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Creating a healthy environment for children: Going back to Primary Health Care. A paper presented at The Human Rights Information Network (HURINET) to mark World Health Day, 2003.

                        "Each year over 5 million children ages 0-14 die from 
                          diseases related to their environment"
                                                                             Dr. Gro Harlem Brundtland.

Each year, on April 07, the world celebrates World Health Day, each time with a new theme. On this day, around the globe, thousands of events mark the importance of health for productive and happy lives. The theme of this year's celebration is "Healthy Environments for children".

There is no doubt that some of us might be tempted to ask why it is all about children, yet if we go round it well enough, we will not fail to understand that a healthy environment for them is also a healthy environment for all of us, though children have a unique vulnerability. Children have phases of rapid growth, common to only them, during which their organs and systems may be particularly sensitive to the effect of certain environmental threats, and if not well protected at this time, the consequences may be irreversible and the future health of the child will be greatly affected. Such burden of ill-health as occasioned by this, constrains social and economic development because the children will not grow up to be healthy and productive people, and since people are their countries' greatest resource for achieving sustainable development, we are all affected.

The World Health Day is a part of continuing initiative to promote healthy environments for children (HED) and is a springboard for raising awareness, stimulating debate, motivating national movements, and focusing on health dangers in the places where children live, learn and play. Thus, this paper will carry on along these lines.


The World Health Organization has classified the environmental risks to children's health into three stages, these are:

1. Basic risks existing in their environments, for which generations of children have suffered. Amongst these are unsafe drinking water, inadequate sanitation, indoor air pollution, insufficient food hygiene, poor housing, and inadequate waste disposal.
2. Today's modern risks, which results from the unsafe use of dangerous chemicals, the inadequate disposal of toxic waste and other environmental hazards, noise and industrial pollution. Even unsafe chemical in toys and household products may also be harmful.

3. Emerging potential threats, which include global climate change, ozone depletion, contamination by persistent organic pollutants and chemicals, and other hazards, and emerging diseases such as HIV/AIDS.

The questions raised by this classification are indeed many, and we might not be able to get all the answers here and now. Some of these are; if we in Africa have not been able to combat those basic risks for which generations of African children have suffered, how can we deal with today's modern risks, and then the emerging potential threats? Why have we not been able to combat those basic risks? Can it be blamed on poverty, certain actions or inactions? Or, does it mean the suffering of children due to environmental hazards is inevitable?

 While I leave the others begging for answers, I must borrow an answer for the last question from the following statement of the Director General of WHO, "the millions of children that die annually from environmentally related illnesses could be saved through the creation of healthy settings whether it be at the home, the school, or the community" Out of the numerous risks to children in their everyday environments, six groups of environmental hazards has been listed by WHO, as top priority issues that must be tackled. These are: 

a. Household water security;
b. Lack of hygiene and poor sanitation;
c. Air pollution;
d. Vector-borne diseases;
e. Chemical hazards and;
f. Unintentional injuries.

Undoubtedly, the above listed threats cannot be wished away, but they can be significantly reduced with positive actions. In the words of Dr. Gro Harlem Brundtland, " most of these priority risks can be overcome by security, stability, emergency preparedness and economic development" To these, I dare to add 'information'. 
In the General Comment (No.14, 2000) on The Right to the highest Attainable Standard of Health, art 12 of the ICESCR, particular emphasis is given to access to information because of its special importance in relation to health "...accessibility includes the right to seek, receive and impact information and ideas concerning health issues".

Concerning environmental health, Rio Declaration on Environment and Development, states in Art.10 par. 1 "...at the national level, each individual shall have appropriate access to information on hazardous materials and activities in their communities. It goes on in paragraph 2, "States shall facilitate and encourage public awareness and participation by making information widely available".

Where do we then come in as civil society organisations, in this quest for a healthy environment? As a network, it does touch on two of our thematic areas; Human Rights and Environment, Human Rights education and Child Rights. Furthermore, the principle of HURINET is that human rights of whatever categorization are of everybody's concern. This is because they protect the essentials of human existence, and when violated, affect all facets of human life. Hence, we must, first of all, understand "Healthy Environment for Children", as "healthy environment for all".

We can press the WHO to make information dissemination the core of the initiative of "a new alliance to promote Healthy Environments for Children", which was launched at the World Summit for Sustainable Development, Johannesburg, September 01, 2002. We must continue to create awareness on the right to health, as not meaning just access to medical care, but that it extends to all things which promote health and well-being and prevent illness and diseases, as enshrined in the People's Charter for Health. We must keep calling for the fulfilment of the human right to health, and healthy environment, and engage our government to carry out its duty of facilitating and encouraging public awareness and participation by making information widely available to the people, on environmental and health issues. We must call for the revival of Primary Health Care, as it "...is based on the application of the relevant results of social, biomedical and health services research and public health experience".

When people are well informed, they are better equipped to take good decisions, it brings about a positive change in public opinion, which will eventually influence policy and decision makers. In Nigeria, specifically, the failure of health programs can be attributed to the inability of policy makers to involve stakeholders at the grassroots level. Yet, the poor rating of the country in the global health scale cannot be divorced from the deplorable environment in which this group (the grassroots) of Nigerians live.
Currently, there is a campaign on the Internet, The Million Signature Campaign (www.millionsignaturecampaign.org), which is designed to put pressure on WHO, UNICEF, other UN bodies, social and political organisations, policy makers and governments to re-emphasize PHC in their programs. The Campaign calls for 'health for all, Now!" Part of what we have to do, therefore, will be to join the growing number of individuals and organizations who endorse this campaign being initiated by the People's Health Movement (www.phamovement.org). We must all endorse the People's Charter for Health, and get as many grassroots people as possible to understand the benefits of this Charter to the health rights of all peoples. Joining an international grassroots movement such as the PHM, will give us more voice, create opportunities for a more holistic and multisectoral approach, and a greater understanding of the varieties of obligation to our rights to health.

Furthermore, we all need to have a better understanding of breastfeeding as the heartbeat of Primary Health Care, and join its promotion and support, especially since it is an already known and easily accessible means to dramatically lower some of the greatest effects of environmental threats on the health of children. Acute Respiratory Infection (ARI), is caused by exposure to indoor air pollution from the use of wood, animal dung and crop waste, poor ventilation. These are situations very prevalent in our society, which we cannot just wish away, but breastfeeding has been proven to reduce the risks of contracting of this disease amongst children. Same with Diarrhoeal disease, a major cause of ill-health and death which is associated with inadequate access to water sanitation. The Integrated Management of Childhood Illness(IMCI), a WHO program,  promotes exclusive breastfeeding as the most powerful and effective means of reducing the incidence and severity of childhood diarrhoea. 

Another WHO/UNICEF program on child health, The Global Strategy on Infant and Young Child Feeding, promotes exclusive breastfeeding and adequate complementary feeding practice that can protect from environmental threats. Then if we want healthy environment for our children, we must not tolerate any barrier to breastfeeding. We in Africa, in general, and Nigeria in particular, have to resort to primary health care to reduce these threats to our children's health. 



I must not conclude this paper without calling to mind the following wordings of Art. 25 of the Rio Declaration on Environment and Development, "peace, development and environmental protection are interdependent and indivisible". 

                               "Used Information is power"

Thank you.


Gloria Okemuo (watiwa at beta.linkserve.com)
P.R.O, HURINET
 

Sources:

WHO website, www.who.org

The Declaration of Alma Ata. 

The Right to the Highest Attainable Standard of Health, art.12 of the International Covenant on Economic, Social and Cultural Rights (CESCR), General comment No. 14 Control.

People's Health Movement (PHM) website, www.phmovement.org,
www.millionsignaturecampaign.org

The Rio Declaration.



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