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ا           The importance of considering the environment in health.

                                                                                                David Leadbetter.

 

Britain’s changing health provision has mirrored the needs of the time. In the first half of the 20th century the foundation stones of  public health, or environmental health, work provided the public with an adequate, clean and safe water supply, clean air, a reduction of communicable diseases and a safe food supply. Even now Britain, and many other developed countries, struggle to safeguard these vital constituents as recent outbreaks of BSE, Foot and Mouth disease, asthma and car exhausts and, most recently, Avian flu have demonstrated. In the latter half of the 20^th century the 'nanny' state instructed the public through health education in what was good for their own health. Only recently is this being replaced by community led action encompassing informed choice, personalization of health delivery and agencies working together. This has meant asking what people want and how they can be helped to realize their aims. In order for Britain to have moved from one strategy to the next there had to be adequate statistical information, an educated public, a reactive health service, sufficient finance and the ability to prioritize and target. The health problems of the country have changed over time and the modern health problems of Britain are now very personal ones, for example reducing the numbers of those who smoke, reducing obesity, improving diet and nutrition, increasing exercise, encouraging and supporting sensible drinking, improving sexual health and improving mental health. These are also the health problems of much of the developed world, though this is not so in Oman.

 

Oman has taken incredible strides in the past 30 years towards development and the Sultan has always seen health and education as priorities. This is reflected in the health statistics where communicable diseases have given way to non-communicable ones. Many of the foundations of public health are present here such as a safe water supply, clean air and reasonable food safety, though communicable diseases still remain such as brucellosis, bilharzias, pertussis (whooping cough) and TB, though generally in downward trends. For non-communicable diseases, areas of concern in Oman are malnutrition in mothers and children, diabetes, hypertension, cancers and accidents.

 

The environment has always had a critical role to play in health. Carefully planned roads with pavements and cycle paths that reduce traffic accidents, communities that are safe for women to walk in and children to play, housing that is not prejudicial to health, adequate provision of safe water, access to healthy foods, parks that promote exercise and ease mental health, public areas that reduce hazards like building site safety, tobacco control, access to condoms and decentralized bureaux that offer information, education and care. As a simple example for Salalah, obesity and its correlation with diabetes are highly prevalent here. Sensible eating and exercise can delay the onset of diabetes but a lack of sports centres, despite an overwhelming amount of derelict land in the city, forces the masses to play football on waste ground, or on the roads, or for girls, not at all. Providing 10…20 mini football pitches across Salalah would reap immediate health benefits at very little cost. Even in England sport centres are open exclusively so that Muslim women can exercise, is the same true here in the public sector?

 

Despite the importance of the environment, health problems need to be tackled holistically if significant health gains are to be made. Let us look at two examples of how a health problem can be solved.

                                           Political support → Finance                                       Role of Media

                                                            1. Taxation 2. Days lost to ill health                           1. Positive images

3. Cost to health service                                                          2. Information 

Individual Responsibility

1. Giving support to individuals to quit.                                             ↑

←  TOBACCO CONTROL  → 

Community Action                                                       ↕          ↓

Statistics                                        Education

1.      Schools and young teens

2.      General public

3.      Specific communities

Legislation                                                                                        4. Pregnant women                                                                                                                                                                5. Workers in smoky areas.

            ↓                                                                      Primary Health Care

Enforcement                                                           1. Response to ill health

1.      Underage smoking

2.      Banning of smoking in public places                                           

3.      Tobacco advertising

4.      Labelling and health warnings.                                        

 

Related Issues.      1.Anti health culture 2.High rate of smokers within the health service 3.Positive smoking images

4. Stress 5. Recognizing rights of smokers. 6. Second hand smoking

 

                             Political support → Finance                                                          Role of Media

                                                            1. Taxation 2. Days lost to accidents                                     1. Positive images (advertising)

3. Cost to health service 4.Insurance                                      2. Information 

Individual Responsibility                                                                                           3. Publishing of offenders names.

                                                                                                ↑

← ROAD ACCIDENTS→

Community Action                                                       ↕                      ↓

Statistics                                        Education

1. Road safety

2.Cycle safety.

Legislation                                                                                                                                                                                                                                                              

            ↓                                                                                                          Primary Health Care

Enforcement                                                                                               1. Response to accidents

1.      Speed limits

2.   Driving tests                                             

3.      Seat belt enforcement

4.      Rules of the road

5. Punishment of offenders

Environment

1.      School buses

2.      Cycle paths

3.      Pavements

4.      Safe roads – signs and signals

5.      Public transport

 

By slotting Oman health problems in to this kind of chart it is perhaps easier to see which areas need to be targeted? Perhaps the persistence of brucellosis is an issue of inadequate education or perhaps farm workers need more individual help? Are the large number of falls adequately described or is this statistical ambiguity? Are the large number of road accidents related to wild driving by young men or a driving test that is too easy?

 

There is a feeling in Oman also that if further health gains are to be made some of the thorny, taboo issues like HIV/AIDS and health inequalities are going to have to be tackled. More openness and better targeting of health provision will always be preferable to turning a blind eye and denying the existence of problems. Social deprivation and problematic cultural behaviour may directly or indirectly cause ill health. Further research into ethnic groups and deprived areas might be the way Oman that should go to improve health. It is possible too that within such communities positive health behaviour might be revealing too. For example simple diets of fish and rice might be more nutritional than a modern diet of fast foods.

 

Further as educators, we have an important role in trying to encourage young Omanis, particularly men, into the health profession. The percentage of Omani doctors stands at less than 30%. Young Omanis need to be encouraged to become more involved in their own society. Omani doctors will provide benefits for the health service through remaining long term in posts, having community links, having a better knowledge of local issues and language and perhaps more acceptable to Omani national patients.

 

In conclusion, the health needs of Britons and those of Omanis are related to sometimes different diseases resulting from different sets of circumstances, but these problems can be solved by working holistically, considering a number of factors, not least the environment in which these diseases occur.