Universal health coverage and well-being for all
While we would all like holidays for greater health and well-being, at least half of the world’s people is currently unable to obtain essential health services. Almost 100 million people are being pushed into extreme poverty, forced to survive on just $1.90 or less a day, because they have to pay for health services out of their own pockets. (World Health Organisation, 2018)
More than 6 million children die even before their fifth birthday every year still, many in places we visit: 4 out of 5 in sub-Saharan Africa. 16,000 children still die each day from preventable diseases such as measles and tuberculosis and AIDS, now the leading cause of death among teenagers in sub-Saharan Africa (UN). These deaths can be avoided through prevention and treatment, education, immunization campaigns, and sexual and reproductive healthcare.
For this reason, Sustainable Development Goal #3 of the 17 Global Goals is:
SDG #3 "Ensure healthy lives and promote well-being for all at all ages"
The Goal addresses all major health priorities, including reproductive, maternal and child health; sexual health; communicable (passed from person to person), non-communicable and environmental diseases; and mental health. It calls for Universal Health Coverage, access for all to safe, effective, quality and affordable medicines and vaccines, more research and development, increased health financing, and strengthened capacity of all countries in health risk reduction and management.
Universal Health Coverage
UHC is key to people’s and nations’ health and well-being, and the World Health Organisation’s number one goal. It's about ensuring all people can get quality health services, where and when they need them, without suffering financial hardship and without having to choose between good health and other life necessities. Universal means “for all”, without discrimination, leaving no one behind. Everyone everywhere has a right to benefit from health services they need without falling into poverty when using them.
We need to get one billion more people to benefit from UHC by 2023 if we are to meet the Sustainable Development Goals by 2030.
Currently, as well as millions of people still with no access at all to health care, millions more are forced to choose between health care and other daily expenses such as food, clothing and even a home. Over 800 million people (almost 12 % of the world’s population) spend at least 10% of their household budgets on health expenses for themselves, a sick child or other family member. They incur so-called “catastrophic expenditures” - a global problem. (WHO, 2018)
National health systems are often under-resourced, private healthcare prohibitively expensive, and affordable services extremely limited, leaving many with no viable healthcare options. Risk reduction strategies are therefore vital to reduce the need for medical care.
Quality, accessible primary health care is the foundation for universal health coverage and we must do more to improve the quality and safety of health services globally: Unsafe and low-quality health care ruins lives and costs the world trillions of dollars every year. At its heart, primary health care is about caring for people and helping them improve their health or maintain their well-being, rather than just treating a single disease or condition.
Health is a political choice. Experience shows that universal health coverage happens when political will is strong and robust financing structures key. More investment in primary health care is needed to make universal health coverage a reality. Countries that invest in UHC make a sound investment in their 'human capital' (WHO), not only enhancign people’s health and life expectancy, but also protecting countries from epidemics, reducing poverty and the risk of hunger, creating jobs, driving economic growth and enhancing gender equality.
To meet the health workforce requirements of the Sustainable Development Goals and universal health coverage targets, over 18 million additional health workers are needed by 2030, especially in low- and lower-middle-income countries. Investments are needed from public and private sectors in health worker education, and in the creation and filling of funded positions in the health sector and health economy.
Tourism Can Help Destinations' Health & Well-Being
Poor health was recognised by the government in Madagascar as one of the key challenges in the Madagascar Action Plan of 2007-2012, but since 2009, political crisis saw government spending on health cut by 75%, education cut by 82%, the price of basic food staples like rice double, and the value of saleable assets like cattle halved. As such, Madagascar is one of the world's least developed countries and most impoverished.
“At only $22 per day, the Malagasy national health system is amongst the worst funded in the world” — World Health Organisation, 2014.
SEED Madagascar volunteers work on grassroots projects alongside Malagasy communities and their own sustainable solutions for health, education, livelihoods and conservation in this amazing destination.
Malawi is also amongst the world's least-developed and lowest per capita income countries in the world, heavily dependent on outside aid to meet needs for healthcare. RSC seek to rectify this through sustainable development by social enterprise, reducing the dependence on the aid industry by driving tourism-generated income to rural communities through partnership and education.
In Kenya, MWCT supports the Maasai with employment of the only doctor and provision of the only ambulance in the area; 4 sustainably solar-powered health facilities with dispensaries and one clinic equipped with modern laboratory for enhanced diagnosis and treatment, a lab technician and 7 support staff.
Jicaro Island Ecolodge’s initiatives have included creating a new community health centre, enabling medical professionals to operate vital equipment needed for medical examinations.
Tiger Mountain Pokhara Lodge in Nepal provide an ambulance for emergencies and have supported the local Nepal Red Cross branch to construct a meeting hall as a training and disaster-preparedness centre.
Children born into poverty are almost twice as likely to die before the age of five as those from wealthier families. And children of educated mothers - even mothers with only primary schooling—are more likely to survive than children of mothers with no education.
In Madagascar, inadequate diets lead to 50% of children under 3 malnourished and suffering retarded growth, with 10% dying (40% in rural areas) before the age of 5 from easily preventable diseases, such as diarrhoea.
In Kenya, MWCT’s health outreach to remote areas has meant greater child immunisation, prenatal care, early disease detection and treatment including for breast and cervical cancers.
In Nicaragua, Jicaro Island Ecolodge aim to fight malnutrition with “a glass of milk” (the project’s name) and a snack before classes for students.
Every day hundreds of women still die during pregnancy or from child-birth related complications. In many rural areas, only 56 percent of births are attended by skilled professionals and in developing regions, where only half of women receive the recommended amount of health care they need, the maternal mortality ratio – the proportion of mothers that do not survive childbirth compared to those who do – is still 14 times higher than in developed regions.
In Madagascar, Malagasy women are over 55 times more likely to die from maternity related causes than women in the UK. Increasing community awareness of healthy practices during pregnancy and birth can be offered through education of pregnant women, their families and community elders. This may include simple messages such as the importance of good nutrition during pregnancy, reinforced through illustrated information cards specifically designed for people who cannot read or write, and home visits.
SEED Madagascar’s health education project in Fort Dauphin increases women’s access to quality sexual, reproductive, maternal and child health information.
In Kenya, MWCT was donated an ambulance in 2012 which is a huge help and has expanded the reach of medical capabilities for emergencies in remote villages. For example, for local Maasai in Kuku Group Ranch, enabling emergency c-sections to be performed where otherwise a mother or baby's life could in jeopardy.
Sexual health is often taboo in traditional societies, but high incidence of Sexually Transmitted Infections (STIs) can suggest widespread practice of risk-taking sexual behaviours and high vulnerability to HIV. STIs are unpleasant and embarrassing at the best of times, no one likes having to go and get tested. However, they are a serious health hazard and can increase the chances of contracting HIV, if exposed through sexual contact, by as much as 200%-500%. So, no matter how embarrassing or awkward to discuss testing with a partner, STIs must be taken seriously and action taken as soon as possible. Without having the correct knowledge, people are prevented from openly discussing sexual health matters and the ability to act on it, so STIs and HIV/AIDS will continue to spread. Education is key.
Globally, adolescent girls and young women face gender-based inequalities, exclusion, discrimination and violence, which put them at increased risk of acquiring HIV, the leading cause of death for women of reproductive age worldwide, due to unequal socio-economic status compromising ability to prevent or mitigate infection. Globally, about 7 in 10 adolescent girls and women 15–24 years old do not have knowledge of HIV (UNAIDS, 2018).
HIV & AIDS
AIDS is now the leading cause of death among adolescents (aged 10–19) in Africa and the second most common cause of death among adolescents globally.
Globally, in 2017, 940 000 people died of HIV-related illnesses and 36.9 million people were living with HIV: An estimated 0.8% of adults aged 15–49 years worldwide.
The epidemic varies considerably between countries and regions. Africa remains most severely affected, with nearly 1 in every 25 adults (4.1%) living with HIV and accounting for nearly two-thirds of the people living with HIV worldwide (WHO, 2018).
HIV and poverty go hand in hand: Poverty both increases vulnerability to HIV infection, and households affected by HIV are more vulnerable to falling into and remaining in poverty. Poverty-induced hunger leads to a lack of nutrition, and lack of universal health coverage restricts access to HIV prevention and treatment. HIV-related illness impedes school attendance and learning, as does stigma and discrimination, leading to yet lower access to health care and housing. People living with HIV experience unemployment rates three times higher than national unemployment rates. It’s a vicious circle.
Malawi’s high prevalence of HIV/AIDS (12% of the population), sees at least 70% of Malawi's hospital beds occupied by HIV/AIDS patients.
In contrast, economic empowerment, safe and secure working and learning environments, social protection and nutritional support can reduce poverty and HIV vulnerability and help keep people with HIV healthy. High-quality education, including on sexual and reproductive health, can empower young people and provide life skills for responsible and informed sexual and reproductive health decisions.
So whilst young people are particularly at risk, they are also quick to pick up new information and more open and willing to change their behaviour than older people. A broad sexual health education can offer the people tools necessary to negotiate safer sexual relationships with the goal of preventing the transmission of HIV and STIs and reducing unintended pregnancies, safe sex, and raising awareness for STIs and HIV. Taking control of sexual health and making healthier life decisions can impact on future generations.
SEED Madagascar works with young people to raise awareness of safe sexual practices and develop their sexual health knowledge prior to the establishment of sexual practices, which can be as young as 11 in the region, encouraging people to change behaviours.
In Kenya, MWCT hold regular friendly youth sports tournaments to encourage health education, promotion, awareness and counselling including for Female Genital Mutilation (FGV) and HIV/Aids, including voluntary testing.
Sanitation & Hygiene
In 2012, an estimated 889,000 people died from infectious diseases caused largely by faecal contamination of water and soil and by inadequate hand-washing facilities and practices resulting from poor or non-existent sanitation services, with household and ambient air pollution resulting in some 6.5 million deaths.
In 2016, one in four health-care facilities worldwide lacked basic water services, affecting more than 2 billion people and increasing the infection risk of people seeking medical care, and one third of all primary schools lacked basic drinking water, sanitation and hygiene services, affecting children’s health, education and future livelihoods, particularly girls coping with menstruation.
In 2017, 60% people worldwide and only 38% in least developed countries had a basic handwashing facility with soap and water at home, leaving an estimated 3 billion people without. The proportion lacking a basic sanitation service decreased 27%, yet 701 million people still practiced open defecation. 1.8 billion people use a drinking water source that could be contaminated with faeces (UN, 2019).
In Malawi, 2 million don't have access to safe water; 10 million don't have access to adequate sanitation and over 3,000 children die every year from diarrhoea caused by unsafe water and poor sanitation.
Travel to Malawi and your costs include a contribution to local projects including health. On many of the trips, you can learn about village healthcare provision, clean water access HIV, malaria, bilharzia and malnutrition, work with a community NGO and volunteer to raise awareness of a key rural health issues.
Open defecation occurs where people have no choice but to defecate outside onto the ground, often in full view of other people. It affects around 15% of the world’s population, almost entirely in poor areas. It’s unpleasant to live with and bad for public health – attracting flies and pests which transfer germs from exposed faeces to food and water sources and spread disease. A single gram of faeces can contain as many as 10,000,000 viruses, 1,000,000 bacteria, 100 parasitic cysts and 100 parasitic eggs. However, a lack of material resources coupled with local taboos can make this no simple challenge.
In Madagascar, poor hygiene leads to typhoid, polio, acute respiratory infections and trachoma blindness. Only 14% of people have access to improved sanitation facilities (Unicef, 2014).
SEED Madagascar is tackling open defecation through projects in urban Fort Dauphin and rural communities to stimulate debate around the issue, encouraging people to question traditional practices and to adopt new, healthier approaches, supported by the construction of hundreds of new latrines built in homes and schools throughout the region. Some 38,000 people (60% of Fort Dauphin’s population) are expected to participate in at least one of the project’s activities and the entire population will benefit from a cleaner, safer environment.
Non-communicable Diseases (not passed from person to person)
Of all deaths among persons under the age of 70, commonly referred to as premature deaths, an estimated 52 per cent were as a result of non-communicable diseases. Of those, over three quarters were caused by the four main categories of non-communicable disease: cardiovascular disease, cancer, diabetes and chronic respiratory disease.
Respiratory disease is a common consequence of smoke inhalation caused by fossil fuel fires.
SEED Madagascar is supporting people to build fuel-efficient stoves to minimise smoke inhalation and eye infections as well as reduce pressure on protected forests.
Substance use and substance-use disorders have also created a significant public health burden.
Worldwide, alcohol consumption was highest in the developed regions (10.4l per person) and lowest in Northern Africa (0.5l per person).
In 2013, only about 1 in 6 people worldwide suffering from drug-use disorders received treatment: Approximately 1 in 18 in Africa, compared with 1 in 5 in Western and Central Europe.
Mental health disorders such as anxiety and depression occur in all regions and cultures and can lead to suicide: 86% under the age of 70, and globally, the second leading cause of death age 15-29.
”It is high time we turn our attention fully to one of the most pressing problems of today – averting the plastic pollution crisis – not only for the health of our planet, but for the wellbeing of people around the world.” - Sir David Attenborough
These are words in #Attenborough's forward in “No Time To Waste”, the first report to highlight the impacts of plastic pollution not just on precious species and natural places but also on the world’s poorest people. The report was produced by the Tearfund development agency, conservation charity Fauna & Flora International and waste management charity WasteAid.
As our ability to produce and use plastic on an industrial scale far outstrips our ability to manage it, plastic chokes up our rivers and seas, and we ship it for payment to poorer countries, where it is causes serious illness and death. Every 30 seconds, 30 double-decker busloads of plastics are burned or dumped in developing countries, causing up to a million deaths a year from diseases caused by mismanaged waste.
According to the World Health Organization (WHO), rain collecting in plastic packaging is a ‘notorious’ breeding ground, with mosquitos flies and rats, then spreading malaria and dengue fever.
Combined with poor sanitation, people living near rubbish-build-ups are twice as likely to get killer diarrhoea-causing diseases like cholera.
The burning of plastic is also thought to cause a fifth of deaths from air pollution, which kills an estimated 3.7 million people a year, causing heart disease and cancer from the tiny particles such as black carbon, mercury and polychlorinated biphenyls compounds released into the air. Children from slums in Ethiopia with uncollected waste have been found to be six times more likely to suffer acute respiratory infections.
It is also damaging farming as goats and cows eat plastic waste, as do wildlife such as albatross and whales, often suffocating or clogging their stomachs and starving to death.
This ‘throwaway culture’ of the west, half of plastic used only once before being discarded, the shipping of our spoils, and the fact that globally two billion people, 25%, don’t have their rubbish collected, is all contributing to this problem.
Take a trip to one of our fantastic destinations and you’ll be supporting their local communities and their wellness initiatives, and not just in their physical health. Healthy activities and sport also play a key role in mental health and attitudes, bringing people together for support and personal development.
In Kenya, MWCT hold regular friendly youth sports tournaments to encourage health education, promotion, awareness and counseling including for Female Genital Mutilation (FGV) and HIV/Aids.
Nikoi Island organised the first children’s sports program on the island of Bintan, their Foundation provides coaching staff, equipment (sold through a village shop on buy back scheme) and ground maintenance.
Our Own Health
To be able to support others, we must not forget our own health.
The accessibility of international flights has been blamed as skin cancer rates have soared overall by 45% in a decade in the UK, especially in men (55% increase) and the under 50s (70% increase). The sun is the primary cause and skin damage in earlier years can permanently increase cancer risk (The Independent, 2018). But a tan is not a sign of good health, rather it is your body trying to protect itself, and as many as 90% skin cancer cases could be prevented by using simple skin protection.
We can also make lifestyle choices in our own consumption and exercise, which can affect the health of communities half the world away (such as reducing all use of plastics) and in taking breaks for our all-round well-being.
We need to get away from work and daily life, to switch off our stressors, breath in fresh air, relax, retreat and recharge. Spending time in nature is energising, connecting with people is motivating and exercise is revitalising, and can support community health projects, such as our partners’:
Enjoy the freedom of the frontier on horseback off the beaten track in Croatia.
And often, change is as good as rest: join a sailing expedition across the ocean for a real change of scene.
Discover true health and wellness with all of our Earth Changers Places.
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