Social vaccine, women s issues, and road traffic most relevant issues to Egypt's health development CAIRO: Amid topics ranging from AIDS research to crisis preparedness, the most critical issues addressed by the Global Forum for Health Research, which concluded Nov. 2 in Cairo, were a proposed "social vaccine, women s issues and road traffic accidents. Chairwoman Pramilla Senanayake told The Daily Star Egypt that themes are chosen in part for relevance to the host countries main concerns. Women s issues, however, have been a concern for the conference from the beginning. Discussing these issues were Egyptian experts Amal Abdel Hadi, Magda El-Karadawy and Mahmoud Fathalla, among other foreign presenters. Sexual violence in health is very important but not discussed enough, said Abdel Hadi, an expert on women's issues. She cited the CNN documentary on female circumcision and the Attaba rape in a public square in the '90s as shocking the public into opening discussions on gender matters. Drawing on international research, she cited the following world estimates: 36 percent of females and 29 percent of males have been sexually assaulted; between 12-25 percent of females are forced into sex work; approximately one-third of women have been battered within the context of marriage. Specific figures for the Middle East are seriously underreported and in Egypt, the problem, as usual, is the lack of information, she added. The issues of rape and the seeking of treatment are fraught with problems in Egypt. Sexual violence cases are taboo, says Abdel Hadi. If a girl goes to the police, she s scandalized. Many girls will not even seek health treatment because they must be sent to police before going to forensics, a process where the victim is re-victimized with double examinations, police harassment, and even being kept in the same room as the attacker. Even when a victim does seek professional help, there are few rape kits and there are no guidelines, no process, for victims of sexual assault. They do not even receive emergency contraceptives and Abdel Hadi says the psychological trauma is not dealt with at all. Hospitals do not even treat victims unless they are severe cases. The experts asserted that the Egyptian law pardoning rapists if they marry their victim punishes the victim twice and is inexcusable. Panelists also addressed controversial issues such as the government s role, marital rape, and sex education. One particularly sensitive issue was that of marital rape. The law also does not even recognize rape within marriage, although Abdel Hadi says as many as 49 percent of women feel they have been raped by their husbands. Forced anal intercourse is prohibited though. Attendees discussed whether this society was ready for talk of marital rape. El-Karadawy suggested an approach to educate men through campaigns as an alternative to prescribing legislation, suggesting the citing of Quranic verses stating that husbands must obtain permission for intercourse. El-Karadaway also focused more generally on battered women syndrome, pushing for increased funding, documentation, and punishment. On the other hand, focusing on HIV and disease, Hind Khattab, director of the Egyptian Society for Population Studies and Reproductive Health, advocated education, Sexual education should begin from before pre-school. It should start with the family. In response to pubic outrage, Khattab says Al-Azhar told her to start and we will support you. Not all discussions of women had to do with sexuality or even reproductive health issues, however. Huda Zurayk reminded attendees of the need to listen to women, especially when of a lower-income status. These complaints are most often musculoskeletal in nature, such as back, joint and limb pain, and should be addressed. Perhap s Professor Fathalla s treatment would work for all female problems; his remedy, If I were to write one word prescribing women s health, I would prescribe power. A more unconventional but important topic for health research in Egypt is road safety. As is commonly known, traffic accidents are rampant in Egypt, with accident rates among the highest in the world. They are the second major cause of avoidable death here, claiming the lives of at least 6,000 people a year, and injuring another 30,000, according to the Ministry of Transport. The economic loss is estimated to be at least LE 3 billion yearly. According to presenter Shanti Ameratunga, 80 percent of global road accidents occur in developing areas and are related to increased urbanization and industrialization. The greatest victims of the modern battlefields are, ironically, lower-income groups within the society, as well as pedestrians. All presenters agreed that road safety and health more generally will improve with education and increased collaboration between ministries and sectors, addressing the health effects of all endeavors. On a more holistic note, a "social vaccine was proposed to tackle all health and safety issues. This social vaccine is an innovative multifold approach that addresses root sources of health such as education, culture, economics, and community. This approach elicited excitement from attendees. As one presenter put it, the session was the beginning of something extremely important. The social vaccine approach addresses large, society-based questions such as What factors in the social and economic environment encourage smoking? A couple of speakers blamed political factors such as neo-liberalism and globalization for negative policies and ill health. Although the experts at the forum were enthusiastic about the idea of a social vaccine, they noted that it is one of the hardest to convince politicians of, as its results are not immediate and are more difficult to quantify. Proponents of the approach emphasize prevention and overall healthier lifestyles, rather than treatment. Fran Baum of the People s Health Movement told The Daily Star Egypt that most people get most health care in the last year of life, illuminating the fact that health services don t give health, a common misperception. Achieving mass vaccination is not impossible, though. Baum suggests that the best method to implement it is by empowering communities. It is not simply a question of wealth, said Baum, citing Sri Lanka, Cuba and China as particularly healthy in relation to their income. She told The Daily Star Egypt that the top investments should be in education and in urban planning. She gave examples of positive planning as those which include community spaces, where walking is encouraged, and roads that are designed around the needs of people. Also important are health impact assessments of policies prior to implementation. Baum thinks the key is in providing a supportive environment where healthy choices are the easy choices. She said that locally people are thinking very seriously about [the social vaccine approach]. With approximately 50 Egyptians registered to attend the conference, including politicians and educators, forum findings and recommendations can be expected to have a positive impact on health policies. As evidence of the practical results of the conference, Chairwoman Senanayake cited multiple partnerships and initiatives emerging from past forums where participants told her, if not for the forum, we wouldn t have come up with them.
