Prof. Lalitha Mendis presents a ‘Snap Shot’ Account:

From disabled to differently abled

Prof. Lalitha Mendis President SLMA presenting a snap shot account on the Sri Lankan situation on the Disabled to Differently abled situation in Sri Lanka, at her induction in office as President SLMA for 2008 said.

From disabled to differently abled

“SLMA as the umbrella body of specialists and doctors in this country has a wide range of activities, an important one among them being advocacy and promotion and taking up position on national health related issues.

In keeping with this, I have selected disability in Sri Lanka “From the disabled to the differently abled” as the subject of this address because I sincerely felt that it is a subject that needs serious attention and focus.

“In the 30-40 minutes available to me I can only present a snap shot account of its many facets in Sri Lanka and hope that the windows I open may capture the essence of the present situation.

Diversity fact of human society

“Diversity is a fact of human society. The human species is comprised of a wide spectrum of persons hugely varying in appearance, intelligence, physical and mental ability?

“The late Prime Minister of Sweden Olof Palme, speaking at the Stanford University Law School in the 1970s summed up the divergence between the US and Swedish attitudes to persons with disabilities.

He said, “Americans regard the able bodied and disabled as effectively, actively or not, consciously or subconsciously, two separate species, whereas - swedes regard them as humans in different life stages: all babies are helpless, cared for by their parents; sick people are cared for by those who are well; elderly people are cared for by those younger and healthier, etc.

Able bodied people are able to help those who need it without pity, because they know their turn at being not able bodied will come. An important, enlightened and liberal perception - We all pass through various phases, swinging between different shades and grades of disability.

The American concept in the 1970s a different species - disabled humans.

The Swedish concept - members of a huge spectrum of the same species of differently abled persons. In short ladies and gentlemen They Are Us, We are Them.

What is the Sri Lankan concept? I invite you to make that judgement at the end of this address.

WHO definition

The WHO definition of 1980 states that - “It is a restriction or lack (resulting from impairment) of ability to perform an activity in the manner or within the range considered normal for human beings. “This may be considered as the medical model.

By contrast, the social model of disability focuses on human rights, and the functioning of the disabled within the environment, highlighting the role of society in labelling, and maintaining disability in the society through attitudes and physical barriers erected by society.

Both models agree that opportunities should be provided to the disabled to adapt to the environment through the dismantling of barriers and this is referred to as a “fostering accessibility.”

Laws on the disabled

Sri Lanka signed The United Nations Convention on the Rights of Persons with Disabilities on the 30th March 2007 but regrettably, so far, the government of Sri Lanka has not ratified it.

Constitution of the Republic of Sri Lanka - has a clause for special provision being made by law, for the advancement of women, children or disabled persons.

The protection of the Rights of persons with Disabilities Act No. 28

This Act was passed in Sri Lanka in 1996 and

Through this act a National Council for persons with Disabilities was established.

The Act provides for the protection of disabled persons against discrimination.

A person who is subjected to discrimination, may apply to the High Court which is given the discretion to grant relief or make directions. However, non-compliance with the provisions contained in the Act does not give rise to specific penalties and/or criminal or civil liability of any kind.

The Disabled persons accessibility regulations gazetted in October 2006 gives detailed regulations with diagrams on how public buildings, public places and places where common services are available should be made accessible within 3 years. Very few of these we see.

There is nothing to say in the Act that such regulations which flow form the Act are given the same status in law as the provisions of the Act. It is usual for an Act to specify that the regulations enacted under its provisions have the force of law and are enforceable in a court of law - but not in this case.

So, there are gaps in the existing regulatory framework

The Public Administration Circular No. 27/88 of August 1988 instructs all ministries departments and corporations to allocate 3 per cent of the job opportunities in the public sector to persons with disabilities. 20 years on, it would be of interest to find out how many institutions have implemented this circular?

Sri Lanka has several more legal enactments pertaining to the disabled, a statement of national policy and more legal enactments are in the pipeline.

What is important is:-

* To amend current legislation to address existing gaps

* To implement them for the benefit of the disabled and

.To create wide awareness among the disabled, their care givers and well-wishers of what redress is available to them through the law.

What is the size of the disability problem in Sri Lanka?

There is a dearth of reliable data of how many disabled persons there are in Sri Lanka. Various estimates including a flawed census have yielded figures ranging from per cent to 13 per cent.

Global statistics show that of a world population of 6.6 billion, 600,000 million i.e. 10 per cent are disabled.

So by global estimates, it may be predicted that any one time, Sri Lanka has about 2 million disabled persons.

(continued next week)

A new vision on health

Dr. Terrance PERERA

The commission on Social Determinants on Health setup by the WHO in March 2005 to study why the WHO goal of Health for all by the year 2000 has been slow to achieve, has in an interim report proposed a ‘new vision on health’ calling it ‘worldwide Health Equity.

Dr. Terrance Perera former WHO senior advisor writing on this states

A new vision - achieving health equity for all

Nearly 30 years ago, the World Health Organization convened a global meeting at Alma Ata, where the member countries adopted the Alma Ata Declaration setting out Health for All by the year 2000 as a new framework for international health.

However, the new millennium came and went with much fireworks, but with health still remaining in the hands of a few wealthy nations.

This was not entirely due to a faulty vision, but to an inadequate understanding for social determinants of health, and thus, hindering the practical application of this knowledge in improving population health.

Interventions aimed at reducing disease and saving lives, succeed only when they taken the social determinants of health adequately into account. Much is known about these determinants from national and international projects and research, but the knowledge is still too fragmentary. That knowledge needs to be more fully developed and widely shared so that it can be used.

Therefore, in keeping with WHO’s continuing commitment to the longstanding Health for All initiative, launched the Commission on Social Determinants of Health, in March 2005, at Santiago, Chile, with equity as the main focus.

The Commission, which comprised of an impressive array of academics, researchers, and political luminaries, was appointed for a period of three years.

The Commission has released its interim report recently (September 2007), which sets out a new vision in what it calls worldwide “Health Equity ‘, to mean, fairness of opportunity for all to achieve and maintain good health.

The intention is to kickstart a global movement to tackle at all levels and all sectors, the social, environmental, economic, and political factors that underpin inequalities in health the so called “causes of causes” of ill-health.

What has previously being lacking is the thorough understanding of the links between the various determinants and the types of illness they can lead to, and a much better evidence base to how they can be tackled. This interim report has looked in depth at three case studies.

Firstly, a trade union of female street vendors in India, which has set up a wholesale health and social service; secondly, a state run welfare scheme for the poor in Brazil; and lastly, a programme to increase employment and promote cardio-vascular health in an economically depressed part of northern Sweden. All three schemes are making a big difference and are sustainable.

Given that all the biggest gains are likely to be made outside the healthcare system, what part can the health professionals play in all this? Potentially, the answer is a very large part.

Health networks are among the most firmly established and extensive in the world, and the health professionals have powerful means for sharing the knowledge, skills, and expertise with communities and nations who could most benefit from them.

The Commission will release the final report with detailed recommendation, next year, which is the 30th. Anniversary year of the Alma Ata Declaration. The report, would help all countries worldwide in the formulation of meaningful policies towards promotion of population health, through health equity for all.

It is interesting to note that our Ministry of Healthcare the Nutrition has published the draft proposal for the National Health Promotion Policy in the Daily News November 6, 2007 inviting views and suggestions from the public on the proposed draft policy.

In this regard it needs to be mentioned, that, the final report of the WHO Commission may help in further contributing to the strategies already mentioned in the present draft national policy proposal.

Children of teenage dads risk problems at birth: study

A child born of a teenage father is more likely to have problems at birth ranging from pre-term delivery and low birth weight, according to a Canadian study published Thursday.

The same newborn is also at greater risk of dying, says the massive study, which examined data for more than 2.6 million live births in the United States between 1995 and 2000.

At the other end of the age spectrum, researchers found that older fathers, 40 and over, posed no additional risk of these problems occurring.

Taken together, these findings which held true independent of other factors such as the age or health of the mother turn conventional wisdom on its head.

It has long been established that advanced maternal age increases the chances of foetal death and a whole range of health problems for newborns.

But the possibly adverse impact of paternal age on births has been relatively ignored, according to the study, published in Human Reproduction, an Oxford University Press journal.

In some cases, data is simply not available. In the United States, recent information on fathers, for example, is missing for 39 percent of unmarried women giving birth.

And earlier research that did link a host of problems at birth to older dads foetal death, spontaneous abortion, pre-eclampsia, heart defects, dyslexia may have been flawed due to small sample sizes or the failure to account for other factors, such as maternal age.

For the Canadian study, a team of researchers led by Professor Mark Walker of the University of Ottawa, looked at data for 2,614,966 babies born live in the United States to married women aged 20 to 29. Multiple births were excluded.

For each of these births, Walker and his team had access to complete information on the age and race of the father, prenatal care, and birth weight of the child.

Women in their twenties were the least likely to be affected by decreased fertility, which can create problems at birth.

The researchers found that babies born to teenage fathers were 15 percent more likely to be born early, 13 percent more likely to have a low birth weight and 22 percent more likely to die within four weeks of birth.

The danger of death doubled to 41 percent for the period between four weeks and one year old.

“The magnitude of the risks to society could be huge, given the numbers of births worldwide,” said co-author Shi Wu Wen of Ottawa University.

Fathers 40 or older did not confer additional risk for their offspring for any of these criteria.

While the link between young fathers and problems at birth is clear, said Wen, the causes are less so.

“It is biologically plausible that paternal age might play a role in the risk of adverse birth outcomes,” he said, pointing to previous studies showing that immature sperm may contribute to the abnormal formation of the placenta in the uterus.

AFP

Mind your heart

Fat people are thin at their hearts! Why? Because their hearts are more prone to disease. For your information, individuals with a BMI of at least 30 have a 50 percent to 100 percent increased risk for death compared with individuals at a BMI of 20 to 25.

Mortality rates from many causes are higher in obese people, but heart disease is the primary cause of death.

People who are obese have almost three times the risk for heart disease as people with normal weights.

Being physically unfit adds to the risk.

Obesity poses many dangers to the heart. Let’s look at some.

* Damage to the Blood Vessels:- Studies have reported higher levels of a factor called C-reactive protein, which is a marker for inflammation and damage in the arteries from an over-active immune response.

Changes in body fat as people age, particularly increasing abdominal fat, have specifically been associated with stiffness in the aorta, the major artery leading from the heart.

* High Blood Pressure:- Hypertension is the health problem most commonly associated with obesity, and greater the weight, greater the risk.

While hypertension carries its own serious risks for stroke and heart attack, overweight people with high blood pressure are also at increased danger for enlargement of the left heart chamber, a major risk factor for heart failure.

The link between obesity and high blood pressure are complexed and may reflect interactions of genetic, demographic, and biologic factors.

Many studies have reported that modest weight loss is beneficial for reducing existing blood pressure and the risk for heart failure.

(For more information, see the Well-Connected Report November 14, High Blood Pressure.)

* Unhealthy Cholesterol Levels and Lipid Levels:- The effect of obesity on cholesterol level is complexed.

Although obesity does not appear to be strongly associated with cholesterol levels, among obese individuals triglyceride levels are usually high while HDL (the so-called “good” cholesterol) levels tend to be low, both risk factors for heart disease.

* Stroke: - Obesity is also associated with a higher risk for stroke.

This is actually a new risk of heart diseases generally most of us neglect.

To prevent heart diseases, we must be conscious about our body weight too.

Though the level of cholesterol is the main indicator of the heart disease, the body weight will indirectly pose a risk.

This is why we always tell you, that you are up to a good course.

By a weight loss program, you will reduce a whole array of risk factors for your life.

Ultimate beneficiary is you, So, do not worry to invest on it.

Laughter the best medicine

A couple comes to the Art Gallery and walks about admiring the paintings.

At one of the rare paintings where, where a gorgeous girl dressed only in a few strategically placed leaves, the man keeps gazing rapturously for a long time.

The woman raps him on the shoulder and says ‘Are you going to wait till autumn comes for the leaves to drop!.

Sent by Kumudu Liyaage, Halawatha.