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Structural interventions vs tropical diseases
The World Health Organization (WHO) recently published its report on neglected tropical diseases and announced its commitment for “complete control” of these sicknesses by 2015
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he World Health Organization (WHO) recently published its report on neglected tropical diseases and announced its commitment for “complete control” of these sicknesses by 2015. These diseases affect one billion impoverished people, mostly in rural and urban areas in Africa, South America and parts of Asia.
It is important to note that tropical diseases such as dengue fever, leprosy and river blindness cause incalculable human suffering, countless disabilities and 534,000 deaths every year. An estimated one billion impoverished people in approximately 150 countries are affected by one or more of these diseases, and many of them have limited access to adequate care or treatment. WHO Director General Margaret Chan said in the report that; “while the scale of the need for prevention and treatment is huge, the poverty of those affected limits their access to interventions and the services needed to deliver to them”.
Ironically, albeit the serious consequences of tropical diseases, these offer little incentive for pharmaceutical industries to invest in developing new or better products for a market that cannot pay.
Limited capabilities of poor and developing countries to provide access to adequate treatment and prevention programs exacerbate the suffering of impoverished people affected by tropical diseases.
In addition, WHO addressed that although tropical diseases, with the exception of dengue, do not kill in the same numbers as HIV/AIDS or tuberculosis, they generate debilitating infections and parasitic diseases, which cause blindness, disability and deformities as well as social stigma, exclusion and discrimination.
Tropical diseases are closely linked to poverty and lack of development, and mostly occur where people do not have access to basic healthcare, clean water, adequate sanitation, housing, education and information. Public health researchers and practitioners therefore advocate the relevance of and the need for human rights-based structural interventions to fight the underlying factors that produce susceptibility to tropical diseases.
These include fulfilling people’s rights to basic infrastructures and increasing poor people’s access to basic preventive and treatment measures. Structural interventions may complement human rights-based approaches to combating tropical diseases by changing the context or environment within which individuals act for the purpose of persuading them to apply healthier and safer behaviors.
In other words, structural interventions attempt to create an environment that enables or empowers people to make positive preferences by providing them a supportive context and sufficient opportunities to make healthier choices. One of the most important tenets of structural interventions is their sensibility to address the economic deprivation and social marginalization that underlie people’s vulnerability to many tropical diseases.
It should also be noted that structural interventions are consistent with the principles of the “new public health” as presented in the Ottawa Charter for Health Promotion. The Ottawa Charter explicitly advocates the need to address social and environmental determinants of health and the need to develop effective responses to public health issues, both at individual and community level.
In the Indonesian context, it is important for the governments (at all levels) to strengthen poverty alleviation programs, both in rural and urban areas, as well as enhancing their performance and coordination to improve basic services such as adequate housing, sanitation, clean water, basic education and health services. Rural areas in the eastern part of Indonesia should be prioritized due to the persistent poverty in these areas and limited infrastructures such as transportation, electricity, schooling and public health facilities.
Many people in rural areas in Sulawesi, Maluku, West and East Nusa Tenggara and Papua are more susceptible to varied tropical diseases because of the clustering of risk factors, including the presence of diseases’ vectors, widespread poverty and the limited basic health and education infrastructure.
Considering the wide remote areas and the large numbers of impoverished people in Indonesia, it will take time. It is not easy to tackle the underlying factors of tropical diseases and increase people’s access to basic services.
However, these are not impossible. After all, the costs and the dramatic human suffering caused by ignoring and doing nothing to significantly reduce poor people’s vulnerability to tropical diseases, particularly in remote area in the eastern parts of Indonesia, are clearly too high.
The writer is a lecturer at the Faculty of Public Health, Hasanuddin Universty, Makassar, and a PhD candidate at the School of Population Health, the University of Melbourne, Australia.
