Tuesday, 17 May 2011

Public Health

One of my alma maters – Taylor University in Upland, Indiana – is starting an undergraduate programme in public health.

As they work towards recruiting the director of this programme and getting the word out for the planned start in Fall 2012, the good folks in the University have sent out feelers to the alumni asking for inputs.

One of the questions they asked was simple and stark: why does public health matter?
Here are some thoughts on this that I am writing from the Herbertpur Christian Hospital where Sheba, the kids and I are visiting lots of our old friends – all of whom are practicing public health.
Why does public health matter?

Public health matters because people matter. People who make choices. People whose choice affect both their own lives as well as the lives of others.

Public health looks at the basic human need for wellness. I believe that this comes from a principal expressed in the Bible – that of Shalom – a peace that goes beyond the absence or even management of conflict – but one that is based on having ‘right relationships all around.’ A 360 degree wholeness and harmony where body, mind, spirit, relationships – the whole complex and beautiful web of our experiences are essentially good.

A public health perspective that is based on this set of ideas sees that good decisions on our part result in the well-being not only of us as individuals – but also and necessarily so – that of our families, our communities and our nations.

Even the most cursory look around us shows us that things are hardly geared to well-being. The challenges of ill-health and disease, the crippling effects of poor decisions and systemic evil have generational impacts.

Public health matters because we know that we are not passive spectators of the world around us. We are called to be stewards and managers of our lives and those whom we are given responsibility for acting on behalf of (which includes those who are yet to come of course).

Public health uses a ‘big picture’ systems approach that sees multiple roles in shaping our shared wellness. But as said before public health takes more than just a descriptive approach – it seeks to be actively involved in shaping the outcome of our lives.

What makes a public health approach different from other ways of looking at how we shape our communities? One distinctive lies in some of the tools Public Health uses.

The man or woman on the street may not be familiar with the terms of epidemiology (the science of understanding how diseases spread) and biostatistics, or be aware of health communication and behaviour change inputs, or even appreciate policy initiatives that are informed by public health considerations – but each of these are powerful ways which can help promote shalom in our fallen world.

In our work at Jeevan Sahara Kendra in Thane, for example, we estimate that HIV affects about 21,000 people in a city of 1.8 million people (epidemiology). A look at the numbers suggest that with an average of 4 other members per family we would expect about 100,000 people to be affected by HIV/AIDS since either they or their immediate family member has the disease.

At JSK we have developed a team to work with local families who are affected by the disease. We are not just dealing with a virus – besides the damage to the immunity, the very real, and very deep stigma and shame that people with HIV face in our society mean that many are dying despite services being available – since they are too scared to access them. Our interventions cannot thus be just a few slogans on a wall – we need to change lives one at a time. Towards this we have developed a small core team of JSK staff and volunteers who meet people with HIV in their own homes.

Using the best available medical understanding of the disease – and the wonderful set of interventions now available – our team discretely meets families who have members with HIV. Our efforts are bearing fruit – we see remarkable changes in the lives of many with the counselling and medication interventions that the JSK staff do.

At the same time we know that we as JSK staff cannot bring about change alone. One of the powerful tools we use are support groups for people with HIV – where people with HIV come together to share their stories – and challenges – knowing that they are not alone. We also are convinced that local churches and prayer groups must reach out and bless people with HIV. Since HIV is a life-long condition we need to have people who are committed for the long-haul who can come alongside families and bless them – and be blessed by them – through practical and life-changing help. Involving the community is not a luxury – social networks are vital to see families affected by HIV change and move forward towards the wellness that we seek for them.

At the same time, it is not enough just to set national policies and expect things to change magically. Going back to the level of the individual - each person needs to make responsible choices. Part of our work at JSK is to help our friends with HIV see that they are created by a loving God who left the glories of heaven for their sake. The specific choices they make all have consequences – whether to share their HIV status with their family members (and how to do so when they want to) – how they spend their resources – how effectively they take their medications – what steps they are taking towards reconciliation and care for each other… the list goes on and on. Each set of choices need to be guided by reliable information that empowers the person and their family to make decisions towards wellness.

So does public health matter? Yes it does – and we at Jeevan Sahara Kendra see it in the lives of men and women who are living with HIV/AIDS despite the climate of hostility and fear that still shrouds the disease. We see it in the gradual change in attitudes towards people with HIV in the church and society at large. We see it in the generation who are growing up without a parent or sibling – and the hope that many of them have to make a new life. We see it in the continued challenge of seeing the spread of HIV stopped – and the dream we have of being able to live in a world with HIV is consigned to the dustbin of history.

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