Social Development and Health: The Case For Eye Care

1. Social Development and Health: The Case For Eye Care G.V.S.Murthy

2. What is Social Development? • A process which transforms social structures and improves the capacity of society to fulfil its aspirations. • Implies a qualitative change in the way society carries out its activities • Improved social actions through more progressive attitudes and behavior by the population • Adoption of more effective social organizations or more advanced technology which may have been developed elsewhere. Though usually beneficial to society, sometimes the process may result in negative side-effects

3. Social Development Spin Offs!!

4. Economic definition of social development • Many economists believe that development is reflected by increasing incomes. • Larger income levels achieved after discounting for population increase are thought to constitute higher levels of development

5. Social Development: UN view • Not just $$$$$$$$$: • Poverty eradication • Employment generation • Social integration

6. Social Development Process Cross cutting approach supporting: • Greater inclusiveness and equity in services, resources and opportunities • Greater empowerment of poor and marginalized groups for participation in social, economic and political life • Greater security to cope with chronic or sudden risks, especially for poor and marginalized groups.

7. Development of Society The development of a society can be judged by: • Quality of its population’s health • Equitable distribution of health across the social spectrum • Degree of protection provided from disadvantage as a result of ill-health

8. Scope of Social Development • Improve the conditions of daily life – the circumstances in which people are born, grow, live, work and age. • Tackle inequitable distribution of power, money and resources as these are the social drivers of daily life

9. Social development aims to empower people to bring about economic and social improvement in their lives. • Development is a process and not a program or a policy • Empowering the poorest people by increasing their human, social and political assets so they are aware of their rights, can claim their entitlements and resist exploitation (BRAC).

10. What has social development achieved globally? • Primary education has been augmented and has a long lasting permanent effect on today’s children • Many individuals are alive today due to immunization, antiretroviral treatment and primary health care • External debts have been written off freeing resources for development • Millions of tons of ozone depleting substances have been prevented from entering the atmosphere

11. Poverty is a significant indicator of the level of social development

12. The ‘Poor’ • Not only those with the poorest incomes, but also: • Those most deprived of health, education and other aspects of human well being

13. Poverty Compromises Development • Poor mothers more likely to due during childbirth • Children from poor families more likely to be malnourished and at a higher risk of disease and death • Poor children receive less education and some may never know what education means • Gender imbalances are more pronounced among the poor excluding them from development benefits and opportunities. • Incomes of the poor are compromised to a greater extent by natural calamities, civil unrest and economic fluctuations

14. Disability & Development • Disability increases risk of becoming poor • Disability leads to loss of employment, change to less productive employment • Disability of one household member limits the employment of other family members • Affected households are more likely to suffer from hunger and food scarcity • Disabled children are less likely to go to school • Greater risk of accidents and mortality among disabled.

15. Disability and Development • Affected households have lower savings and higher debt • Less access to development assistance • Socially isolated • Reduced marriage prospects • Higher rates of domestic violence

16. Visual Impairment and Development Among all disabled, visually impaired are more likely to be unemployed Income loss is most severe among VI 5.5% of productivity may be lost at community level due to disability and VI may cost 0.5% of GDP in poor/ developing countries

17. MDG 1: Eradicate extreme poverty and hunger • Halve between 1990 and 2015, the proportion of people whose income is < 1$ per day: • Food prices have gone up • Agricultural debts have increased • Conflict related migration has increased • Achieve productive employment & decent work for all including women and young adults • Women less likely to have work • Low pay structures • Lack of social security off work • Halve proportion who suffer from hunger • Poor most affected by increasing prices

18. UN Map: Political Borders in Kashmir Disputed

19. MDG1 and Eye Care • Poverty can be both the cause and the consequence of blindness • Poor communities are more likely to be affected by vitamin A deficiency, measles infection, trachoma and exposure to biomass fuels • Blind individuals are less likely to assess eye care services, education or rehabilitation • Blindness can worsen effect of poverty through lower productivity and inability to contribute to family income Gilbert C et al. CEHJ 2007; 20: 62-64

20. Poverty and Blindness • Prevalence of blindness was highest among poor individuals in Pakistan • Cataract surgical coverage was the lowest among the poor households • IOL rate was 45% among poor households compared to 68% among affluent households • Spectacle coverage rate was 7.3% for poor households compared to 25.9% among affluent households Gilbert C et al. BMJ 2008336:29-32.

21. Impact of Cataract Surgery in 3 countries Before Surgery Older people with impairment had: • greater difficulty in activities for daily living, • less able to earn a living or contribute to the household, • less likely to engage in social and family life, • more anxious and depressed, • reduced social status and self esteem After Surgery Subjects reported: • greater social inclusion and participation, • increased self esteem, improved communication and social relationships, • positive social and financial consequences Polock S. CEHJ 2008; 21: 24-25

22. MDG2:Achieve universal primary education • Ensure that by 2015, children everywhere (boys and girls) able to complete a full course of primary schooling • Quality education is also important and encompasses basic literacy and numeracy skills and complete primary schooling in time • Net enrolment ratio increased to 90% in 2006 • Attendance higher in urban schools • Poorest children least likely to attend school

23. MDG2: Education & Eye Care • 90% of visually impaired children in low-income countries do not go to school • There are more boys than girls in schools for the blind • Lack of suitable educational material and teachers • Lack of awareness • Distance to schools • Lack of provision of LV aids/ spectacles may reduce access to school • Blind adults may keep children away from school Gilbert C et al. BMJ 2008336:29-32.

24. MDG3: Promote gender equality and empower women • Target: Eliminate gender disparity in primary & secondary education • Where gender disparity reduces in primary schooling, more girls go on to secondary schooling • Targeted action is needed to help rural poor girls to stay in school • Job opportunities for women have increased but women often remain trapped in low paid insecure jobs • Increased political participation of women will enable decision making empowerment • Women occupy 20% parliamentary seats in 20 countries but none in Asia

25. Gender and development • Gender equality and empowering women helps sustainable development • Relative neglect, bias and discrimination against women pervades most societies in developing countries, more so in South Asia. • Achieving gender parity in primary and secondary school enrolment, women’s self employment and rights to land and other assets are the key to a country’s economic development • Achieving gender equality promotes women’s participation in decision making at all levels from the family to the country.

26. MDG4: Reduce child mortality • Target: Reduce <5 mortality by 2/3 by 2015 • In 2006, 10 million <5 children died globally – the lowest in memory • Leading causes of death are easily preventable by simple improvements in basic health services • 1/3 of all deaths are related to malnutrition • In 2006, 80% of children received measles vaccine

27. MDG4: Child mortality and eye care • Half a million children go blind every year • 60% of blind children die within 2 years • Many conditions that lead to blindness also lead to mortality • Vitamin A deficiency • Measles • Congenital Rubella Syndromme • Meningitis • VISION2020 target of eliminating corneal scarring in children by 2020 • VISION2020 target of halving childhood blindness due to avoidable causes Gilbert C et al. BMJ 2008336:29-32.

28. MDG5:Improve Maternal Health • Target: Achieve universal access to reproductive health by 2015 • In 2005, > 500,000 women died during pregnancy • Proportion of deliveries in institutions was 47% in developing countries in 2005 • Unmet need for Family planning is highest in poor families

29. Why Maternal Health? • Malnourished mothers more likely to have malnourished children • Reduced spacing between child birth increases mortality and malnutrition • Lack of institutional delivery increases risk of mortality and birth trauma • Lack of antenatal care increases infections and malnutrition during pregnancy Hien NN et al. J Prev Med Pub Health2008; 41:232-40; Al Adili N et al. Scand J Public Health 2008;36:292-297; Titaley CR et al.BMC Pub Health 2008; 8:232

30. MDG6: Combat HIV/AIDS, Malaria & other diseases • Target: Halt the spread and reverse trend of HIV by 2015 • No. of newly infected declined to 2.7 mil in 2007 • Women represent growing share of people living with HIV • Children orphaned by AIDS is increasing • Reverse incidence of malaria, TB and other major diseases

31. MDG6 and Eye Care • People with disability (including blind) are more exposed to infectious diseases • They have less access to information • Reduced access to treatment and rehabilitation services • Experience of Oncho Control will help in control of other NTD Gilbert C et al. BMJ 2008336:29-32.

32. MDG7:Enusure environmental sustainability • Sustainable development to reverse loss of environmental resources • Contain greenhouse gas emissions • Limit ozone depletion substances • Reduce biodiversity loss with significant reduction by 2010. • Halve the population without access to safe drinking water and basic sanitation by 2015 • Significant improvement in lives of 100 mil slum dwellers

33. Facets of Sustainable Environment

34. MDG7 and Eye Care Adequate safe water and environmental sanitation are related to social development and blinding eye conditions like Trachoma and Vitamin A deficiency on the other

35. MDG8: Ensure global partnership for development • Developed countries pledged to increase aid from $80 billion in 2004 to $100 billion in 2010 at 2004 prices. • Debt relief grants have decreased between 2005 and 2007 • Aid disbursement ↓ by 8.4% in 2007 compared to 2007 • Development assistance needs to be scaled up significantly by 2010 • Improved market access needed for developing countries • Provide access to affordable essential drugs in developing countries. • Increase access to new technology especially information and communication

36. MDG8 and eye care • VISION2020 is built on global, regional and national partnerships • Supporting VISION2020 therefore supports the global development agenda

37. Eliminating Poverty- The Millennium Development Goals: Current Challenges • Environment existing since 2000 is now under threat due to: • Global economic slowdown • Food security crisis • Global warming • Economic slowdown will: • Diminish incomes of poor • Increase number of people in hunger • Push millions more into poverty • Climate change will affect the poor disproportionately

38. Moral of the Story • Impaired health (including vision related) exacerbates poverty and undermines development, either directly or indirectly by lowering growth. • Conditions in which people live, work and die are shaped by political, social and economic forces

39. How can we help in Social Development?

41. ‘Anywhere’ Development

42. ‘Somewhere’ Development

43. What Comes First? SOCIAL DEVELOPMENT HEALTH ILL HEALTH POVERTY

44. PRIMARY COMMUNITY Where Can We Act? SECONDARY

45. How Can We Act NOW? INTER SECTORAL COLLABORATION ADVOCACY POLICY LEVEL SHARE SUCCESS STORIES RESEARCH 4 EVIDENCE PARTICIPATE IN SHG ORIENT DEVELOPMENT WORKERS ORIENT TEACHERS INSURANCE SCHEMES IMPLEMENTATION LEVEL PEC & PHC CHILD-2-FAMILY INVOLVE COMMUNITY-VC, DECISIONS VILLAGE WATER/ SANITATATION VILLAGE DEVELOPMENT FUND COMMUNITY FINANCING

46. Organizational Support • Earmark a specific proportion for development work in the Health Programme Budgets • Monitor Performance by support to development activities • Support Staff to help in Adult Literacy • Set up incentives for development staff and teachers who participate in eye care activities – Case detection; Motivation; Communication of Health messages • Support SHG with eye care services • Identify and Support Poor Families by creating a corpus for health services

47. LET US ALL CONTRIBUTE BRICK BY BRICK TO HELP OVERALL DEVELOPMENT OF SOCIETY THANK YOU