Aligning USAID Funding Targeting Adolescent girls and Young Women; Cues For Local Government Councils In Uganda

Aligning USAID Funding Targeting Adolescent girls and Young Women; Cues For Local Government Councils In Uganda    

Muyunga-Mukasa, T.R.                      

                                                     SUMMARY:

Local government officials can present over 25 performance indicators below following the use of USAID funds:

1) focus on the poor; 2) improve engagement of the private-for-profit sector; 3) enhance efficiency; 4) strengthen stakeholder coordination; 5) improve service quality; 6) stimulate consumer-based advocacy for better health;  7) programming in maternal; 8) newborn and child health; 9) immunization; 10) family planning and reproductive health; 11) nutrition; 12) health systems strengthening; 13) water/sanitation/hygiene; 14) malaria; breaking cycle of transmission of HIV; 15) pediatric HIV care and treatment; 16) increase in numbers of women attending at least one antenatal care visit with a health care provider; 17) Opportunities for women to deliver their babies with a skilled attendant present will increase; 18) planning meetings on targeted health themes;  19)  identify key persons to contact as far as HIV/AIDS, Adolescent girls and Young Women issues go; 20) develop a community health information management system with vital statistics, targets for treatment, prevention and anti-discrimination; 21) lists of partnerships such as schools, villages, faith-based organizations and traditional healers involved in promoting health;  22) existence of strategic plans at different levels of governance reflecting needs of communities;  23) realizable PEPFAR engagement and an expanded capacity to use Ambassador’s Small Grant Program for advocacy, community mobilization;  24) generating disaggregated statistics giving insight into population demographics and;  25) lists or action plans by Village Health Teams.

A PRIMARY SCHOOL IN A RURAL PART IN UGANDA. DOES THE GIRL CHILD HAVE OPPORTUNITY TO WASH HER HANDS AFTER USING THE WASHROOM?  DOES SHE GET A FAIR CHANGE OF SANITARY PADS?

Local governments in Uganda can design systems that promote the health and life of adolescent girls and young women (5-24 years). A mental, sexual and reproductive health plan targeting adolescent girls and young women, can be effective if it is integrated with other activities. At a three percent (3%) population growth by 2025, a young population and a high total fertility rate, Uganda’s high population rate will continue to drive health expenditures upwards. Local Governments in Uganda are entities that can mobilize for action through planning and partnerships. This is captured in the Health Sub-District concept bringing essential health services-especially basic surgical and obstetric care closer to the communities. The attendant staffing, infrastructure, equipment and operating costs become resources for promotion of health. A  comprehensive WHO review of Uganda’s Health System conducted in 2011, found that whereas significant efforts are being implemented to qualitatively and quantitatively improve health in Uganda, more needs to be done to a) focus on the poor; b) improve engagement of the private-for-profit sector; c) enhance efficiency; d) strengthen stakeholder coordination; e) improve service quality; and f) stimulate consumer-based advocacy for better health. At local government level there are opportunities to conduct local health assessment and devise community health improvement plans. These local government entities are in a better position to tap into, say, the USAID funding if a focus on quality of care, service integration, and equity are to become a reality. The generated mechanisms and resources at an initial phase may be costly but these costs are reimbursed under the inbuilt cost of doing the U.S. government’s PEPFAR Business (CODB). The critical fiscal space thus created is an opportunity to increase government expenditure on health.  This will in turn create a standardized service delivery across all local government regions. Uganda has a Maternal mortality ratio of 435/100,000 live births. By end of 2015, Uganda needs to reduce that figure to 131/100,000. Poor access to quality maternal care services, is a significant barrier to improving maternal mortality in Uganda. “HIV/AIDS, malaria and respiratory infections are the top three causes of overall disease burden in terms of Disability-Adjusted-Life-years (DALYs) lost,” (Fiscal Space For Health In Uganda).

THIS SCHOOL IN A RURAL PART OF UGANDA IS A CO-EDUCATION FACILITY. WILL THE GIRL CHILD THINK ABOUT A SANITARY PAD OR HOW EARLY SHE HAS TO RISE FROM BED IN ORDER TO COMPETE FOR WHERE TO SIT IN THAT OVERCROWDED CLASSROOM?

There are two documents I hope local government planners can use. One is the Country operational plan guidance document provided by USAID, with focus on eradicating HIV/AIDS. It is a comprehensive tool that local council members in Uganda can find useful as they try to utilize PEPFAR funds in a bid to align money in prevention investments. At the local government level, planned and costed investments are called votes, e.g., providing insecticide-treated mosquito nets to a given number of households. In a bottom-up planning, promoted by decentralization, it is possible to harmonize targets for treatment, prevention and anti-discrimination at Local Council I, II, III, IV, V, Town Council, Municipality, Division and district. There are two outcomes that come to mind. One, it will strengthen an existing local public system that ensures health promotion and prevention of diseases. Two, it will critical forces of change at community level with health promotion and prevention of diseases at the planning core.

A CLASSROOM

The second document is the:The Maternal and Child Survival Program (MCSP). MCSP supports programming in maternal, newborn and child health, immunization, family planning and reproductive health, nutrition, health systems strengthening, water/sanitation/hygiene, malaria, prevention of mother-to-child transmission of HIV, and pediatric HIV care and treatment. The Program places greater emphasis on key cross-cutting issues such as innovation, e/mHealth, equity, quality, gender, public-private partnerships, and involvement of civil society, community approaches and behavior change interventions. While maintaining focus on the technical high impact interventions, MCSP works toward sustainable scale up to include strengthening the health systems that deliver these interventions. (http://www.mcsprogram.org/). “It is at the heart of improving maternal-newborn health services globally: ensuring care is patient-focused; integrating programs to better serve the needs of mothers and babies; and extending innovative health services to the poorest and most socially vulnerable mothers and babies,” (Bliss, K. 2015). This USAID funding will help local governments mobilize for action through planning and partnerships where a woman in Uganda can seek appropriate counseling and maternal care services in any facility. There will be an increase in number of women attending at least one antenatal care visit with a health care provider. Opportunities for women to deliver their babies with a skilled attendant present will increase.

DO THESE MEN HAVE A PLAN TO PROVIDE THE ADOLESCENT GIRL WITH COMPREHENSIVE SEXUAL AND REPRODUCTIVE HEALTH COUNSELLING AT SCHOOL? THE PROFESSOR WHO IS ALSO A PRESIDENTIAL CANDIDATE IN UGANDA FOR THE 2016 PRESIDENTIAL ELECTIONS IS STANDING IN THE CENTRE WITH TWO TEACHERS. NB. ALL THESE PICTURES BELONG TO THE PRESIDENTIAL CANDIDATE PROFESSOR VENANSIUS BARYAMUREEBA.

The health sector at the district and sub district level in Uganda is governed by a district health management team (DHMT). The DHMT is led by the District Health Officer (DHO) and consists of managers of various health departments in the district. The heads of health sub districts (HC IV managers) are included on the DHMT. The DHMT oversees implementation of health services in the district, ensuring coherence with national policies. A Health Unit Management Committee (HUMC) composed of health staff, civil society and community leaders is charged with linking health facility governance with community needs (http://gov.ug/ministry/ministry-health).

USAID funding into a local government budget plan will cause: 1) planning meetings on targeted health themes including national and district indicators (UBOS, 2010)  2)  identify key persons to contact as far as HIV/AIDS, Adolescent girls and Young Women issues 3) develop a community health information management system with vital statistics, targets for treatment, prevention and anti-discrimination 4) lists of partnerships such as schools, villages, faith-based organizations and traditional healers involved in promoting health 5) existence of strategic plans at different levels of governance reflecting needs of communities 6) realizable PEPFAR engagement and an expanded capacity to use Ambassador’s Small Grant Program for advocacy, community mobilization 7) generating disaggregated statistics giving insight into population demographics and 8) lists or action plans by Village Health Teams as a continuum of response who bridge the gap and increase equity in access to health services ( http://www.pathfinder.org/). With the above it is more likely to have information on: voluntary medical male circumcision (VMMC), Test and treat, Viral load, TB/HIV, virology suppression, children health, pregnant women receiving B+, adults on life-saving anti-retro viral treatment, health needs of groups that are higher risk than total population, identified community resources  that support the public health system in promoting health and improving quality of life. A list of themes would be developed, which in turn could be used to assess community health status and community themes. 

Form a team amongst you and check with the US Embassy to see how your local government entity qualifies. A devolved institutionalized public health service is possible in Uganda. Turnock (2015) in “Essentials of Public Health” lists outcomes of deliberate community health improvement plans. I have chosen some points from the long list that I feel would be further outcomes of using USAID funds at a local government level. These are some of the further outcomes: 1) working with policy-makers, promote partnerships, educate, inform, develop policies and plans that support individual and community health efforts and plans 2) Social-community level activity plans 3) Social marketing and targeted media public 4) joint health education programs with schools, churches, Faith-based Organizations, cultural organizations and other entities 5) undertaking health improvement planning e.g., preventive screening, rehabilitation and support programs 6) building coalitions drawing from a wider range of potential human/material resources to improve community health.

REFERENCES:

1. Bliss Katherine (2015). http://www.smartglobalhealth.org/

2. Fiscal Space For Health in Uganda. World Bank Working Paper No. 186 Africa Human Development Series 

3. Government of Uganda, Ministry of Health. http://gov.ug/ministry/ministry-health

4. National Village Health Teams (VHT) Assessment In Uganda. 2015. http://www.pathfinder.org/

5. Statistical Abstract. Ministry of Health. 2010. http://www.ubos.org/

6. Turnock, B. J. (2016). Essentials of public health (3rd ed.). Burlington, MA: Jones & Bartlett.

7. USAID (2015). Country Operational Plan Guidance 2016 – Draft

8. USAID (2015). http://www.mcsprogram.org/our-work/ 

21st Century USA From a Public health Perspective

The main role of public health in the 21st Century will be to protect us from various diseases or life threatening conditions deriving from: climate change; emerging diseases; bioterrorism; racism; stigma; prejudice; and political dilemmas. Public health practitioners of the 21st Century must be in position to understand the complexities of cultural diversity, e.g.,different generational, economic, professional, ethnic, religious, linguistic background, gender, gender identity, sexual orientation, stereotypes, prejudices, physical status, conscious bias, unconscious bias, structural bias, enjoyment of access to resources, access to opportunities, access to options, safety from violence,  affordability of housing, civil rights, access to food, access to jobs, opportunities for job trainings, access to recreation and readiness to be  a compassionate provider. Many clients and communities face bias and discrimination when they attempt to access health and social services and , as a result, receive fewer services and services of poorer quality (Berthold, T. 2009). In order to provide public health services, government has concrete plans such as enacting laws, enforce laws, provide financial support and oversight to ensure promotion of health, prevention of diseases and instituting a preparedness mechanism.The most important new or expanded roles for public health occupations in the 21st century will include:

1. Strengthening the public health activities framework that is interlinked by a network of federal, state and local public health agencies with emphasis on referral mechanisms and oversight processes.

2. Ensure a reporting mechanism that dovetails into the overarching design where: the contribution of USA to international health-related interventions continues; the legal foundation gives gives primacy for health concerns to states; allows the federal government to promote consistency and minimum standards across the 50 diverse states; and a practical foundation of LHDs serving as the point of contact between communities and the three-tiered government.

3. Shifting mobilization tasks to advocacy entities at community level as a means of having a pulse on changing needs, resource needs and meeting public expectations.

4. Investing in early warning mechanisms for threats from fires to bio-terrorism. There will be need to have a contingency for fire hazards now that the globe is getting warmer. This will mean wildfire-prone geographical zones like Mid-Western and California will have more established fire departments. The quarantine points at border entry points, airports and ports need to be strengthened now that there is more likelihood for bioterrorism, hostility and acts of sabotage against the U.S. or any other nation by terrorists and enemies (www.nytimes.com). 

5. Public health practitioners reaching out to the indigent or marginalized. This will rely on the work of local health agencies. These will in turn report to second tier government levels and different organizations that form the backbone through which the power to protect the public’s health is possible.

6. Providing training and promoting competencies for public health professionals in the 21st century mostly in these areas: conducting essential public health services; legislation; regulation; policies; and the ability to negotiate,  justify public funding for many public health initiatives. For public health to be perceived, such essential services as are relevant: monitoring the health status of the population; diagnosing and investigating problems deemed hazardous to the public’s health; educating the population on health issues; mobilizing communities to act on their own health issues; developing policies; enforcing laws and regulations that protect the public; linking people to health services; ensuring a competent health care workforce; evaluating the effectiveness, access and quality of health services and researching to continue progress and innovation in healthcare (Turnock, B. J. (2016). Essentials of public health (3rd ed.). Burlington, MA: Jones & Bartlett).

7. Use of Technology, which will enable complex research to be translated into action in a faster and flexible way. Technology can be used in many other forms as well. One way is establishing a centralized health management information templates that can be used to report for instance compliances to the Healthy 2020 vision and mission. Events in which equity and equality are addressed can be captured at local, state, regional and federal levels. Racial biases are shown to be a part of the social structure of medical practices at both macro and micro levels (Centre for excellence in health care journalism). Use of web-based platforms to share information can help improve on coverage of what works and who is served. Public health will be a means for America to deal with the hot topics that focus on: race, culture, ethnicity, lifestyle, health status and health care in America. This might be the great quest of technology as well. Through technology it will be possible to level the health care playing field. Socioeconomics, individual racism, and institutional racism that represent the three predominant pathways to differential treatment for diseases will be targeted and redress provided. Reporting mechanisms will provide common indicators used to gauge quality of life for women and men irrespective of their gender, sexuality, race and social status.  Compiling reports into a format that can be disseminated to all concerned is another good use of  print technology and the world-wide web. In this format the media can be relied upon to make information available or the applicability of the information by society in form of case reports/studies or any format that is reliable for dissemination. However, newsprint, radio and TV tend to tap into our anxieties focusing on trivia. “The CDC has had to contend with bogus reports of imported banana carrying flesh-eating bacteria, drug addicts placing HIV-infected needles in pay coin-return boxes, virus soaked sponges arriving with the mail,” (Drexler, M. 2010). 

8. Understanding the need for post trauma stress counseling and care arising from the link between terrorism, massacres and resultant traumas, e.g., counseling after separation from loved ones, death and shock,  care after post traumatic stress disease (PTSD), homelessness following destruction of homes or infrastructure and other needs. A global nightmare envelopes the world every time wars, genocides and terrorist attacks occur anywhere in the world. The rallying call that brings together nations ready to do rescue activities is to profess solidarity with the suffering nations. Rescue efforts are made by nations. This was seen after September 11, 2001, in UK, in Uganda, in Tanzania, in Kenya and most recently in the 10th district of Paris where the most recent attacks have occurred. The San Francisco editorial has this to say, “France’s loss is our loss. Its grief is our grief. And its fight to counter the forces of inhumanity is our fight”  (San Francisco Chronicle, Editorial, November 14th, 2015). 

9. The effects of political pronouncements such as the recent debate on mass deportations sends trauma shocks to those who are  not documented yet they many have lived in USA all their life and some are employed. These people may end up not attending social services for fear of being hounded and put on hot lists.

10.  Establishing a structure of international partnership to deal with climate change, neglect, poverty and famine  at a global level which in turn make humans and in some cases livestock vulnerable to influenza, Legionnaires’ disease, Lyme disease, toxic shock syndrome, E. Coli 0157:H7, STDs, Ebola virus, AIDS, severe acute respiratory syndrome (SARS), H1N1 influenza (Drexler, M. 2010). 

11. Understanding the increasing relation of chronic low-level inflammation, wide range of common debilitating disorders, stealth infections, deadly sepsis, how to balance use of antibiotics and inflammatory-quashing steroids. Research findings recommend Mediterranean style diet for those suffering from inflammatory disorders (Sachs J.S., 2007).

In the 21st Century, stigma discrimination, bias and prejudice will be the issues that need addressing. This in turn will clear the way for addressing neglect, poverty and famine. In situations where equality, respect and dignity are promoted, proper protection of life and ensuring individual well-being will be achievable.

REFERENCES:

1. Berthold, T. 2009. Foundations For Community Health Workers. San Francisco, MA: Jossey-Bass.

Centre For Excellence in Health Care Journalism. 2006.

2. Drexler M., 2010. Emerging Epidemics: The Menace of New Infections: H1N1 Flu, SARS, Anthrax, E.Coli.Penguin Books.

3.http://www.nytimes.com/2015/11/15/world/europe/strategy-shift-for-isis-inflicting-terror-in-distant-lands.html?emc=edit_th_20151115&nl=todaysheadlines&nlid=60949333&_r=0

4. Sachs, J.S. 2007. Good germs,Bad Germs: Health and Survival in a Bacterial World. New York, NY: Hill and Wang.

5. SFChronicle.com

6. Turnock, B. J. 2016. Essentials of public health (3rd ed.). Burlington, MA: Jones & Bartlett. 

Applying Country Based Health Metrics From a Public Health Perspective; Case of USA and One African Country ( Uganda)

All countries have a Public Health Provision Model that combines maximizing individual positive outcomes as well as minimizing adverse collective outcomes. The countries promote population-based activities, monitor health status, investigate health problems and hazards, inform and educate people about health issues, mobilize communities, develop policies and plans, enforce laws and regulations for the wellness of their citizens.

To promote public health practice, medical health practice and long term care practice that in turn ensure quality life, these countries invest money of different amounts. They commit resources which cause health outcomes. However, the social-ecological factors in these countries make it a unique framework within which to provide public health and medical health services. Biologic, environment, behavioral, social, cultural and health services available in a given country in turn affect the well-being of the citizens.  These in turn affect the impact of the strategies or interventions. 

The US has a population total of 320,051,000. Its total expenditure on health as a percentage of GDP for the year 2013 was $ 17.1, a total expenditure on health per capita for 2013 at $ 9,146 and life expectancy of males at 76 and females at 81 (www.who.int/countries/en/).  It has committed over 15 million workers in the Public Health workforce and $ 3.0 trillion in resources. The public health needs presently facing the US include: slowing population growth rate, and older population, increasing diversity of population, changes in the family structure, a persistent lack of access to needed health services for many Americans and relative prevalence of particular diseases (Turnock, B. J. 2016).

On the other hand, Uganda has a population total of about 37, 579,00, its total expenditure on health as a percentage of GDP for the year 2013 was $ 9.8 a total expenditure on health per capita for 2013 at $ 146 and life expectancy of males at 57 and females at 61 (www.who.int/countries/en/). faced with lukewarm commitment in funding the health sector. The funds keep vacillating below or above $294,117, 000 as in the case of 2011. This amount is far below what the international ceiling ( e.g., Abuja Declaration) calls for.  Uganda still battles parasite infestation e.g., malaria-causing mosquitoes.  Plans to commit to eradicate malaria are half hearted pronouncements made at electoral campaigns most of the time. “The Government also committed itself towards developing and implementing a comprehensive strategy to eradicate malaria and strengthen its prevention, diagnosis and treatment. It also committed itself to reduce morbidity and mortality from the major causes of ill health and premature death,” (www.newvision.co.ug).

In order for public health to be a collective effort that promotes quality health outcomes, countries need to back public health initiatives with a funding commitment and not just lip service. Public Health Provision can be effective if it combines maximizing individual positive outcomes as well as minimizing adverse collective outcomes. 

REFERENCES:

1. http://www.newvision.co.ug/news

2. http://www.who.int/countries/en/

3. Turnock, B. J. (2016). Essentials of public health (3rd ed.). Burlington, MA: Jones & Bartlett.  

Health Promotion, Ethics, Food and Vaccines from a Public Health Perspective

Promotion of health is possible through a vast health system. This relies on moral obligation, skills and resource mobilization appropriate for prevention and treatment of illnesses and injury. Planning for financing, programming and service providing are some examples of the resources.  A successful health system must deploy and integrate a variety of strategies and activities in terms of their strategic intent, level of prevention, and community and individual focus. Wellness and illness are dynamic states influenced by cultural, social, behavioral,, environmental and health service factors that interact within a social-ecological framework. The strategies intervene prior to the development of disease or injury by altering factors in ways to avert or alter occurrence of injury/disease. Or when disease/illness strike there is need for care, limiting disability, eradicate diseases, prevent death and lastly, return individual to the maximum level of function consistent with their capacities (Turnock, B. 2016). But, this is not enough.

Public health practitioners have a duty to promote practical strategies for qualiy life. This is both a mind set and moral conduct that will help, say, increase immunization attendances or good nutrition. Ethicists link consistency with previous behavior good results to responsible conduct (G. Cornelissen et al, 2013). There are profound emotions attached to, say, health promotion. Ethicists, again, have established the link between moral reasoning and moral action in form of emotions of fear, guilt, love, play a central role in all thinking and behavior, including moral behavior (Association for Psychological Science, 2011).  A trained practitioner will have the skills to do no harm to others. It is this feeling of obligation as well as duty that is a compulsion to have something done using the acquired combination of skills. The skills enable one to engage in planning interventions, moral forecasting and moral action. This could explain the single purpose why a public health practitioner engages in health promotion, disease prevention and preserve life. The commission or omission of interventions become what are known as health outcomes. It is these outcomes that have enabled humans adopt survival and leadership skills. The four domains--movement, food acquisition, within-group conflict mediation, and between-group interactions contribute to the scale of collective action which is critical for survival and reproduction (Smith J.E, 2015). Fulfilling one’s duty has health outcomes and so does promoting good feeding and vaccination. The three cases below illustrate this point.

John is a 55 year old man and he is a soft and hardware inventor who lives in an upper class neighborhood in New York. He comes from an accomplished loving family and all his relatives are well-to-do. He has access to the best healthcare system in the world and can afford the best nutrition on the market. In the last two years he has been a recluse living off his accrued money from three patents with Apple and GM. John has had to visit the clinic 12 times in the last year. It is during one such a visit that John exhibited clinical depression. The last 7 visits were with a psychiatrist who prescribed Trazodone, Venlafaxine, Naproxen (a combination of anti-depressants and sleeping pills) and Omega-3 food supplements.

Nswemu is a 60 year old, indigenous and semi-literate man from the Baganda people of an East African country. He has lived all his life as an agriculturalist in Bigasa, Bukomansimbi District, South of Kampala City. This area experiences ample rains and is the bread basket of Buganda. The people are essentially hunters, foragers, few are engaged in wholesale business, professions such as teaching and administration, and some are into animal and crop husbandry whose products are either sold or used as food crops.  Their diet consists of:  legumes, nuts, cereals, edible insects, small rodents, red-meat, fish, game, fresh-fruits and leafy vegetables. The people are extremely active and most use the two-wheel bicycle for most of their transport needs. Nswemu, has visited the clinic twice in the last two years for malaria-related complaints. The primary-care provider used both these opportunities to gauge depression and in both there were no exhibited signs of depression. Nevertheless, the primary-care provider encouraged Nswemu to engage in day to day activities within his extended family and emotionally supportive community.

Vaccination is one way of preventing infections in humans of say, measles. Those who are not vaccinated or are under-vaccinated are highly susceptible to becoming ill. Measles can easily be eradicated from countries. It is still prevalent and is acquired through direct contact and droplets that can spread through the air. Measles is one of the most contagious of the vaccine-preventable diseases (Infectious Diseases Society of America, 2015)

The above three cases show the prevailing circumstances in which life is either put at risk or preserved.  We see two different default means to accomplish a good feeding status. For John, it is the norm to feed properly given the existing first class public health system in his country. For Nswemu, it is the cultural default on which he falls back to feed so well as the fore parents had fed. In John’s case large amounts of processed foods in form of snacks and fast foods have tended to increase his supply of Omega-6 while reducing intake of Omega-3.  Home cooked meals in his case has been something he did in his early 20’s. He confessed that he occasionally has a diet full of fresh whole foods, including leafy greens, raw fruits and vegetables at home. He said he consumes much coffee and alcohol. A good recipe for good mental an physical health should involve low caffeine and alcohol consumption as well as regular diet full of fresh whole foods, leafy greens, raw fruits  and vegetables (Leap Dennis, 2012). The brain which is the physical component of the mind functions so well when fed healthy foods. This food is primarily fat (Leap Dennis, 2012). The human brain is 60% fat by dry weight. Fat molecules, such as cholesterol and saturated fats, play a very important role in the construction of brain cells,  their repair work and insulation of nerve fibres. The brain needs healthy fats to thrive and these fats are found missing in the blood of depressed people. Omega-3 fatty-acids can be found in such foods like fish, flaxseeds, kale, brussels sprout, green leafy vegetables, olive oil, salad greens, walnuts, spinach, avocado. Omega-6 fatty-acids can be found in non-hydrogenated cold press olives, coconut  oil, palm oil, butter, seeds and nuts or oils produced by them. A healthy diet must balance both these fatty-acids.  Highly processed foods contain large amounts of Omega-6 fatty-acids (cereals, cookies, chips, crisps, crackers, shakes and fast-food). If not for reasons of general health, it should be good practice to provide the brain with good nutrition.

To function well, the brain needs oxygen-rich blood. This can be inexpensively got by engaging in outdoor activities. Invigorating walks are an inexpensive way to remain physically fit and mentally balanced.  The average Baganda walk long distances a day, carry firewood, use the bicycle, hunt, forage for fruits, engage in mock battles, engage in cheer leading using traditional songs, sleep for at least 8 eight hours and volunteer their time for all social activities such as funerals, community clean up campaigns and attending spiritual gatherings. Exercise and activity as treatment for depression have proved that walking briskly for 30 minutes only three times a week is better ( Leap, D., 2012). Obligation to feed well has its good side. In the next paragraph we see the need for vaccination against, say, Measles.

In the case of vaccination, there should be mechanisms to balance administering vaccines to those who need them and to find other ways to provide cover to those other people to whom administering this vaccine may end up causing more harm. Children should receive two doses of measles containing vaccines at the recommended ages. There is concern for children who haven't received any doses for any of a variety of reasons, including: lack of access, being unaware of the need for vaccines and being opposed to vaccines. In addition, doctors need to ensure those who received only one dose receive a second dose at the recommended age. The Measles, Mumps and Rubella (MMR)  vaccine is given to children in two doses, the first at 12 to 15 months and the second at four to six years old. While children are required to receive the MMR vaccine before attending school, some are exempt because they have a medical issue, such as an immune disorder or cancer. (The weakened live virus, and while it does not cause disease, it is not recommended for those whose immune systems are compromised.) Further, most states offer exemptions for religious or personal reasons (Infectious Diseases Society of America, 2015).

There are lessons to be drawn from the above scenarios and these include: qualifications prepare one for responsibilities in given callings, vaccination and nutrition are two areas that show why there is need to promote health in communities, lifestyles affect the brain and in turn our brains have an effect on our ability to adjust to our social-ecological environment. Lastly, there are easy ways that can be adopted to improve on the quality of life.

REFERENCES:

Association for Psychological Science. (2011, February 23). Are we more -- or less -- moral than we think?. ScienceDaily. Retrieved November 9, 2015 from www.sciencedaily.com/releases/2011/02/110222151344.htm

Association for Psychological Science. (2013, March 7). Do-gooder or ne'er-do-well? Behavioral science explains patterns of moral behavior. ScienceDaily. Retrieved November 9, 2015 from www.sciencedaily.com/releases/2013/03/130307124655.htm

Cell Press. (2015, November 6). What makes a leader? Clues from the animal kingdom. ScienceDaily. Retrieved November 9, 2015 from www.sciencedaily.com/releases/2015/11/151106132923.htm

Leap, D. January 2012 trumpet.com

5.  Turnock, B. 2016. Essentials of Public Health. Johns and Bartlett. Burlington, MA

The Food that feeds the brain; From a Public Health Perspective

A simple story of Omega-3 and Omega-6 fatty acids

There is an inherent duty by public health practitioners to make the vast life promoting knowledge into practical strategies for quality of life. One way to do this is to show relationship between the way people live and health outcomes. The organization of the health system must use the appropriate means for prevention and treatment of illnesses and injury by planning for financing, programming and service providing. A successful health system must deploy and integrate a variety of strategies and activities in terms of their strategic intent, level of prevention, and community and individual focus. Wellness and illness are dynamic states influenced by cultural, social, behavioral,, environmental and health service factors that interact within a social-ecological framework. The strategies intervene prior to the development of disease or injury by altering factors in ways to avert or alter occurrence of injury/disease. Or when disease/illness strike there is need for care, limiting disability, eradicate diseases, prevent death and lastly, return individual to the maximum level of function consistent with their capacities (Turnock, B. 2016). 

John is a 55 year old man and he is a soft and hardware inventor who lives in an upper class neighborhood in New York. He comes from an accomplished loving family and all his relatives are well-to-do. He has access to the best healthcare system in the world and can afford the best nutrition on the market. In the last two years he has been a recluse living off his accrued money from three patents with Apple and GM. John has had to visit the clinic 12 times in the last year. It is during one such a visit that John exhibited clinical depression. The last 7 visits were with a psychiatrist who prescribed Trazodone, Venlafaxine, Naproxen (a combination of anti-depressants and sleeping pills) and Omega-3 food supplements.

Nswemu is a 60 year old, indigenous and semi-literate man from the Baganda people of an East African country. He has lived all his life as an agriculturalist in Bigasa, Bukomansimbi District, South of Kampala City. This area experiences ample rains and is the bread basket of Buganda. The people are essentially hunters, foragers, few are engaged in wholesale business, professions such as teaching and administration, and some are into animal and crop husbandry whose products are either sold or used as food crops.  Their diet consists of:  legumes, nuts, cereals, edible insects, small rodents, red-meat, fish, game, fresh-fruits and leafy vegetables. The people are extremely active and most use the two-wheel bicycle for most of their transport needs. Nswemu, has visited the clinic twice in the last two years for malaria-related complaints. The primary-care provider used both these opportunities to gauge depression and in both there were no exhibited signs of depression. Nevertheless, the primary-care provider encouraged Nswemu to engage in day to day activities within his extended family and emotionally supportive community.

Both the above cases rely on two different default means to accomplish a good feeding status. For John, it is the norm to feed properly given the existing first class public health system in his country. For Nswemu, it is the cultural default on which he falls back to feed so well as the fore parents had fed. In John’s case large amounts of processed foods in form of snacks and fast foods have tended to increase his supply of Omega-6 while reducing intake of Omega-3.  Home cooked meals in his case has been something he did in his early 20’s. He confessed that he occasionally has a diet full of fresh whole foods, including leafy greens, raw fruits and vegetables at home. He said he consumes much coffee and alcohol. A good recipe for good mental an physical health should involve low caffeine and alcohol consumption as well as regular diet full of fresh whole foods, leafy greens, raw fruits  and vegetables ( Leap Dennis, 2012).

The brain which is the physical component of the mind functions so well when fed healthy foods. This food is primarily fat (Leap Dennis, 2012). The human brain is 60% fat by dry weight. Fat molecules, such as cholesterol and saturated fats, play a very important role in the construction of brain cells,  their repair work and insulation of nerve fibres. The brain needs healthy fats to thrive and these fats are found missing in the blood of depressed people.

Omega-3 fatty-acids can be found in such foods like fish, flaxseeds, kale, brussels sprout, green leafy vegetables, olive oil, salad greens, walnuts, spinach, avocado. Omega-6 fatty-acids can be found in non-hydrogenated cold press olives, coconut  oil, palm oil, butter, seeds and nuts or oils produced by them. A healthy diet must balance both these fatty-acids.  Highly processed foods contain large amounts of Omega-6 fatty-acids (cereals, cookies, chips, crisps, crackers, shakes and fast-food). 

To function well, the brain needs oxygen-rich blood. This can be inexpensively got by engaging in outdoor activities. Invigorating walks are an inexpensive way to remain physically fit and mentally balanced.  The average Baganda walk long distances a day, carry firewood, use the bicycle, hunt, forage for fruits, engage in mock battles, engage in cheer leading using traditional songs, sleep for at least 8 eight hours and volunteer their time for all social activities such as funerals, community clean up campaigns and attending spiritual gatherings. Exercise and activity as treatment for depression have proved that walking briskly for 30 minutes only three times a week is better ( Leap, D., 2012).

There are lessons to be drawn from the above scenarios from the two worlds. But,what remains uncontested is that our lifestyles affect the brain and in turn our brains have an effect of our ability to adjust to our social-ecological environment.

REFERENCES:

1.   Leap, D. January 2012 trumpet.com

2.  Turnock, B. 2016. Essentials of Public Health. Johns and Bartlett. Burlington, MA

Mental Illness, Stigma, Discrimination and Workplace Productivity From a Public health Perspective

        In a milieu of opportunities, provisions and policies through which Public health services are availed to society, a friend asked me how mental illness, stigma and discrimination do affect workplace productivity. It was a loaded question but, I attempted to giver her some insights. That very night I stayed up all night thinking about what we discussed. I answered her question in a case-by-case approach beginning with defining a situation, going into causes and effect. I began with defining mental illness, then proceeded to locate the link between mental illness and productivity, I talked about racism and privilege, I bought in the issues of gender, I used examples from USA and Canada, I showed the economic importance of planning for and anticipating mental illnesses of employees, then I concluded by showing that dealing with mental illness is just the tip of an iceberg. I hope you enjoy the write up.


      Mental illness is a human condition caused by factors such as: trauma, accidents, racism, subjugation, lopsided laws, inequity, inequality, torture, criminalization and social structures (homelessness and treatment of women). Mental illness affects productivity due to: the different diagnosable mental disorder and how they are treated; work-defined disability; employer-defined disability; utilization and access of workplace rehabilitation facilities. Mental illness is a health condition that has been the trigger of stigma and discrimination.  

           To locate how productivity and mental illness affect each other one has to first understand how productivity at the workplace is nested as well as how mental illness is perceived in society today.  Productivity at the workplace involves a multitude of baseline factors. The factors are: human resource; shelter; economic status of people;  the money invested to establish the job, the level of qualifications, skills, competency, assets; and job description. The jobs range: army, intelligence, banking, law, government, Non Government Organizations, Faith Based Organizations, education, hospitality, service industry, transport, post, telecommunication, administration, media, broadcasting, artisanship, architecture, engineering, construction and publishing. At a minimum, a job requires one to match the job requirements, appear on time at work, stay at work for the requisite duration, have the ability to interpret and transform all work processes into performance. To be good at a job, one has to have values such as: must be able a team-player, dependable and responsible. Human-resource related factors depend on health status of an individual. The way one is treated at work or in society has repercussions on performance. Cognitive levels directly affect  safety behavior, workplace accidents and level of conscientiousness (Wallace, 2003).

              Privilege, class, racism, levels of sophistication and the striation due to patriarchy or matriarchy directly affect the way societies produce materials. In today’s world, one has to appreciate the presence of social, cultural and behavior values that are different. One has to also appreciate that some values in one culture may be ridiculed by another. Whole races have had to be subject to denigration by others. Many examples abound. This is seen in the service, education, banking, government, law and health-care. For the purpose of mental illness and productivity in the workplace, the way diagnosis of mental illness need to be tailored to the client who presents the illness. Follow up care should be tailored to that person’s cultural background.  Historically, western social and behavioral scientists have focused largely on the individual as a major source of psychological and social dysfunction or impaired mental health. This tends to ignore the role of social structures that certain cultures depend on.  There is power in social structures and practices and their impact on individual behavior. This needs to be in-built in the rehabilitation path of one with mental illness. Addressing minority issues in the US calls for this (Dorothy, 1990). 

                Women have borne the brunt of mistreatment and many end up with mental illness. In the workplace, a woman may choose to keep secret the way she is treated by her husband or men in her life. This can affect her workplace productivity. Women’s struggle for equality is impeded by over 800 pieces of blatantly sex-discriminatory law currently on the US statute books. In most states women cannot co-sign for a loan even though property is jointly owned. In rape cases, a woman with prior sexual experience is less likely to be believed if she claims she was raped. To an extent, a woman is still seen as “property” to be controlled and owned by men( Chambliss, W.J., 2011).

               Mental illness, unfortunately has been used as the reason to discriminate and stigmatize those suffering from it. There is potential in many who are labelled and stigmatized as mentally ill. Because of this many isolate themselves and never seek opportunities available to them to rehabilitate as well as be of service to their communities. In this, they are depriving society of taxable incomes. By the year 2020, depression arising from mental illness will emerge as one of the leading causes of disability globally (WHO). Mental illness in and by itself affects workplace productivity. Mental illness arises when social economic opportunities are absent; combined with substance abuse; low socioeconomic class; differential family structure; poor performance in school;  and antisocial behavior of parents (Williams, 1986). Under diagnosed mental illness in a culturally diverse setting from the standpoint of stereotyping may perpetuate the very illness it is supposed to treat. Multicultural context approach e.g. transcultural, inter-cultural, cross-cultural, anti-racist and feminist are forms of counseling needed if one is to deal with minority groups. These have sound theoretical base, value and effectiveness if beneficiaries participate in them (Moodley, 1999).

                     In the US, 75%-85% of people with severe mental illness are un employed and in UK they are 61%-73%. Just because they have severe mental illness, it should not be a reason for them to be denied employment.  There are compelling ethical, social and clinical reasons  for helping people with mental illness to work. From an ethical stand point, the right to work is enshrined in the Universal Declaration of Human Rights 1948. From a social stand point, high un employment rates are an index of the social exclusion of people with mental illness, which the US and UK governments are committed to reducing. From a clinical stand point, employment may lead to improvements in outcome through increasing self esteem, alleviating psychiatric symptoms, and reducing dependency (Crowther, 2001).

                 A given percentage of employed people with diagnosable mental disorders are employed. Employees with mental disorders need to be cared for and this costs money. Canada loses $ 4.5 billion attributed to work-related productivity losses due to depression (Dewa, 2004). Mental illness contributes to absenteeism and disability days. This in turn contributes to decreased productivity. Mental illness is also associated with short term and long term disability, which in turn is often related to insurance coverage. Mental illness accounts for 30% of disability clams, at a cost of $ 15- $ 33 billion annually (Dewa, 2004). 

                 Mental illness affects productivity due to the different manifestations such as: co-morbid disorder; mental disorder (major depressive disorder, mania disorder); anxiety disorder ( social phobia, agoraphobia, panic); affective disorder; substance dependence (alcohol dependence, illicit drug dependence). Work-defined disability is defined as any restriction or lack of capacity to perform an activity in a manner or within a range considered normal (Orme and Costa e Silva, 1995). Employer-defined disability, on the other hand is defined as that which accounts for the additional administrative costs the employer incurs as a result of the sick day or the cost of finding a substitute for the absent worker (Dewa, 2004). 

                Workplaces that anticipate providing employee rehabilitation need to have a responsive  environment. The responsive environment through which workplaces provide rehabilitation cost money. Achieving employment for people with mental illness involves focusing on individual enhancement. This builds behavioral coping skills and task ability. The individual is able to manage symptoms and the job is able to increase diversity at the workplace (Akabas, 1994). 

                   Depressive disorders have the largest medical plan costs of all behavioral health diagnosis in US. There are implications for the medical benefit plan design, disability plan management, and occupational health professionals’ training (Conti et al, 1994). Depression adversely affects work productivity in form of work absence and reduced performance while at work (Stewart et al, 2003). 

                   Litigation due to discrimination cases is another means through which mental illness affects productivity. Work is a major determinant of mental health and a socially integrating force. To be excluded from the workforce creates material deprivation, erodes self confidence, creates a sense of isolation and marginalization and is a key risk factor for mental disability.  This in turn may be the cause of stigma and discrimination experienced by people with mental disabilities. Stigma is both a proximate and distal cause of employment inequity for people with mental disability who experience direct discrimination because of prejudicial attitudes from employers and workmates and indirect discrimination owing to historical patterns of disadvantage, structural disincentives, against competitive employment and generalized policy neglect. There are multiple attitudinal and structural barriers that prevent people with mental disabilities from becoming active participants in the competitive labor market (Stuart, 2006).

                   In talking about the relationship of mental illness and productivity one has to also explore the nesting ground in which mental illness thrives. Addressing mental illness in the workplace is just a tip of the iceberg. The issue of stigma must be addressed at policy, program and community level. We have seen that mental illness is a human condition caused by factors such as: trauma, accidents, racism, subjugation, lopsided laws, inequity, inequality, torture, criminalization and social structures (homelessness and treatment of women). Mental illness affects productivity due to: the different diagnosable mental disorder and how they are treated; work-defined disability; employer-defined disability; utilization and access of workplace rehabilitation facilities. Mental illness as a health condition triggers off stigma and discrimination.  The treatment of women as second class citizens, discrimination and stigma should be given extra attention wherever they rear their ugly heads.

REFERENCES: 

1. Akabas, Sheila H. 1994. Psychosocial Rehabilitation journal, Volume 17 (3), 91-101. http://dx.doi.org/10.1037/h0095572

2. Chambliss, W.J. et al. 2011. Criminology: Connecting Theory, Research and Practice. McGraw-Hill Higher Education.

3. Conti, Daniel J. and Burton Wayne.1994. The Economic Impact of Depression in Workplace. The American College of Occupational and Environmental Medicine.

4. Crowther, R et al. 2001. Helping People with Severe Mental Illness to obtain Work: Systematic Review. BMJ 2001: 322 doi: http://dx.doi.org/10.1136/bmj.322.7280.204.

5. Dewa C. et al, 2004. Nature and Prevalence of Mental Illness in the Workplace.

5. Dorothy Smith Ruiz.1990. handbook of mental Health and Mental Disorder Among Black Americans. Greenwood Publishing Group.

6. Moodley, R. 1999. Challenge and Transformations: Counselling in a Multicultural Context. International Journal For The Advancement of Counselling. Volume 21, Issue 2, pp 139-152. DOI: 10.1023/A:1005347817892.

7. Stewart, F. et al . 2003. Cost of lost productive Work Time Among US Workers With Depression. JAMA. 2003: 289 (23): 3135-3144. doi: 10:1001/jama. 289.23.3135.

8. Stuart, H. 2006. Mental illness and Employment Discrimination. Lippincot Williams and Wilkins, Inc.

9. Wallace, J.C. et al. 2003. Workplace safety performance: Conscientiousness, cognitive failure, and their interaction. Journal of occupational Health Psychology, Volume 8(4), October 2003, 316-327. http://dx.doi.org/10.1037/1076-8998.84316.

10. Williams, Donald. 1986. The Epidemiology Of Mental Illness in Afro-Americans. 

The clickety-clackety noise of the train; journal of an African immigrant in USA

Unlike the trains back in Africa that use wood fuel and have zygomatic-like pistons telling of the effort to move the wheels as they chug along, the T-train's only noise was the sound of the panels vibrating. An occasional squeak, like an umpire moderating a foul or about to end a match, would be heard as the train made a curve. I was one of the many passengers of this morning ride from Sunnydale to Downtown San Francisco.

On this particular morning (October 22nd, 2015), the San Francisco Metropolitan Transportation Authority has extra conductors on the trains and buses. They are there to ensure that all transport fares are paid. They do their work so fast so well. When that was done, an SFMTA officer happened to see a long lost cousin. The SFMTA officer made eye contact, drew the mother's attention, they happily met and talked. This cousin had a three year old child.  This child must have sensed that the mother was giving someone else attention. The child made the loudest noise about this. As a child would do! The train, joined in the noise making. It had reached at a particular area just after AT&T Ball Park stop, where the rail is so straight and in some places it has bends.These bends cause it to vibrate. That must have scared the child more. More noise!

A lady next to me, probably a child welfare officer, walked to the two persons in deep conversation and oblivious of the child. "Excuse me sir, can you leave the mother so that she concentrates on re-assuring her child? You are taking up her time." The perhaps child-welfare officer said.

"Hey, I know her. Did you pay? Next time when you pay just go to the front cabin where there are no children. Can you imagine that? Can you believe this is still happening in America?"  This from the SFMTA officer. He asked whoever was listening and watching this newer event.

The child never ceased to make noise even when the mother soothed her. The SFMTA officer  bent down, gave the child a sticker and at first this seemed to pacify the child. No sooner had he straightened up, than the child got noisier. No amount of convincing could take her away from her mother. This seemed to be the strategy of this man in black, the child must have thought. Meanwhile, the perhaps-child-welfare woman had walked back to her place and when the train stopped she got out.

The train continued and we finally got to my stop. I got out wondering. The child was doing what the child does. The train equally so and all of us onlookers did what onlookers on a morning commute do. Life, meanwhile went on and on and on! In life, things that are meant to go on, will!