Rural Health in the Third World

If statistics regarding health in rural areas of developed countries such as the United States are discouraging, rural health statistics for developing countries are even more so. Infant mortality is 60% higher in rural versus urban South Africa. Rural children are 77% more likely to be underweight or under height for age. Eighty percent of the poor in Latin America, 60% in Asia, and 50% in Africa live on marginal agricultural lands of low productivity and great susceptibility to degradation, encouraging migration from rural to urban areas. This exacerbates the already terrible problems of the world's cities where more than a billion people live without garbage disposal or water drainage facilities and breathe heavily polluted air. If this unhealthy urban drift is to be reversed, both the economic and physical health of rural populations must be addressed. Poverty leading to ill health and low productivity is a vicious downward spiral (8).

Patterns of illness and injury in rural areas are not only related to poverty. Work injuries, in general, are more serious and more severe in rural areas, following from the stoic attitude and "too tough to care" mindset of farmers and agricultural workers. The specifics differ from country to country, but there are always diseases and illnesses that are peculiar to living and working in rural areas such as zoonoses and other animal or insect-borne diseases. In many rural areas, at least some of the time, there is no means of transportation or evacuation for critically ill or injured patients. In addition, simple communication between rural areas and sites of higher level care is inconsistent to nonexistent.

In response to these problems, the World Health Organization has initiated the Towards Unity for Health (TUFH) project, which will attempt to integrate individual health and community health-related activities through involvement of traditional medicine and public health. WONCA, the World Organization of Family Doctors, has been a co-leader in the development of this project.

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