Interview: health begins in the family

6 World Health • 48th Year, No. 2, March-Aprill995 Interview Health begins in the family WHO's recognition that families pro vide an entry point through which health care can be made available to al/ members of society throws new light on the Organization's fundamental strategy for attaining Health for Al/. World Heolth asked Dr Hiroshi Nakajima, the Director-General, to exp/ain why this is so. World Health: Dr Nakajima, can you tell us about WHO s approach to family health? Dr Riroshi Nakajima : WHO is proposing a simple yet dynamic approach to health , a powerful strategy to intensify and move forward the integration of health care, disease prevention and rehabilitation. It is based on an inclusive vision of health , comprising the individual, the family, the community, and the environment, in which families serve as entry points for health promotion, disease prevention and care. WH: Sorne people say that the family is an outworn concept. RN: Families are not a concept, but the primary setting for human development and the basic unit of society. The family has Provided ils members ore properly informed, the fa mi/y makes an excellent partner for the health professionals in maintaining good health status. evolved through history, presenting us with different structures in different ages, regions and countries. Y et it remains a universal reality, irrespective of its diverse forms. WH: What can families do for the health of individual people? RN: Families share a great deal more than their genes. Their members share lifestyles, diet, exercise and the same environ- ment, sometimes even the occupational environment- and frequently infections. Above ali, they have a common social environment, with its roles and relationships , pressures and pleasures, value systems, beliefs, modes of conduct and behaviour. Ali these represent a reality we cannot afford to ignore, especially if our ai rn is to improve people's health. Also, it is within the family that ill health is first identified and care initiated. WH: Don 't you think that in empha- sizingfamilies sorne groups of people may be left out? RN: On the contrary. While to sorne extent WHO has tried to target activities on so-called "vulnera- ble groups", it also realizes that no group or individual can be considered in isolation. Today, in general, people live longer, and the way in which they live each stage of the ir life cycle is changing profoundly. This, together with rapid social and economie change, makes it even more important for the natural links between generations to be strengthened because families can provide continuity and soli- darity between different age groups. For instance, in many World Health • 48th Y eor, No. 2, Morch-Aprill995 Fath 11 ebrs need lobe encouraged lo lake their shore of responsibility in ensuring the family's we- emg. places, the only support for the elderly and the only hope of escaping solitude remains their family. WH: ls the family health approach going to prove successful? HN: The family health approach makes sense technically, socially and financially. It makes good use of limited resources and is wellliked and accepted in ali cultures. Health is best promoted in families through their shared lifestyles, environments, food and hygiene. This is a major oppor- tunity for action, particularly in developing countries. WH: A re families aware of this? another, and of opportunities they can create for themselves. Informed opinion leads to au- tonomy and allows people to get away from the role of passive recipients into that of activists for their own health. We can open new partnerships inside families, in communities, between health professionals and farnilies, and between dif- ferent sectors of development. WH: How do WHO and its Member States encourage those partner- ships? 7 HN: By making health services acceptable to families and accessible to ali. By understanding the patient's expectations and grasping the many factors that determine health- not only biological fac- tors but those that are linked with the environment, personal- ity and behaviour. Cultural, economie and social factors to- gether defi ne the way patients are taken care of by the family, the medical institutions, and the whole of society. Here, 1 wish to emphasize that the family health approach does not place the burden of care on women alone. On the contrary, it is meant to involve whole families. WH: What about the rote of men in thefamily ? HN: WHO strongly supports the in- creased participation of men as an essential element in the fam- ily health approach. Men can and must play an important part in keeping track of children's immunization schedules and making sure that these are complied with. They can be enlisted to share responsibility for planning their family, pre- HN: Many families are aware of the care they can provide, but their knowledge and confidence are often undermined by an intimi- dating health system. Families need to be empowered and, through them, ali individuals. We can reinforce the knowledge and skills that families need to promote their own health, and keep them informed about health hazards and their preven- tion. We can make them aware of the ir potential as a farnily to pro vide care and support for one The more women know about health the belier they con core for their 8 venting sexually transmitted diseases and HIV/AIDS, caring for the young, and supporting and protecting the physical and psychological safety and well- being of the whole family. Together with women, men should receive appropriate information to enable them to take prompt action in an emer- gency, for instance in cases of acute respiratory infections and diarrhoeal diseases in children, or of complications in pregnancy and childbirth. WH: Does WHO fee! it is important to empower women ? HN: WHO is very much in favour of empowering women - ail women, not just a small élite of women working alongside men in the higher spheres of the economy. Every woman, wherever she lives, must be empowered so that she has the means of caring for and enhan- cing the health of her family as weil as her own health. In fact, women's health should be a major objective for public poli- cies, to be pursued as an end in itself and also as a catalyst for the health and development of ail family members, communi- ties and societies worldwide. WH: What is your view on family planning as a means ofliberat- ing women and a positive step towards economie development? HN: I see family planning as an essential means of achieving a satisfactory lev el of health in the family. Last year 's International Conference on Population and Development, held in Cairo, provided a lesson on how certain policies and principles - particularly the development of primary health care and the princip le of equity in access to health care- which WHO has been advocating and promoting for a long time, are now being integrated into public policies and strategies for overall devel- opment. First, the Conference, in which WHO played a vital role, confirmed that human develop- ment, with particular attention to the role of the family, is the centre-piece for sustainable so- cial and economie development. Reproductive health, of which family planning is only a part, is essential to the healthy growth, development and maturation that contribute to human devel- opment. Second, the Cairo Conference declared that the family should serve as the model for initiating equitable relationships between the sexes. This, in tum, will allow women to real ize their potential and to lead self-fulfilling and produc- tive (not merely reproductive) World Health • 48th Y eor, No. 2, Morch-Aprill995 lives. The Conference further stressed that men - through an understanding of women 's needs and their own behaviour- would be better able to enhance their own reproductive health and that of women. The WHO goal of health for ail provides a valid universal model for sustainable develop- ment. It is based on primary health care and district level services; it aims at achieving greater equity in health care and contributes to the social and economie well-being of indi- viduals and families. Health for ail is not a slogan. It is a profoundly humanistic objective which WHO and the countries of the world are gradually bringing doser to realization. • For many eider/y people, the on/y lifeline and defence against solitude is their fa mi/y