News Flash 563: Weekly Snapshot of Public Health Challenges

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

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News Flash 562: Weekly Snapshot of Public Health Challenges

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

Aeolian islands (Italy) overview

News Flash 562

Weekly Snapshot of Public Health Challenges

 

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Bridging the Gap: Elevating Preventive Healthcare in Pakistan’s Health Agenda  by Muhammad Noman

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Bridging the Gap: Elevating Preventive Healthcare in Pakistan’s Health Agenda

IN A NUTSHELL
Author's note

In the intricate web of Pakistan's healthcare landscape, one critical thread often remains overlooked: preventive healthcare. While the nation grapples with numerous health challenges, the focus has predominantly been on treatment and cure, sidelining the crucial role of prevention. This article sheds light on the pressing need to elevate preventive healthcare in Pakistan's health agenda and explores the multifaceted dimensions of this neglected aspect

By Muhammad Noman

Healthcare System, CHIP Training and Consulting

Quetta, Balochistan Pakistan

Elevating Preventive Healthcare in Pakistan’s Health Agenda

Bridging the Gap

 

The Prevalent Disparity

Pakistan’s healthcare system is characterized by a stark disparity between investments in curative services and preventive measures. The private sector, driven by profit motives, heavily invests in hospitals and specialized treatments, relegating preventive healthcare initiatives to the sidelines. Consequently, preventive services struggle to gain traction and resources, perpetuating a cycle of illness and treatment rather than proactive health maintenance.

The prevalent disparity in Pakistan’s healthcare system between investments in curative services and preventive measures underscores a fundamental imbalance in healthcare priorities. While the country boasts a robust network of hospitals and specialized treatment facilities, preventive healthcare initiatives often languish in the shadows, receiving inadequate attention and resources. This imbalance perpetuates a cycle of reactive healthcare, where illnesses are treated after they manifest rather than being proactively prevented.

At the heart of this disparity lies the orientation of the private sector towards profit-driven healthcare models. Private healthcare entities predominantly invest in hospitals and advanced treatment modalities, which yield higher returns on investment compared to preventive interventions. Consequently, preventive healthcare services struggle to garner the same level of financial support and infrastructure development, creating a lopsided healthcare landscape where treatment takes precedence over prevention.

In communities across Pakistan, this disparity manifests in the prevailing mindset that prioritizes seeking medical attention only when illness strikes. Preventive measures such as regular health check-ups, vaccination drives, and lifestyle modifications often take a backseat, as individuals and communities focus on addressing immediate health concerns rather than proactively safeguarding their well-being. This reactive approach perpetuates the burden of disease and contributes to the escalating healthcare costs associated with managing preventable illnesses.

Moreover, the policy landscape exacerbates this disparity, with government healthcare policies predominantly centered around building hospitals and expanding access to curative services. While these initiatives are essential for addressing acute healthcare needs, they often neglect the foundational role of prevention in promoting population health and reducing the burden of disease. The lack of cohesive preventive healthcare policies reflects a systemic failure to recognize the long-term benefits of investing in prevention.

Addressing the prevalent disparity in Pakistan’s healthcare system requires a paradigm shift in healthcare priorities and resource allocation. Governments must recognize the intrinsic value of preventive healthcare and prioritize the development and implementation of comprehensive preventive healthcare policies. This includes investing in public health infrastructure, promoting health education and awareness campaigns, and incentivizing preventive healthcare practices at the community level.

Additionally, private sector entities have a vital role to play in bridging this disparity by redirecting investments towards preventive healthcare initiatives. By aligning profit motives with public health goals, private healthcare providers can contribute to building a more balanced healthcare system that prioritizes both treatment and prevention.

Community Perceptions and Practices

In communities across Pakistan, there exists a prevailing mindset that prioritizes seeking medical attention only when illness strikes, rather than adopting preventive measures to safeguard health. This reactive approach undermines the significance of preventive interventions and perpetuates the burden of disease. Community awareness and education on the importance of prevention are crucial to fostering a culture of proactive health-seeking behavior.

Community perceptions and practices play a pivotal role in shaping healthcare outcomes and the effectiveness of public health interventions. In Pakistan, as in many other countries, these perceptions and practices are influenced by a multitude of factors including cultural beliefs, socioeconomic status, access to healthcare services, and exposure to health education. Understanding and addressing these community dynamics are essential for designing targeted and culturally appropriate health interventions that resonate with the population’s needs and values.

One of the key aspects of community perceptions is the cultural beliefs surrounding health and illness. In Pakistan, traditional healing practices and folk remedies often coexist alongside modern healthcare systems. Many communities rely on traditional healers, herbal medicines, and religious rituals to address health issues, particularly in rural areas where access to formal healthcare services may be limited. Understanding and respecting these cultural beliefs are crucial for healthcare providers and policymakers seeking to engage with these communities effectively.

Socioeconomic factors also play a significant role in shaping community perceptions and practices related to health. In Pakistan, disparities in income, education, and access to healthcare services contribute to differential health outcomes among different socioeconomic groups. For example, individuals from lower-income households may face barriers such as cost-related access issues, limited health literacy, and a lack of awareness about preventive healthcare practices. As a result, they may be more likely to rely on home remedies or delay seeking medical care until conditions worsen.

Access to healthcare services is another critical determinant of community perceptions and practices. In rural and remote areas of Pakistan, where healthcare facilities are scarce, communities may have limited options for seeking medical care. This can lead to a reliance on informal healthcare providers or traditional healers, who may not always adhere to evidence-based practices or standards of care. Improving access to quality healthcare services, especially in underserved areas, is essential for empowering communities to make informed decisions about their health.

Health education and awareness initiatives play a vital role in shaping community perceptions and practices towards health. By providing culturally sensitive and linguistically appropriate health information, these programs can help dispel myths, promote healthy behaviors, and encourage preventive healthcare practices. Community-based approaches, such as peer education and community health workers, can be particularly effective in reaching marginalized populations and addressing specific health concerns within local contexts.

In conclusion, understanding and addressing community perceptions and practices are essential for promoting public health and improving healthcare outcomes in Pakistan. By recognizing the cultural, socioeconomic, and access-related factors that influence these dynamics, policymakers and healthcare providers can develop targeted interventions that empower communities to take control of their health. Through collaborative efforts that prioritize community engagement and participation, Pakistan can work towards building a healthier and more resilient society for all its citizens.

Policy Disconnect

The policy disconnect in Pakistan’s healthcare system reflects a misalignment between healthcare policies and the actual needs and realities of the population. Despite investments in healthcare infrastructure and services, there is often a lack of emphasis on preventive healthcare measures and community health promotion. This disconnect is evident in several areas:

  1. Focus on Curative Care: Healthcare policies often prioritize curative care over preventive measures. While hospitals and specialized care facilities receive significant attention and resources, efforts to promote community health, prevent diseases, and address social determinants of health are relatively neglected.
  2. Limited Investment in Prevention: Preventive healthcare measures, such as vaccination programs, health education initiatives, and early screening for diseases, receive insufficient investment and attention compared to curative interventions. This imbalance perpetuates the cycle of illness and disease rather than addressing root causes and promoting wellness.
  3. Fragmented Approach: Healthcare policies may lack coherence and integration across different sectors and levels of government. This fragmentation leads to inefficiencies, gaps in service delivery, and duplication of efforts, hindering the overall effectiveness of healthcare programs.
  4. Insufficient Community Engagement: Policies often fail to adequately involve communities in decision-making processes and health promotion activities. This lack of community engagement results in limited awareness, poor health-seeking behaviors, and barriers to accessing healthcare services, particularly among marginalized populations.
  5. Inadequate Public-Private Collaboration: There is often a disconnect between the public and private healthcare sectors, with limited collaboration and coordination between the two. While the private sector plays a significant role in healthcare service delivery, especially in urban areas, there is a need for greater alignment with public health priorities and policies.

Addressing the policy disconnect in Pakistan’s healthcare system requires a comprehensive approach that prioritizes preventive healthcare, fosters multi-sectoral collaboration, empowers communities, and promotes equity in healthcare access and delivery. By bridging the gap between policy intentions and implementation realities, Pakistan can improve health outcomes and enhance the well-being of its population.

The Imperative for Change

The neglect of preventive healthcare in Pakistan’s health agenda is not merely a policy oversight but a systemic failure with far-reaching consequences. Prevention not only reduces the burden of disease but also promotes overall well-being and saves healthcare costs in the long run. By prioritizing prevention, governments can mitigate the incidence of diseases and improve the health outcomes of the population, ultimately leading to a healthier and more resilient society.

The imperative for change in Pakistan’s healthcare system is clear, given the persistent challenges and disparities in health outcomes. Several key areas require urgent attention to bridge the gap between policy intentions and implementation realities:

  1. Shift Towards Preventive Healthcare: There is a critical need to prioritize preventive healthcare measures, including health education, vaccination programs, and early screening for diseases. This shift can help reduce the burden of disease and improve overall health outcomes.
  2. Enhanced Community Engagement: Policies should focus on empowering communities to take charge of their health through active participation in health promotion activities and decision-making processes. Community-based approaches can lead to more effective and sustainable health interventions.
  3. Integrated Health Policies: Healthcare policies should be integrated across sectors and levels of government to ensure coherence and effectiveness. This includes aligning health priorities with broader development goals and coordinating efforts among various stakeholders.
  4. Public-Private Collaboration: There is a need for greater collaboration between the public and private healthcare sectors to leverage resources, improve service delivery, and enhance access to healthcare services, particularly in underserved areas.
  5. Focus on Equity: Policies should prioritize equity in healthcare access and delivery, ensuring that vulnerable and marginalized populations receive the care they need. This includes addressing social determinants of health and reducing disparities in health outcomes.
  6. Enhanced Monitoring and Evaluation: A robust monitoring and evaluation framework is essential to track progress, identify gaps, and inform policy decisions. This includes regular assessment of healthcare services, health outcomes, and the impact of policies on population health.
  7. Capacity Building: Investment in healthcare workforce development and infrastructure is crucial to strengthen the healthcare system’s capacity to deliver quality care. This includes training healthcare professionals, improving facilities, and enhancing service delivery mechanisms.
  8. Policy Advocacy and Implementation: There is a need for strong policy advocacy and political commitment to drive change in the healthcare system. Policies should be evidence-based, responsive to local needs, and implemented effectively to achieve desired health outcomes.

By addressing these key areas, Pakistan can build a more resilient and responsive healthcare system that meets the needs of its population, improves health outcomes, and contributes to sustainable development.

A Call to Action: Transforming Pakistan’s Healthcare System

Addressing the gap in preventive healthcare requires concerted efforts from all stakeholders – governments, private sectors, and communities. Governments must develop and implement comprehensive policies that prioritize preventive interventions, including awareness campaigns, vaccination programs, and lifestyle interventions. Private sector entities should invest in preventive healthcare initiatives, recognizing the long-term benefits for both individuals and society.

Pakistan stands at a crossroads in its healthcare journey, facing persistent challenges and disparities that hinder progress towards better health outcomes for all. As we reflect on the current state of healthcare in the country, it becomes increasingly clear that bold and decisive action is needed to address the underlying issues and pave the way for a healthier future.

  1. Prioritize Prevention: We must shift our focus from a predominantly curative approach to one that emphasizes preventive healthcare. Investing in health education, vaccination programs, and early disease detection can help reduce the burden of illness and improve overall well-being.

2. Empower Communities: Engaging communities as active partners in healthcare delivery is essential. By involving local residents in decision-making processes and empowering them to take ownership of their health, we can foster a culture of wellness and self-care.

  1. Integrate Health Policies: Healthcare policies must be integrated across sectors and levels of government to ensure coherence and effectiveness. This includes aligning health priorities with broader development goals and coordinating efforts among various stakeholders.
  2. Foster Public-Private Collaboration: Collaboration between the public and private healthcare sectors is key to expanding access to quality services and leveraging resources efficiently. By forging partnerships and sharing expertise, we can strengthen the healthcare system and reach more people in need.
  3. Promote Equity: We must prioritize equity in healthcare access and delivery, ensuring that vulnerable and marginalized populations receive the care they deserve. Addressing social determinants of health and reducing disparities are essential steps towards achieving health equity.
  4. Enhance Monitoring and Evaluation: A robust monitoring and evaluation framework is critical for tracking progress, identifying gaps, and informing policy decisions. By regularly assessing healthcare services and outcomes, we can ensure that our efforts are yielding tangible results.
  5. Invest in Capacity Building: Investing in healthcare workforce development and infrastructure is essential for building a resilient and responsive healthcare system. By training healthcare professionals, improving facilities, and enhancing service delivery mechanisms, we can strengthen our healthcare infrastructure and better meet the needs of our population.
  6. Advocate for Change: Strong policy advocacy and political commitment are essential for driving transformative change in the healthcare sector. By advocating for evidence-based policies and holding decision-makers accountable, we can create an environment conducive to positive health outcomes.

It is time for all stakeholders – government agencies, healthcare providers, civil society organizations, and individuals – to come together in a concerted effort to transform Pakistan’s healthcare system. By working collaboratively and taking decisive action, we can build a healthier, more prosperous future for our nation. The time for action is now.

Conclusion

In Pakistan’s healthcare landscape, the disparity between investments in curative care and preventive measures persists, hindering progress towards better health outcomes for all. The neglect of preventive healthcare initiatives reflects a systemic failure that requires urgent attention and action.

Addressing this disparity requires a multifaceted approach that prioritizes prevention, empowers communities, integrates health policies, fosters public-private collaboration, promotes equity, enhances monitoring and evaluation, invests in capacity building, and advocates for change.

By bridging the gap between treatment and prevention, Pakistan can pave the way for a healthier future. It’s time for all stakeholders – governments, private sectors, communities, and individuals – to come together and prioritize preventive healthcare in the nation’s health agenda. Through collective action and a renewed commitment to preventive measures, Pakistan can overcome its health challenges and build a resilient healthcare system that prioritizes the well-being of its people. The time for action is now.

 

LINKS OF INTEREST 

www.nhsrc.gov.pk 

www.polioeradication.org 

www.epi.punjab.gov.pk 

www.emro.who.int 

www.fda.gov 

www.immunize.org 

www.rotary.org 

www.cdc.gov 

www.vaccinetimes.com 

www.gatesfoundation.org

By the same Author on PEAH 

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  Balochistan Primary Healthcare: What Has Been Done and What Needs to Improve?

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Polio Eradication Programme in Pakistan: Critical Analysis from 1999 to 2023 

 

News Flash 561: Weekly Snapshot of Public Health Challenges

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

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Wavering Sexuality During Covid Pandemic

IN A NUTSHELL
Editor's Note

An exhaustive overview here on sexuality multifaceted flux during recent COVID pandemic, whereby attention is paid to aspects including sexual desires, virtual intimacy, dynamics of isolation, sexual health services, among other relevant issues.  

As the Authors maintain, this essay …serves as a reminder of our collective strength, adaptability, and our ever-present desire to connect, even when the world feels fractured. It is an exploration that celebrates the resilience of humankind, fostering a deeper understanding of our own desires while providing solace in the pursuit of intimacy…

…Fragmented by the disruptive forces of the COVID-19 pandemic, this exploration of human sexuality is both a reflection of our collective experiences and an unyielding search for connection in a time of isolation.

By Subhash Hira, MD, MPH

Professor of Global Health, University of Washington, Seattle, USA

and Rajiv Hira, MD, MPH

Former Assistant Professor, Intervention Radiology, LTMG Medical College Hospital, Mumbai, India

Wavering Sexuality During Covid Pandemic

 

Introduction

In an era of Covid-19 pandemic where physical connection became elusive and intimacy got transformed, this essay on human sexuality emerges as a testament to our resilience, adaptability, and the enduring quest for a deeper understanding of our own sexual desires. Fragmented by the disruptive forces of the COVID-19 pandemic, this exploration of human sexuality is both a reflection of our collective experiences and an unyielding search for connection in a time of isolation.

Human sexuality is a complex and multifaceted topic that has evolved over billions of years. While the study of human sexuality began relatively recently in comparison, say around the late 19th and early 20th centuries, it is essential to understand the broader context of sexual evolution and behavior throughout history. During prehistoric times when human beings were evolving, say approximately 4 to 6 million years ago, our ancestors exhibited sexual behaviors that were primarily aimed at reproduction and ensuring the survival of the species. While precise details are scarce due to the limited evidence, it is believed that early humans engaged in heterosexual mating patterns, similar to other primates. Later, with ancient civilizations and cultures such as Mesopotamia, ancient Egypt, and the Indus Valley’s ancient site called ‘Mohenjo-Daro’ witnessed the development of more complex social structures and belief systems. These societies often associated sexuality with religious and cultural practices. While information on sexual behavior during these eras is mostly derived from artwork, it suggests that the ancient Egyptians celebrated sexual pleasure and fertility, while the Mesopotamians and Indus Valley believed in fertility rituals and sexual equality.

During the Classical Period, the ancient Greeks and Romans were well-known for their diverse perspectives on human sexuality. In ancient Greece, sexual relationships between men were common, alongside with heterosexual relationships for procreation. This phenomenon is known as pederasty, which typically involved an older man mentoring a younger adolescent. Ancient Roman society also exhibited a more open attitude towards sexuality, with practices such as bisexuality and orgies. With the advent of Middle Ages, and the rise of Christianity in Europe, the Middle Ages witnessed a shift in sexual attitudes. The Church played a significant role in shaping sexual morality and emphasized the necessity of procreation within the confines of marriage. Extra-marital sexual activities were condemned and considered sinful. This period also saw the rise of ‘courtly love’, an idealized form of love, romance, flirting, dancing that was illicit but that influenced how people viewed relationships and sexuality. However, during the Renaissance and Enlightenment periods, a more nuanced understanding of human sexuality began to emerge. Scholars explored various aspects of sexuality, often challenging and critiquing the Christian teachings. Figures like Leonardo da Vinci and Michelangelo explored the male form in their artwork, while philosophers like John Locke and Jean-Jacques Rousseau questioned prevailing societal norms. Sexual sculptures and carvings in ancient temples and caves of India, Thailand, Indonesia were used to document sexual postures of ‘Kamasutra’ for teaching and learnings for adolescents.

The field of sexology emerged during the late 19th and early 20th centuries, marking a shift towards scientific study and understanding of human sexuality. Figures like Sigmund Freud, Havelock Ellis, and Alfred Kinsey made significant contributions, revolutionizing the understanding of sexual orientation, gender identity, and sexual behaviors. This period saw the beginning of exploring and understanding diverse sexual orientations, such as homosexuality and bisexuality. Lately contemporary times starting with the mid-20th century, more liberal attitudes towards human sexuality have continued to evolve. The sexual revolution of the 1960s and 1970s challenged traditional norms and brought discussions surrounding contraception, reproductive rights, and sexual freedom with multiple sex partners to the forefront. The ongoing fight for LGBTQ+ rights, gender equality, and sexual education has further shaped modern attitudes and understanding of human sexuality. The knowledge accumulated over years was deflected back into the sexual practice itself in order to shape it as though it came from within and amplify its effect. In this way sexual partners were counselled that knowledge must remain secret, not because an element of infamy that might be attached to it but because of the need to hold it in great reserve for future generations. According to tradition, it was taught that sexual knowledge will lose its effectiveness and its virtue by being divulged. Consequently, relationship with the master who holds the secrets was of paramount importance. The norm ‘to keep this knowledge secret’ is now broken because there is a need felt by the state to understand more about transmission of infections in order to control pandemics. In conclusion, the history of human sexuality spans billions of years, reflecting the complex interplay between biology, culture, and societal norms. It is a continuously evolving field of study that remains a crucial aspect of human existence and shows no signs of diminishing in significance.

There are a variety of reasons why young adults may engage in multiple sex partners. It is important to note that not all young adults engage in this behavior, and individual motivations also vary greatly. However, some potential reasons may include:

  1. Exploration and curiosity: Young adulthood is typically a time of self-discovery and exploration, including exploring one’s own sexuality. Engaging in multiple sexual partners can be a way for some individuals to satisfy their curiosity and learn more about their own desires and preferences.
  2. Lack of commitment: Young adulthood is often a period of transition, exploration, and personal growth. Some individuals may prioritize personal and career goals over committed relationships. Engaging in multiple sex partners may offer a sense of freedom and avoid the perceived commitment and responsibilities of a monogamous relationship.
  3. Social and peer pressures: Social norms and peer influence can play a significant role in shaping sexual behavior. Some young adults may feel pressured to conform to societal expectations or the actions of their peers, which may include having multiple sexual partners.
  4. Desire for variety and excitement: Some young adults may value novelty and variety in their sexual experiences. Engaging in multiple sex partners can offer a sense of excitement, newness, and exploration in their intimate relationships.
  5. Emotional fulfilment: Some individuals may seek emotional connection and validation through sexual encounters. Engaging in multiple sexual relationships allows for the potential to fulfil emotional needs with multiple partners.
  6. Concerns about long-term commitment: Past experiences, personal beliefs, or a fear of commitment may lead some young adults to prefer non-monogamous relationships. Engaging in multiple sex partners can provide a sense of freedom and avoid the potential pressures and expectations of a long-term commitment.

It is vital to remember that everyone’s motivations and experiences are unique, and the decision to have multiple sex partners should always be consensual and based on personal preference, mutual respect, and safe practices.

There could be several reasons why some elderly individuals opt for multiple sex partners:

  1. Increased life expectancy: With advancements in healthcare and better overall quality of life, people are living longer. For example, the average life expectancy of female-to-male in Japan is 87:82 years; in Europe is 83:78; in North America is 79:73; in India is 69:66, in Africa is 64:57 years, respectively. As a result, they may have more opportunities and desires for sexual experiences.
  2. Freedom and liberation: Some elderly individuals may feel freer to explore their sexuality later in life, as varied societal norms and expectations around sexuality have evolved. They may no longer have familial responsibilities or societal pressures, allowing them to embrace their desires and seek multiple partners.
  3. Desire for companionship and intimacy: Loneliness is a common issue among the elderly, especially those who may have lost a long-term partner or experienced significant life changes. Seeking multiple sex partners can be a way to fulfil their need for companionship, intimacy, and human connection.
  4. Increased confidence and better self-image: As people age, they may develop a stronger sense of self and increased self-assurance, which can positively impact their sexual behavior. This newfound confidence may lead them to seek out multiple sex partners.
  5. Sexual fulfilment and pleasure: Sexual desire and pleasure do not diminish with age; in fact, some studies suggest that older individuals may experience increased sexual satisfaction due to decreased performance anxiety and enhanced self-acceptance. Seeking multiple sex partners can help fulfil their sexual desires and provide a source of pleasure.

Regardless of these reasons, it’s important to remember that individual preferences and choices vary greatly, and not all elderly individuals opt for multiple sex partners. It is essential for everyone, regardless of age, to engage in consensual and safe sexual practices.

During Covid-19 pandemic, the following important areas of human sexuality were affected: sexual desires,

1: Defining Sexual Desires

In a world that suddenly closed down and turned inward, the first chapter delves into the complexities of desires, attempting to untangle its intricate web. From the profound longing for physical touch to the exploration of newfound pleasures within the confines of our homes, we examine the shifting landscape of human sexuality, navigating through the fragments of restrained intimacy to avoid Corona virus transmission.

The anatomy and physiology of sexual desire refers to the biological components and processes that contribute to the desire or interest in engaging in sexual activity that ranged between foreplay to penetrative sex.

Anatomy: The anatomical aspects of sexual desire involve various structures and organs in the human body that play a role in the experience of sexual desire. These include:

  1. Brain: The brain is a crucial organ that regulates sexual desire. Certain regions, such as the hypothalamus and limbic system, are particularly involved in processing sexual stimuli and generating sexual desire.
  2. Hormones: Hormones, such as testosterone in males and oestrogen/ progesterone in females, play a key role in sexual desire. These hormones are secreted by the reproductive organs and affect the brain regions involved in sexual motivation. Dopamine and oxytocin from the Pituitary gland in the brain, also known as happy hormones, stimulate and control sexual desire.
  3. Genitalia: Sexual desire involves activation of specific genital structures, such as the penis and clitoris, which have rich nerve endings that enhance sexual pleasure.

Physiology: The physiological processes related to sexual desire encompass various mechanisms and events that occur in the body during sexual arousal. These include:

  1. Neuro-transmitters: Neurotransmitters, such as dopamine and serotonin, are involved in regulating sexual desire. They act on the brain’s reward and pleasure frontal centers, contributing to the feeling of desire and excitement.
  2. Blood flow: Sexual desire leads to increased blood flow to the genital region, resulting in engorgement and erection of the penis in males and clitoral swelling in females. This increased blood flow is facilitated by the dilation of blood vessels, ensuring adequate oxygenation and promoting sexual response.
  3. Nerve signalling: Nerves play a critical role in transmitting signals from the genital area to the brain, and vice versa. Sensory nerve endings in the genitalia detect sensations and send signals to the brain, triggering sexual desire. Any damage or slowing of nerve conduction due to diabetes or neuropathies cause loss of sexual desire, also known in lay terms as libido.
  4. Psychological factors: While the focus is primarily on anatomy and physiology, it’s important to note that psychological factors, such as emotions, thoughts, and experiences, also influence sexual desire. Psychological arousal and context can affect the physiology of sexual desire, amplifying or inhibiting sexual motivation. Thus, understanding the anatomy and physiology of sexual desire can help shed light on the complex interplay between the body, brain, and psychological factors that contribute to human sexuality. 

2: Virtual Intimacy

The pandemic propelled us into an unprecedented digital realm, where internet-empowered screens and computers became the conduits of human connection. Here, as we dipped into the domain of virtual intimacy, exploring the intricacies of online dating, sexting, and the surge of virtual platforms that expanded the boundaries of sexual exploration. Despite the restricted continuity of physical proximity due to the pandemic, these fragments of intimacy thrived amidst the personal, economic, health, social, and environmental chaos unleashed by Covid-19.

During the pandemic, virtual intimacy served as a means to maintain and foster connections with friends, relatives, jobs, and loved ones while practicing social distancing. Here are some ways virtual intimacy was used during such times:

  1. Video calls: Platforms like Zoom, FaceTime, or Skype allowed people to have face-to-face conversations with their loved ones. This helped maintain a sense of connection and intimacy, overcoming physical barriers.
  2. Online dating: Virtual dating platforms provided opportunities for individuals to establish new relationships or maintain existing ones during the pandemic. Video chats, messaging, and other virtual tools helped facilitate getting to know someone and fostering emotional bonds.
  3. Online support groups and psychotherapy: Many individuals relied on support groups and psychotherapy to cope with difficulties during the pandemic. Virtual platforms offered an effective way to access these services, providing a sense of emotional intimacy and support through sharing experiences and seeking professional guidance.
  4. Online gaming: Playing multiplayer games online provided an avenue for social interaction and intimacy during pandemics. Collaborative gameplay allowed individuals to connect, communicate, and build relationships with fellow gamers, fostering a sense of camaraderie.
  5. Virtual events and gatherings: Organizing virtual parties, reunions, or celebrations allowed people to connect and celebrate special occasions together while maintaining social distancing. Virtual platforms offered options for group video calls, shared activities, and interactive experiences, simulating real-life social gatherings.
  6. Long-distance relationships: Virtual intimacy became crucial for couples in long-distance relationships during the pandemic. Regular communication through video calls, messages, and virtual date nights helped maintain emotional and hormonal closeness and preserved the romantic connection despite physical separation.
  7. Sharing personal moments online: Social media platforms was used to share personal stories, photos, or videos, allowing individuals to feel connected and involved in each other’s lives. This helps overcome the absence of physical interactions and fostered a sense of intimacy with a wider network. Virtual intimacy during pandemic, while it did not fully replace physical intimacy, served as an essential tool to mitigate the effects of isolation, loneliness, and uncertainty. It acted as a bridge, providing moments of emotional connection, support, and social interactions, helping individuals navigate challenging times while staying safe from infections.

3: The Dynamics of Isolation

Human sexuality is intricately intertwined with our social fabric, and the isolation imposed by COVID-19 interrupted these delicate threads of our social life. Chapter three examines the profound impact of social distancing, exploring the human longing for touch, hug, kiss, fondling etc and the challenges of maintaining relationships at a distance. Instead, the novel virtual ways in which individuals adapted to sustain emotional and sexual connections.

The dynamics of isolation during COVID-19 restrictions were complex and varied among individuals and communities. It’s important to note that the dynamics of isolation varied across regions depending on the severity and duration of COVID-19 restrictions, as well as the effectiveness of government measures and community adherence to guidelines. Here are some key points:

  1. Social distancing, masking, and hand hygiene: Governments worldwide implemented social distancing guidelines of minimum distance of 6 feet. A variety of face masks, including those made of cotton cloth having a layer of satin and frequent use of hand sanitisers were recommended but these received limited compliance. These led to reduced physical interactions, limiting social gatherings, and increasing isolation.
  2. Quarantine by local health authorities versus self-isolation: Individuals who tested positive for COVID-19 or had been exposed to someone with the virus were required to self-isolate or quarantine for periods ranging between 7-14 days. This involved staying at home and avoiding contact with others, leading to extended periods of solitude and separation.
  3. Workplace and school closures: Many workplaces and educational institutions were temporarily closed or shifted to remote work and online learning. This disruption to daily routines contributed to isolation, as people were physically separated from their co-workers, classmates, and friends.
  4. Restricted travel and border closures: International and domestic travel restrictions were implemented to prevent the spread of the virus. This led to isolation not only within countries but also globally, as people were unable to visit or be visited by their loved ones living in other regions or countries.
  5. Mental health impact: The extended periods of isolation resulted in increased feelings of loneliness, depression, irritability, and anxiety for many individuals. Lack of social support and limited access to mental health services further exacerbated mental health challenges.
  6. Technology and virtual connections: The use of technology played a crucial role in mitigating the effects of isolation. Virtual platforms and social media allowed people to stay connected with friends and family, work remotely, and attend online to social and cultural events.
  7. Economic impact: COVID-19 restrictions and subsequent job losses or reduced working hours impacted many individuals economically. Financial stress and uncertainty contributed to increased social isolation as people faced challenges in maintaining social connections and participating in activities.

4: Redefining sexual relationships based on sexual pandemics

The pandemic forced us to re-evaluate the very foundation of our relationships and necessitated a redefinition of love, commitment, and companionship. Fragmented by the mental, emotional, and physical constraints of COVID-19, chapter four delves into the various forms of relationships that emerged – from the vitality of long-distance love to navigating the complexities of polyamory (desire for romantic relationships with more than one partner at the same time, mostly considered as illicit) during times marked by physical separation.

  1. Lack of sexual education: One of the crucial lessons learned from the HIV/AIDS and STI pandemics is the importance of comprehensive sexual education. Many individuals did not have access to adequate information about safe sex practices, leading to the rapid spread of these diseases. Proper education programs can help individuals make informed decisions about their desires, frequency, and sexual health, reducing the risk of disease transmission.
  2. Stigma and discrimination: The pandemics highlighted the harmful impact of stigma and discrimination on individuals living with HIV/AIDS and other STIs. This not only created barriers for people to seek testing and treatment but also contributed to the spread of these diseases by driving people underground and making it harder to access preventative measures.
  3. Importance of prevention methods: The HIV/AIDS and STI pandemics highlighted the urgent need for effective prevention methods, such as condoms, pre-exposure prophylaxis, and vaccinations (where available). These prevention measures, when widely accessible and utilized, can significantly reduce the transmission rates of these diseases.
  4. Global collaboration and awareness: The pandemics emphasized the importance of international collaboration and awareness campaigns. Joint efforts by governments, non-profit organizations, and healthcare providers have been crucial in raising awareness about safe sex practices, reducing stigma, and ensuring access to testing and treatment for all individuals.
  5. Holistic approach to healthcare: The HIV/AIDS and STI pandemics highlighted the significance of a holistic approach to healthcare, including integrating sexual healthcare into primary healthcare systems. By recognizing sexual health as an integral part of overall well-being, individuals are more likely to seek timely testing, treatment, and follow-up care.
  6. Access to healthcare services: Another important lesson learned during Covid pandemic was the need for accessible and affordable healthcare services. Lack of access to healthcare, especially for marginalized populations, has contributed to the spread of HIV/AIDS and STIs. Addressing structural barriers to healthcare access is essential in preventing and controlling future pandemics.
  7. Research and development: The pandemics have underscored the importance of ongoing research and development efforts to improve diagnostic tools, treatment options, coping skills, and potential vaccines. Continued investment in science and research is crucial in developing effective strategies to combat future pandemics related to sexual transmission.
  8. Communication and information dissemination: The pandemics taught us the importance of effective communication and information dissemination. Clear and accurate messaging, targeted outreach efforts, and community engagement are essential in spreading awareness about sexual health, prevention measures, and available resources. Overall, the lessons learned from the HIV/AIDS and STI pandemics of the 20th century highlight the need for comprehensive sexual education, prevention methods, global collaboration, accessible healthcare services, and ongoing research to control and prevent the spread of sexually transmitted infections.

5: Sexual Health Services during the pandemic

As the world grappled with a devastating Corona virus, attention to sexual health and safety became pivotal, but paradoxically, more complex. This chapter unravels the fragmented landscape of sexual health services during the pandemic, examining the impact on reproductive rights, the rise of telemedicine, and the unique challenges faced by marginalized communities. The case study presented here highlights many issues of personal relationship that became challenging to individuals in Mumbai in 2021.

A young married couple was trying to cope with their social and sexual needs during the Covid pandemic. Husband was working as a plumber in northern suburb of Mumbai and lived in a rented shack. His wife worked as a secretary in a small garment company in a nearby suburb. In April 2020, the national unemployment rate had reached a record high of 23.52% during the national Covid lockdown and both were rendered without jobs. But the second wave delivered another hit to the job market in April and May 2021. Almost for a year, they spent increasing time together! The usual complaint of many families to counsellors was that had to adjust to spending more time together at home due to lockdowns and social distancing measures. While this has provided opportunities for quality family time, it has also posed challenges in terms of maintaining work-life balance and dealing with potential conflicts arising from increased togetherness. Their sexual frequency had reduced from once or twice a week to once a fortnight. Their relationships with identical families in neighbouring shacks became more intimate and they got introduced to consensual partner swapping. In a way, what each partner was otherwise doing individually in terms of multi-partner sex outside the home before the Covid pandemic changed its character to consensual partner exchange; more of a barter system than exchange of scarce cash outside the home. Their episodes of respiratory infections and genital illnesses appeared almost twice a month and counselling on phone as to how to avoid face-to-face sex and use of condoms with casual partners did not get their acceptance. (Posture figure of CDC was shared with the couple on social media) Their bartering of partners in the neighbourhood continued unabated till early 2022 when the couple gradually went back to their workplaces but continued their old and new patterns of sexuality. Again, they ignored compliance with Covid posture and mask, and HIV/AIDS/STI prevention with condom use (sexual tree). They continued to ignore testing and insisted on taking antibiotics whenever infections set in.

6: Healing and reconnection with receding pandemic

Amidst the chaos and fragmentation of psychosexual fabric of communities, humans possess an innate ability to heal and reconnect. The final chapter explores the transformative power of resilience and offers guidance on navigating the fragments of intimacy left behind by the pandemic. From self-exploration to erotic imaginations, we delve into the diverse ways individuals work towards reclaiming and rebuilding their sexual selves.

Despite the uncertainty and unpredictability of COVID-19, our innate human sexuality persistently shines amidst the fragments. This essay serves as a reminder of our collective strength, adaptability, and our ever-present desire to connect, even when the world feels fractured. It is an exploration that celebrates the resilience of humankind, fostering a deeper understanding of our own desires while providing solace in the pursuit of intimacy. Finally, for solace and healing we involved sexual counselling that helped to embrace fragments.

Sexual counselling for responsible sex can encompass a range of topics and approaches, depending on the specific needs and concerns of individuals or couples seeking guidance. Here are some key areas that sexual counselling for responsible sex should focus on:

  1. Education and information: Sexual counsellors provide accurate and reliable information about sexual health, contraception, sexually transmitted infections (STIs), respiratory infection, and safe sex practices. This helped individuals make informed choices and reduced the risk of infections.
  2. Consent and communication: Counselling helped individuals and couples develop effective communication skills and understand the importance of consent in sexual relationships. This included learning how to discuss desires, boundaries, and expectations openly and respectfully with partners.
  3. Safer sex practices: Sexual counselling helped individuals or couples explore various methods of planned parenthood, pregnancy control, and understand sexual practices. Counsellors also addressed the importance of regular STI testing and how to reduce the risk of transmission.
  4. Sexual pleasure and satisfaction: Responsible sex involves mutual pleasure and satisfaction for all individuals involved. Counsellors supported clients in exploring and understanding their own sexual desires, needs, and preferences, as well as those of their partners. They provided guidance on enhancing intimacy, exploring different sexual activities and postures, managing love performance anxiety, and addressing concerns related to sexual dysfunctions.
  5. Relationship dynamics: Sexual counselling also addressed broader relationship dynamics that impact responsible sex practices, such as trust, emotional intimacy, conflict resolution, and overall relationship satisfaction. This involved exploring how relationship issues affect sexual experiences and vice versa.
  6. Consent in the digital age: With the growing role of technology in intimate relationships, sexual counselling covered topics related to responsible online sexual activity. This included discussing consent in sexting, sharing explicit media clips such as Kamasutra etc, or engaging in virtual sexual encounters. Overall, sexual counselling for responsible sex aims to support individuals and couples in developing a healthy sexual life while prioritizing communication, consent, safety, and mutual satisfaction. Counsellors provided a non-judgmental and confidential space for clients to explore their concerns, ask questions, and receive appropriate guidance.
The Kama Sutra, an ancient Indian text, does contain information about sexual positions and techniques. While the text does mention group sexual encounters, it primarily focuses on positions for two partners. It is essential to approach such activities with respect, consent, and the well-being of everyone involved. If you are considering exploring sexual activities involving penetrative sex, it is recommended to have open and honest conversations with all parties involved, as well as to educate yourself about safe sex practices, emotional well-being, and always be consensual and safe for all involved parties. 

 

References / Recommended reading

These are just a few examples of the multitude of articles and books published on sexuality in the past 50 years. The field of sexuality research and discourse has expanded greatly during this time, providing diverse perspectives and knowledge on this important aspect of human life. Here are some significant and influential ones:

  1. “Sexual behavior in the Human Female” by Alfred C. Kinsey et al. (1953): This study was one of the first comprehensive works on human sexual behavior, challenging cultural norms and providing empirical evidence on various aspects of sexuality.
  2. “The Hite Report: A Nationwide Study of Female Sexuality” by Shere Hite (1976): This groundbreaking publication challenged prevailing notions of female sexuality and highlighted women’s experiences and desires.
  3. “Human Sexual Response” by William H. Masters and Virginia E. Johnson (1966): This pioneering work examined the physiological and psychological aspects of sexual response, providing a scientific approach to the understanding of human sexual function.
  4. “The Joy of Sex” by Alex Comfort (1972): This popular and widely read book discussed various aspects of human sexuality, including sexual technique, contraceptive methods, and sexual satisfaction.
  5. “The History of Sexuality” by Michel Foucault (1976-1984): This influential series of books explored the social and cultural construction of sexuality, challenging conventional ideas about sexuality as a natural and essential aspect of human identity.
  6. “Sexual Fluidity: Understanding Women’s Love and Desire” by Lisa Diamond (2008): This research-based book challenged the notion that sexual orientation is fixed and explored the concept of sexual fluidity, particularly in women.
  7. “Sex at Dawn: How We Mate, Why We Stray, and What It Means for Modern Relationships” by Christopher Ryan and Cacilda Jetha (2010): This book presented an alternative perspective on human sexuality and questioned conventional narratives about monogamy and sexual behavior.
  8. “Come as You Are: The Surprising New Science that Will Transform Your Sex Life” by Emily Nagoski (2015): This book provided an in-depth exploration of female sexuality and how understanding the science behind it can lead to improved sexual well-being.
  9. “The Ethical Slut: A Guide to Infinite Sexual Possibilities” by Dossie Easton and Janet Hardy (1997): This book challenged societal norms around monogamy and explored the concept of ethical non-monogamy, promoting consensual and responsible open relationships.
  10. “Savage Love” by Dan Savage (1991-present): This advice column-turned-book addressed various aspects of sexuality and relationships, exploring topics such as sexual orientation, kink, and communication.

 

News Flash 560: Weekly Snapshot of Public Health Challenges

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

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News Flash 560

Weekly Snapshot of Public Health Challenges

 

Statement by Principals of the Inter-Agency Standing Committee (IASC): Civilians in Gaza in extreme peril while the world watches on

Webinar registration: High-level dialogue between the WHO Director-General and the UN High Commissioner for Human Rights: ‘Realizing the Right to Health in a world in turmoil’ Mar 6, 2024 

Ethiopia: How Persistent Unemployment and Low Motivation Affect Health Workers and the Healthcare System  by Melaku Kebede 

Advancing primary health care in Africa through capacity building, advocacy, and partnership: the International Institute for Primary Health Care in Ethiopia 

AidWatch 2022 | 1 euro in every 6 not going towards those left furthest behind

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Many efforts yet few achievements: Where should healthcare quality improvement policies focus in LMICs?

Children’s lives threatened by rising malnutrition in the Gaza Strip

In eastern Chad, people fleeing Sudan continue to face unmet needs amid limited response

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UN agriculture fund bets big on innovation to improve food security

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Ethiopia: How Persistent Unemployment and Low Motivation Affect Health Workers and the Healthcare System

IN A NUTSHELL
Editor's Note

A first hand outburst&complaint snapshot here about the perceived motivational and salary gaps inside the public healthcare system in Ethiopia, whereby feelings of irony and paradox arise in the Author from still critical shortages of health workers in key areas coupling with many doctors being unable to find public employment

By Dr. Melaku Kebede

Public Health Advocate

Head of Pediatrics Department at Olenchiti Hospital

Ethiopia

Ethiopia: How Persistent Unemployment and Low Motivation Affect Health Workers and the Healthcare System

 

Ethiopia has made some strides in improving its healthcare system, but it still faces many challenges, particularly in rural areas where access to quality care is limited by scarce resources. Health workers, who are essential for delivering health services, suffer from low morale due to poor working conditions and inadequate compensation.

I, a medical doctor, can paint a bleak picture of the situation. Healthcare professionals battle diseases and a dysfunctional system, lacking essential supplies and basic amenities. According to a survey conducted by the World Health Organization (WHO), only 1% of the health facilities assessed in Ethiopia had all the basic amenities, such as water, electricity, sanitation, and waste management. I want to emphasize the effect of these constraints on health workers’ motivation, saying that they drive many of them to look for alternative careers that do not involve direct patient care or to join the private sector, which offers better pay and working environment.

The Ministry of Health recognizes the difficulties faced by the health sector, including low availability of medicines and high turnover of staff. It has made commitments to improve the situation, but many doctors remain dissatisfied with their financial situation, as expressed by the fact that it’s impossible to fulfill basic needs with current salaries.

The irony is that while many doctors are unable to find employment, there are still critical shortages of health workers in key areas, such as maternal and child health, infectious diseases, and emergency care.

This unemployment paradox reflects the need for increased investment in the healthcare sector and the need for health professionals to explore alternative career paths amidst limited opportunities in the private sector.

 

News Flash 559: Weekly Snapshot of Public Health Challenges

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

Common octopus (Octopus vulgaris)

News Flash 559

Weekly Snapshot of Public Health Challenges

 

Global Health Centre Side Events during the 77th World Health Assembly, 2024 CALL FOR PROPOSALS Deadline 6 March 2024, 23:45 CET

Meeting registration: Resilient and scalable MCM ecosystem: CSOs engagement forum for advancing timely and equitable access to medical countermeasures against pandemic threats 22 February 2024 14:00 – 17:00

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What Is It Like to Live in Ecuador, One of the Most Violent Countries?

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Lessons From Ecuador: A One Health Perspective

IN A NUTSHELL
Editor's note
By One Health critical lens of examination, this extremely documented masterful article turns the spotlight on the challenges and threats to health currently being perceived in the Ecuadorian areas of Amazon rainforest and Galapagos islands. At a time when consensus has gained traction that humans, animals, plants, and the whole ecosystems are intimately enmeshed and mutually dependent as for individual and global health, this article strongly recommends that a One Health vision shaping the human policies, strategies and practices should be embraced by all policy leaders and decision makers. As a matter of fact, closer collaboration under One Health umbrella would definitely add strength towards global health security and ecosystems integrity achievements

By Laura H. Kahn, MD, MPH, MPP

Co-Founder, One Health Initiative

Lessons From Ecuador

A One Health Perspective

 

 

A One Health Overview 

One Health is the concept that human, animal, plant, environmental, and ecosystem health are linked. It’s a relatively new term but an ancient concept understood by indigenous peoples around the world. In her book Braiding Sweetgrass, Robin Wall Kimmerer, a Professor of Environmental Biology at the State University of New York (SUNY), Syracuse and a Citizen Potawatomi Nation tribal member describes how indigenous peoples consider plants and other animals as ‘kin’ and not as objects to own or exploit. Indigenous peoples value the teachings of their kin—the plants and animals—for their health and well-being.

Western cultures do not emphasize how nature sustains us. But we literally incorporate nature into our bodies every day. From the air we breathe, to the plants and animals we eat, to the water we drink, our health and well-being depend on a healthy planet. The One Health concept acknowledges that we are a part of nature, not superior or separate from it. Unfortunately, our hubris and a sense of invulnerability to nature’s limits jeopardizes our future and the future of all species.

There are many ways to visualize the One Health concept. The Tripartite (World Health Organization, Food and Agriculture Organization, World Organization for Animal Health) and UN Environment Programme depict One Health in a complex way using multiple intersecting circles involving humans, animals, environments, and societies. The US Centers for Disease Control and Prevention (CDC) promotes One Health as intersecting circles involving Coordinating, Communicating, and Collaborating between human, animal, and environmental health professionals.

One Health can also be visualized as a Rubik’s cube representing three intersecting dimensions that form a matrix: a One Health dimension, a Complexity dimension, and a Political, Social, and Economic dimension.

The One Health dimension represents the linkages between humans, animals, plants, environments, and ecosystems. Environments are defined as the abiotic (e.g., soil, water, air) aspects of a defined geographic area. Ecosystems are defined as the biotic (e.g., microbes, flora, fauna) aspects of a defined geographic area. The Complexity dimension provides scale at the microbial/cellular, individual, and population levels. The Political, Social, and Economic dimension can be represented as political borders at local/regional, national, or international levels. This third dimension represents the important social determinants of health and the need to consider health in all policies. Time (e.g., days, months, years) can be a fourth dimension but will not be visualized or discussed in this paper.  The intersecting dimensions can be used in whole or in part to provide a systematic, comprehensive, and concise framework to analyze a wide variety of complex, multidisciplinary health-related challenges including those affecting the equitable access to health.

For example, intact forests provide extremely important environmental and ecosystem services such as carbon storage, erosion prevention, climate and water regulation, timber, and non-timber products, as well as food, shelter, and income for indigenous peoples. Forests depend on their environment to supply fresh water for their survival. Andean tropical glaciers deliver essential melt waters to the rainforest and to the indigenous peoples and animals living in the region. Unfortunately, these Andean glaciers are rapidly melting because of climate change, threatening the future of the delicate ecosystems.

In this brief article, the One Health matrix will be used to examine the geographically diverse nation of Ecuador which includes the biodiverse Amazon rainforest and the biosparse Galapagos Islands. With a total area of slightly more than 283 thousand square kilometers, Ecuador is a relatively small nation located on the equator on the west coast of South America. It has a total population of approximately 18 million people. In this paper, the Complexity dimension will focus on the population level.

One Health dimensions of the Amazon Rainforest

While Ecuador possesses only 2 percent of the total Amazon basin, its biodiversity is immense, possessing around 10 percent of Earth’s plants and 8 percent of its animals. Ten out of 14 indigenous tribes in Ecuador live in the tropical rainforest and depend on its natural resources to live. Not surprisingly, the indigenous peoples are important stewards of the land and fight for the forest’s and their own survival. For decades, one of their greatest challenges has been the aggressive presence of large-scale oil drilling that has been causing deforestation and environmental degradation in their territories that threatens their lives. This deforestation taking place in Ecuador is different than in Brazil which has been largely due to intensive agricultural purposes. From 1985 to 2022,  Ecuador lost almost 3 million acres of natural land cover, much of it in the Amazon rainforest. Oil extraction has led to multiple spills, emissions, and heavy metal contamination of the region adversely impacting human, animal, and plant health.

Despite their efforts to improve their rights and to protect their ancestral lands by establishing the Confederation of Indigenous Nationalities of Ecuador (CONAIE), the indigenous peoples of Ecuador continue to experience ongoing injustices including serious health threats. Oil drilling is known to contaminate environments and create health risks especially for children. While few quality health studies have been done in the Ecuadorian rainforest, there is evidence to suggest that living near oil production facilities jeopardizes the health of indigenous peoples including increased cancer rates of the colorectum, skin, and kidneys in adults and leukemia in children. One analysis published almost 15 years ago found that indigenous populations had a 30 percent higher mortality rate and a 63 percent higher all-cause morbidity rate compared to non-indigenous colonists living and working in nearby areas. The indigenous peoples particularly suffered from chronic as well as gastrointestinal and vector borne diseases. Many seek traditional medicine from shamans rather than care from Western clinics and hospitals. The Jambi Huasi clinic is attempting to integrate both traditional and Western medicine to meet the cultural demands and health needs of the indigenous peoples.

Data on wildlife health in the Ecuadorian Amazon rainforest is limited. The Wildlife Conservation Society (WCS) has been conducting conservation-based research on wildlife in South America including the LlanganatesYasuni landscape in Ecuador. A search of the WCS publications database on “Ecuador” yielded 40 unique records, ranging in dates from 2005 to 2020. The publications included census studies of Andean condors, bears, primates, mammals, and birds as well as identifying conservation threats to wildlife such as trafficking and other human activities.

While it’s illegal to possess, buy, or sell wildlife in Ecuador, illegal activity does occur. Private individuals and groups have established centers to protect injured or captured wildlife. For example, in 1993, a small group of individuals established a non-governmental organization (NGO) called amaZOOnico that has received, rehabilitated, and reintroduced thousands of wild animals confiscated from illegal activities. In its 31-year history, it has become one of the largest animal rescue establishments in Ecuador, relying on volunteers and donations for its efforts. Another animal welfare and rehabilitation center established by a private family has been caring for wildlife injured by habitat destruction and illegal trapping for 18 years.

Several non-government organizations exist to protect the Amazon rainforest, although not necessarily only in Ecuador. For example, the Rainforest Alliance fights deforestation and climate change and works to improve the human rights of the indigenous peoples. The Amazon Conservation Team works to protect the rainforest and the indigenous peoples living there, and Amazon Conservation is another one. Like the indigenous peoples of the Amazon, their efforts are in conflict with financial interests.

In August 2023, eight Amazonian nations met and agreed to create an alliance to protect the Amazon rainforest.  Unfortunately, they could not agree on a common goal to end deforestation. Instead, they decided to let each nation develop its own deforestation and conservation goals. They agreed that indigenous people’s rights should be considered as well.

One Health dimensions of the Galapagos Islands

In contrast to the Amazon rainforest, the Galapagos Islands are an isolated volcanic archipelago located about 1000 kilometers off the Ecuadorian coast. Discovered in 1535, the islands remained largely uninhabited because of the paucity of fresh water and the dry, inhospitable environment. In the 1920s, Europeans and North Americans began settling there. Today, four (i.e., Santa Cruz, San Cristobal, Isabela, and Floreana) of the 19 largest islands are inhabited by approximately 25-30,000 year-round residents. The population has been growing at a rate of about 6.4 percent per year, but these inhabited areas constitute only about 3 percent of the total area of the islands. In 1959, ninety-seven percent of the islands were designated as a national park which is visited by 170,000-220,000 tourists each year.

The Galapagos Islands were made famous by Charles Darwin’s 1835 visit on board the HMS Beagle which inspired him to develop his theory of “natural selection.” Because the islands are so remote, most species arrived either by flying, being blown by wind, swimming, or floating on a raft. As a result, the wildlife populations on the islands are unique. There are very few native mammals, no native amphibians, a variety of terrestrial and marine birds, and many reptiles. Plant seeds arrived by the wind, or if saltwater tolerant, by sea. The sparce biodiversity created open ecosystem niches that facilitated species to evolve to fill them.

Humans introduced invasive species such as rats to the islands. For example, in the 17th or 18th centuries, the black rat (Rattus rattus) was introduced by whalers and/or pirates. In the 1980s, the brown rat (Rattus norvegicus) was introduced to several islands. Rodents disrupted the delicate ecosystems, and rodent eradication programs have been ongoing.

The people who live in the Galapagos Islands reportedly depend upon imported food for their sustenance and have some of the highest rates of obesity, diabetes, and other chronic diseases in Ecuador. One study published in 2020 found that poor water quality and unhealthy diets consisting of primarily highly processed food contributed to the high disease burden even though the standard of living on the islands compared to the mainland was relatively high. Contaminated tap water led to a reliance on bottled water and sweetened beverages. The authors concluded that rapid population growth, expanding urbanization, food and water insecurity, and tourism contributed to the disease burden.

In June 2022, the Galapagos Science Center (GSC) hosted the World Summit on Island Sustainability on San Cristobal Island. While “One Health” wasn’t the title of the summit, the agenda covered the islands’ ecosystems, environments, animals, and humans. However, Dr. Enrique Teran, a professor at the University San Francisco de Quito, presented his research titled, “One Health Approach to Understanding Human Health on Galapagos Island.” In 2014, he conducted a hospital survey on San Cristobal Island and found that 30 percent of the population was diagnosed with gastrointestinal infections, and many also suffered with urinary tract infections. Poor water quality contaminated with coliforms was a major contributing factor to the infections. Another contributing factor was low socioeconomic status and the ownership of companion animals sick with parasitic infections. In 2019, he found that almost 31 percent of the residents owning companion animals reported that the animals received regular veterinary care, but around 13 percent of the animals had been recently ill. Risk of parasitic illness was higher for humans of lower socioeconomic status (SES) with sick companion animals compared to those with higher SES.

Wildlife and ecosystem health in the Galapagos Islands receive extensive attention and study given the global interest in the islands. For example, since 2016, the GSC has been hosting annual international summits for scientists to share their research on island conservation efforts, the restoration of Galapagos Island marine and terrestrial ecosystems, and the socio-economic issues and health of the island’s human population. The World Wildlife Service (WWS) established a Galapagos Animal Doctors project to treat both wild and domestic animals living on the islands. The Galapagos Conservancy is a U.S. based non-profit organization dedicated to protecting and restoring the Galapagos Islands.

One Health Lessons 

From a One Health perspective, human health relies on sanitation and hygiene as well as on healthy animals, plants, environments, and ecosystems. But the indigenous peoples of Ecuador live without sanitation or clean water, and many get sick and die from waterborne diseases. In the Galapagos Islands, only the affluent can afford bottled water.

In Ecuador, the lessons from the Industrial Revolution on the importance of sanitation, clean water, and health are slowly being learned. While the situation has improved over the past decade, the availability of quality drinking water and coverage of sanitation services remains insufficient for the public’s needs particularly in rural areas. In general, wastewater treatment is virtually nonexistent in South America. Most wastewater is dumped into rivers and oceans leading to environmental and ecosystem contamination as well as contributing to water-borne diseases.  The indigenous peoples of Ecuador had the highest burden of getting sick and dying from waterborne diseases compared to other ethnic groups in the country.

Unlike the Galapagos Islands which are stringently protected, the Amazon rainforest in Ecuador is not despite having parts of it designated as a UNESCO Biosphere Reserve. The challenge is to convince the political leaders that having an intact rainforest and healthy indigenous peoples is economically beneficial for the country.

Efforts such as the Natural Capital Project seek to quantify the economic value of intact ecosystems. For example, Ecuador is one of the countries working with the Natural Capital Project and the Inter-American Development Bank to design and inform finance and policy decisions. However, surpassing the income generated from oil reserves that would allow the rainforest to remain intact would be a challenge. From a One Health perspective, the world’s leaders should make the health of the rainforest and its indigenous caretakers a priority for the future of humanity and for all other species on the planet. 

Addendum 

A Brief Historical Aside: Political leaders must be convinced that improving health is beneficial for their nation’s economy. There is historical precedence for this observation. The French Revolution in the late 18th century created fertile ground for French pioneers such as Drs. Louis-Rene Villerme, a pioneer in social epidemiology, and Alexandre Parent-Duchatelet, a leader in the French hygienic movement to improve health. But it wasn’t until Jeremy Bentham, a British social reformer, lawyer, and poor relief advocate, who helped pass a set of “Poor Laws” through Parliament, that actual efforts began to help the working class and poor. Edwin Chadwick, an investigative journalist and lawyer, was hired by Bentham to enquire into the effectiveness of the poor laws.

Bottom line: The poor laws did nothing

Chadwick’s investigation led to the publication of The Report from the Poor Law Commissioners on an Inquiry into the Sanitary Conditions of the Laboring Population of Great Britain. This famous report detailed the wretched environmental and social conditions of Britain’s working class and poor during the beginning of the Industrial Revolution. People lived in slums without sanitation, clean water, pure air, or healthy food. Diseases were rampant. The report planted the seeds for a nascent public health movement. However, only after a deadly cholera epidemic in 1848 did advocacy efforts intensify leading to Parliament to approve a Public Health Act that established a General Board of Health, but it had limited powers and no money. Over the next 50 years, the law was amended to give more power to local boards of health. Ultimately, the political leaders had to be convinced that having healthy workers living in healthy environments benefited the economy.  Efforts to improve the equitable access to health for poor, working class, and indigenous peoples, must take this political reality into consideration.

 

 

 

News Flash 558: Weekly Snapshot of Public Health Challenges

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

Bluespotted cornetfish (Fistularia commersonii)

News Flash 558

Weekly Snapshot of Public Health Challenges

 

Global health inequities: more challenges, some solutions

The Responsibility of My Country in an Unjust Global System: Do No Harm

Stop taking the Global South for granted

WHO and Health & Environment: Need to Rethink Role of Civil Society  by Raymond Saner

Health policy implications of corporate social responsibility provisions in international investment agreements

EXCLUSIVE: Reject Drug Procurement Secrecy, Civil Society Urges ‘Big Five’ Buyers

Forum Discusses High Drug Prices in Wealthy Countries and Access to Medicines in Conflicts

Much Ado About Nothing: Why ‘March-In’ Rights Won’t Lower Drug Prices

Measuring The Health Of Primary Care: Lessons From US And Global Scorecards

Meeting registration: „„EB TODAY – EB154 Review (continued) on 13 February 2024“ verwalten  

Developing an agenda for the decolonization of global health

About 13 children die each day at a camp in Sudan for displaced people, medical charity MSF says

Addressing health inequalities in gender diverse people

Putting survivors at the forefront of the global movement to end female genital mutilation

Female Genital Mutilation and Cutting in Asia Remain a Neglected Problem

Envisioning an End to FGM/C

Colombia takes significant next step to expand people’s access to affordable HIV treatment, and moves forward with compulsory license for HIV medicine dolutegravir

Polio Eradication Strategies and Challenges: Navigating Hidden Risks  by Muhammad Noman

Pakistan Pushes Towards Polio Eradication – Can Elections Help Pave the Way? 

Taking the neglect out of neglected tropical diseases

Neglected Tropical Diseases Persist in the World’s Poorest Places

South American cities release mosquitoes to stem disease

Southern African Govts Tackle Cholera at Extraordinary Summit

WHO and MPP announce technology transfer license to enable greater patient access to multiple essential diagnostics

Tobacco COP10 to Address New Products and Industry Interference

Shrimp farms threaten livelihoods of small-scale fishers

Call for Papers MITIGATING AND ADAPTING TO CLIMATE CHANGE: EVIDENCE FOR PUBLIC HEALTH Deadline: April 30th 2024

Climate risks in urban areas

Burning e-waste contaminating breast milk in Ghana

‘A deeply troubling discovery’: Earth may have already passed the crucial 1.5°C warming limit

Recommendations for 2040 targets to reach climate neutrality by 2050

EU Commission chief to withdraw the contested pesticide regulation