By Isah Adamu
In considering the health inequalities, IFEH has decided to work with partners ‘to close the gap in inequities within a generation’ by means of improving Environmental Health Services world-wide.As has been established inequity and inequality lead to poor health. In fairness, the worst kind of inequity is that in regard to health services where in Nigeria like in other settings, have been ‘medicalized’. This is evident in the allocation of resources; prioritization of policies and programmes at every tier of Government whose leadership are mostly concerned with provision of hospital buildings, equipment and consumables as well as hospital-based manpower, leaving out the preventive health aspect.
For any addressing of health inequalities to succeed, Governments and societies must have a re-think concerning environmental health which is the vehicle that will improve the Social determinants of health that will in turn impact on the goals of WHO Resolution 65.8. Over the years Environmental Health has been relegated to the background as a result of neglect of the highest order, little wonder that the country’s morbidity and mortality continue to deteriorate because the basics have been forgotten. The Federal Government that ought to provide leadership is not willing, the State governments that are supposed to guide feel unperturbed while the Local Government which has responsibility to deliver EHS is grounded and moribund.
In addressing health inequities, the starting point should be addressing environmental health inequalities by accepting the roles assigned to the profession of environmental health by the WHO. When one takes a look at the housing sector for instance, what is glaring is the existence of slums not only in the densely populated settlements but also in high profile or exotic settlements where inhabitants feel they are above board. In fact you technically can detect a lot of issues that warrant declaring some high brow dwellings as posing health risks for their inhabitants. The collapse of building is a common occurrence now – this is mostly attributed to failure of engineering. Agreed, but collapse does not happen overnight, it gives signs like cracks on the walls especially near beams or pillars which degenerate to the point of having the strength of the building compromised.
This could easily have been detected by the simple routine Sanitary Inspection of Premises can reveal the smallest potential threats which would be highlighted in the improvement notice to the owner report of which would be forwarded to the town engineering department to enable appropriate actions. Other health hazards include poor ventilation leading to poor air circulation consequence of which is impacting negatively on both out-door and in-door air quality, as the buildings are erected without recourse to health considerations. Poor ventilation gives rise to moisture which attracts disease vectors like mice and cockroaches and mold which cause and/or aggravate allergic illnesses. In the same manner, finishing materials like paints are improperly used leading to chronic lead poisoning. Due to unavailability of adequate human and material resources, these go unchecked to the extent that buildings remain uninspected for a long period of time and hence resulting in the exacerbation of housing associated health hazards which are silent causes to disease conditions.
The same scenario plays out in the other components of Environmental Health thereby resulting in very poor health indices as reflected by Nigeria’s high morbidity and mortality which are mostly attributable to poor environmental health services organization and management. The conscious and combined efforts of those who think are lords and who know it all in the running of the health services has ensured that environmental health services (EHS) remain the way they were when bequeathed by the colonial masters in the mid 20th century. This way, their myopia has ensured that environmental health is thus reduced to only everyday sanitation and hygiene when it goes far beyond that. If it were only for sanitation and hygiene, the G-7 nations would not have any needs for it, but quite contrary the world economic super powers like Great Britain and the United States of America do not only maintain robust environmental health structures but also prioritize it among their most important services at all levels of governance.
Poor leadership of EHS has been the major drawback. At the Federal level, the absence of a full pledged Directorate of EHS in any Federal Ministry has left the profession vulnerable without the much needed leadership thereby leaving it in the wilderness and scattered around the Ministries of Environment and that of Health – resulting in conflict of authority between the two. Despite all entreaties spanning decades the Government is yet to be allowed to do the right thing as every move is blocked by the ‘chosen ones’. This is a form of inequality that remains fatal till today. A sharp comparison is what obtains in our peer that is South Africa which has a Directorate of Environmental Health headed by an EHO in the National Department of Health which is the equivalent of our own Federal Ministry of Health.
It is quite reprehensive that despite having avalanche of well trained Environmental Health Officers who distinguished themselves in their chosen career in the Federal Civil Service, it was not until 2008 that an EHO was promoted into the Directorate Cadre much to the amazement of many. As is known, the Directorate cadre is the circle where policy statements and decisions are moulded for upward submission for approval. This is the policy level where critical thinking, professional articulation and masterly deliveries are supposed to lead via sound professionals well grounded in the job are at the helms of affairs. In place of the rightful bearers of these positions – the EHOs, the job of articulating professional inputs for EHS is left at the mercies of clinicians who by virtue of their training are not equipped to lead EHS. The end result is so glaring for everyone to see. What is more manifest as inequality than this?
Isah Adamu wrote in from Kaduna.