Let’s start by deliberating on a few critical questions… How important is health awareness and education to you? How much do you know about your health and the risks of becoming diseased? How acquainted are you with the health issues in the world today? Why is it necessary to know about these health issues and how to prevent them?

The United Nations, through the Virtual Knowledge Center to End Violence Against Women, defines public awareness as the public’s level of understanding about the consequence and implications of women’s safety. Applying this definition to this topic, public health awareness generally means the public’s level of understanding about the importance, causes and implications of health. Public health awareness is important because good health and well being are produced when the government, health organizations or institutions and individuals  partner to educate and promote health in communities. The public also has to believe that health awareness and disease prevention are important issues in the community. Public health awareness involves health education and knowledge sharing through campaigns, media and promotions. It does not mean dictating or commanding, but rather explaining issues and disseminating information, thereby empowering and allowing people to make their own decisions.

Increased rate of public awareness occurs when a substantial proportion of the public know and agree that an issue, notably health, is of great importance to all citizens. On the contrary, low rate of public awareness occurs when majority of the public do not think an issue is of significance. Public health awareness involves two levels which include general public health awareness and a personal or self awareness. General public health awareness is a situation  where the public has a basic knowledge of good hygiene and healthy habits as well as know where and how to seek help and obtain resources to maintain either optimum health, prevent diseases or obtain treatment for diseases.  On the other hand, personal or self-awareness involves an understanding of how the environment and the health of the public affects  an individual so as to prevent diseases. Disease prevention focuses on strategies targeted towards reducing the risk of developing acute or chronic diseases. Health promotion and disease prevention programs are ways of raising public awareness. These programs are often aimed to address the social determinants of health, which influence risk behaviors such as tobacco use, poor eating habits, and physical inactivity.

Major ways to promote health and increase public health awareness in order to prevent diseases include:

1. Communication: This involves sharing information and raising awareness about healthy behaviors through public service announcements, health fairs, mass media campaigns, and newsletters.
2. Education: Educating people to inform, empower and inspire them to make behavior change and take actions through increased knowledge. This can be achieved through formal and informal courses, trainings, workshops and support groups.
3. Policy making: Governments, organizations and public agencies can make health enhancing policies that regulate and mandate activities that encourage healthy decision-making and behaviours.
4. Enabling environment: This involves creating, enhancing and changing structures in environment to increase the likelihood and easiness of making healthy choices.

Housing is a socio-economic factor that significantly impacts health and well-being. Therefore, houses and housing plans must accommodate the health and well-being of individuals and communities to support and build resilience. Healthy housing is a human right because the lack of it would result in poor health, higher mortality rates and increased risk of chronic diseases. Substandard or deficient housing is a major health risk and is usually common to low-income households. Some conditions associated with poor housing include the use of lead-based paints, build up of radon gas and the presence of mould, mites, and allergens. Approximately 40% of childhood asthma is attributed to indoor exposures to substances in low-quality housing. About 2,000 Canadians die yearly from lung cancer associated with Radon, a colorless, odorless gas that often builds up in some poorly maintained houses. Problems related to poor housing such as potential for fire hazards, poor ventilation and other unsafe conditions that do not meet building standards, can result in critical injuries or even death.

The scientific evidence on the association between housing and health has increased considerably in recent years. These evidence can be used to direct primary prevention measures such as housing construction, renovation, use and maintenance, to promote better overall health. Healthy and efficient housing is promoted for many reasons; to conserve energy in this era of climate change, address the housing needs of urbanization and to prevent or eradicate homelessness. There is an apparent need for governments and other organizations to promote health by investing in healthy housing. The World Health Organization (WHO) emphasized the importance of developing an international guidance on healthy housing after the consultation of 40 experts from 18 different countries, a conference hosted in Geneva from 13^th  to 15^th October, 2010. This international guidance is intended to support the prevention of a wide range of diseases and unintentional injuries through healthy housing.

The cost of private, for-profit housing makes it impossible to meet the housing needs of low-income households. Consequently, governments must intervene and provide subsidies to accommodate people who cannot afford the healthy houses they need. National governments have a responsibility to provide citizens with the building blocks of health, including safe, healthy and affordable housing. Unfortunately, many levels of government have remained reluctant to investing in healthy housing for low-income people. Ironically,  it is economically better to invest in healthy housing because the social and health costs of poor housing and poverty consistently outweigh the costs of investing in subsidized social housing.

Ways in which the government, and housing agencies, can accommodate health and well being into housing plans include:

• Encourage healthy housing designs, construction and maintenance across the housing continuum
• Work with housing agencies to create plans that meet the specific needs of people
• Promote superior indoor air quality through properly ventilated houses
• Provide safe water and lighting
• Conserve resources, especially water and energy -including the consumption of electricity and other fuels, and encourage the use of renewable energy
• Ensure houses are environmentally responsible through the use of alternative water and wastewater systems, site planning that reduces land requirements, resource-efficient landscaping and a consideration for broader community planning issues such as transportation.
• Invest in affordable housing

Youth and young adulthood are stages of development where risk factors for violence are most evident and pronounced. Consequently, more people at this stage die from acts of violence compared to all diseases combined (Irwin, Berg & Cart, 2002). On a daily basis, young people across the world are exposed to violence in their homes, schools, and communities. These exposures to violence cause significant physical, mental, and emotional damage in addition to long-term behaviour disorders that can last well into old age.

Youth violence is a global health problem. The World Health Organization (WHO) estimates 200,000 homicides yearly among youth and young adults aged 10-29 years, making homicide the fourth leading cause of death in this age group. About 83% of these perpetuators and victims are male, and most of these deaths occur in low and middle-income communities across countries. In the United States, homicides among individuals aged 15 to 24 were one of the top three leading causes of death in 2015. A study in Ontario Canada showed that 10% of students reported having carried weapons (such as guns or knives) while 6% reported having participated in gang fights (Adlaf, Pagua-Boak, Beitchman & Wolfe, 2005). Of the individuals that reported carrying weapons, 79% had experienced a physical assault in the last year (Wortley & Tanner, 2006). Therefore, it remains unclear why these young people carry weapons; whether to offend (commit crimes) or to defend themselves against criminals.

The term youth violence cuts across a wide range of behaviours and actions. According to the Centers for Disease Control and Prevention (CDC), youth violence can be described as the harmful or destructive behaviours carried out by youth beginning from early ages of life,  and may continue into young adulthood. Some implicated behaviours and actions that constitute violence among youths include bullying, slapping, pushing, shoving, hitting, fist-fighting and killing. Some kinds of violence, such as bullying, can cause more emotional harms than physical harms while others, such as robbery and assault (with and without weapons) can lead to serious injury and even death. Exposing young people to violence can also  hinder development, cause traumas and create long lasting scars. These youth are usually underserved, and the social assistance and welfare systems responsible for their upkeep are often  fragmented, indifferent, inefficient and ineffective.

The best way to tackle youth violence is through prevention; stopping it before it starts. Several prevention strategies have been identified and proper application can help stop or prevent the cycle of violence. Schools and communities can help reduce youth violence by developing interventions  that combine prevention and treatment strategies. Center for Addictions and Mental Health (CAMH) has the following recommendations:

• Support marginalized communities by building capacity for healthy and supportive environments.
• Engage and include communities most involved in youth violence, in identifying solutions
• Create strong community and school-based programs and service
• Provide parenting resources for families to improve parent-child relationship as well as to address mental health concerns linked to youth violence
• Develop tools and targeted interventions that support individuals, families and communities along the continuum of prevention, intervention and treatment

Internally displaced people (IDP) are people who are on the run within their countries, but unlike refugees, have not crossed international borders to find safety. IDP are the most vulnerable group of people in the world because they’re stuck in countries where their safety is uncertain, and remain under the care and protection of the government, even if that government caused their displacement. Internal displacement often results when people run around due to fear of persecution for their ethnicity or race, religion, membership of a particular social group and political opinion. It is also caused by natural disasters or made-made events, for example, earthquake, famine, drought, conflicts, disorder, wild fires, development projects and war.

There are millions of internally displaced people around the world. According to the Internal Displacement Monitoring Centre (IDMC) of the Norwegian Refugee Council in Geneva, at the end of 2014, about 38 million people worldwide were reportedly displaced internally due to violence.  Of this number, 11 million were newly displaced in the same year – making 2014 a year with the highest record of human displacement, totalling about 30,000 people a day. Iraq suffered the most new displacement, with at least 2.2 million people displaced. Ukraine was also affected by a war which caused the internal displacement of more than 640,000 people.  The IDMC’s 2015 Global Overview further showed that the disproportionate increase in the rate of displacement was as a result of  the prolonged crises in countries such as Democratic Republic of the Congo, Iraq, Nigeria, South Sudan and Syria. These five countries alone accounted for over 50% of all new displaced individuals worldwide. So far, Syria has the highest number of displaced people in the world- 40% of the population, approximately 8 million people.

Displaced persons are vulnerable and susceptible to infections; they therefore need help and support in many areas of their lives, especially health. They suffer significantly higher rates of morbidity and mortality, and have higher risks of experiencing harsh, unfair, violent and abusive conditions such as physical attack, sexual abuse, kidnap, hunger and deprivation of basic needs including shelter and health care. It is also very challenging for them to access services related to health, education and other areas due to the lack of finances, housing, security, safe and clean water, basic sanitation and stability. The following health problems have been identified among IDPs in Africa: post-traumatic stress disorders, malnutrition, fever, malaria and acute respiratory infections.

A way to reduce internal displacement is to tackle it’s root causes such as wars, discrimination and insurgency through a combination of diplomacy and democracy, good governance, other political measures. Additionally, a well coordinated and pecuniary emergency preparedness plan, including active surveillance, should be in existence in case disasters occur. Most of the internally displaced people are women and children, who they have an even higher risk of being sexually abused. Due to the high vulnerability of IDP, many international organizations such as World Health Organization (WHO) and The United Nations Refugee Agency (UNHCR) use their expertise to protect and assist them.

Social injustice may be defined as inequities or unfair actions and practices in the society, usually by the dominant populace against the minority groups. It has been described as the unequal distribution of advantages and disadvantages in all areas of life in a society. Like every kind of inequity, social injustice is a threat to health and wellbeing, and can affect all aspects of life including education, housing, employment, income, access to health services, transportation and government benefits and services. The major example of social injustice is discrimination, which can also be considered the root cause of all other social injustices. Other manifestations of social injustice include unequal distribution of wage relative to labor, oppression, religious violence, racism, patriotism, casteism, capitalism, classism, ableism, sexism, ageism, and homophobia.

As stated earlier, most forms of social injustice are rooted in discrimination. Discrimination is the biased and unequal treatment of persons or groups of persons for reasons based on illegal stereotypes and prejudices such as age, race, gender, sex, race and other factors. It is considered an illegal act by the federal and state laws of the United States, and many other countries. Discrimination is evident in many areas in the society including employment and right to promotion, availability of housing, opportunities for education and scholarships, civil rights and use of facilities. Surveys conducted by researchers at Brown University found that in the US, minority groups at every income level live in poorer neighborhoods than white people with comparable incomes. In addition, another study in Arizona showed that between 2006 and 2007, highway patrol was more likely to stop drivers who were African Americans, Native Americans, Middle Easterners and Hispanics compared to Caucasian in all the studied highways. These are not co-incidences but socially and structurally constructed limitations that beset minority groups.

Discrimination is a mindset mostly caused by thoughts, theories and principles that are promoted by cultural beliefs and prejudices or stereotypes. One way to reduce discrimination is through government intervention via laws and regulation that prohibit it, and punish offenders. A second way to reduce discrimination is to promote and encourage diversity in societies. Diversity is necessary because it helps to create a color-blind society rather and having a color-conscious society where social injustice thrives. Cultural diversity is important and can be promoted workplaces and schools by hiring and admitting people from various cultural, racial, and ethnic groups. A culturally diverse society enables people to learn and understand other cultures and perspectives by living and communicating with them daily, and in turn dispelling and nullifying societal stereotypes and personal biases.

Occupational health injuries are conditions that result primarily from an accident or exposure to physical, chemical or biological hazards in a work environment, such that the normal physiological or psychological functioning of workers are affected, and health is compromised or impaired. These conditions include any occupational injury for which a worker is entitled to benefits under the Workplace Safety and Insurance Act. Occupational injuries are acute and instantly visible personal incidents which differ from occupational diseases, in that diseases are contracted over a period of time due to exposures to risk factors arising from work activities. World Health Organization (WHO) and Occupational Safety and Health Administration (OSHA) considers a disease to be work-related if it has multiple causes, where factors in the work environment play a role, together with other risk factors, in the development of such diseases. Given the period of time it elapses for some disease to be established, it is not always easy to prove that they occurred in the workplace, and subsequently claim associated benefits.

Occupational injury statistics are reported based on the nature or type of Injury, body part affected, source of the injury, type of accident resulting in the injury (for example, fall or burn), the industry in which worker was employed when the accident occurred (for example health or manufacturing), occupation of the injured or worker and personal characteristics of the injured worker such as gender and age. In order to be statistically reported and compensated, an injury must be accepted by a Workers Compensation Board (WCB) or commission as a time loss-loss injury. Some occupational injuries may not be accepted by WCB if they are considered minor-‘first aid only’ or occurred among some work groups that are not covered by WCB (such as the self-employed).

Some examples of occupational injuries include:

• Physical and mechanical injuries which are the most common types of occupational injuries resulting from accidents. They include falls, sprains, lower back pains, bruises, cuts, lacerations, needle punctures, burns and musculoskeletal disorders
• Skin disorders caused by exposure to chemicals, irritants, plants or other substances: contact dermatitis, eczema, rash, oil acne; friction blisters and skin inflammation.
• Respiratory conditions associated with inhaling hazardous biological agents, chemicals, dust, gases, vapors or fumes: silicosis, asbestosis, acute congestion and pharyngitis.
• Poisoning caused by the ingestion or absorption of abnormal concentrations of toxic substances such as lead, mercury, , arsenic, carbon monoxide, hydrogen sulfide, benzene, carbon tetrachloride, formaldehyde and insecticides.

Impacts or costs of occupational injuries are broad and may be direct or indirect. Some impacts may be potential while others may be , depending on the severity of the injury.

• Direct impacts: These are measurable impacts or costs directly relating to the accident, the injured individual and ways to treat the injury. They are usually covered by the occupational health and safety plan. They include medical, hospitalization, and rehabilitation costs, administrative and legal costs and property damage- being damages caused to the company’s machines, equipment, tools, and other property in the course of the accident.
• Indirect impacts: These are impacts that are not directly related to the worker, the injury or treatment but rather to the lost opportunities of the injured employee, his family, the employer, the co-workers, and the community at large. In contrast to direct costs, these costs do not involve out-of-pocket expenses, are not usually insured and are more difficult to measure. They include loss of education, career and social interactions, economic impacts of loss of work and worker, productivity losses involving stopping or slowing down of production due to property damage, loss of salary and benefits, limitations workers’ ability to perform household work, impact on the organization’s reputation and human impacts, such as pain, emotional and suffering.

Why is gun violence a global health problem?

Globally, there are over 900 million firearms with most of them belonging to civilians (the public); a number which is approximately 253 million or 29% greater than passenger vehicles. About 8 million guns and 10 to15 billion rounds of bullets are manufactured yearly. The number of bullets manufactured in a year is double the world’s population, meaning that there are more than enough bullets to shoot- and potentially kill, everybody in the world. As many as 1000 people die daily from firearm or gun-related homicide, much more are injured. According to the United Nations (UN), deaths due to guns and firearms surpass that of all other weapons combined. As a matter of fact, some years record more deaths from gun related violence than there were in the atomic bombings of Hiroshima and Nagasaki combined. Financially, the legal international trade in firearms and bullets are in the excess of $7.1 billion dollars annually. Apart from the public health trauma and emotional pain of losing so many lives, the economic costs of gun related violence in the United States is $229 billion annually including hospital, court and prison costs.

In the year 2000, the then UN Secretary General, Kofi Annan, described the magnitude of the menace and death due to gun violence in these words:

“The death toll from small arms dwarfs that of all other weapons systems — and in most years greatly exceeds the toll of the atomic bombs that devastated Hiroshima and Nagasaki. In terms of the carnage they cause, small arms, indeed, could well be described as ‘weapons of mass destruction’.” — Kofi Annan, UN Secretary-General, March 2000”

The facts above point to the fact that gun violence is a costly global health problem that needs to be controlled. This problem is particularly prevalent for so many reasons, but one clearly identified in the 2011 Global Study on Homicide is that it is much more common in countries with low standards of human development, high income inequality and weak regulations and law regarding the sale and use of firearms. In the United States of America for example, an average  of 88 per 100 people own guns, which is the highest gun ownership rate in the world. The second and third countries, Yemen and Switzerland, have a gun ownership rate of 54.8 per 100 people and 45.5 per 100 people respectively. However, it’s not always the country where people have the most guns that have the worst firearm murder rates. For instance, countries such as Iraq, El Salvador and Jamaica are reported to have the highest murder rates due to guns and firearms, even though some reporters believe that the US has the highest.

In more equitable societies with socio-economic stability, there seems to be less occurrences of homicide and gun related violence. Gun control laws and policies are essential to regulate the manufacture, sale, transfer, possession, modification, or use of guns by the public within a country. People against gun control argue that it is a great means of self defense that plays an integral role in one’s protection, others in favor contend that while guns play an important role in protection, they have also caused much destruction. At such, rigorous background checks and investigations are recommendations that should precede the purchase and use of firearms.

References available on request.

Youth violence and other ferocious behaviors such as weapon carrying and fighting, have been associated with early school bullying (Kim et al., (2006). Bullying and being bullied are public health problems and also major risk factors for the later development of psychopathologic behaviors (Kim et. Al, (2006). Through an observation of prospective design, use of large samples and precise analytic approaches, (Kim et al., (2006) showed that many youths are involved in bullying and that there are inherent health  and social problems that result from both being a bully and being bullied.

Prevalent at between 9% and 54%, bullying is a global endemic that requires urgent efforts towards prevention and intervention. In a study involving 1,639 children, (Wolke et al (2001) examined the association of two kinds of bullying, direct (hitting) and relational (cruel manipulation of peer relationships), with common health problems. His findings showed that approximately 4% of the children studied were found to be direct bullies while 10.2%  were relational bullies. He also found that 39.8% of these children were victims and had been bullied. Both bullies and their victims were most likely to have physical health symptoms such as sore throats, colds, and coughs. High psychosomatic health problems including poor appetite and fear of going to school were mostly observed in bullied victims (Wolke et al (2001).

The association between victimization from bullying and adverse effects on physical and psychological health is well documented in literature. However, it remains unclear whether it is the victimization that precedes the health-related symptoms or vice versa. A six-month cohort study with baseline follow-up measurements of 18 elementary schools in the Netherlands showed that victims of bullying were significantly more likely to develop new psychosomatic and psychosocial problems compared to children who were not bullied. On the other hand, some children with existing psychosocial disorders such as depression and anxiety were more likely to experience bullying and victimization. The study involving 1,118 children aged 9 to 11 years, measured a wide variety of psychosocial and psychosomatic symptoms, including depression, anxiety, bedwetting, headaches, insomnia, anorexia and feelings of pressure or fatigue (Fekkes, Minne, et al, (2006).

Because bullying and victimization can result in a variety of health problems and adversely affect  children’s attempts to cope with pre-existing health conditions, it is imperative to educate and empower children with resistant and coping skills. To ensure more children neither become bullies nor bullied, they should be taught these skills at every level in the society including family, school, church and the community at large.

Racism is an ideology and prejudice that directly or indirectly emphasises that one group is inherently superior to another. It is an intentional or unintentional distinction, conduct, action, inaction or predisposition towards people based on their ethnicity and characteristics such as accent or manner of speech, name, clothing, diet, belief and leisure preferences. Being a socially constructed term, racism can prove difficult to define. However, it is easily reflected in racial jokes, slurs, hate crimes, presumptions, attitudes and stereotypical beliefs.  In many cases, these reflections have become unconsciously assimilated over time as true, and have formed systematic, institutional and structural foundations in the societies. Racism can occur at any level including, individual, families and communities, leading to disparities in many areas of life such as health, economy, social class and education, to name a few.

Racism is a major problem because it is very common and affects  lives on a daily basis. Many disparities between ethnic groups can most likely be attributed to racism. A national survey in the United Kingdom (UK) revealed that about 40% of participants would discriminate against ethnic minorities. In 1999, an estimated 282,000 crimes committed in the UK were motivated by racial discrimination. Racism inspires fear in about  one-third of people from ethnic minorities causing them to constrain their lives, thereby stifling their opportunity to contribute fully to the future and growth of their societies.

Some studies have shown an association between racism, morbidity and mortality and that it may be of etiologic importance in the development of illnesses or diseases (McKenzie, K. (2003) Karlsen S, Nazroo J., 2002, Karlsen S, Nazroo J., 2002). Cross sectional studies in the United States show associations between perceived racial discrimination and hypertension, birth weight, self related health, and sick days. Additionally, victims of discrimination were more likely to have respiratory illness, hypertension, long term limiting illness, anxiety, depression, and psychosis in a recent study from the UK. Racial biases and cultural insensitivity among doctors have been linked to poor communication with patients, dissatisfaction with care and decreased global health outcomes. The risk of mental illness was seen to increase in people who believed that most companies were discriminatory. Furthermore, racism may be associated with illness at an ecological level since a 1% increase in racial disrespect in a state in the US was associated with an increase of 350.8 per 100 000 in “black” all cause mortality.

It is important to note that racism, being a social construct with confounders that may not properly be accounted for, is a difficult concept to measure. At such, most the studies done are only secondary analyses, even though it seems well established that discrimination at multiple levels influences health. Furthermore, the different ways that racism is reflected such as through interpersonal violence, institutional discrimination, or socioeconomic disadvantage, have different damaging effects on health, notwithstanding of the health indicator used.

On a final note, the starting point to effectively address racism and racial discrimination is to acknowledge it’s existence, and then fight it through public education and advancement of human rights.

So, if you ever thought, “what on earth racism does racism have to do with health?… now you know, and you’re welcome!

The enduring wealth gap faced by the world today is a public health problem, and a social determinant of health. It is created by income inequality, defined as the unequal and unfair distribution of individual or household income across various contributors in an economy. Statistically, income inequality is described as a ratio of the percentage of an income to a percentage of population. Compared to previous years, the world seems to have become wealthier overall. This may be attributed to the fact that minimum wage increases, it may also be as a result of more people getting educated and therefore, earning more since education has been linked to increase in income.  However, this increase in the world’s wealth does not seem to narrow or close the enduring wealth gap between the rich and the poor. In fact, the gap between rich and poor people continues to widen, creating disparities in all areas of life, notably health.

Since the 80’s, income inequality has been increasing at an obvious rate. At that time, 30 to 35% of national income was going to the top 10% of earners while 90% of earners had the remaining percentage. More recently, the wealth gap has even become more obvious as the percentage of income going to the top 10% has increased to 50%, creating a huge disparity between high earners and low earners. According to Forbes, the 10 richest billionaires in the world own $505 billion in combined wealth, a sum greater than the total goods and services produced annually by most countries. A 2006 study published by the United Nations University’s World Institute for Development Economics Research found that the richest 1% of world are worth at least 39.9% of the world’s household wealth. This amount is a lot greater than the wealth of the world’s poorest 95% combined.

There are many consequences of income inequality and the resulting wealth gap. These consequences are consistent across a broad spectrum of both economic, health, political and social indicators. The impacts of high levels of income inequality exist across and within countries reflecting areas of economic growth, health, social well-being, and political stability, social inequalities. Some of these impacts include: decreased economic growth, increased health and social problems, political instability and social inequalities, especially among children. Needless to say, the poor are usually the ones affected by these consequences as they do not have the power or the position to help themselves. These poor individuals, being deprived may not sufficiently contribute to the economy, further hindering  economic growth and development.

Strengthening labor unions, increasing minimum wage and investing in education are few ways that may reduce income inequality. However, it’ll take years of commitment and consistence from governments of all nations to have a world where income inequality is absent and wealth gap is at the barest minimum.