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Time Traveling


Around the world ...

A week-long meeting on Community Health Development was held in Salzburg, Austria earlier this year that should be of interest to all readers of the CEDROS newsletter. Your Executive Secretary, Thomaz Chianca from Rio de Janeiro, was an active participant as well as 75 others from 33 countries in North and South America, Africa, Europe, and Asia.

The meeting was held at the Schloss Leopoldskron, a picturesque castle set on an Alpine lake and operated by the Salzburg Seminar, an international conference center affiliated with Harvard University. The Kellogg Foundation provided a modest amount of financial assistance for the meeting.

The purpose of the Seminar was to explore the meaning of "community" and its critical role in assuring the conditions under which people can become or stay healthy. Dr. Dan Kaseje, a Kenyan who is affiliated with the International Red Cross / Red Shield Agency in Geneva, Switzerland, opened the meeting by examining the causes that have led to the current high levels of ill health and death, especially among the vulnerable groups worldwide. He discussed the key role of health professionals in leading an agenda for change. He challenged Seminar Fellows to commit themselves to a process that would lead to societal transformation, one that would involve the true liberation of every person from personal, social, cultural, political, and economic limitations.

John McKnight, Director of the Center for Urban Affairs and policy Research at Northwestern University (USA), advanced the vision of the Seminar by defining "community". Communities are not like organizations or institutions... they don't take a systems approach to decision making, he said. Rather, they are associations of citizens who by consensus develop a plan of action. Organizations provide services and products; communities provide care; both are needed for a healthy society. It is not uncommon for professionals to concentrate almost entirely on health systems/services, however, and ignore the enormous assets and potential contributions of community groups.

Seminar fellows took two days to examine the role of different kinds of communities in three case studies: Ceara (Brazil) Proais Primary Health Care Project; Slovakia National Program for Health Promotion; and the Aga khan Kisumu Primary Health Care Project in Kenya.

Dr. Sheila Tlou from the University of Botswana nursing faculty then led a discussion on the concept of collaboration in community development, focusing on some of the non-health parameters of building community capacity. Among other things she discussed were education, jobs, housing, environmental programs, transportation, and economic and social improvement.

Dr. Eugenia Eng from the University of North Carolina School of Public Health examined the social change model of health educators as an academic/practice discipline, then reflected on their broad mission as "community health developers". She gave a scholarly review of the lifework of Guy Steuart, a South African behavioral scientist and teacher, and of his philosophy of connecting community behavior and health practices.

Towards the end of the week two members of the Seminar faculty took the discussion towards its ultimate conclusion: Dr. John Bryant from Vermont (USA) discussed Community-Related Primary Health Care as practiced in the Aga khan University medical and nursing school in Karachi, Pakistan. He discussed such issues as health system development in impoverished communities, the pursuit of equity in health care, costs and impacts, the role of universities, going upscale to larger health systems, and an international convergence of perspectives.

Professor Sebastião Loureiro from the International Association of Health Policy in Salvador, Bahia, Brazil, discussed community health from a policy perspective. He framed his ideas in a context of conflict and power issues, discussing desirable objectives such as empowerment, citizenship, learning, social control, control of bureaucracy, and negotiation. Finally, he reviewed a number of successful community policy experiences.

For the few who were privileged to attend this Salzburg Seminar it was a life-changing event. For the first time in memory we saw important issues and experiences in the Southern hemisphere that were shared meaningfully with leaders from the North. More importantly, those who were present experienced community at the same time that they talked about it! Through a series of small group seminars, regional meetings, and working groups the practical implications of the keynote lectures and plenary sessions were explored. Evenings were devoted to intensive discussions and networking between people of many cultures who were present.

For those who were not able to attend, the lessons are just as real: Health Is Not An Island! The solutions to the most important health problems of our time lie not in tons of money and thousands of new health services, but investing in partnerships of shared responsibility between (1) people in communities who understand the cultural context of many of the most important health problems and (2) professionals who have knowledge and expertise to share, plus the willingness to collaborate. Dr. Kaseje speculated that health professionals in the future will likely practice in quite a different mode... "In the final links", he said, "we may begin to rediscover ourselves through the eyes of our own dispossessed and hungry - (and at that time a phenomenal change will be seen in) our value judgements, our life-style, our government".

Mailing address:

Dr. Thomas Bruce

W. K. Kellogg Foundation

One Michigan Avenue East

Battle Creek, MI, 49017-3398

USA

Fax: (616) 969 2127


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