Public Health Is... More than Just Medicine

Coming in to study public health I thought all you needed to eradicate a disease was medicine. Green Valley is an impoverished township where I have been job-shadowing the community caregiver, Ronel. Tuberculosis is an airborne disease that involves a bacteria that grows inside the lungs. Despite the free health care and medicine that Ronel and the community clinic offer, this township still suffers from Tuberculosis due to poor housing conditions.

Most of the families live in two-bedroom houses that are often shared by another family. About half of the houses in Green Valley don't have windows and the roofs are made out rusty sheet metal that leak during the rain. Some residents can't afford to put glass in their window frames, so instead they cover it up with cardboard to keep the cold and the mosquitoes out. Ronel says, "The problem with not having windows or some kind of ventilation system is that people spread their sickness easily to their family." Since tuberculoses is an airborne disease, high-density housing allows it to spread easily. On top of not having any ventilation system to cycle out the germs, some of the houses are practically on top of each other, making this a perfect environment for tuberculoses and other diseases to spread.

There is a cure for tuberculoses; the patient must take a pill everyday for six to eight months. The South African government has provided free services and medicine for anyone in need, but in order to eradicate tuberculoses, the housing problems need to be fixed. The government should create stronger housing codes that would require a ventilation system other than the windows that are often broken. There also needs to be more community planning that would require for houses to be sufficiently spaced out from each other. Just with the three weeks I have been here, I have realized that public health policy will be most effective once the problems with infrastructure are addressed.

And for further information search "tuberculoses at"

1. New England Journal of Medicine
2. Center for Global Development

Questions and Answers
For: Public Health is More than Just Medicine

QI. If the South African government required stronger building codes, would the residents be able to afford to upgrade their homes?

A1. You are right. Most people would not be able to afford upgrades unless the government provided assistance.

There are two types of housing in Green Valley. One is government housing. Ever since Nelson Mandela's presidency, the government has been building houses that have windows and are sufficiently spaced from one another. Green Valley is promised a certain number of houses every year, but that promise isn't always kept. Ronel applied for a government house in 1995 and they just finished building it last week. The 15-year wait is not uncommon.

The second type is called informal housing. These houses are insufficiently spaced and often have no window frames built into them. Private construction is not regulated. About 1/3 of the houses in Green Valley are informal housing. Often the contractors try to build near the community water supply making the area more crowded.

During my year with Thinking Beyond Borders, my peers and I often find one solution to a problem, but realize that the potential solution has to overcome barriers. Building new houses cost a lot. If the government's top priority were to eradicate Tuberculosis, they would build new houses faster or make them more affordable through subsidies.

Q2. I realize you didn't study public health in the other countries you guys have visited, but some of the pictures showed similar housing construction. (like Ecuador). Do you know if they have similar public health issues?

A2. The houses in Bua do look similar to the houses in Green Valley. Tubercolsis is was the 10th leading cause of death for men in 1999 (www.www.sk.lung.ca), However in Bua it wasn't an issue we herd about. The houses are more spread out and all have windows. One of biggest health issues there is malnutrition. The Tsachila mostly eat starch-based foods with little protein and vegetables. Without a balance diet, students don't have enough energy in schools to concentrate and children are born with growth problems.

The government is doing very little to address this problem. With Thinking Beyond Borders we planted citrus trees, which have nutritious value. In Ecuador the government pays for the health care services, but patient pays for medicine and any tools used including gloves, syringes, etc. It is great that the government provides services, but the government needs to extent public health services to focus on malnutrition.

Thank you for the questions and if you have more please don't be shy.