen-year Trends in San
Francisco (A)
Risk Behaviours For Sexually Transmitted Infections (STIs) in Canadian
Street Youth: Docs Time Spent On The Street Matter? (A)
Access to Health Care for Homeless People with Serious Health
Conditions in Toronto, Canada (A)
TBA
Homelessness Following Eviction in Amsterdam (A)
D. Academic Stream
Mental Health
1.
II.
111.
IV.,
V.
Stressful Neighbourhoods and Depression: An Examination of 25
Metropolitan Areas in Canada (A)
A Learning Collaborative to Improve Mental Health Service Use for LowIncome. Urban Youth (A)
Affective Suffering in Older Women: Evidence of a Threshold Affect that
Varies by Race/Ethnicity (A)
Mental Illness as a Risk Factor for Poor Health, Substance Use, and
Dependence Among Unmarried Urban Mothers (A)
Quality of Life Outcomes for Mental Health Care Clients Engaged in the
Workman Theatre Project (C)
E. Academic Stream
Gender and Urban Health
1.
II.
III.
IV.
3:30 - 5:00 pm
Friday, October 28
Community Tour
»
Gender Differences in Depression among Low Income Recent Immigrants
in Canadian Urban Centres (A)
Gender Issues and the Health of Disadvantaged Persons (A)
Whither Gender in Urban Health? (A)
Housing Policy. Women, and Health in Canadian Cities (A)
S:00 - 9:00 am
Poster Session 111 and Breakfast
8:00 - 9:00 am
International Society for Urban Health: Annual General Meeting
9:00 - 10:30 am
Plenary Session
Keynote Address: Dr. Richard Lessard.
Researcher and former Director of Public Health, Montreal Regional Health and Social
Services Board
Featured Speaker: Dr. Francisco Armada.
Minister of Health and Social Development, Venezuela
10:30 - 10:45 am
Break
10:45 - 12:15 pm.
Breakout Session 4
A. Community Stream
Innovative Youth Engagement
1.
11.
III.
IV.
V.
Toronto Teen Survey (TTS) Phase One: How Do We Meet the Specific
Sexual Health Needs of Youth in Diverse Urban Environments? (C)
Young People in Control; Doing It Safe. The Safe Sex Comedy (C)
Youth-Led Research: A Successful Model of Community-Based
Participatory Action Research (C)
Queer Youth Speak: A Model for Developing Equitable Partnerships for
Community-Based Research (C)
A Community-Based Participatory Approach To Assess The Context Of
Sexual Risk Taking In Urban, African-American Girls (A)
B. Community Stream
Community-University Partnerships
1.
II.
111.
IV.
Making a SWITCH: Opportunities and Challenges in Establishing a
Student-Run, Interprofessional Health Clinic in a Saskatoon Core
Neighbourhood (C)
Using Community-Based Participatory Research to Develop and
Implement Church-Based Cancer Education Modules (C)
Urban Aboriginal Community-Based Research (C)
Making Things Work: On Being an Academic Research Working with a
Community Partner (A)
C. Academic Stream
Environmental Justice
1.
II.
’
III.
IV.
V.
The Right to Clean Waler: How Community Groups Mobilize to Block
Water Privatization (A)
Food Deserts: Do Food Deserts Exist in More Disadvantaged
Communities and How Are They Studied? (A)
Neighborhood Poverty And Inequitable Exposure To Stressful Social
Environments: Results from a Community-Based Participatory Research
Partnership In Detroit (A)
Pollution And Health in Two Toronto Neighbourhoods: Challenges To
Ensuring Environmental Justice (C)
Community Health Study in "Chemical Valley", Sarnia, Ontario (C)
D. Academic Stream
Immigrants and Urban Health
I.’
II.
HI.
IV.
V.
Community-based Intervention Strategies to Prevent Obesity among
Turkish and Moroccan Women in Amsterdam (A)
TBA
Serologic Immunity to Chickenpox among Adult Immigrants and
Refugees in Toronto (A)
The Role of the Urban Environment on Discrimination among Latino Day
Laborers and Migrant Workers in California (A)
Socioeconomic Disparities in Birth Outcomes by Recent Immigration
Status in Toronto. 1996 - 2000. (A)
E. Academic Stream
Injection Drug Use in Urban Settings
I.
II.
HI.
IV?
V.
Vancouver's Supervised Injection Facility: The First Two Years (A)
HIV Outbreak among Injecting Drug Users in the Helsinki Region: Social
and Geographical Pockets (A)
Risk Profile of Individuals who Provide Assistance with Illicit Drug
Injections (A)
Examining the Effects of Illicit Drug Markets and Local Labor Markets on
Employment and Self-Rated Health in Philadelphia (A)
Residence in Vancouver’s Downtown Eastside and Elevated Risk of HIV
Infection among a Cohort of Injection Drug Users (A)
F. Academic Stream
HIV Intervention and Risk Reduction Strategies
1.
II.
HI.
IV.
12:15 - 1:30 pm
Addressing the Methamphetamine-Sexual Risk-Taking Link among MSM:
Information Exchange between Science and Practice (A)
HIV Risk Taking and Associated Cultural Factors (C)
TBA
Employing Social Network Analysis in the Evaluation of Information
Provision for HIV-positive Patients: An Exploratory Study (A)
Closing Event
*Please note that scheduled events in this program arc subject to change.
‘♦Community Stream abstracts are identified by a (C); Academic Stream abstracts are identified by an (A).
4th International conference on Urban Health
Held at Toronto, Canada from 26-2811' October 2005
A report by S.J. Chander
1 made two poster presentation on this conference; one on a qualitative study on ‘Patients
perspective regarding TB treatment” and the other on “ the Right to Health Care in India”
Pre conference workshop
The politics of Social Determinants of Health
Facilitated by Prof: Dennis Raphael and Toba Bryant presentation focused on Canadian
situation. Both from the York University facilitated the session. 20 out of the 36 participants
registered turned out for the session. Prof. Dennis said the concepts such as SD originated
from Canada.
They said Canada has a history of playing the role in initiating many important health
movements. He quoted the following movements:
The Healthy city movement began there in 1948 and the WHO website mentions this. Since
1986 Canada has been focusing on structural approach such as income and exclusion. Health
promotion, population health approaches were developed here. However social determinants
received a marginalized view.
They said chronic diseases such as heart diseases, respiratory diseases, and arthritis are high
among low-income group in Canada but the government programmes focus on diet and
exercises. 300 million dollars was allotted for promoting exercises and diet during the year.
They said heart attacks are high among poor in Canada. Low income and social exclusion are
major cause of heart disease in Canada. The government has taken from the poor and given to
middles class.
They said unequal distribution resource is the cause for the present status. They compared the
GDP of Sweden. Though Sweden's GDP is less than Canada's but Sweden has better health
indicators as result of better distribution of resources. They said political decision-making
plays a major role in allocation of resources. They also said effects of liberalization also has
an effect of health of the urban poor. This was well articulated in a book “Health for some”
published by center for social justice. Evidence from UK and USA show evidence for health
iniquity this is described as breadline poverty and the widening gap between the rich and the
poor.
Regarding public policy making they said the rationalization theory, focus on data and the
public choice theory is a trouble for policy makers.
Regarding food supply and housing they said there is a need for intersectoral coordination.
Regarding the causes of some of the illnesses they said income and premature years of life
correlated to most disease. They said life style diseases accounts for only 10-15%. The poor
people are at four times greater risk due to lack of income and premature years of life.
Barriers to effective action
Regarding the barriers for initiating effective action they said ideological, institutional,
attitudinal. Political and personal are some of the barriers that affect effective action.
Model for change
Regarding the model of change they advocated the civil societies on top. The professional
policy analysis to be carried out with citizen activist. They also advocated a shift frorm for
evidence based policy making -to-policy based evidence. Regarding social expenditure they
said Norway and Finland spend more, Canada spends lowest. They emphasized the need to
negotiate with the government on minimum wages as 30% of the Canadian income goes for
rent. They also advocated for a census model to conflict model. They emphasized the need
for the role of a socio epidemiologist and social economist. They explained the present
situation as lack of political will and the powerlessness of the people. They commented on
Michael Marmot and Wilkerson that they don’t understand the poor. Their theory is based on
the middle class and they depoliticize.
Plenary Achieving Social Justice - Key note address Dr. Gro Bruntland
Dr. Gro Bruntland in her speech said the public health challenges are a threat to local,
national and global security. She said cholera and malaria kills more people. She referred to
social economic problems and access to treatment in developing counties as Globalization
made problems. She said access to treatment of malaria and TB is a major problem in
developing countries.
Regarding HIV she said the health system is slow to response though condom use and ART
have increased. While HIV is not a problem in some countries but it had a devastating effect
on, Africa, China, India and many Asian countries.
She said while food insecurity, sanitation is a major problem in many countries war headlines
in the newspapers reports deaths due to war than many killer diseases. She said SARS is a
global public health problem but global out break was effectively controlled. She said China
tried to hide but could not succeed.
She said the poor countries are worst hit by many diseases. She said in the 1990-2000 the
Human Development index has declined. 1/3 all children are malnourished. Average African
consumes 20% less. A billion people live on less than a dollar. IMR seven times higher
Export led global market
She refereed to the export led global market is the cause as in many countries the IMR is
increasing and the Life Expectancy is going down. Wars and conflict are a major threat in
many countries. She said though the FCTC is signed by 119 countries and the continuing
advertisement of tobacco products increase consumption.
She said while polio was eradicated in 16 African countries problems related health,
development and Security persist in many countries. She said many countries views health as
consumption not as investment. She said the stewards of global economy the IMF and WTO
are turning the world into an altruistic war. She mentioned the report of Prof. Jeffery Sax
commission on macroeconomics.
2
She said the malaria burden in Africa is increasing and there is need to invest in health and
education. She mentioned social insurance, private insurance, community insurances can
narrow thee health and eqtiily gap. She mentioned in China 71% are insured for health.
She emphasized that democracy should lead to right to health and education and the
governments must invest in health, education and environment. The approach of democracy
is to safe guard basic human right and social justice. She said it is desirable that the
Development Corporations invest 5% in health and even if they invest 2 % it would be
possible it make difference. She referred to the GDP of Norway, which is 1%.
Regarding research she mentioned the 10/90 gap. She said the reason for this was the less
monitory resources available with the public than the private sector. She said the media
dominated by private money She referred the Public Private Partnership in malaria was
successful initiative.
Breaking out session
1.
Conceptualizing and measuring social justice
In this session a comparative study conducted in US was presented on Pre term Birth
Disparity (PTB) the presenters said when they compared the birth outcome between black
and white women, it is evident that that PTB is steadily rising among the black. The study
found PTB among the black was 17% and among the whites it was only 11%. They said poor
socio economic factors among the black are the cause for this.
Methods
The presenters said the data for the study was gathered from the Census reports, Crime
reports and the research included as explanatory variable.
Model
The model of the study was ecological using the following index housing, neighborhood
deprivation and violent crime rate.
•
•
•
Violent crime associated with PTB
Stressful neighborhood
Housing and high rent associated with PTB disparity
Conclusion:
The presenters reported that the, study found the PTB was high among the people lining in
stressful neighborhood, living in area where the house rent is high and there was violent
crime rate.
2. MCH and neighborhood context
The next presentation that I attended focused on MCH outcomes. The study examined the
relationship between contextual and individual determinants.
Method
The researchers reviewed the literature on the subject of the past five years and identified 31
selected articles. The researchers reported that they analyzed the following characteristics
using a multilevel model.
3
.Neighborhood characteristics
Income/wealth
Employment
Family structure
Population composition
Social resources
housing
mobility
education
occupation
violent crimes and deviant behaviors
Conclusion: theoretical, methodological and practical barriers in the measurement of
neighborhood context. They said they found it difficult to fit into the operationalization of the
study into a theoretical framework and they also faced methodical problems related to the
index measures used by the and finally there were practical limitation such as no availability
of respondents.
3.
Exploring ideological barriers to addressing health inequities at the local level.
The next presentation that 1 participated focused on the above-mentioned topic.
Objective: To understand how the values of active citizens in Hamilton, Ontario could act as
facilitators or barriers to address the local health inequities.
Method: The method of study was through postal survey of volunteers and employees of
CBOs. The researchers reported that 240 surveys were conducted.
Conclusion: They said less than 46% of the respondents were aware of SDH prior to the
study. Being aware was positively associated with increased openness and greater support of
addressing SDOH. The study also identified the gap in knowledge and action. The
respondents identified political system, structural barriers and attitude of service providers as
barriers. They respondents did not see voting as a political activity
STREET HEALTH VISIT
’
The next progarmme that I attended was a visit to an organization that works with people
living on the streets. According to the 2001 census there are about 15000- 20000 homeless
people in Toronto, which is out of the 2 million populating of the city.
The organization’s name is ‘Street Health’ located in the prime locality of Toronto. It was
started by a group of nurses in 1986. At present there about 10-12 staff both volunteers and
full timers working for the organization. 50% of the board of director of Street Health are
homeless people themselves. The working hours are 9-5 Monday to Friday. They said the
organization has built up a good street credibility over the years. The users their service users
are people who are homeless, homosexuals and large number of transgender.
The strategy adapted by the organization is to advocacy. They said they go to the people and
people don’t come to them. Street Health is a politically active organization; they are
constantly engaged in dialogue with the people in power to advocate to meet the need of the
people living on the street. They said they lobby with the government to get more funds,
Health Cards (They have helped over 5000 people to procure ID cards)
4
The director of Street Health said the cause of homelessness in Canada is due to cut in
welfare, hosing projects are being scarped and the evacuation drives. The common health
problem among their services users are URI. chronic cough, skin diseases, parasitic infection
such as such as bed bugs, scabies and lies. TB, Mental Health, muscle ache are the other
problems.
BREAKING OUT SESSION III
1. Global Urban Health
The last session that I attended was on Global Urban Health. The presenters listed the
following as major problem of the urban dwellers: Spatial patterns of mortality and
morbidity, five major urban health problems in urban environment identified were;
homicides, pregnancy among adolescents, asthma hospitalization in children, dengue and
visceral leishmaniasis. These problems were high among socio economically disadvantaged
Methodology
The Researchers aid the data was collected from the city health offices.
The second session that participated under global urban health was on violence among young
men.
Violence among young men
The researchers did a study on the hypothesis that violence high risk factor for negative
health outcomes. The researchers identified 949 both men with the age group of 16- 24 in Dar
es Salaam. They reported that more than 10% reported history of childhood sexual abuse.
42% reported serious physical violence. 46 % felt it was acceptable for a mean to beat his
wife.
Finding: violence was higher in those men with a history of sexual or physical violence in
childhood.
My feedback
The conference was well organized with appropriated resource persons. The conference
venue was well suited for the purposes of holding sessions on both the community stream and
the academic stream. The plenary sessions also had right people. The address of the
Venezuelan health minister through satellite medium had technical problem with linkage, it
interrupted the continuity of his message. The technical sessions were too packed with many
presentations as a result there was not much time for discussion. Most of the presentations
were from the North American continent and a few were from European and Latin American
continents. Since this was an international conference, though the participation of Asians
were there, more space in oral presentation would have been helpful. Since the conference
had the theme Achieving Social Justice in Urban Communities, it would have been helpful a
declaration or statement be issued at the end of the conference highlighting the concern areas
regarding the urban communities.
5
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