Intersectoral Action in Practice

WHO Parallel Event: “Intersectoral Action in Practice: Examples of Health and Sustainable Development”
By Kul Chandra Gautam
At the World Summit on Sustainable Development
Johannesburg, 31 August 2002

It is often said that health is too important to be left to the care of medical professionals. Medical professionals are good at treating sicknesses. And we need them. But each one of us, no matter what our profession, we are responsible for our own health and the health and wellbeing of our loved ones.

Ministries of health play an important role in combating diseases and promoting health. But their effectiveness is greatly enhanced if they can mobilise support from sectors outside health.

In her address to the World Health Assembly a few months ago, my boss, Carol Bellamy called upon all Ministers of Health to become Ministers of Health Outcomes. This is an important point. The high burden of disease in the world’s poorest countries coupled with severe resource constraints of ministries of health means that while the health sector can and must be strengthened, achievement of better health for the vast majority of the world’s poor cannot be left to the health sector alone.

From the point of view of child health, the number one health worker is the mother. The more we can do to empower her with basic knowledge, information and skills in good infant feeding practices, care and stimulation of the young child, nutrition, hygiene, sanitation, better birth spacing, etc. the better the health outcomes of her child. Good maternal health and nutrition is, of course, of paramount importance.

The best way to promote this is actually through action in the education sector. As we know, girls’ education is probably the most effective of all health interventions. An educated girl marries later. She can better protect herself from diseases, including HIV/AIDS. She has reduced fertility, lower infant and maternal mortality. Her children are likely to be better nourished and healthier. They are more likely to go to school and perform better. And as they become adults, they help break the intergenerational cycle of ill health and poverty.

Teachers are another group of potential health workers that we tend to underestimate. Most children spend many years as a captive audience of their teachers. If teachers, especially at primary and pre-primary level were better informed about psycho-social stimulation and development of children, if they had the basic knowledge of nutrition, hygiene and sanitation, and were empowered to impart it to their students, they could make an enormous contribution in bringing about good health outcomes.

Alas, at present schools tend to be breeding grounds for sicknesses and malnutrition. Millions of school age children are infected by worms and parasites, which leads to malnutrition, anaemia and retards their physical development and learning capacity. Lack of safe water, and sanitary facilities in schools is a major impediment to good learning outcomes in schools, particularly for girls.

That is why in her speech to the plenary of the WSSD yesterday, one of Carol Bellamy’s key messages was: that in the course of this decade, every primary school in the world should be equipped with separate sanitary facilities for girls and boys – and should have a source of clean and safe drinking water. That would be a major contribution for both education and health outcomes.

In partnership with WHO and many other organisations UNICEF has produced this little booklet called “Facts for Life”. It has now been published in 215 languages and over 15 million copies are in use worldwide. Containing advice on safe motherhood and breastfeeding, child development and nutrition, diarrhoea and malaria, HIV/AIDS and prevention of injuries, it is a primer for health promotion aimed at ordinary people – parents, teachers, health workers and community leaders. We believe that if fully utilised, the messages contained in this little booklet could do more to promote public health than all the university hospitals of the world.

It is said that the greatest reductions in infant and child mortality in the 19th century in Europe were attributable, not to medical breakthroughs but to dramatic progress in potable water and sanitation. Water and sanitation in many countries are not in the domain of ministries of health, but those of ministries of public works. An effective public works department can therefore be a very good contributor to good health.

Similarly, in most countries, nutrition is in the domain of ministries of agriculture. And effective working of the agriculture sector can therefore be of great significance to health outcomes.

And in today’s world, mass media and communication can be a great provider of good health information or a promoter of unhealthy life-styles. The communications media, both public and private, can therefore be the greatest ally of ministries of health in their mission of health promotion.

Indeed, if we look at the great success stories of health improvement in recent decades, from the campaigns to eradicate smallpox and polio, to promotion of oral rehydration therapy against diarrhoeal diseases, salt iodisation against iodine deficiency disorders and the good examples of HIV/AIDS prevention work in Uganda and Thailand, the key to great success has been action by other sectors, complementing that of the health sector.

As we pursue the millennium development goals and look forward to the next wave of revolution in health outcomes, I have no doubt that effective inter-sectoral collaboration will be the key to the kingdom of better health in the 21st century.