Comment: Urbanisation is a challenge for public health

Historically, Malé city has been an engine of economic growth, a centre of culture, and a generator of ideas. But while human potential is infinite, resources are finite.

Urbanisation creates problems, but healthy cities can solve them. A billion people now live in the world’s urban slums. The urban population of Asia is expected to double between 2000 and 2030. The health sector needs to take the lead in calling attention to the enormous implications of this growth in cities for the health of the people who live and work in them.

On 7 April 2010, World Health Day, WHO will focus on the themes of Urbanisation and Health.

With the possibility that over the next 30 years all population growth will be in urban areas, urbanisation becomes a real challenge for public health.

Urbanisation is associated with many health challenges related to water, environment, violence and injury, noncommunicable diseases (NCDs) and their risk factors like tobacco use, unhealthy diets, physical inactivity, harmful use of alcohol as well as the risks associated with disease outbreaks.

In poorly planned cities, the urban poor are the ones who will suffer the burden of these and other health problems, including an increased risk for violence and for some communicable diseases such as tuberculosis and HIV/AIDS.

In 2008, the Human Rights Commission of Maldives (HRCM) carried on a “Rapid Assessment of the Housing Situation in the Maldives”.

In interviews in Malé, the study described issues such as exorbitant rent levels, housing space, size, overcrowding, unaffordable access to clean drinking water, and many other problems like unhealthy living conditions, social problems as a result of overcrowding.

Many of the respondents indicated that these problems were the key causes of rising social issues such as gang warfare and drug abuse.

Furthermore, several social problems are also faced within the household including child abuse, psychological impact in growing up in areas of overcrowding, breakdown of many families due to the hardship faced by them stimulating a ripple effect of social disorder for the families, particularly the children caught in the situation.

The assessment highlighted that the sources of such housing stress are many, but it is mainly attributed by the raising demand for housing as a result of increased migration of Maldivians and foreigners to the capital. There are over 30,000 international migrant laborers now living in Malé under more crowded situations.

In the rapid assessment, local residents reported as many as 30 men sharing 3m x 3m flats without running water or sanitation facilities. These workers have to queue at public water taps to access clean water and often have to sleep in shifts as not all of them are able to fit into the space they occupy at the same time.

Among nationals, they felt that public services in Malé and to a lesser extent in Hithadhoo, Thulusdhoo and Kulhudhufushi were significantly better than the services they could receive at home or urban centers closer to them, being hospitals, secondary schools and higher education the most commonly mentioned services.

Other important factors for individual and family migration included the availability of employment opportunities and higher wages in Malé and better prospects for developing one’s own business from the capital.

As we can see, it is important to note that the major drivers, or social determinants, of health in urban settings are beyond the health sector, including physical infrastructure, access to social and health services, local governance, and the distribution of income and educational opportunities.

The solution? Proper urban planning can promote healthy behaviours and safety through investment in active transport, designing areas to promote physical activity and passing regulatory controls on tobacco and food safety. Improving urban living conditions in the areas of housing, water and sanitation will go a long way to mitigating health risks. Building inclusive cities that are accessible and age-friendly will benefit all urban residents.

Such actions do not necessarily require additional funding, but commitment to redirect resources to priority interventions, thereby achieving greater efficiency.

The Rapid Assessment of the Housing Situation in Maldives conducted by the HRCM, concluded providing a series of recommendations, which together are designed to kick-start a broader process leading to continuously improving housing conditions in the Maldives.

Dr Jorge Mario Luna is the WHO Representative to the Maldives.

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Agreement signed for new higher education institution managed by Villa Education Services

An agreement has been signed between the government and Villa Education Services Private Limited (VES) for the development and management of a higher education institution at the Centre for Higher Secondary Education (CHSE) Annex.

The agreement was signed yesterday at the President’s Office by Minister of Education Dr Musthafa Luthfee on behalf of the government, and Dr Ahmed Anwar on behalf of VES.

President Mohamed Nasheed said VES was selected after considering all proposals submitted in response to the government’s requests in June 2009 for Public Private Partnership (PPP) initiatives for the education sector.

He added that this proved that local business could compete with international companies and win bids under the PPP initiative.

President Nasheed said the government’s aim was to improve the quality of education in the Maldives.

The agreement states that a new higher secondary institution named Villa International High School (VIHS) will be established and managed by VES.

VES must ensure the school caters for at least 800 higher secondary students in a period of three years, while progressively increasing the number of places for courses.

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HRCM begins human rights program for teachers

The Human Rights Commission Maldives (HRCM) has begun a two day training program for Teacher Educators of College of Higher Education’s Faculty of Education.

The program will be held on 23-24 March and is aimed at promoting human rights awareness among teachers and in schools.

The inauguration of the program this morning was attended by State Minister for Education Dr Ahmed Ali Manik, who highlighted the importance of right to education.

The program is part of HRCM’s efforts to create a human rights culture in Maldivian schools, and it will focus on topics such as the importance of human rights education, gender equality in schools and creating a human rights friendly school environment.

Twenty-four teachers will participate in the program.

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Police seek cooperation to stop gang violence

Police are launching a major operation to minimise gang violence, reports Miadhu.

Police have communicated with the courts, the Prosecutor General’s office, People’s Majlis and the media.

Police said gang violence is rising, and a gang-related case is reported to the Police every 27 minutes. There have been thirteen deaths and many injuries in the last three years relating to these cases.

Police said the main reasons behind gang violence were lack of education, unemployment and drugs. Police said most gang members were aged between 15 and 21.

Police Commissioner Faseeh asked the media for their full cooperation. He said full cooperation from all concerned members was essential in abating crime.

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President Nasheed speaks of development and politics in Noonu Atoll

President Mohamed Nasheed has said political rivalry in the islands should not impede their development.

Speaking at Noonu Manadhoo, in the final leg of his visit of the northern atolls, President Nasheed urged all parties to communicate in situations of disputes and disagreements.

He said the government would consider public opinion before implementing all its policies.

He spoke on the measures to be taken in improving the education system. He said school boards were formed in most of the schools and they were given considerable authority in the management of the schools.

The president noted the connection between educating the youth and the future development of the country.

President Nasheed also mentioned the transportation and housing projects being set up for Noonu Atoll.

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A little about Alison, IVP volunteer

Alison Warnock is a 24 year old from Edinburgh, Scotland. She describes herself as “a very over-enthusiastic Scottish girl” and says she absolutely loves the Maldives.

She is starting her second year teaching at Jalaluddin School in Kulhudhuffushi Island in Haa Dhaalu Atoll, in the upper-north province, as part of the International Volunteer’s Program (IVP).

She was working at a cancer charity in Scotland when her friend Sarah, who was also a volunteer in 2009, heard about the IVP. She asked Sarah if she could come along for the interview and got the job. Alison “saw what an incredible opportunity it was and took it.”

Her friends and family were all very excited about her coming, and some of them were slightly jealous. She says “there’s a misconception that every single island will look like the resort islands, with houses on stilts in the water and long, white sandy beaches.”

Even though she knew there would be some home comforts that she would miss, she packed her bags and flew half-way around the world.

Coming to Kulhudhuffushi

Alison arrived in the Maldives in May 2009 and taught until November of the same year. She then went home for five weeks and returned to the Maldives in January 2010.

Coming from a city like Edinburgh to a small island like Kulhuduffushi would be a great challenge for many people, but Alison says she “thrives in small communities”. She attended St. Andrew’s University, a soon-to-be 600 year old university in Scotland, which has “about 3,000 people less than the island.”

“I’m quite used to the small community feel where everybody knows your name. I like knowing where everything is and who everybody is. I love being in small communities, especially when everybody is so welcoming and friendly and everything is so beautiful.”

She says the entire community has been very supportive of her.

“If my washing machine isn’t working or I don’t know how to cook something, they all help me.” She says she never feels alone.

She is picking up some Dhivehi, but says she can understand a lot more than she can speak.

“My accent doesn’t help,” she says with a giggle, “it makes words sound completely wrong, and sometimes it just means a completely different thing.”

Her neighbour finds Alison “hilarious” and they have bilingual conversations in the mornings.

Jalaluddin School

Alison is currently teaching three biology classes at Jalaluddin School: two grade 9 classes and one grade 10 class. One of her grade 9 classes is one she also taught last year, and she says they work like a “well-oiled machine” now: “I’m getting used to them and they’re getting used to me.”

The school’s head of department gave her an “idea of what needs to be taught and over what time-frame” at the beginning of the term. The departments then have weekly meetings where they discuss what the students have been learning.

“You can’t choose what to teach, but you have freedom to do it in whatever way you want,” she says, adding that her students enjoy films and slideshows. She’s teaching them about the heart this week.

The program has provided her with everything she needs and she says “even the things I didn’t think I would need I can get easily on the island.”

The school went on a science trip once, and Alison says it was nice to be around her students in a non-classroom environment which allowed her to get to know them better.

“Everybody is really friendly, and we have been on some really nice staff trips. They have been some of the best days here for me, going on picnics to uninhabited islands.”

Home Sickness?

Alison has travelled to Canada and Thailand, among other places, but she has never been away from home for so long. “I’m really enjoying it, it’s an amazing country, it’s wonderful.”

The school organised a house for her, with bright purple and aqua walls, which is less than a five minute bicycle ride from the school.

“The house is so uplifting: I never feel depressed,” she says.

Although every now and then she gets a craving for something (unhealthy) to eat from back home, “some ice cream or chocolate or popcorn,” she says she loves Maldivian food. “It’s so healthy and tasty; just looking at my skin I can see how good the food is for me.”

Alison also tutors a girl after class and says the girl’s mother has just about adopted her. “She’s always checking up on me and she gives me dinner.”

Alison says she’s very lucky that the school has really good internet access.

“The internet just makes the world so much smaller. I can keep in touch with everyone,” she says. She speaks to her parents every Friday so she doesn’t “feel so far away.”

She loves the lifestyle, the colours, the food, the weather, the view, and her job. And she says if she ever gets stressed, she just has to walk 500 feet and she’s at a spectacular beach: “What’s not to like?”

Alison will continue to teach until November this year, when she will decide whether or not to renew her contract for a third year. “I don’t know if I will renew it again,” she says. “It’s something about the Maldives, I don’t have to look too far ahead.”

There are currently fourteen other education volunteers in different islands throughout the Maldives working through the IVP.

The International Volunteer’s Program (IVP) began operating in 2009 in a partnership between Friends of Maldives (FOM), the Ministry of Health and Family, the Ministry of Education and the Ministry of Foreign Affairs. It is coordinated principally by the Maldivian High Commission in London.

Its intent is to recruit qualified teachers and health professionals from overseas. The education volunteers teach in local schools in small island communities.

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Vice President says improving standard of education is top priority

Vice President Mohamed Waheed said improving the standard of education was a top priority for the government, speaking at the 25th anniversary assembly of Jamaluddin School yesterday morning.

Speaking to the students, he urged them to be obedient and strive for excellence, assuring them that the government is working to improve the standards of education.

He spoke of the importance of good behaviour and social discipline, and said the school environment should facilitate extracurricular activities.

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Maldives’ youth delegates return from Copenhagen

Three of the four young climate delegates from the Maldives have returned from representing the island nation at the youth climate conference in Copenhagen, Denmark.

The event preceded the United Nations’ Climate Change Conference (COP 15) that began today, where 192 parties are meeting with the intention of formulating an agreement to stabilise the level of greenhouse gases in the atmosphere. Organisers hope the conference will prove as successful as COP3 in 1997, known as the Kyoto Protocol, which led to agreements on mandatory emission reductions.

Aishath Shifana, Mohamed Ansar and Aminath Riuman Wasif returned home on Sunday while the fourth Maldivian delegate, Mohamed Axan Maumoon, will remain in Denmark for a several more days after being chosen to meet the Danish Prime Minister.

Axan is revelling in his role as youth climate ambassador of the Maldives, appearing on award-winning US news program Democracy Now, the largest community media collaboration in North America.

“On the basis that you know what you are doing is wrong and you can see that the victim is begging for mercy, would you commit murder?” Axam asked the program’s viewers.

The other school students were welcomed home at the UN building by Education Minister Dr Mustafa Lutfy and UN staff including Mansoor Ali, Unicef representative to the Maldives.

Mansoor urged them to “keep up the momentum”, by trying to engage more of their contemporaies in tackling climate change, pledging the support of Unicef, while Lutfy offered the support of the education ministry to buoy the efforts of the schools’ climate clubs.

“I hope the trip was useful from an individual perspective as well as anchoring your efforts into the future,” Mansoor said, adding that he hoped the students had also had time to see Denmark.

Officer-in-charge of the United Nations Development Program (UNDP) in the Maldives, Dr Arun Kashyap, suggested the students continue to work together and develop a proposal for a youth climate summit to be held in the Maldives.

Coping in Copenhagen

The Maldivian delegates explore a forest in Denmark
The Maldivian delegates explore a forest in Denmark

During the week-long visit to Denmark, over 200 delegates aged 14-17 from 42 countries set up stands in Copenhagen town hall promoting their country’s efforts to combat climate change. The Maldivian delegates confessed theirs “was one of the most popular”, with many people fascinated by the immediate threat climate change and sea level rise poses for the low-lying island nation.

“It was very interesting to see how people responded to the issue of sea level rise,” Wasif explained. “Everyone kept saying: ‘we’d better go and see the Maldives before it is under the sea.'”

The Maldivians’ response, Ansar said, was to say “we don’t want to be under the sea. We’re an innocent [party] suffering from the actions of developed countries.”

The students’ enthusiasm for their subject was quickly picked up by the attending media and the group were inundated with interviews throughout their time in Denmark, frequently making national headlines.

There were a lot of journalists and we were always busy with interviews,” Ansar said. “I don’t think we’ll ever be afraid of journalists again,” he laughed. The trick, he explained, was “to talk normally, as you would to a friend.”

Seeing an opportunity to gain support from the education ministry, Shifana asked Lutfy to “please give the school climate clubs more support, because they are the least popular clubs in school.”

“We would like more students to join and be as interested in the environment as we are,” she said.

The four students were chosen from across the Maldives. A short-list of 10 competed in a quiz broadcast on TVM, from which the final four were selected.

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