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. 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.
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.

[Footnotes]
The six are diphtheria, measles, poliomyelitis, tetanus, tuberculosis, and whooping cough. WHO recommends that hepatitis B, which kills many more people than AIDS now kills, also be included in immunization programs.
Pinch the child’s abdominal skin. If the skin takes longer than two seconds to go back to a normal state, the child may be severely dehydrated.

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.’

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.

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