Before we talk about gender inequality, let’s first take a look at what gender is…

World Health Organization defines gender as the socially constructed qualities of women and men- such as norms, roles and relationships with people. These qualities vary from society to society and may depend on location, age, religion and other social or economic factors. Gender is different from sex; which is our anatomy as female, male, or intersex based on internal and external bodies including sexual and reproductive organs, genetic makeup, and hormones. When people are born into a certain society or community, they observe and are taught gender norms and behaviours peculiar to that group including standards on how to interact with people of the same or opposite sex, within households and work places.

Given that gender roles are set ‘standard observed in communities, individuals or groups that do not “fit” these established gender norms often face stigma, discriminatory practices or social exclusion, all of which negatively impact health. Most times, the roles of men and women are already “defined” in many societies. These gender norms, roles and relations can influence people’s susceptibility to different health conditions and diseases and potentially affect their mental and physical health and wellbeing. They also influence health outcomes and the likelihood of accessing health services due to fear of being judged.

In many societies, not just Africa, these gender roles put women at a disadvantage, creating wealth and consequently, health gaps between men and women. In Canada, the Center for Social Justice records that this gender gap is much wider than most people know, despite many years of trying and several efforts to close the gap. A few general facts and examples to buttress this point include:

• In many countries, while husbands can divorce their wives with much ease, wives’ access to divorce is often extremely limited.
• Women are poorer in may countries. For example: In Canada, poverty rates for women in general is as high as 20%; for women of colour and aboriginal women, it is 37% and 43% respectively. The percentages for men are lower.
• Women’s low income would constitute high risk of poverty in retirement and this can limit access to health care. Due to poverty, many female seniors may also not afford quality health care since retirement income is a function of lifetime earnings.
• Many countries still deny women the opportunity of going to school. We all know that education is a social determinant of health
• Many countries do not have laws to punish domestic violence, of which women are usually vulnerable to and victims of
• In countries like Egypt, Bahrain, Syria, Iraq, Libya, Jordan, Morocco, Oman, Yemen, and Saudi Arabia, decision to travel for women is completely at the mercy of the men.

In conclusion, gender inequality affects health like many other social determinants of health.

Engagement is a two-way process which involves any interaction and communication, with the goal of generating mutual benefit. It is a planned process where identified groups of people who are connected by geographic location, common interest, affiliation or identity, work together to address issues affecting their well-being. Depending on the situation, engagement is  used to broadly describe various interactions between people and may represent both one-way or two-way interactions including consultation, communication, education, public participation, participative democracy, partnership, information delivery, involvement and collaboration. These interactions lead to decision-making through empowered action in either informal groups or formal partnerships. Community is also used broadly to define various groups of people who may be stakeholders, interest groups, citizens, union members or colleagues. The term community may represent a geographic location (community of place), a community of similar interest (community of practice), or a community of affiliation or identity (such as industry or sporting club).

What is Community Engagement? Community Engagement is a means by which community members plan, work and learn as a united group on behalf of their communities in order to conceive and achieve present and future goals that are common to, and benefit the community at large. As Community Engagement increases, citizens progress from being just passive consumers of information to taking active leadership and decision making roles. Engaging as much members in a community as possible is a critical component of any work that will greatly impact that community in any way. It involves listening to the community’s needs through needs assessment, interviews, focus groups or surveys and then responding to address those needs using their feasible recommendations. Engagement increases unity and allows for the community to be responsible and have ownership over the outcomes of their decisions.

The major aim of engagement in any community is to foster inclusiveness, sustainability and ensure considerations and decisions are reflective of the diversity that exists within the community. These in-turn promote the quality of life, wellbeing and improve the health of the engaged and empowered citizens and enable them to take control of their health.

In the academic environment, community engagement describes the numerous ways in which the activities and benefits of research are shared with the public and community. It is a process that involves informing, engaging, partnering with, and empowering citizens about initiatives designed for them, in a collaborative manner so as to generate solutions and reach desired outcomes together. In politics and policy making, community engagement specifically relates to the role of government which involves mutual communication and deliberation that occurs between government and citizens. It is a bottom-up approach, rather than a dictated top-down approach, where the government ensures decisions are reflective of the input of citizens. Generally, community engagement takes different forms and covers a broad range of activities including:

• Informing the community of policy directions from government or intending partners
• Consulting the community as part of a process to develop policies, or build community awareness and understanding.
• Involving the community through a range of mechanisms to ensure that issues and concerns are understood and considered as part of the decision-making process.
• Collaborating with the community by developing partnerships to formulate options and provide recommendations.
• Empowering the community to make decisions and to implement, manage and sustain change.

Recession is defined as any significant continuing decline in activities across the economy of a country, industry or trade. Technically, recession is a normal part of the business cycle, despite being a major challenge. Many events precede a recession including one or more of the following: high interest rate, stock market crash, wage price controls, war, falling housing prices and sales, a slow down in manufacturing orders, deregulation, credit crunch, asset bubbles and deflation. The 2007-2009 global recession emphasized the precarious nature of investment strategies used by large financial institutions as well as the global nature of financial systems. The recession caused a significant setback for economies of virtually all the world’s developed and developing nations.

Within a country, a negative economic growth persisting in two consecutive quarters signifies the occurrence of an economic recession. A country’s economic growth is measured by it’s gross domestic product (GDP) which is the current market value of all goods and services produced within the country in a particular time period. Economic recession is therefore defined as a consecutive decline in a country’s gross domestic product (GDP) for two or more quarters. During an economic recession, everyone is impacted in various areas of life due to the many uncertainties that come with it. The most impacted group during this period remains the unemployed who are often impaired psychologically due to feelings of hopelessness.

The economy of a country shapes the cost of living and budget allocation including how much is assigned to healthcare and services. These factors can directly impact the health of the population by influencing the income value of the residents. Income, a socio-economic factor which is a social determinant of health, in turn influences the health and quality of life of these residents. Several studies across the globe have shown that recession influences health and health outcomes negatively.  Firstly, a study on the economic recession in Japan titled “Economic recession and health inequalities in Japan: analysis with a national sample, 1986–2001” found that self- reported health improved in absolute terms for all classes of residents after the economic recession. Another study in the United States recorded an increase in suicide rates in an estimated excess of 4,750 suicide deaths during the economic recession in 2012. Finally, a 2010 study in Spain showed that recession significantly increased the frequency of mental health disorders and alcohol abuse, particularly among families experiencing unemployment and difficulties in paying mortgage. It is notable that poor populations in all countries are usually the first and hardest to be impacted by any recession or downturn since recession is accompanied by increased cost of living.

In countries affected by an economic downturn the total health expenditure, public spending and private out-of-pocket expenses tends to decline. This reduction in total expenditure causes an increase in the cost of care, medicines and medical equipment. It also results in a negative impact on population health since reducing operating costs related to surveillance or supervision are likely to have immediate damaging effect on service delivery. Every recession would likely affect health directly or indirectly, depending on the cause, type, magnitude and how long it lasts. However, to limit the potential impact of economic recession on health, it is important to maintain the following:

• Active labour market programmes that support the unemployed as well as keep and reintegrate workers in jobs
• Increased family, parenting and social support programmes
• Control of alcohol price and availability
• Debt relief programmes
• Increased strength of social capital
• Accelerated mental health care reforms

Population growth is defined as the increase in the number of individuals in a population. Globally, human population grows up to 75 million or 1.1% annually. Since 1800, world population has grown from 1 billion to 7.4 billion in 2016 and is expected to keep growing. Estimates show that the total population will reach 8.4 billion by mid-2030, and 9.6 billion by mid-2050.

Growth and changes in the characteristics of a population are factors that influence health, the quality of life as well as the scope and significance of public health programs. The rate at which a population grows affects the availability of basic needs required to sustain life. It also affects health care costs, short-term and long term planning of community health and medical facilities. Specific changes such as alterations in age composition, internal migration of racial or industrial groups, population density and urban-rural movement call for modification of related health programs so as to address current and existing problems created by these changes. The social and economic effects of a growing and changing population have long been recognized and are well documented in research.

As the world’s population continues to grow and humans exploit nature to meet their present needs, natural resources are depleted at a much faster rate than they are replenished. This invariable confers pressure on these resources, threatening public health as well as social and economic development. Although most developed economies consume resources at a rate faster than they can regenerate, developing countries- with rapid population growths, endanger natural resources on which they depend and pose irreparable harm. Many nations with rapid population growth have continuously demonstrated low standards of living, whereas nations with lower rates of population growth have shown high standards of living.

If the world population continues to grow at this rate, the world’s population is projected to reach 8 billion by the year 2025- in less than ten years. At that time, it is also projected that about 48 countries with 3 billion people will be faced with problems such as chronic water shortage. Moreover, in 25 years, human beings alone could be using up to 90 percent of all available freshwater and only 10 percent will be left for the remaining living things namely plants and animals. Recently, 64 of 105 developing countries have documented a population growth that is much more than the availability of food supplies. To meet the food demands of population pressures, these countries resort to over-cultivation, which unfortunately has degraded an overwhelming 2 billion hectares of arable land.

To preserve the earth and her resources for future generations, humans must practice sustainable development which requires slower population growth. Without this, humanity would potentially face deteriorating environments and ecological disasters including water shortage, soil exhaustion, trees and forest loss, air and water pollution, and degradation of coastlines. The following are steps in the right direction for a more sustainable environment:

• Efficient use of energy
• Better city management
• Water resource management and fresh water protection
• Harvesting of forest products
• Preservation of arable land and increase in food production
• Better management of coastal zones and ocean fisheries
• Protection of biodiversity hotspots
• The adoption of a climate change convention among nations
• Stabilization of the population through good quality family planning services

The lack of an easy, centralized way to identify and link patients to their health data has resulted in the creation of numerous unrelated patient-identity numbers that overwhelm medical-records system in health care. More so, with health care organizations growing, merging, and forming affiliations, it has become increasingly important to create and use single unique codes of critical patient information called Single Patient Identifiers (SPIs). For this reason, there’s a requirement established by the Health Insurance Portability and Accountability Act (HIPAA) to uniquely identify participants involved in the provision of health care services. In the same way, payer organizations have the responsibility of distinctively identifying and covering individuals, irrespective of how they’re identified in different provider systems.

Many current health service problems that complicate patient care and related communications can be solved when SPIs are used. Creating a system where each patient has their own SPI ensures that regardless of any physician they visit or anywhere their care team members is stationed, clinicians can easily access the information they need about the patient in an instant. This form of information sharing across teams and health systems will result in more efficient collaboration and care. It’s a given that the idea of primary care physicians or other health professionals being able to instantaneously access complete medical records of patients would improve care coordination, ensure effective patient care and ultimately reduce medical errors. Other benefits of SPI include:

• Being a web-based, it allows for multiple users and ease of access to patient data
• Maintains a centralized database which enables data integration and allows local systems to operate independently
• Automatically creates a global, cross-indexing for record matching across different systems

• Uniquely identifies patient records and flags potential duplicate records

It would certainly be wonderful to no longer have to fill out long medical history forms whenever one visits a new doctor. With SPIs, up-to-date medical records of any patient can be retrieved once the personal code is entered. Clearly, this will save patients a lot of time and frustration from repeatedly filling medical forms every time they see a specialist or new doctor. In addition, it will allow clinicians to devote more time to engaging their patients.

Despite the forgoing, some groups- particularly privacy activists aren’t in support of SPI. They argue that despite the pros and importance of SPI or centralized unique healthcare system IDs, it would tremendously encourage commercial gain through the routine collection and selling of information from medical records without patient consent. As a consequence, more patients would lose trust in the confidentiality of health systems and hide health details from their doctors, resulting in a deterioration in care.

Like any major change, the debut of SPI is certain to generate heated arguments of pros and cons between proponents and opponents respectively. However, a common ground between these groups can be reached by ensuring that SPI, an efficient system in itself, can be successfully used without the invasion of patients’ privacy.

Disease surveillance systems are continuous, systematic and standardized information-based systems which involve the collection, analysis and interpretation of large volumes of health-related data obtained from a variety of sources. Surveillance data are used for different purposes including evaluating the effectiveness of control and preventative measures, monitoring changes in infectious agents such as antimicrobial resistance, supporting health planning, allocating resources within the healthcare system, identifying high risk populations or target areas and providing valuable archive of disease activity for future reference. To be effective, a surveillance system must be nationally standardized and made available at local, regional and national levels.

The importance of surveillance is well documented by World Health Organization and other international organizations because it is used for the planning, implementation, and evaluation of public health practice. It also aids the documentation or evaluation of interventions, provides information that serves as early warning for impending public health problems and monitors disease epidemiology to allow prioritization and inform public health policies and strategies.

The realization of the importance of disease surveillance systems increased in the late 20^th century due to the emergence of human immunodeficiency virus and infectious diseases mainly new strains of influenza. Following this realization, some disastrous events further emphasized the need for surveillance systems in the early 21^st century and raised awareness of the value of public health surveillance for national security. Given their tragic nature, these disasters further showed the need to share global responsibility for surveillance and disease control. Some of these events include bioterrorism using anthrax spores in 2001, 2003 epidemic of severe acute respiratory syndrome (SARS), re-emergence of a panzootic of avian influenza A(H5N1) in 2005, and the sudden emergence of pandemic H1N1 in North America in 2009.

Disease surveillance systems are essential for the identification and prevention of new and re-emerging infectious and non-infectious diseases. It provides health information in a timely manner, enabling countries to have the information they need to prevent and fight outbreaks. The development and maintenance of effective surveillance systems have helped address several public health problems such as small pox and poliomyelitis, which were eradicated following the initiation of efficient surveillance systems that provided insight about the epidemiology and etiology of the infectious agent and disease. Given these facts, it’s no doubt that one of the major ways of addressing public health problems around infectious diseases both nationally and internationally is through the development and sustenance of effective surveillance systems.

Vital Statistics is the department of government registries responsible for the registration of important events such as birth, death, marriage, stillbirth and domestic partnership which occur in the country. Family events are key elements of genealogy and family history research and information from these statistics inform research, policies and other governmental decisions. Our lives as individuals are composed of events that occurred at different times such as birth, marriage and death. Vital Statistics Agencies are responsible for administering and enforcing The Vital Statistics Act, The Marriage Act, The Change of Name Act and processing disinterment under The Public Health Act. These Agencies register vital events and provide documents as proof of those events. The accessibility of the records held by these agencies are governed by legislations protecting privacy and these records are often held in perpetuity.

Historically, important events such as, baptisms, marriages and burials have been recorded in Church Records and Indexes. Subsequently, in the late 1800s and early 1900s, governments of various countries introduced the civil registration of births, marriages and deaths. The aim of vital statistics is to ensure the accuracy of information, trace the records relating those events, preserve the memory of the events and, if possible, obtain copies of these records. According to World Health Organization (WHO), a well-functioning civil registration and vital statistics (CRVS) system has the mandate to register all births and deaths, issue birth and death certificates, and subsequently compile and disseminate vital statistics, including cause of death information. It may also record marriages and divorces. Examples of vital statistics include:

• Birth
• Death
• Marriage
• Domestic Partnership
• Seperation and Divorce
• Genealogy
• Name Change
• Sex Change

Sources of vital statistics include:

• Hospitals
• Adoption facilities and Orphanages
• Parish Registers
• Church Records and Indexes
• Civil Registrations
• Databases
• Cemeteries and Wills
• Virtual Exhibitions

What is Malnutrition? Malnutrition is a term that almost everyone is familiar with because it’s a topic often taught in high school, alongside “balanced diet”

Malnutrition is a preventable medical condition characterized by lack of proper nutrition due to not having enough to eat, not eating enough of the right things, or the body being unable to use the food that is eaten. Individuals are malnourished if their diet does not provide them with adequate calories and protein for maintenance and growth, or they cannot fully utilize the food they eat due to illness. Also, people can become malnourished from consuming food with insufficient, excessive or imbalanced nutrients. Several different nutrition disorders may develop, depending on which nutrients are lacking or consumed in excess. Other words that can be used to describe malnutrition include undernourishment, malnourishment, poor diet, inadequate diet and unhealthy diet, lack of food.

Children are the most visible victims of malnutrition- geographically; over 70% of malnourished children live in Asia, 26% in Africa and 4% in Latin America and the Caribbean. In many cases, these children were born by malnourished mothers, resulting in low birth weight- a risk factor for neonatal deaths and a major cause of learning disabilities, mental retardation and poor health. In these developing parts of the world, malnutrition is responsible for over 300,000 deaths per year in children younger than 5 years, contributing to over half of all deaths in children worldwide. Impacts of malnutrition include low mood, and reduced energy, muscle wasting, low sex drive and fertility issues, reduced mobility, decrease in white blood cells and corresponding immunity, increased risk of falls, infections and hospital admission, longer healing times for wounds, longer recover times from infections and reduced independence.

Malnutrition is caused by a lack of essential nutrients and results in poorer health. In developing countries malnutrition is widespread and the major cause is poverty and a corresponding lack of food to eat. In developed counties, it is caused by poor diet and eating habits, mental health problems, digestive disorders and alcoholism. Severely malnourished children typically experience slow behavioral development including mental retardation. Even after treatment, malnutrition may have long-term effects in children, causing impaired mental function and digestive problems permanently. On the other hand, adults usually make a full recovery when treated.

Clinical signs and symptoms of malnutrition include loss of weight and fat (adipose tissue), difficulties in breathing and higher risk of respiratory failure, depression, higher risk of hypothermia – abnormally low body temperature, total number of some types of white blood cells falls, higher susceptibility to feeling cold, Longer recovery from illnesses, reduced tissue mass, tiredness and fatigue, irritability, decreased social responsiveness, anxiety, and attention deficit. In more severe cases of malnutrition, the skin becomes thin, dry, inelastic, pale, and cold, cheeks look hollow and the eyes sunken as facial fat is lost, hair becomes dry, sparse, and falls out easily and finally, there may be heart, liver and respiratory failure.

Clearly malnutrition is a dangerous condition… but the good news is that it can be prevented. Since malnutrition is caused mainly by not consuming the right balance of nutrients- balanced diet- from major food groups including carbohydrates, fruit and vegetables, protein, dairy and fats, prevention is majorly by ensuring that foods consumed contain these. However, when malnutrition is caused by other underlying conditions such as eating and digestive disorders, mental health issues and other factors, a healthcare professional should be contacted for a treatment plan. National Institute for Health and Clinical Excellence (NICE) in the United Kingdom recommends that the average human should drink at least 1.2 liters of fluid per day, so drink enough water, eat a balanced diet and stay nourished!!!

What can you do to end malnutrition? Let’s start with this mindset… always remember that that the food you waste can save a child’s life!

The Health Belief Model (HBM) is a model used to explain and understand health behavior, especially in view of preventing a negative health outcome. The model was developed in the early 1950’s and has been used to develop health education strategies and promote healthy behaviors including condom use, seat belt use, medical compliance, and health screening use. The rationale behind the model is that a person will take a health-related action, for example, eat healthy foods, if that person feels or believes that a negative health condition, for example obesity, can be prevented.

Our culture and belief system have the potential to influence the actions (health behaviour) we take or fail to take regarding our health. Here’s an example- if, by reason of your culture or who you are, you believe that eating unhealthy foods would lead to obesity, then, it’s very likely that you’ll choose to eat healthy foods. On the contrary, if you neither see unhealthy foods as threat to your health nor perceive any benefits from it, then you’re probably not going to care about your diet. As with many models, the flaw here is that the likelihood of making a behaviour chance is not actually an action but an intention, Therefore, it is possible for one to intend to eat healthy foods (perceive weight gain or obesity as a health threat and really want the benefit not being obese) and still not follow it through by eating healthy foods. Structural factors such as cost of healthy foods and proximity to grocery stores are typical reasons why intentions may not translate to behaviour.

In general, the Health Belief Model is structured to inspire people to take positive health actions- example, HIV is a negative health outcome, so, the desire to avoid HIV can be used to motivate sexually active people to practice safe sex. Similarly, the perceived threat of a heart attack can be used to motivate people suffering high blood pressure to engage in physical activity. People choose their behaviors due to various factors such as their beliefs, cultures, education, gender, social class and economic situations. The following are constructs of the HBM:

1. Perceived Susceptibility: A person’s belief about the probability of ending up with a negative health condition- the subjective perception of the risk of acquiring a condition.
2. Perceived Severity: A person’s belief of how serious a condition and its consequences will be if acquired- the subjective evaluation of the seriousness of the consequences associated a condition
3. Perceived Benefits: A person’s conviction of the effectiveness of the advised action to reduce risk or seriousness of the condition- the subjective positive gains of taking a positive health action.
4. Perceived Barrier: A person’s opinion of the costs and difficulties associated with the advised health behaviour.
5. Cues to Action: Reminders to take follow through with the advised and intended behaviour.
6. Self-Efficacy: This represents the confidence in oneself to make follow through with the advised and intended behaviour.

Sustainability can be described as the processes by which natural systems continue to function, remain diverse and produce everything necessary for the ecology to remain in balance. It takes into account how humans can live in harmony with the natural world around; protect it from depletion, damage and destruction and most importantly, preserving it for the future generation. In general, sustainability and sustainable development focus on maintaining a balance between two essential but competing human needs- the need for technological and economical advancement, and the need to protect the environments in which we inhabit. Environmental sustainability is defined as the interaction of human beings specifically with the environment to avoid depletion or degradation of natural resources and allow for long-term environmental quality. It is the ability of communities of plants, animals, micro-organisms, and their non-living surroundings to sustain themselves, and people, far into the future. Environmental sustainability ensures that the needs of today’s population are met without endangering the capability of future generations to meet their own needs.

The natural environment has the amazing ability to replenish itself through a recycling system in order to remain viable and sustain life- for example, a dead and decomposed plant adds nutrients to the soil which helps to sustain the growth of other plants. The major principle underlining environmental sustainability and sustainable development is that we, as human beings, must be able to live within our environmental limits. The consequences of going beyond these limits by stretching, wearing out and depleting the natural environment and resources are climate change and scarcity of resources. Presently, humanity is facing serious environmental and social sustainability challenges- global warming and inequity respectively. These challenges have been worsened by the dependence on innovation and technological solutions.

Human beings and other living things can interfere negatively or positively with the recycling capacity of the environment thereby influencing health, well being and survival. Unfortunately, human actions can deplete natural resources to a point where the environment cannot keep up with replenishing them; hence, the need to apply sustainability methods to support long-term viability.

However, sustainability is not just about the environment, it’s also about the health of the society- ensuring that environmental legislation and actions of humanity are conducive to the health of individuals and populations. This means fostering a strong, healthy and just society by meeting the diverse needs of all people, promoting personal well-being, social cohesion and inclusion, and creating equal opportunities. Sustainability is a broad discipline that gives insight to most aspects of the human world from business to technology to environment and the social sciences. It draws on politics, economics, philosophy, civic planning, environmental science, agriculture, corporate strategies, health assessment and planning, law and decision making and other social sciences.

The attainment of global environmental sustainability is dependent on intact and healthy ecosystems. Healthy ecosystems are crucial to maintaining health, food security, economic growth, and social peace. Unfortunately, the earth’s ecosystems have been degraded- some to the point where recovery is impossible. Natural resources such as potable water and local food sources have been compromised and compounded by climate change and natural disasters.

For over 30 years, the global community has been collaborating to preserve the environment and sustain human life and health. These collaborations have achieved some progress in key areas such as carbon emissions, desertification, organic pollutants, and biodiversity. More so, sustainable agriculture, forestry and energy are some of the specific applications of environmental sustainability where agriculture, selective logging and use of renewable energy sources respectively, are used to sustain the environment.