NORTH SOUTH UNIVERSITY

School of Health & Life Science

Department of Public Health
Semester: Summer 2020

Course Name: Introduction to Public Health

Course Code: PBH 101
Section: 15

Submitted to:
Lecturer, Segufta Dilshad (Sgd)

Submitted by:

Mashiwiyat Tabassum 1610567030

Critical Analysis on the paper ‘Community health case studies selected from developing
and developed countries – common principles for moving from evidence to action.'

The research paper, Community health case studies selected from developing and developed
countries – common principles for moving from evidence to action, by Franklin White & Debra
Nanan was published  Archives of Medical Science 4(4):358–63 in December 2008. The paper's
thesis is the importance of household & community health care in developing and developed
nations. Through case studies of healthcare initiatives in various countries, the evidence is
observed about the success of these frameworks and strategies. The paper also addresses the
importance of action and leadership to promote social development, public health policies, and
healthcare system development in countries suffering from poor health conditions. From the
paper and the case studies, it is understood that to have a healthier society, health risks should be
addressed from homes and community levels. By incorporating health goals within a wide range
of public agendas, government programs & private sector initiatives, and also by committing to
the evaluation and outcomes of these processes, substantial evidence can be achieved to the
actions of applying an effective strategy for community health. Although the author has provided
convincing evidence through case studies and research, my understanding and interpretation of
the author's findings have been presented in the following critical review of the research paper.

In the case studies of the developing countries, the first story is about AMREF, an African health
NGO. For the first two decades, they used to deliver their service through the clinic, where the
people used to visit them whenever necessary, like the traditional way. However, they soon
realized that this was not enough, and they needed to involve the community in it by informing
them and teaching them about good health care. AMREF later worked for different diseases like
malaria, HIV, and school health, water. Sanitation and hygiene. They succeeded in their work
behind primary health care and tried to improve people's health by working with other factors
that play a role in people's health, such as environment, culture, economics, micro-financing,
politics, etc. In Kenya, there have been many problems with diseases and hygiene, such as
swarm flies and wives preparing meals on the adulterated floor. This caused diseases like
trachoma for which WHO supplied antibiotics and hygiene supplies with environmental
improvements.
Another example is given about the health field side of Aga Khan University, AKU. They
worked for the Karachi's squatter settlements and resulted in decreasing the mortality rate of the
infants and maternal by more than half. After this, Pakistan's educational model also involved
learning about primary health care. They started following the evidence action strategy by
designing, implementing, and also evaluating their projects. AKU had a major growth surpassing
the boundaries of the country. In the Lasmo operation states, the most successful work was
setting up a healthcare center in Jangara, which looked after Maternal and Child health,
providing ambulance service, etc. resulted in increased visits of patients. Moving clinics were
sent to isolated villages. Mauritius showed a great decrease in chronic diseases by changing their
lifestyle, such as healthy eating habits, exercising, stopping smoking, and reducing alcohol
intake.

The very first example given in the article about the developed countries include the North
Karelia Project, where ischemic heart diseases decreased to more than half in Finnish province
due to a reduction in the use of tobacco, hypertension and blood lipids. The locals' diet was high
in salt and fat, but they educated the population about the adverse effects and made them shift to
margarine and vegetable oil from butter to low-fat milk from whole milk, which showed a
significant decline in the cardiovascular diseases.

WHO had a project named 'Healthy Cities- Healthy Communities, ' which focused on improving
the quality of life by exercising, sports, physical activity, and recreation.

Another example is included, which is of the ActNowBC, where they aimed to avoid diseases by
spreading prevention and changing lifestyles. They aimed to reduce chronic diseases by bringing
out changes in the determinants like smoking, physical inactivity, low fruit, and fiber intake, and
alcohol misuse. ActNow went beyond the health sector, trying to include other sectors like
community services, education, agriculture, etcetera under the health ground.

The writer tries to paint an awareness about changing our lifestyle, habits rather than just trying
to cure ourselves with medical help when we get ourselves entangled with diseases. He tries to
prove his point that other than medical help, there are a lot more determinants in the health of
communities. There are many more things that can be done and are successful in doing so as
statistical shreds of evidence support his argument. It is better to reform our eating habits and
lifestyle to prevent ourselves from diseases rather than crying for it. Afterward, a disease gets us.
He gives evidence about diseases in Kenya, decreasing from 47% to 16% in 3 years old children,
trachoma declining from 4.5% to 1.7% by merely improving hygiene and living in a cleanlier
environment. The AKU's project about improving healthcare and educating the community
through locally recruited health workers has shown such constructive results that the article has
evidence of AKU crossing the border throughout South Asia and East Africa. AKU attracted the
government's attention, and the government's policy for resource companies to provide 5% of
their profits for local development was also inclined towards AKU. It proves that it was only
happening as the projects were actually working. People became more aware of the health care
of children and themselves. There is also statistical data about the Lasmo operation states where
less than 200 people used to visit clinics, the number increased to 800, due to learned
communities. In Mauritius, in 2005, life expectancy increased from 66.7 years to 69.2 years for
men and 74.5 to 75.7 years for women. All these improvements were possible not only due to
better medical care but as stated in the article due to everything, including social development,
healthy public policies, and health system developments.

There are pieces of evidence stated in the article that more than half of the heart diseases
decreased in the Finnish States, and after 25 years, cardiovascular diseases reduced by 73%, lung
cancer by 71%, and the mortality rate by 49%. The 'Healthy City-Healthy Communities
'movement spreaders to more than 50 countries, which proves its success.

The writer says that the success factor can be measured by looking at how motivated
stakeholders and interest groups are. The writer writes about the plans and projects funded by
different investors, which proves their work for the community is on the right track.

The writer starts the paper with a quote, and I would like to conclude with the same quote from
the African Medical and Research Foundation (AMREF): “80% of health is made in households
and communities; only 20% is repaired in hospitals and clinics” and proves it all the way along
the passage. When we get infected, hospitals and clinics are the way; however, the infection
should be prevented by maintaining a healthy lifestyle, healthy nutrition, involving in physical
activities, staying in a healthy environment, and definitely maintaining hygiene. However,
leadership and political support are imperative in all stages.
T“there is strong evidence that
behavior and environment are responsible
for over 70% of avoidable mortality,
and health care is just one of several
determinants...”
“There is strong evidence that
behavior and environment are responsible
for over 70% of avoidable mortality,
and health care is just one of several
determinants...”
“There is strong evidence that
behavior and environment are responsible
for over 70% of avoidable mortality,
and health care is just one of several
determinants...”
“there is strong evidence that
behaviour and environment are responsible
for over 70% of avoidable mortality,
and health care is just one of several
determinants...”
“there is strong evidence that
behaviour and environment are responsible
for over 70% of avoidable mortality,
and health care is just one of several
determinants...”
“there is strong evidence that
behaviour and environment are responsible
for over 70% of avoidable mortality,
and health care is just one of several
determinant