BY: MARIA THERESA MAAN - BEŠIĆ
SARAJEVO, BOSNIA AND HERZEGOVINA
8 SEPTEMBER,2008
Even in the developed and richest countries, there are differences and differentials in health for women and men that are not taken into account. Although „women live longer than men, they suffer a greater burden of morbidity. Women are over-represented among the poor, while their income is on average only 70% of that of men.“ Although women throughout the world are healtier than ever and thier life expectancy rates are raising. „Over half a million women around the world die from pregnancy – related causes every year, while another 15 million suffer serious long-term complications. Women now account for nearly half of all new causes if HIV infections.“
Women utilize the public health care system more than men. Women are more likely to experience depression and stress linked to their experience of inequality and discrimination, to experience chronic conditions such as arthritis and osteoporosis, and to suffer ill health and death as the result of abuse.
In BiH war impose a whole range of stressors, it is reasonable to presume that the population’s need for mental health care increased. The war has almost completely destroyed the health system, the evidence of which is in the data of the Institute of Public Health of the Federation of BIH. According to the report based on Smajkić A. in year 1997 the „population’s health is such two times more people are affected by epidemics than before the war, and tuberculosis rate has increased. Also, the number of chronic mental health patients is three times lesser, which suggests that many patients from this category have not survived the war.“
However, the evidence women’s health priorities across Europe and even in Bih may differ between countries. Special attention should be paid to the special health problems of more than four million women belonging to migrant groups, refugees and ethnic minorities. Yet, progress has not always been even, and some part of the world have suffered resent reversal. There are many places in the world were women's „average life expectancy is less than 50 years and where the great majority of women can either read nor write. And in the country , women consitue the majority of the poor, accounting for more 70% of the world's 1.3 billion people living in poverty.“ These result shows that, women have the advantage of a disease resistant biology, but the disadvantage of lower social status and less access to wealth. Hence, men and women have, to a certain degree, different patterns of ill health. This is due to their different biology, to the reproductive function of women, and to the fact that their lifestyles and risk factors differ because their gender roles are different.
Inspite of the situations in all part of the world, these essay will provide to understand the context of „Health in the 21st century“ , which will serves as a sample framework for BiH to construct systematic policies and strategies for improving the health of their populations.
CONCLUSION
Target-setting has been a traditional approach in the European Region’s Health for All policy formulation. Recently, however, there has been a consensus that establishing common targets for all countries in the Region can often be artificial, unfair or simply uninspiring. It does not take into account significant differences in Member States’ public health and economic development. Nonetheless, setting targets can be an important exercise at national and sometimes sub-national levels. National targets can be an excellent implementation and guidance tool, as well as a means for a country to articulate its degree of ambition. And when all stakeholders are involved, the formulation of national health targets can help ensure their joint ownership of health policy. The recommendations included in this update are not exhaustive, nor do they cover every field of public health. Instead, the focus is on fields and methods that are either new or have evolved significantly since 2000.
Even though Health21 was adopted a short time ago, the intervening period has seen many significant changes in the health systems of Member States. Some of the experience and knowledge they have acquired is presented here. In other words, rather than attempting to produce an authoritative document that finalizes the Region’s Health for All policy, this update aims to encourage an open-ended Health for All process. The Health for All policy frameworks can then be continuously enriched by the broad range of Health for All activities that individual countries themselves choose to carry out. Some countries may decide to develop and analyze national case studies.
Other Member States may regard this update as an invitation to re-examine and revisit their health policies. Still others might devote special attention to the communications challenge – how best to communicate the Health for All values, the concept of health and human rights, and the model of ethical governance to different audiences and stakeholders. There may also be countries that elect to develop concrete benchmarks against which to measure the implementation of Health for All policies. Meanwhile, a given country might focus on the local level because it sees decentralization and the meeting of local health needs as essential in successfully implementing Health for All. Finally, a group of countries could invest effort in developing national and sub-national health targets and linking them to the United Nations Millennium Development Goals (MDGs).
Member States have been urged to consider the Health for All concept when formulating policies and action plans. It was believed that, by interpreting Health for All in a national social, political and developmental context, each country would be able to contribute to the global aim of health for all by the year 2000. The call for health for all was, and fundamentally remains, a call for social justice, equity and solidarity, and a societal response that strives for unity in diversity. Rather than enshrining a single finite goal, Health for All is instead a process of bringing countries to progressive improvement in the health of all their citizens.
The Health on the 21st century in the form of a policy guide, enable the targets to be considered from the perspective of women. It emphasized that the health care delivery system plays a vital role in assuring the health of the public. Academic institutions train health and public health workers and conduct essential health related research. Communities function as both sites where health is supported or undermined and, through their various organizations and constituent entities, as potential partners within a public health system. Business and employers play important roles in shaping population health, not only in the occupational setting, but also through environmental impacts, as members of communities, and as purveyors of products available for mass consumption. The media has tremendous importance as people increasingly purchase, socialize, and gather information through electronic media and the Internet. News and entertainment media also play a major role as shapers and reflectors of popular culture, interests, and priorities.
The role of the state - government public health agencies should develop strategies to ensure that public health workers who are involved in the provision of essential public health services demonstrate mastery of the core public health competencies appropriate to their jobs. And there must be a leadership training, support, and development should be a high priority for government public health agencies and other organization in the public health system and for schools of public health that supply the public health infrastructure with its professionals and leaders.
The private sector must sees it as desirable to encourage a positive corporate culture in relation to employee health and to identify and foster good management practice consistent with national standards of good practice in HR management. To achieve this each business must provides information on the access to relevant resources, encourages a positive approach towards those with disabilities and endeavors to alter public health attitudes by employer initiatives in the workplace. It is important for business to developed standards of good practice for health promotion in the workplace by thorough and systematic review of available research evidence.
The common customer service challenges include improving coordination, access, and services for patients traveling from outlying areas to provide the best patient experience possible and keeping rural-based physicians and providers connected with the main campus to support their professional and personal development.
The Media has important contribution to advocate and recommend to government agencies and others. The Public health and communication researchers should develop an evidence base on media influences on health knowledge and behavior, as well as on the promotion of healthy public policy.
The academia should take steps to expand the external peer review mechanism for review of investigator-initiated research, allow more generous time lines, often required by prevention research, establishing a central mechanism for coordination of investigator-initiated proposal submissions. While the state or any institutions should increase the portion of its budget allocated to population and community-based prevention research that evaluates the application and impact of new discoveries on the health of the population, focuses on behavioral and/or environmental factors associated with primary and secondary prevention of disease and disability in populations.
The public health practitioners need in order to work at the inter - section of the following areas on built environment and health; work and health; housing and health; media and health; public interest law and health; tax structure and health and corporate business and health. And the initiative will encourage getting other sectors to involve as a partner in public health work for action.
Most of these ideas were suggested by individual countries during consultation on the present update. They are only a few among many possible national activities and developments that could help give the European Health for All process a new, open-ended dynamic. The process could serve as a forum for exchanging up-to-date health policy information, experiences and ideas. National and sub-national updates could in turn contribute elements and ideas to the continuing evolution of the regional Health for All policy, in a permanent process of renewal and improvement. Such a development would be the best testament to this document’s relevance and usefulness. It is also hoped that the present update will serve as a valuable tool for promoting the ethical development of health policies that will benefit women in every countries.
However, this paper also highligthened the importance of role of women in all spheres of health should be re-examined. Women are one of the strongest means for improving health in families and communities. They form the huge majority of those working in health care, mostly being in underpaid jobs with serious occupational hazards. Empowering women and avoiding medicalization are health promoting strategies that should be integrated into health care organizations. Self-help and patients’ rights groups should be institutionalized as main interested parties in all health programmes. It should be ensured that women’s interest groups and consumer organizations lobbying for patients’ rights receive adequate funding to represent the weakest groups within the health care system.
Women themselves should be encouraged to be actors, partners and decision-makers in all work in women’s health. Women’s voices have often been ignored in policy development, programme design and priority setting. The voices of women are essential as both providers and consumers of health information, service and care.
References:
1. World Health Organisation. Women's Health Strategic Planning International Cooperation Europe. Copenhagen: Regional Office for Europe. 2001. p.10.
2.Neft, Naomi, Levine, Ann D. „An International Report on the Status of Women in 140 Countries 1997 – 1998.“ Women' in Today's World. USA:Random House New York. 1997. p.5
3.Smajkic A, and associates. Health Status of Population Bosnia and Herzegovina, Report 2005. Council of Ministers Ministry of Civil Affairs. Institute for Public Health of B&H, Sarajevo. 2006.
4. HEALTH21. „European Health for All Series.“ The health for all policy framework for the WHO European Region. Copenhagen: WHO Regional Office for Europe. No. 6. 1999
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