Cholera broke out in Haiti in October 2010 for the first time in the country’s history, soon becoming the worst modern-day cholera epidemic in the world. By May 2017, at least 9,600 Haitians have died from the disease, and a further 800,000 have been sickened. Already the poorest country in the Western hemisphere, cholera has devastated Haiti, leaving families without breadwinners and children orphaned. While significant progress has been made towards containing the epidemic, Haiti’s most marginalized communities continue to be severely vulnerable to shocks such as heavy rains and natural disasters (as was seen following Hurricane Matthew in 2016). The UN estimates that another 30,000 Haitians will contract cholera in 2017. Scientific consensus has established that cholera was introduced to Haiti by UN peacekeepers deployed from Nepal, where the disease is endemic. The peacekeepers were stationed on a base that discharged untreated human waste directly into the river system used by tens of thousands of Haitians as a primary water source. This occurred despite knowledge of the risks of introducing infectious disease at a time when Haiti was still reeling from the 2010 earthquake, leaving populations particularly vulnerable. For over six years, the UN refused to acknowledge its role in causing the epidemic, or take adequate steps to ensure justice for the victims of its negligence. This also complicated cholera relief and elimination efforts. Only through ongoing advocacy, including legal action seeking to enforce victims’ rights to a remedy, did the epidemic, and responsibility for resolving it, remain in the public eye. Finally, in the face of growing international pressure, culminating in a scathing report by the UN’s own Special Rapporteur on Extreme Poverty and Human Rights, the Secretary-General issued a historic public apology for the UN’s role in the outbreak in December 2016.
• Baseline data is critical to understand the local situation and key barriers and enablers to health, including social and gender dimensions of accessing health.
• In order to fully realize the value of baseline data, surveys must be designed not only as a tool for M&E, but also as an essential step in collecting data to identify the health needs of those the project is meant to serve.
• In order to improve health equity and reach the most vulnerable, projects must reflect and act on the health challenges they face. Interventions must reflect the needs of communities by taking action to address the health barriers identified in baseline research.
• Social and gender dimensions should be incorporated into baseline tools, analyses and interpretation of results in order to maximize the benefits of baseline findings for designing project interventions.
Dr. Blake Poland is a professor in the Dalla Lana School of Public Health (DLSPH) at the University of Toronto, Director of the Collaborative Specialization in Community Development, co-Director of the WHO Collaborating Centre in Health Promotion, co-lead of the DLSPH Healthier Cities & Communities hub. Trained in social/health geography (PhD McMaster 1994), Blake’s research has focussed on the settings approach to health promotion, the health of marginalized groups, the sociology of tobacco control, theorizing and working with context in public health intervention research, and community development as an arena of practice for health professionals. Since 2006, his work has focused primarily on ecological public health, community resilience, urban sustainability transitions, social movements as agents of change, and authentic dialogue as a tool for transformative social change.
This is the first global analysis of all forms of pollution (air, water, soil, occupational) and examines the burden of disease, economic costs, and the social injustice of pollution. The aggregate impact from all forms of pollution poses one of the greatest public health and human rights challenges of the 21st century. The authors highlight the aspects of pollution that have been largely ignored by international donors and philanthropic organizations, despite the massive death toll.
On October 20th, The Lancet Global Commission on Pollution + Health will release the findings of a multi-year collaborative analysis by many of the world’s top environmental and health scientists, and organizations analyzing the global health and economic impacts of pollution.
Marie Hatem, Université de Montréal
Human healthcare resources and the quality of mother and child’s healthcare: which recommendations have to be considered in Togo and Guinea?
University of Waterloo, School of Public Health and Health Systems, Canada
What will it take to improve the lives of adolescent mothers in rural Uganda? Reflections of adolescent mothers and community stakeholders
Aga Khan University School of Nursing and Midwifery, Pakistan
The intersection of school corporal punishment and youth violence: baseline results from a randomized controlled trial in Pakistan
Abdul Latif Jameel Poverty Action Lab (J-PAL), Massachusetts Institute of Technology (MIT), United States of America
Worth the wait: policy lessons from economic randomized evaluations to reduce early childbearing in Africa and South Asia
Main Messages: Community and Policy maker engagement in implementation research project is key and should be on-going throughout the project. Community health workers are an essential component of the health system, however, their engagement requires financial renumeration and significant training and ongoing support. M-health applications can be used by community health workers to improve access to family planning, prenatal and delivery services and are useful research tools, however, government uptake may require more time and support. Improving women’s health will require commitment from government and communities to invest in key interventions as well as a shift in gender and socio-cultural values. Interventions should be context-specific and designed with local input, however, there are cross learnings for other communities facing similar challenges.
The presentation will be led by 5 speakers covering different aspects of the research in progress: Dr. Bwire Chirangi: Dr. Chirangi will review the context of maternal health in rural Tanzania including barriers to care, access to antenatal and delivery services at health facilities, and provision of family planning services.
Background: Tanzania has one of the highest maternal mortality rates in the world (556/100,000, 2016). Women living in rural Tanzania experience multiple barriers to access health care facilities for antenatal care and delivery and family planning interventions. This symposia will describe a multi-phase implementation research project in progress funded by IDRC, CIHR and GAC. The project uses community health workers to introduce multiple interventions to assist women in accessing care for antenatal care and delivery, and family planning services through m-health applications. A strong focus on policy maker-uptake of the project will also be a focus of the discussion.
Learning objectives include:
1) The context of the cholera epidemic in Haiti from a public health and human rights perspective, including the impact of the disease on its victims;
2) The role of victim-centered accountability and justice movements in securing more effective public health responses
3) The possibilities entailed in the UN’s cholera plan for eliminating cholera, improving underlying determinants of health, and realizing victims’ rights in Haiti;
4) How to get involved in the global coalition in support of a robust cholera response;
5) The opportunities for applying the strategies used in response to the cholera epidemic in Haiti in order to lift up marginalized communities’ health rights in other contexts.