In a world, where water is becoming a scarcity and more and more expensive, and while governments fail to provide safe drinking water and sanitation facilities for their citizens, alternative approaches are needed. Dry sanitation offers a sustainable solution for the improvement of sanitation for the disadvantaged. Conventional water closets consume a lot of fresh water for transportation and purifying wastewaters. Dry toilets function without water, which has become a scarcity in the regions battling with sanitation problems. (Zimbelman and Lehn 2006) Eco sanitation has been acknowledged by the UN (Langergraber and Muellegger 2005) and dry toilets are presented to different kinds of communities in several countries around the world, such as South-Africa, Zambia, Mexico, Romania and Vietnam (Rautanen ja Viskari 2006; Jensen et al. 2008). Furthermore, as the need for articial fertilizer has increased and people are not able to afford it (Guzha et al. 2005), dry toilets provide a lucrative fertilizer turning waste into resource (Zimbelman and Lehn 2006). In Sub-Saharan Africa, the annual production of human excreta per person is enough to cover the amount of artificial fertilizer needed for the annual food production of the individual (Winker et al. 2009). Urea is also considered one of the most important industrial nitrogen producing fertilizers (Heinonen-Tanski et al. 2007). In dry toilets, the faeces are collected into two chambers. When the other one is full, it is left to compost and the other chamber is put to use. After every use organic material, such as sawdust or bark-mulch, is added. In warm temperature and adequate airflow, faeces are degraded by fungi and bacteria. (Zimbelman and Lehn 2006)

Possible challenges with dry sanitation are the stigma of using human faeces as a fertilizer in order to produce food, and participation of the recipient for safe use and ensured ownership of the toilet. (Heinonen-Tanski et al. 2007, Peasey 2000) Water closets are usually considered to be a symbol of modernity, so dry toilets can be perceived as a sign of inadequate progress. Yet, in some areas sanitation is perceived as a secondary matter, while dry toilets are wanted for the appearance reasons only. (Langergraber and Muellegger 2005, Folke 2006) Dry sanitation is said to work better in the rural areas, where the space is not so limited, opposed to urban, densely populated urban settlements. (Zimbelman and Lehn 2006) Nevertheless, dry sanitation should be considered as an option in suitable areas as a provider of improved sanitation, environmental development and increased food supply.

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References:

Folke, S. (Ed.) and Nielsen, H. (Ed.) 2006. Aid Impact and Poverty Reduction. Palgrave MacMillan. New York.

Guzha, E., Nhapi, I. and Rockstrom, J. 2005. An assessment of the effect of human faeces and urine

on maize production and water productivity. Physics and Chemistry of the Earth 30. 840–845.

Heinonen-Tanski, H., Sjöblom, A., Fabritius, H. and Karinen, P. 2007. Pure human urine is a good fertiliser for cucumbers. Bioresource Technology 98. 214–217. 

Hollander, J. M. 2003. The Real Environmental Crisis: why poverty, not affluence, is the environment’s number one enemy. University of California Press Ltd. England/USA.

Jensen, P.K.M., Phuc, P.D.,  Knudsen, L.G., Dalsgaard, A. and Konradsenc, F. 2008. Hygiene versus fertiliser: The use of human excreta in agriculture –A Vietnamese example. Int. J. Hyg. Environ. Health 211. 432–439.

Langergraber, G. and Muellegger, E. 2005. Ecological Sanitation—a way to solve global sanitation problems? Environment International 31 433– 444.

Rautanen, S.L. and Viskari, E.L. 2006 In Search for Drivers for Dry Sanitation. Land use and water resource research. Tampere Polytechnic University of Applied Sciences. Tampere, Finland.

Peasey, A. 2000. Health Aspects of Dry Sanitation with Waste Reuse.  Well Studies in Water and Environmental Health. Task No 324. London. UK.

WHO, UNICEF, WSSCC 2000. Global water supply and sanitation assessment 2000 Report. Geneva, Switzerland.

Winker, M., Vinnerås, B., Muskolus, A., Arnold, U. and Clemens, J. 2009. Fertiliser products from new sanitation systems: Their potential values and risks. Bioresource Technology 100. 4090–4096.

Zimbelman, M. and Lehn, H. Contribution of dry sanitation to the MDGs and a sustainable development. Vortrag auf der 2nd International Dry Toilet Conference: Dry Toilet 2006. Tampere, Finland, 16. - 19.08.2006

Even though HIV/AIDS prevalence have started to regress, the social and economic consequenses as well as increasing morbidity due to the disease is all yet to come. Condoms and education on attitude change are perhaps the best known prevention methods. Others include decreasing infections among drug users, transmission from mother to child and antiretroviral therapy for those who are already infected. Antiretroviral therapy needs to be emphasized since less than 10 % of HIV/AIDS infected people have access to it. Also basic prevention services need to be taken care of with legal and social changes that ends discrimination of women, HIV infected populations and individuals. For this a scaled up prevention strategy is suggested. A concrete target is to educate skillful health care professionals by non-stop investment, delegation of tasks and expansion of roles. The linkage between HIV/AIDS and tuberculosis needs to be acknowledged and promote new support mechanism in order to increase peoples access to appropriate drugs.

To prevent these infectious diseases not only more development aid from the public and involvement of the private sector is needed, more efficient coordination and management is needed. More innovations are needed as well as improved priority-setting. Payments for the use of health care needs to be removed. All this has to come from the developing country itself, it can not be forced on them. In return for increased funding, developing countries will make sure that investments are directed to improvements in health care system and results of the improvements can be shown afterwards. Efficient interventions are hindered by bleak health systems in the developing countries. The health care isn't able to reach the people that need it the most. Prevention of all infectious diseases is needed instead of preventing one while the others prevail. Health system needs more attention and resources in order to be improved. With all these prevention methods, other development issues needs to be addressed since all of them are linked together e.g. sanitation, food, poverty, gender equality and education.

References:

Red Cross and Red Crescent 2008: Malaria Prevention Campaign.

Ruxin, J. Paluzzi, J., Wilson, P., Tosan, Y., Kruk, M., Teklehaimanot, A. 2005. Emerging consensus in HIV/AIDS, malaria, tuberculosis and access to essential medicines. The Lancet, Vol 365 (12) 618-621.

http://www.who.int/mediacentre/factsheets/fs104/en/index.html

In 2008, nearly 9 million children died, most of them in the developing part of the world. Three out of four child deaths happened before the age of five. Nearly all of them occurred in 18 countries, out of which approximately half in five: India, Democratic Republic of Congo, Pakistan, China and Niger. Every one in third deaths occurred either in India or Niger. 40 % of the child deaths under the age of five happen in the neonatal phase, during the first month after being born. 26 % of the neonatal deaths occur due to infections, such as pneumonia or sepsis. Out of the deaths before age of five, 17 % occur because of diarrheal related diseases and 15 % due to malaria, HIV/AIDS or measles.                                                        

During the same year 2008, 358 000 maternal deaths happened. Maternal deaths are caused by complications during either pregnancy or delivery. Only 1 % out of maternal deaths happens in developed countries, while 99 % occur in the developing part of the world. One mother in every 13 dies in developing countries, while in Northern Europe the number is one out of every 3 900 mothers. Moreover, 87 % of the deaths take place in either Sub-Saharan Africa or South Asia. The main cause is haemorrhage, while other includes sepsis, protracted or some how aggravated delivery, disorders caused by elevated blood pressure during pregnancy or unsafe abortion. Generic cause is lack of skilled personnel, equipment and medication while any of aforesaid occurs. In the Sub-Saharan Africa, nearly 50 % of the maternal deaths are caused by the lack of good emergency service during delivery. Genital mutilation is a traditional procedure in some of the developing countries performed on girls who are between infancy and 15 years old. This violation of human rights causes complications during delivery and deaths of newborn babies. 100-140 million women are living with genital mutilation today.

What other causes are there that results in such high numbers of child and maternal deaths in the developing countries?

Lack of services, technology and information, interaction of conditions, diseases and nutrition affect both the child and maternal deaths. 30 % of the child deaths are nutrition related, while lack of clean water, proper sanitation and hygiene cause diarrheal diseases but also increase under-five mortality caused by pneumonia, neonatal disorders and malnutrition.

Poverty is once again a huge factor in this issue as well. An uneducated poor in the rural area are more susceptible to maternal and child deaths. Moreover, an adolescent mother has twice as big of a risk to maternal death.

AIDS orphans have been a growing group of children left behind after the epidemic. These orphans face lack of looking after, deficit immunisation, poor nutrition and education and are more vulnerable to other diseases, such as malaria. Bad sanitation causes diarrheal diseases, intestinal infections and cholera.

Also about 2 million children died during the last decade due to bad nutrition and diseases caused by armed conflicts. Populations are displaced to unhygienic conditions, with no food and no health care, which causes epidemics and diarrheal diseases. Natural disasters and environmental mismanagement are other causes to increased number of child deaths. E.g. floods in Pakistan are a combination of these too, since the environment had been shaped by humans and therefore made it more vulnerable during a natural disaster.

An interesting fact is that more baby boys than girls die- except in India, China, Pakistan and Nepal. In China girls have actually 33 % bigger risk of dying, since boys are more often taken to medical care than girls. However, girls survive better than boys during the first year after being born, but tables are turned during the years 1-5. During the first year girls do better due to genetics, parental care and breast feeding but there after girls are more discriminated.

References:

Childinfo 2008. Monitoring the situation of children and women. UNICEF

UNICEF 2008. Why are millions of children and women dying?

WHO 2008. Fact sheets. Female Genital Mutilation.

WHO 2008. What are the key health dangers for children?

WHO 2008. 10 Facts on maternal health.

Maitra, P. & Gangadharan, L. 2000. Does Child Mortality Reflect Gender Bias? Evidence from Pakistan. University of Melbourne.

http://www.who.int/whr/2003/chapter1/en/index2.html

Basic education is stated as a free and obligated right to everyone in the United Nation’s declaration of human rights in 1948[1]. But still 115 million children are not in school[2].

In primary school enrolment, gender equity has nearly been reached in the developing countries. Yet, Southern Asia and Sub-Saharan Africa lack behind despite their progress during the years 1990-2002. Better progress can be seen in Northern Africa, in countries like Ghana, Gabon and Liberia.[3] Still there are large differences between countries and regions, such as Botswana and Zimbabwe in the otherwise rather uneducated Southern Africa. Despite the progress in primary school enrolment and attendance, which is one of the Millennium Development Goals, it is the secondary school where inequality still prevails. In Southern Asia and Sub-Saharan Africa, where the progress had happened in primary school enrolment, same hasn't occurred in secondary schools.   Especially in Benin the enrolment ratios are low: 41 % vs. 23 % and also in Afghanistan 24 % vs. 8 %. Good examples are Botswana with literacy rate over 90 % in both genders, but still secondary school attendances are low even here. Another one of the few goods is Zimbabwe with literacy rate of 98 % for both male and female, and rather high ratios in all of the other categories. Biggest differences between genders in all of the categories are in Central African Republic, Niger and Chad. The percentages of primary school entrants reaching grade 5 are surprisingly high even in the worst areas like Sub-Saharan Africa with 86 % even though there are big differences between admin data and survey data (Malawi 42 % vs. 87 %). But therefore, the drop in secondary school enrolments is even more staggering as about half of the children are enrolled to secondary school in developing countries. In Sub-Saharan Africa the numbers are as low as 20 % versus over 60 % in the north.

Basic education is said to lead the path to economic wellbeing, scientific and technological development, decrease of unemployment, social equity and political socialisation and cultural liveliness1. Education of girls has social and economical benefits not only to themselves, but for the whole community. As educated girls become women they participate more, they are prone to have fewer children and also to educate them, the children are healthier and more protected towards HIV/AIDS. All these are important factors in breaking the cycle of poverty.^2,4

Although gender is generally said to be one of the biggest factors in receiving education, there are those who disagree. Kanbur states in his article Education, empowerment and gender inequalities that gender is actually less influential to education than income as gender-related inequity is not as big of an issue as it is presented to be. Even though the article states that equity does not lead to macro-level growth, the attention should still be focused on economic and social inequity such as education.[5] The means to battle for education are diverse and country specific¹.

So what are the reasons for uneducated children especially in the developing countries? In Cimombo´s article the reasons are diverse. Families have to make a choice between the cost of educating their children now and perhaps benefiting in the future or benefiting now of their part in home chores and work. Parental characteristic is one of the main reasons whether children are educated or not. Value of education varies. Culture and customs can state that girls can’t attend to schools or use the same facilities with boys. In some cultures girls are to stay home and work.¹ Protestant religion is said to be more education prone than Islam and Hindu[6]. Deprived groups of people are in weaker position due to e.g. race or language. Use of another language in school than at home is said to be an important factor for children to be enrolled and not to drop out of school. Especially with girls teaching methods, curriculum, class room and other facilities and the sex of the teacher makes an important factor. In rural areas the situation is even more difficult, as the distances are long and number of children high. The quality of education is another factor in lack of schooling of children. Poor teachers increase the number of repeaters and therefore costs of education are even higher. ¹

Rural people, ethnic minorities and low-income families are said to be in most risk concerning schooling. Poverty, isolation, parents, ethnicity and community characteristics of indigenous people are other factors in determining whether children get to go to school or not.[7] Other challenges stated by the World Bank are HIV/AIDS, orphan hood, conflicts and other emergency situations, gender-related violence and also gender gap in information technology.4

One fact that I was pondering over with the statistics was the numbers that exceeded 100 % in some countries as the enrolled pupils. An explanation for this could be the high number of repeaters, which are included in this rate. Also the teachers and policy makers are prone to exaggerate the rates in order to make them look better. This could be demonstrated in the rather high differences in administrative data and the survey data, but in the table in question only Comoros and Bolivia had higher administrative rates than survey rates. According to Handbook, the best comparison between countries is by comparing the rates of primary school entrants reaching grade 5. Yet, these figures don’t show the decreasing numbers of secondary education. Low-income countries are said to be 30 years behind middle-income countries, which in turn are 60 years behind the developed countries. The differences e.g. girls and boys get more and more narrow as the country gets more and more developed. In the developed countries girls actually overtake boys. Nevertheless, there are exceptions such as Swaziland where women are statistically outranking boys in literacy rates.[8]

Another and closely linked to structural violence, relevant concept in the Farmers article is social disease. Social disease has different interpretations, but the main idea is that the illness has been caused by social structures or social behavior. HIV/AIDS is perhaps the best known disease, which has been regarded as a social disease.[2] As HIV/AIDS spread vigorously in the North America in the 1980`s[3], it was considered a disease of the minority which was caused due to their lifestyle and behavior. Nowadays it is seen as a disease of the poor and especially a disease of the Sub-Saharan Africa. Regardless of the interpretation of HIV/AIDS as a social disease, the diagnosis, progress and treatment are all affected by social structures such as poverty, racism and gender equality.[4]

Contrary to my first impression, social violence as a concept is not a new invention- instead it was defined already in 1969[5]. What is relevant in the article is the observation that the health professionals are not able to act on the structural violence, which causes additional desocialization. As the medical professionals are trained only to treat the diseases, they don’t recognize the symptoms of social violence. Or even if they do, they are not trained and authorized to act on it. The article makes also a notable statement that even though the causes of ill health are often due to poverty, poverty reduction actions such as education and promotion of equality should not displace helping the already sick. Social safety nets, such as education, water and food, should be seen as basic individual rights instead of as commodities of the affluent.[6] As Amartya Sen has noted, individual freedom and capabilities to influence your life matters. Political and social freedom promotes economical status, and vice versa. “Freedoms of different kinds can strengthen one another”. [7]

Purely changes in the health care system don’t help the poor. Targeted improvements, which take into account local conditions instead of treating the poor as one homogenous group, need to be made, in order to develop access to health care and lower the bar to seek treatment by e.g. improving attitudes towards the poor.[8] By participating the poor, valuable information concerning the local conditions are gathered but also they are given a voice, possibility to influence their lives and they are respected.

By better health, social capital is built, productivity is increased and therefore economical improvements made. Hereby promoting health should be included in the core of decision-making and politics, and seen as a cross-sectoral issue of e.g. education, labor and environment. [9]

While considering structural violence and its affects on the individual or society, one (though I’m sure there are many) challenge comes to mind. How do we, the western world, make sure that we define and act on structural violence without practicing a form of neo-colonialism? Social exclusion is a term, which is referred to marginalized people who are e.g. unemployed, landless or part of ethnic minority, and therefore victims of deprivation. Sen states that’s social exclusion can lead to e.g. lack of self-reliance and deteriorated physical health.[10] But who defines which people are socially excluded or victims of structural violence for that matter? In the research by UNDP, none of the Indian or Peruvian groups saw themselves as socially excluded.[11] What if a person doesn’t consider his/herself as a victim? Do we force him/her to treatment by structural intervention in the name of global health? Or where do we draw the line of practicing natural healing or seeing rather traditional healers as a form of indigenous culture, which should not be westernized?

[1] Farmer et al. Structural Violence and Clinical Medicine. 2006. Plos Medicine

[2] Farmer et al. Structural Violence and Clinical Medicine. 2006. Plos Medicine

[3] http://www.avert.org/aids-history-86.htm cited 17.10.2010

[4] Farmer et al. Structural Violence and Clinical Medicine. 2006. Plos Medicine

[5] Galtung, J. 1990. Cultural Violence. Journal of Peace Research vol 27 no 3. pp. 291-305. USA.

[6] Farmer et al. Structural Violence and Clinical Medicine. 2006. Plos Medicine. Also WHO and World Bank. Dying for Change. p. 24

[7] Sen, A. Development as Freedom. 1999. USA. pp. 11.

[8] WHO and World Bank. Dying for Change. p. 22, 26.

[9] WHO and World Bank. Dying for Change.  p. 23

[10] Sen, A. Development as Freedom. 1999. USA. p. 21.

[11] UNDP. Poverty in Focus. 2006. p. 11.

Globalization enables people, as well as services and connections, to reach distant areas of the world

rather freely in the today’s world. Even though globalization has its many benefits, through better

cooperation and liaison between countries and multinational organizations, the downsides are the risks

on health impacts. Infectious diseases are being spread and cause a threat on people’s health.

The environment has a close linkage to the global health as well. Environmental degradation has both

local and global impacts on health. Water pollution, waste problems and climate change are just a few,

but crucial, phenomena that pose a threat to global health. As the average temperature rises, the diversity

of the cultivated plants diminishes and e.g. the insect-borne diseases are more easily spread. A vicious

circle is created as e.g. floods in Pakistan causes losses in rice crops and therefore affects not only the

producer’s economy, but also the global price and affordability to people in other countries[1].

As said, global health is also a matter of politics and economy. 90 % of the world’s health care resources

are spent on diseases that affect 10 % of the world’s population. HIV/AIDS has been one of the many

epidemic diseases that have had catastrophic impacts on nation’s economy.[2] As the international

cooperation has been emphasized, it is a matter of western world’s stature which is at stake when it comes

to global health problems, prevention of diseases and education on health hazards. Basic health care system

and a decent standard of living pose an ethical and humanitarian incentive for the international community as well.