The principle characteristics of Environmental health promotion: The ‘generic’ strategy
Health promotion is giving individuals power to have control over their own health. The Ottawa Charter for health promotion states that there are five ways of promoting health. It includes devising healthy public policy, building appropriate environment for promoting health, strengthening the power of the community in fostering well-being, refining personal skills of the individuals and remodelling the health services. Environmental health refers to the practice of identifying and controlling the environmental factors that have the potential of impacting the health of generations in a negative way. It focuses on the causal effects of the environment on human health. The approach of environmental health promotion is to protect human beings by limiting their exposure to the environmental hazards such as toxic substances or microbiological contamination. ‘Germ theory’ of environmental health postulates the cause and effect approach (Parkes et. al., 2003). This approach had been embraced by John Snow who was instrumental in eradicating the 19th century cholera epidemic in London. He discovered the handle in the Broad Street pump that was the source of contamination of water. Certain social factors can also increase the susceptibility of human beings of being exposed to environmental hazards. The social approach to environmental health identifies factors such as social inequalities, psychosocial processes affecting health (Schulz and Northridge, 2004). Furthermore, an important factor in promoting environmental health is healthy and safe environment and resources such as water, food and air (BROWN et. al., 1992). Health hazards originate from an alteration in the relationship between society and environment (Parker et. al., 2004). The global environmental problems have contributed to alarming health issues. Global ecological crises such as the depletion of the ozone layer, uninhibited air and water pollution and global warming have resulted in serious health problems. In most of the developing countries, individuals are dependent on coal and biomass that appear in the form of wood, crop and dung (Fullerton et. al., 2008). They usually burn these materials with insufficient combustion. As a result, women and young people in these countries are exposed to indoor air pollution on a day-to-day basis. Consequently, they are susceptible to developing chronic illnesses such as pulmonary disease and acute respiratory infections, asthma, pulmonary tuberculosis, lung cancer, nasopharyngeal and laryngeal cancer (Duflo et. al., 2008). Poverty is an essential barrier that hinders people in the developing countries from using cleaner fuels (Poverty, 2001). The particles in the biomass that are hazardous to health include carbon monoxide, sulphur oxides (mainly from coal), nitrous oxides, polycyclic organic matter and formaldehyde (Pope et. al., 2010). The combustion of these materials is almost always not complete. A large amount of emissions as well as poor ventilation of the rooms make indoors extremely polluted. The impact on people’s health is also dependent on the duration of exposure to the indoor pollution. As women in developing countries engage themselves in cooking, their exposure level to the pollution is higher than men. Consequently, young children who are always with their mothers also spend many hours indoors in the exposure of toxic pollutants. People in the developing countries are usually exposed to the indoor pollution for 3-7 hours every day.
Environmental health promotion initiative: An example of the strategy in action
The ITDG (Intermediate Technology Development Group) Smoke and Health project 1998-2001 aims to alleviate indoor air pollution in the rural households in Kenya. It aims to work in collaboration with the communities in rural Kenya to find out solutions. 80% of the people in sub-Saharan Africa rely on biomass (wood, crop, dung residues) as sources of domestic energy. There have been evidences of children being affected by illnesses such as pneumonia and chronic lung disease. This particular project had been launched on May 6, 1998. The primary purpose of this project is to minimise the exposure to toxic pollutants. This project worked with 50 households in rural Kenyan communities. Kajiado and two communities in West Kenya were chosen for this project. These areas are geographically and culturally different from each other. Monitoring the kitchens of these areas showed that the level of indoor air pollution is extremely high (Ballard-Tremeer and Jawurek, 1996). This project served in promoting environmental health by aiming to achieve several goals. First of all, one of the objectives is to better the quality of life of these people and open up new avenues for further research. The project purports to conduct a baseline assessment of pollution, exposure to pollutants, fuel expenditure and structure of the houses (Thomas and Allen, 2000). Developments and installation of interventions are another objective. The affordability of the interventions is also to be tested. Another objective is also to make the inhabitants aware of the risks associated with house smoke and the ways of alleviating them. The other objective of this project was to spread the interventions internationally and ensure the implementation of the best practice in other countries in the world. Its purpose was also to develop an imitable methodology on suitable methods to alleviate indoor air pollution. As a result of this project, there was substantial reduction in the level of carbon monoxide (Albalak et. al.,2001) . The interventions of this project have also improved the ventilation of the households and helped in the passage of natural lighting in the households. Using stoves rather than three stone fires were encouraged. By consulting the community, smoke hoods were used rather than chimney stoves. Windows and eaves spaces had been used to make ventilation possible. The use of the Upesi stove in West Kenya minimised fuel use by 40 percent in contrast with the three stone fires (Abbott, 2000). The reports from the households using these stoves are positive. They have reported that the kitchens are cleaner than before after installing these stoves. Accidents of children being in close proximity of the fires were significantly reduced (Bruce et. al., 2000).. The most important invention adopted by Kajiado was the use of windows when 50 percent of the households adopted the use of smoke hoods. In West Kenya, the community was consulted about their idea of indoor air pollution (Naeher et. al.,1996). Additionally, they had been shown the pictures of the interventions used in Kajiado to make them more enthusiastic about the implementation of the interventions. Thus, this project promoted the health of the inhabitants by taking interventions and strategies to control the environment and better the lives (WRI, World Bank 1998).
Planning, evaluation, context
Participation by the community had been an essential aspect of this project. It is important for the people of the community to express their own needs and identify solutions that correspond to those needs. During this project, the opinions of indigenous population especially women have been prioritised. They were made aware of the project’s criteria that made them help in the process of house selection that are most suitable for the study. Participatory Technology Development (PTD) was an integral tool that had been used in the study throughout. It refers to the operational techniques and methods that accentuate the user’s participation in developing and implementing technology. It allows the participants to select the technology that is best suited for their purpose. This particular approach assumes that community is the essential part in decision-making. Moreover, focus group meetings were arranged to pay heed to the wishes and requirements of the indigenous population (Naeher et. al., 2001). These meetings were also conducted in order to enlighten the population about the risk factors associated with indoor air pollution and the usefulness of the interventions for alleviating it (Mishra et. al., 1997). Exchange visits were paid. it refers to the act of paying visits to the households in which interventions have already been installed. Structured visits were particularly paid in order to disseminate the awareness (Gitonga et. al.). Because of the geographical distance between Kajiado and West Kenya, photographs were also exchanged by the local people in order to increase awareness. Although women have been particularly helpful in this project, there were certain constraints such as the distance between Kajiado and West Kenya. The project had a multi-disciplinary team including project managers, statisticians, and scientific advisors and so on. The selection of households was done keeping in mind certain paradigms. The households with children of 0 to 5 years were preferred as those children and their mothers were more likely to spend maximum amount of time in the kitchen (Bruce et. al., 1998). Enumerators were appropriately trained so that they are able to collect descriptive as well as numeric data. Data gathered from monitoring to find particulates and carbon monoxide showed the quantitative data of the level of indoor air pollution (Budds et. al., 2001). Questionnaires were provided to people to estimate the factors in these people’s lives that can result in increased levels of indoor air pollution. Pre-intervention meetings were held to discuss about possible interventions, the probable causes of indoor air pollution. The project team suggested the use of enlarged size of windows, smoke hoods, eaves spaces as well as installation of better cook stoves as possible interventions. Similarly, in Post-intervention West Kenya meetings, the indigenous population were made aware about the changes after installing the interventions (Parker et. al., 2004). They were also educated about the maintenance of the interventions. For example, they were made to realise that it is important to keep the windows open for them to be effective. Time activity studies were undertaken in order to estimate the changes in people’s lifestyle and behaviour after the installation of the interventions.
Ottawa Charter in action
The Ottawa Charter for Health Promotion is the first conference on health promotion that had been held in Ottawa on 21 November 1986 (World Health Organization. 2017). It presented a charter with the purpose of achieving health by 2000 and afterwards. The basic conditions for health and well-being are peace, shelter, education, food, income, social justice and equity and so on. The Ottawa Charter mentions three strategies for promoting health.
Advocate: Political, social, environmental, cultural, economic, biological factors can influence health in both positive and negative ways. Health promotion aims to make these conditions conducive of maintaining health and well-being.
Enable: Health promotion ensures the equality between people so that everyone can avail equal opportunities to achieve their full potential in terms of well-being. It entails ensuring the availability of a secure environment, life skills, as well as opportunities so that they are capable of making healthy choices. It also involves making sure that there is no discrimination between men and women in terms of availability of these resources.
Mediate: Health promotion needs to be ensured with the help of not only the health sector but also other governmental bodies, social and economic sectors, voluntary organisations, media and local authorities.
While conducting this project, all the factors were taken into consideration so that the interventions taken are effective in making a difference. To estimate the societal, environmental factors, the participatory approach had always been maintained throughout the project. Women’s participation played a major role in this project. Consequently, there was no discrimination on the part of the project team. Moreover, many governmental and non-governmental bodies were immensely supportive of the project. All the principles of the Ottawa charter had been religiously maintained while conducting this project. The interventions used in this project had many social impacts. The project has helped in alleviating poverty in these areas. This project has also contributed in empowering women by making them more confident in decision-making regarding their own kitchens. The improvements in health were significant and note-worthy. Coughs, dizziness and chest pains of the population were significantly reduced (Ezzati, & Kammen, 2001). There was improved sleep and fewer headaches. Moreover, food was no longer prone to soot contamination. There were also improvements in overall environment. The visibility was better as a result of smoke removal (Young, 1994). There was fresh air circulation resulting in refreshed breathing (Ezzati and Kammen, 2001). There was increased opportunity for both the children and the adults. The adults were able to increase their income as less time was spent for ill-health. Children’s grades were also better as a result. Financial aspects also improved (Von et. al., 2002). Kerosene was not used less than before because there was less need for lighting. On the other hand, cooking was done by using daylight instead of artificial light. Food was not rotten as the environment improved. The households became safer as the smoke hoods acted like shields. Thus, the project improved all factors that can influence the health and well-being of the indigenous population.
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