Health For All - A Reality Or A Mirage?
Imagine a community of about 3500 people composed of women, men and children of various age groups. Imagine that for almost 40 long years no one in the community has died of any natural medical condition inspite of the fact that women are giving birth five or more times in their lifespan. And not only that, sickness of any type (including the myriad of non-communicable diseases) is so unusual that it becomes a major surprise when it occurs rather than an expectation.
Yes, you will not be wrong to imagine that you are in a dreamland or probably in heaven! But the fact of the matter is that the scenario depicted above is a reality happening right before our eyes in a community of African Hebrews Israelites in the village of DIMONA in the southern part of Israel. This community does not only believe that it is possible to be healthy, but actually they are living what they believe and reaping the benefits thereof. Against the backdrop that in this modern world where sickness is not only expected but, as someone rightly said, “we have all been programmed to accept sickness as inevitable and eagerly and helplessly awaited for!” what is happening there is almost miraculous.
Health for AllCome to think of it, the fact that people believe that it is possible to be healthy is not really strange because that is what the international community has since 1977 proclaimed in the famous vision of “Health for All by year 2000”. In 1977, health was defined as “a State of Physical, Social and Mental WELL BEING, and not merely the absence of disease nor infirmity”. In 1978 the international community, at the Alma Ata conference, formulated the Primary Health Care (PHC) concept to guide all of us to achieve this vision of Health for All. Since then, and even before that in Ghana, the principles and concepts envisioned in PHC have guided public health practice in Ghana and elsewhere although with minimal degree of success. Twenty eight years after, we are still saddled with all types of diseases (though major progress has been made in various preventable childhood diseases). Under 5 Mortality, Infant Mortality and Maternal Mortality rates are still very high in developing countries, sanitation - related diseases are on the increase and, unfortunately, non-communicable diseases such as hypertension, diabetes and cancers are on the rise.
A closer look at what is contributing to the success story in DIMONA reveals that largely it is the same guiding principles envisaged under PHC that are shaping their lives, in addition to Biblical principles as enshrined in the first five books of the Old Testament. The difference largely is that they not only believe in those principles but are actually living them and setting up systems to support their lifestyles and beliefs. The difference is there for all to see.
PHC Principles and ConceptsWhat were the PHC principles and concepts? The key ones, among others, are:
1. Focus on promotion of health and prevention of diseases
2. Community participation
3. Inter-sectoral collaboration
5. Appropriate technology and self-reliance
Promotion of health encompasses all interventions and actions designed to make people healthy and stay healthy. These may include proper dietary practices, exercises, mental harmony and adequate rest and recreation. Prevention of diseases includes immunization, good environmental practices and personal hygiene, and avoidance of tobacco and alcohol. Community Participation envisages a group of people in a defined area with a common vision, each being the others keeper and all working together to achieve the shared vision. Inter-sectoral collaboration recognizes that individuals and institutions have their own individual and corporate strengths and advantages and no single individual or institution has all the knowledge, skills and resources to achieve the common goal or vision. There is therefore the need for inter-dependence and due recognition of the contribution of all, no matter how small it may appear. Appropriate technology is based on the fact that simple things can work and one does not have to wait for complex technologies in order to succeed. More often than not what is workable locally may be sufficient for the task ahead if only the necessary information and skills are provided as part of capacity building. Equity is based on justice, fair play, solidarity, and respect for human rights.
The Dimona CommunityThe DIMONA community has literally established systems to actualize these principles and they are practically attempting to live them and the results are almost miraculous. After closely observing that community, as far as I can deduce, their success stems from the fact that from the womb through nursery, adolescence and adulthood, everyone in the community has the shared vision of healthy living. Messages are deliberately designed all the time to positively affirm the vision that it is possible to be healthy and stay healthy. In addition, as someone once said, “we are what we eat” and the community takes very seriously what they eat, how and when to eat and drink. Through its regenerative nutrition programme the community encourages eating mostly plant-based diet with no artificial additives, with plenty of vegetables, fruits and water. They also believe in elimination of waste through various measures including regular colonic cleansing with pure water.
Through its healthy lifestyle programme, individuals are encouraged to exercise and rest regularly, positively affirm and encourage each other and minimize all forms of stress, especially stress with respect to inter-personal relationship. They focus a lot on clean environment and personal hygiene and inculcate these values in their children right from birth. The community’s support systems are designed to facilitate the actualization in their lives of the principles of PHC of equity, community participation and inter-sectoral collaboration. Every person who is employed (by the community or outside) contributes a proportion of his/her income (depending on the means) into a common fund for a social welfare scheme. Everyone has to find a defined period to offer free service to the community in the spirit of solidarity.
I can go on and on. One need not accept all what they believe or practice (and certainly I do not accept all their religious beliefs, interpretations and practices) but certainly any unbiased student of public health will recognize that something very interesting and positive is happening in that community. The people are very healthy and enjoy living it - something that has eluded most people especially in the developing world. Not surprisingly, their basket ball team made up of 50 year olds and above won the 2006 national basketball tournament championship in Israel and the team, I am told, is to represent Israel in the European championship in 2007!
We have a lot to learn from the DIMONA community. There are social, cultural and religious differences which cannot be wished away. These differences should guide us in modifying what they practice to suit our environment. As the Honourable Minister of Health keeps on saying there is the need for a paradigm shift - a shift back to the basis of life, the positive things in how our fore fathers lived and ate and actualizing the guiding principles of PHC. This paradigm forms the basis of the new health policy and a Regenerative Health and Nutrition project about to be launched and implemented countrywide.
There is obviously a need for a paradigm shift to promotion of holistic health, healthy lifestyles, salubrious environment and shared vision of health for all. The alternative, unfortunately, is worsening mortality and morbidity statistics and a saddling with increasing prevalence of hypertension, diabetes, cancers, and dependence on drugs!
Health for All is a reality not a dream or a mirage. The international community in 1977 believed it was possible to achieve it by 2000. The DIMONA community has demonstrated that it is not only possible but a reality. They have shown us the way to be healthy and stay healthy. Let us live to be healthy and be healthy to live.
Director Public Health, Ghana Health Service
Article was presented for publication by Dr Edward Addai (Director Policy Planning Monitoring and Evaluation, Ministry of Health )
Views expressed by the author(s) do not necessarily reflect those of GhanaHomePage.