Institute for Health Metrics and Evaluation (IHME). Health related SDG's. Seattle, WA: IHME, University of Washington, 2016. Retrieved from http://ihmeuw.org/3xfm
Go to the following website for more health data.
Health Factors and Disease
The relationship between health determinants and disease can be directly linked. Three elements that foster these relationships include environment, occupational and nutrition health. According to Skolinik (2016, p.172) “24% of the global disease burden… [and] 33% of the total disease burden in children are attributable to... environmental risk factors” that include sanitation, hygiene and air pollution. Occupational health is broadly defined as an unintentional injury and includes, but is not limited to, road traffic accidents, falls and drownings. Nutrition and health are synonymous; nutrition is the foundation for many Sustainable Developmental Goals (SDG). Important nutritional resources are improved water and micronutrients. Health starts with women, proceeds through maternity and is societally impactful if mother and child make it through birth alive (Skolinik, 2016). The following will detail these concerns and suggest possible health promotion.
The environment has many factors that lead to disease and death in low income countries. Betty Neuman, a nursing theorist and mental health expert, believed (as cited in Alligood, 2014, p.287) the client “interacts with this environment by adjusting himself to it or adjusting it to him.” The primary interventions for her Systems Model is prevention. Through identification, education and support, the client can achieve a state of wellness.
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Household and ambient air pollution account for 197.2 deaths per 100,000 people and household air pollution has 41.5% risk-weight prevalence. Many rural families cook inside the house and a majority of menstrating women use hand made heat sources when they go to the customary chaupadi shed. Fossil fuel and biomass fuel don't burn completely and leave very fine air particles. Goal 7 for the SDG focusses on “[ensuring] access to affordable, reliable, and sustainable modern energy for all.” Many people in Nepal are moving toward the cities and this can be seen by the increase in fine particulate matter (smaller than 2.5 microns) of 60.3 mcg/meters cubed in 2005 to 75.0 mcg/ meters cubed in 2015 (IHME, 2016). These pollutants include carbon monoxide, sulfur dioxide, lead, and many others (Skolinik, 2014). As the population adapts to new environments, so too, does the environment adapt to the population.
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Sanitation and hygiene is part of the environment that rely on infrastructure improvements. Rural areas don't have road systems to expand sanitation or water capabilities and the political unrest for 10 years halted any possible improvements. There is 45.3% of the population still using unsafe or unimproved sanitation; that "is" improved from 97.5% in 1995. Unfortunately, hygiene has not made great progress. In 1995, 98.8% of people had poor hygiene compared to 97.6% in 2015. Poor sanitation and hygiene habits lead to increased illness and diarrheal or parasite disease. Menstrating women, young children and older adults need to be included in any focus groups that target improvements.
Environmental Health
Occupational injuries are identified by working environments and unintentional injuries. The top three causes of death in low to middle income countries are road injuries, falls and drownings. Unfortunately, disability from these factors play an equally detrimental role. A study by Wadman (as cited in Skolinik, 2016, p 405) concluded “for every person who died from an injury there were approximately 153 people who were injured seriously enough to seek the help of a health professional.” In 2010, there was only 1% difference between death or disability from unintentional injuries in low and middle income countries. Risk factors include child labor, unsafe work environments, immature developmental ages for specific tasks, and multiple issues with road traffic like car and road safety, more motorcycles, and poor road structures (Skolinik, 2016). The OCCUPATIONAL HAZARD DATA link above show the different values for falls, drownings, and road injuries that include pedestrian and motorcycle injuries. There are almost double the occurrence of injuries from males than from females (IHME, 2015). Data that highlights child labor risk factors were calculated when the United States Department of Labor (2015) estimated that 33.7% (2,097,163) of children, ages 5-14 yrs., are working in Nepal. Their work sectors include 88.8% in agriculture and 8.1% in industries like construction, metal crafts and stone work. Workplace environment and immature child development lead to multiple injuries.
Nutrition
Nutrition is the key to health. Not only is nutrition ingrained in the SGD's, it has a direct link to the life and sustainability of women and children. Skolinik (2016, p. 193-224) provided detailed relations between nutrition, mothers and children, and Millennium Development Goals (MDG).
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Breast feeding for 6 months promote better cognitive development
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45% of deaths in children under 5 years of age are linked to nutritional deficits
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Underweight and micronutrient deficiencies lead to childhood illness and death
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Poor nutrition causes and is a consequence of poverty
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Undernourished children miss more school and have poor performance
The Health Related SDG's show cause for concern with mortality, stunting and wasting of children.
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36.9 deaths per 1,000 live births, under 5 yrs mortality rate
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21.6 deaths per 1,000 live births, neonatal mortality rate
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37.7% stunting of children under 5 years of age
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11.0% wasting of children under 5 years of age
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84.6% of people use unsafe or unimproved water
There are good results related to maternal care. Family planning (60.9%) and skilled birth attendance (50.7%) are continually increasing. This can have a long term influence on knowledge and better nutritional outcomes.
Changing the lives for Nepal women and children can continue to improve. Using Dorothea Orem's Theory of Self Care (Alligood,2014, p.248),"Self-care must be learned, and it must be performed deliberately and continuously... [and] associated with their stages of growth and development, states of health..., level of energy expenditure, and environmental factors." In a paper examining client participation and co-production of health care, it is concluded that women, children and adolescents can transform their lives. Through community, government, private organizations and individual participation, shared responsibility can support the underserved until the individuals can take full ownership (Marston et al., 2016).
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One way to increase the knowledge of nutrition and maternal/child care is to facilitate local community mentors and use trained health care agents. Teaching individuals proper nutrition, breastfeeding, good hygiene, proper hand washing and sanitation, can empower women to be autonomous in their health care. Using other women in the community helps solidify participatory learning and confidence in the delivered knowledge (Marston et al., 2016).
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Another way to ensure continued progress is to create services based off the community needs. Including the people in the community is necessary when planning and implementing quality improvement plans. These individuals are respected in their community and can advocate for the underserved (Marston et al., 2016).
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The last tool for promoting good health is using up to date technology. Advertising can be sent through television, radio, paper fliers, billboards, school class, and village health committees. Knowledge brings power and that will drive many to seek better care. With power, they will demand their rights and seek refuge with organizations that can support them (Skolinik, 2016, p.182).