The World Health Situation​—A Growing Gap

BY AWAKE! CORRESPONDENT IN BRAZIL

WHEN Ali Maow Maalin caught smallpox in Somalia in 1977, it landed him in the hospital and in the headlines as well. After he was treated and cured, WHO (World Health Organization) announced in 1980 that smallpox​—after ravaging millions of people for centuries—​had been eradicated from the face of the earth. Ali was said to have been the world’s last victim.

In 1992, WHO reported other health-​care gains: During the 1980’s, more people in the developing world gained access to safe drinking water and sanitation facilities. In addition, a higher percentage of the population in the least-​developed countries gained access to a local health service. As a result, during the last decade, the number of childhood deaths dropped in some places.

Frightening Facts

These gains, however, are offset by losses and eclipsed by looming threats. Consider a few frightening facts.

HIV/​AIDS​—More than 17,000,000 people worldwide are infected with HIV, the virus that causes AIDS. About 3,000,000 became infected in one recent year, some 8,000 a day. More than a million children have contracted HIV. Deaths from AIDS among children may soon more than wipe out any gains in child survival in recent decades. And the epidemic is just now moving into the early explosive phase in many places, such as in Asia. Over 80 percent of all HIV victims, says Aids and Development, live in developing countries.

Tuberculosis (TB)​—Though largely ignored for the past two decades, TB once more haunts the world, killing some three million people each year, making it the world’s number one killer among infectious diseases. Over 98 percent of those deaths took place in developing countries. To make a bad situation worse, the TB bacterium teamed up with HIV, forming a deadly alliance with devastating results. It is expected that by the year 2000, a million HIV-​infected persons each year will die from TB.

Cancer​—The number of cancer cases in developing countries is now greater than that in developed countries.

Heart Disease​—“We are close to a global coronary catastrophe,” warns WHO’s Dr. Ivan Gyarfas. Heart disease is no longer the plague of industrialized nations alone. In Latin America, for example, two to three times more people will die from heart disease than from infectious diseases. Within a few years, coronaries and strokes will be the leading cause of death throughout the developing countries.

Tropical Diseases​—Warns WHO: “Tropical diseases seem to have gone on a rampage, with cholera spreading to the Americas . . . , yellow fever and dengue epidemics affecting even greater numbers, and the malaria situation deteriorating.” Time magazine says: “In the world’s poorer countries, the fight against infectious disease is already a disaster.” The death toll from malaria alone is now about two million a year​—this after it was thought to be largely eradicated some 40 years ago.

Diarrheic Diseases​—The toll among the young in the developing countries is shocking. Almost 40,000 children die every day as a result of infection or malnutrition; one child dies every eight seconds from diarrheic diseases alone.

Health and Poverty​—A Connection

What is this health picture telling us? “The developing countries are hit with a double blow,” says a health expert. “They are now hit with all the emerging modern chronic diseases but with the residual tropical diseases as well.” The result? A worrisome “geographical rift” has come into focus, notes the book Achieving Health for All by the Year 2000. Thus, health care in some 40 African and Asian countries is “not keeping pace with the rest of the world.” The health gap is huge​—and growing.

Though there are numerous reasons for this growing gap, one main cause of poor health, says World Health magazine, “is poverty.” (Compare Proverbs 10:15.) Often poverty condemns people to inadequate shelter marked by lack of sanitation, lack of safe and sufficient water, and overcrowded, cramped living conditions. These three factors not only hamper health but actually promote diseases. Add to this malnutrition, which weakens the body’s defenses against sickness, and you can see why poverty does to health what termites do to wood.

When deadly diseases contaminate dwellings, cripple bodies, and kill children, the poor are hardest hit. Note some examples. In the poor sections of South Africa, the incidence of tuberculosis is a hundred times higher than that among high-​income areas of the same nation. In impoverished areas of Brazil, six times more people are dying from pneumonia and influenza than in bordering wealthier neighborhoods. And the number of babies dying among India’s destitute families is ten times higher than that among India’s richest families. The painful fact stands out: ‘Poverty is dangerous to your health!’

No wonder that the more than one billion global slum dwellers are left with a feeling of despair. The underlying causes of poverty are beyond their control, and the sickening consequences dominate their lives. If you are suffering the ill effects of poverty, you too may feel hopelessly stuck on the miserable side of the health gap. Yet, poor or not, there are some steps you can take to protect your health and that of your children. What are those steps? The following article offers some suggestions.

What Shapes Your Health​—What You Can Do

UNLIKE rice or flour, health cannot be dished out by a relief worker. It does not come in a bag because it is not a commodity but a condition. “Health,” defines WHO (World Health Organization), “is a state of complete physical, mental and social well-​being.” What, though, determines the degree of that well-​being?

A modest house may be built using boards, nails, and corrugated iron, but the different parts are often supported by four corner posts. Similarly, our health is shaped by numerous influences, but all are related to four “corner” influences. They are (1) behavior, (2) environment, (3) medical care, and (4) biological makeup. Just as you can strengthen your house by upgrading the quality of the posts, so you can better your health by improving the quality of these influential factors. The question is, How can that be done with limited means?

Your Behavior and Your Health

Of the four factors, your behavior is the one most within your control. Changing it for the better can help. Granted, poverty limits the changes you can make in your diet and habits, but by utilizing the choices that are available, you can make a substantial difference. Note the following example.

A mother usually has a choice between breast-​feeding and bottle-​feeding her baby. Breast-​feeding, says the United Nations Children’s Fund, is “the superior choice, both physically and economically.” Mother’s milk, say experts, is “the ultimate health food,” giving the baby “precisely the right concentrations of protein, fat, lactose, vitamins, minerals and trace elements that are needed for harmonious growth.” Breast milk also transports disease-​fighting proteins, or antibodies, from the mother to the baby, giving the infant a head start in combating diseases.

Especially in tropical lands with poor sanitary conditions, breast-​feeding is best. Unlike bottle milk, breast milk cannot be overdiluted to save money, mistakes cannot be made during its preparation, and it is always served from a clean container. In contrast, “a bottle-​fed baby in a poor community,” notes Synergy, a newsletter from the Canadian Society for International Health, “is approximately 15 times more likely to die from diarrheal disease and four times more likely to die from pneumonia than a baby who is exclusively breastfed.”

Then there is the economic advantage. In the developing world, powdered milk is costly. In Brazil, for example, bottle-​feeding a baby may take one fifth of a poor family’s monthly income. The money saved by breast-​feeding can provide healthier meals for the whole family​—including mother.

With all these advantages, you would expect breast-​feeding to be booming. Yet, health workers in the Philippines report that breast-​feeding there is “gravely threatened with extinction,” and a study in Brazil showed that one of the main factors associated with infants dying from respiratory infection is “lack of breastfeeding.” Your infant, however, may escape that fate. You have a choice.

Mother’s efforts to protect baby’s health are often undermined, though, by the unhealthy behavior of other family members. Take as an example one mother in Nepal. She shares a damp room with her husband and three-​year-​old daughter. The tiny room, writes Panoscope magazine, is filled with kitchen and tobacco smoke. The child suffers from a respiratory infection. “I cannot stop my husband from smoking,” sighs the mother. “I now buy cigarettes for my husband and medicine for my child.”

Sadly, her dilemma is becoming increasingly common as ever more people in the developing countries waste much-​needed income by taking up smoking. In fact, for every smoker who stops smoking in Europe or the United States, two people start smoking in Latin America or Africa. Misleading advertisements, notes the Dutch book Roken Welbeschouwd, are much to blame. Slogans such as “Varsity: for that fine clear-​headed feeling” and “Gold Leaf: very important cigarettes for very important people” convince the poor that smoking is linked to progress and prosperity. But the opposite is true. It burns up your money and ruins your health.

Consider this. Every time a person smokes a cigarette, he shortens his life expectancy by ten minutes and increases his risk of heart attack and stroke, as well as lung, throat, and mouth cancers and other diseases. Says UN Chronicle magazine: “Tobacco consumption is the single greatest preventable cause of premature death and disability in the world.” Please note that it says “preventable cause.” You can snuff out your last cigarette.

Of course, there are many more behavioral choices that influence your health. The box on page 11 of this article lists some material that you can read in the library of a Kingdom Hall of Jehovah’s Witnesses. True, informing yourself takes effort. Nevertheless, a WHO official says: “You cannot have health without the involvement of enlightened people who have been informed and educated about their health situation.” So take this free health-​promoting step: Educate yourself.

Health and the Home Environment

The environment that influences your health the most, states the book The Poor Die Young, is your home and your neighborhood. Your environment can be a health hazard because of the water. Infections, skin diseases, diarrhea, cholera, dysentery, typhoid, and other afflictions are caused by insufficient and unsafe water.

If washing your hands requires nothing more than opening a faucet, it may be hard for you to appreciate how much time people who lack running water in their homes spend getting water each day. Often more than 500 persons use one tap. That requires waiting. But low-​income people work long hours, and waiting, notes the book Environmental Problems in Third World Cities, “takes away from time which could be used in earning an income.” No wonder that to save time a family of six will often carry home less than the 30 buckets of water needed each day for a family that size. But then there is too little water for washing food, dishes, and clothes and for personal hygiene. This leads to conditions that, in turn, attract lice and flies, which endanger the family’s health.

Think of this situation. If you depend on a bicycle to reach your faraway job, would you consider it a loss to spend some time each week to oil the chain, adjust the brakes, or replace a spoke? No, since you realize that even if you gain a few hours now by neglecting maintenance, you may lose a whole day of work later when your bicycle breaks down. Similarly, you may gain some hours and a little money each week if you stop short of hauling enough water to maintain your health, but later you may lose a lot of days and money when, because of poor maintenance, your health breaks down.

Fetching enough water can be made a family project. Though local culture may dictate that mother and children serve as water bearers, a caring father will not shun lending his muscle to haul water himself.

After the water reaches home, however, a second problem arises​—how to keep it clean. Health experts advise: Do not store drinking water and water used for other purposes in the same place. Always cover the storage container with a close-​fitting lid. Allow the water to stand for a while so that impurities sink to the bottom. Do not touch the water with your fingers when scooping it out, but use a clean cup with a long handle. Clean the water containers regularly with a bleach solution, and after that rinse them out with safe water. And rainwater? It surely is a bargain (provided it rains!), and it can be safe if no dirt washes into the storage tank with the rainwater and if the tank is protected from insects and rodents and other animals.

When you are in doubt about whether the water is safe, WHO suggests that you add a chlorine-​releasing substance to it, such as sodium hypochlorite or calcium hypochlorite. It works, and it is cheap. In Peru, for instance, this method costs an average family less than two dollars a year.

Health and Health Care

Often the poor only see two forms of health care: (1) available but not affordable and (2) affordable but not available. Donna Maria, one of São Paulo’s nearly 650,000 slum dwellers, explains package one: “For us, good health care is like an item in a window display in a luxurious shopping mall. We can look at it, but it is beyond our reach.” (Vandaar magazine) Indeed, Donna Maria lives in a city where hospitals offer heart-​bypass operations, transplants, CAT scans, and other high-​tech medicine. For her, though, these things are not affordable.

If unaffordable health care is like a luxury item in a mall, then affordable health care is more like a low-​cost item for which hundreds of elbowing customers are reaching at the same time. Noted a recent news report in a South American country: ‘The sick are standing in line for two days to get a consultation. There are no vacancies. Public hospitals lack money, medicine, and food. The health-​care system is sick.’

To improve such ailing health care for the masses, WHO has gradually shifted its work from disease control to health promotion by educating people in prevention and control of diseases. Programs promoting primary health care, such as proper nutrition, safe water, and basic sanitation, writes UN Chronicle, have resulted in “a substantial improvement in global health.” Do these programs benefit you? One of them may have. Which one? EPI (Expanded Program on Immunization).

“The vaccinator has replaced the postman as the most familiar visitor to home and hamlet,” notes a report on EPI. During the last decade, vaccination needles were felt from the Amazon to the Himalayas, and by 1990, WHO reported, 80 percent of the world’s infants had been inoculated against six killer diseases.a Yearly, EPI is saving the lives of over three million children. Another 450,000 who might have been crippled can walk, run, and play. Thus, to prevent diseases, many parents make the personal decision to have their children inoculated.

At times you cannot prevent a sickness, but you may still be able to control it. “It has been estimated that well over half of all health care,” says World Health magazine, “is self-​care or care provided by the family.” One form of such self-​care is a simple, inexpensive mixture of salt, sugar, and clean water called oral rehydration solution (ORS).

Many health professionals regard oral rehydration therapy, including use of ORS, as the most effective treatment for dehydration because of diarrhea. If used worldwide to control the 1.5 billion diarrhea episodes that occur yearly in developing countries, a tiny packet of ORS salts costing only ten cents could save the lives of many of the 3.2 million children who die from diarrheic diseases each year.

It could, but the use of antidiarrheic drugs in some countries, states the Essential Drugs Monitor, a WHO newsletter, is still “far more common than the use of ORS.” In some developing countries, for instance, drugs are used three times more often to treat diarrhea than is ORS. “This unnecessary use of drugs is extremely costly,” notes the newsletter. Poor families may even have to sell food for this purpose. Moreover, it warns, antidiarrheic drugs have no proved practical value, and some are dangerous. “Doctors should not prescribe such drugs, . . . and families should not buy them.”

Instead of suggesting drugs, WHO offers the following for treating diarrhea. (1) Prevent dehydration by giving the child more fluids, such as rice water or tea. (2) If the child still becomes dehydrated, see a health worker for assessment, and treat the child with ORS. (3) Feed the child normally during and after the diarrheic episode. (4) If the child is severely dehydrated, he should be rehydrated intravenously.b

If you cannot obtain prepackaged ORS, follow this simple recipe carefully: Mix one level teaspoon of table salt, eight level teaspoonfuls of sugar, and one liter (five cupfuls at 200 milliliters each) of clean water. Give one cupful for each loose stool passed, half that for small children. See the box on page 10 for more information on this matter.

What, though, about factor number four, our biological makeup? How can it be influenced? The next article discusses that question.

[Footnotes]

[Box on page 8, 9]

PRIMARY HEALTH CARE​—HOW DOES IT WORK?

To find the answer to this question, Awake! talked with Dr. Michael O’Carroll, a WHO representative in South America. Some excerpts follow.

‘WE INHERITED a health-​care system based on a medical approach to health. If you are sick, you go to a doctor. Forget about the fact that you drank two bottles of whiskey. Forget that you never exercise. You see the doctor and say: “Doctor, cure me.” Then the doctor puts something in your mouth, puts something in your arm, cuts something off, or puts something on. Now, I am speaking grossly here, as you will understand, just to get the point across, but this kind of medical approach has prevailed. We have wrongfully medicalized society’s problems. Suicide, malnutrition, and drug abuse have become medical problems. But they are not. They are not even health problems. They are social problems with health and medical consequences.

‘Then, over the last 20 years, people said, “Hey, slow down. We’re doing things the wrong way. We need to redefine what health is all about.” Some principles underlying the primary-​health-​care approach developed, such as:

‘It is more humane and more cost-​effective in the long run to prevent disease than to treat it. It is, for example, against this principle to build a clinic to deal with open-​heart surgery when you do nothing about the causes. That does not mean that you do not treat diseases if they occur. Of course you do. If you have a hole in the street that is causing accidents every day of the week, you will treat the poor fellow who falls and breaks his legs, but the more humane and cost-​effective thing to do is: Fill the hole.

‘Another principle is to use your health resources efficiently. It is against this principle to send someone to a clinic for a problem that can be handled at home. Or to send someone to a sophisticated hospital to deal with a problem that could have been taken care of in a clinic. Or to send a doctor, who has been trained for ten years at a university, to go out and give vaccinations while someone who has been trained for six months can do the same job. When that doctor needs to perform the job that he is trained for, he should be available. This is what primary health care is telling us: Educate the people, prevent diseases, and use your health resources wisely.’

[Box on page 10]

ANOTHER ORS FOR CHOLERA

WHO now recommends that rice-​based ORS (oral rehydration solution), instead of the standard glucose-​based ORS, be used for treating cholera patients. Studies show that cholera patients treated with rice-​based ORS had 33 percent less stool output and shorter episodes of diarrhea than cholera patients given standard ORS. One liter of rice-​based ORS is made by replacing the ounce [20 g] of sugar with two to three ounces [50-80 g] of cooked rice-​powder.​—Essential Drugs Monitor.

[Box on page 11]

FURTHER READING ON . . .

Behavior: “Good Health​—What Can You Do About It?” (Awake!, December 8, 1989) “Tobacco and Your Health​—Is There Really a Link?” (Awake!, July 8, 1989) “Helping the Children Stay Alive!” (Awake!, September 22, 1988) “What Alcohol Does to Your Body”​—Awake!, March 8, 1980.

Environment: “Meeting the Challenge of Cleanliness” (Awake!, September 22, 1988) “Stay Clean, Stay Healthy!”​—Awake!, September 22, 1977.

Health care: “Other Lifesaving Measures” (Awake!, September 22, 1988) “A Salty Drink That Saves Lives!”​—Awake!, September 22, 1985.

[Picture on page 7]

Collecting water takes waiting and work

[Credit Line]

Mark Peters/​Sipa Press

[Picture on page 9]

Enough safe water​—a must for good health

[Credit Line]

Mark Peters/​Sipa Press

Perfect Health for All

LIKE behavior, environment, and health care, our biological makeup also affects our health. That makeup is influenced by heredity and sicknesses we may develop later because of having a genetic disposition toward them.

“The biological envelope in which you arrive in the world,” says one health professional, “determines by and large whether you live well, live long, or live at all.”

In whatever way we acquired them, headaches, stiff muscles, frazzled nerves, embrittled bones, failing hearts, and other maladies remind us daily that our health is compromised by an impaired body and mind. What is the root cause of these pervasive health problems?

The Root Cause

A medical doctor named Luke living in the first century C.E. answers this question in an inspired biography he wrote about Jesus Christ. One day, writes Luke, a paralyzed man was brought to Jesus in hopes of his being cured. Jesus told the paralytic: “Your sins are forgiven.” Then, to show that he indeed had the power to forgive sins, Jesus commanded the man: “Get up and pick up your little bed and be on your way home.” The man did! As a result, “an ecstasy seized one and all” who witnessed the healing, and “they began to glorify God.”​—Luke 5:17-26.

What sin did Jesus refer to? The answer helps us to understand why we get sick, grow old, and die. Being assured that “all Scripture is inspired of God,” we can look to the Bible for that answer. (2 Timothy 3:16; 2 Peter 1:21) It tells us that the first man, Adam, was created perfectly healthy. He enjoyed vibrant health as long as he obeyed his Creator.

Adam, however, chose to break God’s law. By being disobedient and deliberately rebelling against his Creator, he was sinning. As a result, he became imperfect, vulnerable to sickness, and in time he died. Sin, therefore, was the cause of Adam’s sickness and death.

Just as some diseases are passed from parents to children as an operation of the laws of genetics, so imperfection and resulting sicknesses were passed from Adam to his offspring, the human race. Thus, all diseases are the result of Adam’s original sin. (Genesis 2:17; 3:1-19; Romans 5:12) Is there a way out?

The Way Out

The change from perfect health to poor health was brought about by sin​—Adam’s rebellion against God’s law. The change from poor health to perfect health is possible only through the removal of sin. (Romans 5:18, 19) How? Another perfect human, the exact counterpart of Adam when he was perfect, would have to sacrifice his life as a ransom. God’s law is that “soul will be for soul,” that is, a life for a life.​—Deuteronomy 19:21.

However, none of Adam’s sinful descendants could provide such a ransom. Thus, Jehovah himself lovingly provided his Son, Jesus, as a perfect human to give his life as “a ransom in exchange for many” so that “we might gain life through him.”​—Matthew 20:28; 1 John 4:9; Psalm 49:7.

While on earth, Jesus showed that his Father, Jehovah, had given him the power to remove sins when he told the paralytic, “your sins are forgiven,” and the healed man walked home. Time and again Jesus used this power from God by instantly healing the blind, the deaf, and many others with various ills.

Regarding these miraculous cures by Jesus, the Bible relates: “Then great crowds approached him, having along with them people that were lame, maimed, blind, dumb, and many otherwise, and they fairly threw them at his feet, and he cured them; so that the crowd felt amazement as they saw the dumb speaking and the lame walking and the blind seeing.” (Matthew 15:30, 31) Even more remarkable, Jesus was able to bring dead people back to life. The Bible tells of several of these resurrections.​—Luke 7:11-16; 8:49-56; John 11:14, 38-44.

These miraculous healings assure us that no disease is beyond Jesus’ power to cure. Will he use this God-​given power again? Can we benefit?

Perfect Health a Certainty

Bible prophecies show that Jesus is already ruling in heaven as the King of God’s heavenly government. God has authorized him to remove all human governments now existing and to rule over the entire earth. (Psalm 110:1, 2; Daniel 2:44) Fulfilled will be the prayer that Jesus taught his followers: “Let your kingdom come. Let your will take place, as in heaven, also upon earth.” (Matthew 6:10) Under the rule of that heavenly Kingdom, part of God’s will for this earth will be to improve health conditions dramatically for the human family.

Then, in a literal as well as in a spiritual sense, “the eyes of the blind ones will be opened, and the very ears of the deaf ones will be unstopped. At that time the lame one will climb up just as a stag does, and the tongue of the speechless one will cry out in gladness.” “And no resident will say: ‘I am sick.’”​—Isaiah 33:24; 35:5, 6.

Under God’s heavenly Kingdom, perfect health will mean that people will not have to die as we do now. God’s Word promises: “Everyone exercising faith in him [will] have everlasting life.” “The gift God gives is everlasting life by Christ Jesus our Lord.” (John 3:16; Romans 6:23) Yes, long ago the inspired psalm promised: “The righteous themselves will possess the earth, and they will reside forever upon it.” (Psalm 37:29) As he did when on earth, Jesus will then resurrect the dead and give them opportunity to benefit from perfect health. The Bible promises: “There is going to be a resurrection of both the righteous and the unrighteous.”​—Acts 24:15.

The earth itself will prosper under Kingdom rule so that hunger, which contributes to bad health, will never again exist. Bible prophecies tell us: “The tree of the field must give its fruitage, and the land itself will give its yield, and they will actually prove to be on their soil in security.” (Ezekiel 34:27) “The earth itself will certainly give its produce; God, our God, will bless us.” (Psalm 67:6) “There will come to be plenty of grain on the earth.” (Psalm 72:16) “The wilderness and the waterless region will exult, and the desert plain will be joyful and blossom as the saffron.”​—Isaiah 35:1.

Summarizing the situation that will exist in God’s new world, the prophetic last book of the Bible declares: “[God] will wipe out every tear from their eyes, and death will be no more, neither will mourning nor outcry nor pain be anymore.”​—Revelation 21:4.

Do you say, ‘That’s hard to believe’? Then, think of this. Before Adam became a sinner, he had perfect health. Imagine that it had been possible for someone to talk with him at that time and tell him that one day the earth would be filled with aching, ailing, and aging people. Do you not think that Adam would have found that hard to believe? Yet, it is now the reality.

In reverse, perfect health will become a reality under God’s Kingdom. Jehovah’s Word assures us: “These words are faithful and true.” (Revelation 21:5) What God says is going to happen will happen because “it is impossible for God to lie.”​—Hebrews 6:18.

What can you now do to be assured of enjoying these coming blessings? The way to perfect health and eternal life was made clear by what Jesus said in prayer to his Father: “This means everlasting life, their taking in knowledge of you, the only true God, and of the one whom you sent forth, Jesus Christ.”​—John 17:3.

Ask Jehovah’s Witnesses for a free Bible course in your home. They will be happy to help you learn more about the marvelous promises of God. It will be your first step on the route to perfect health!

[Picture on page 14]

In God’s new world, all humans will enjoy perfect health