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January 24, 2019

Of Health, Crime And Punishment

Everywhere, all the time, there is health advice being given; some for free, others at a fee. When you pay for it the assumption is that you have realised that you need it and therefore at the very least you have some knowledge of your own ignorance.

When you act on the advice that is offered to you - for free - by a total stranger then a question arises as to whether you have the capacity to utilise such information.

As Albert Einstein once said, “information is not knowledge”. A key role of government should be to provide information that citizens can use to improve themselves.

We do have a government spokesperson, but the role is taken as almost purely political to clear the misunderstanding created by inarticulate persons rather than one that seeks to inform the public on their wellbeing.

Within Kenya we have a strong belief in punishment yet in contradiction once something happens we quickly want to “move on”. So we find it perfectly reasonable to have a policeman hide himself and wait to pounce when you take a wrong turn.

Yes it is illegal, careless and dangerous to do an illegal turn down Valley Road, Nairobi; stopping oncoming traffic coming downhill at speed because you are special and everyone can see why you need to behave contrary to everyone else.

What is incredulous is that having noted that this is dangerous behaviour, the police will rather than prevent such behaviour, they will hide, wait for the person to commit the crime at great risk to other road users, and then haul them away for either a bribe or fine depending on the season.

Hide and seek is a great game but with limited appeal when played for too long. As a child you can play it all day but adults soon tire. After a day or too of discipline the behaviour creeps back.

Are there some days when Valley Road or any other road in Kenya is less dangerous? Hardly. Anyone who graduated from school after 1997 is likely to have had very few days of civics learning given that teachers have been on strike since then.

We add new drivers everyday. Careless driving happens all the time. Logic would therefore dictate that what drivers lack is information about the risks they are taking. Traffic rules are about road safety, about health ultimately.

In public health today, we talk about the double burden of disease. What it means is that countries like Kenya have the old infectious diseases like malaria, tuberculosis, newer infectious diseases like HIV/Aids. These are the original burden of disease that people thought could be controlled and even eradicated like small pox.

Then there is the rise of non-communicable conditions like hypertension, diabetes, cancer and injuries. The injuries include road traffic, occupational and those sustained at home.

The old infectious diseases have been studied for hundreds of years, so we know a lot about them. We know for example that a mosquito weighs on average 2.5 milligrams; that is 400,000 mosquitoes make a kilo.

We know that mosquitoes infected with the malaria parasite bite and cause malaria. We also know that sleeping under an insecticide-treated mosquito net helps prevent the spread of the disease.

Then we are surprised to learn that among some communities around Lake Victoria people there use their mosquito nets in the gardens to protect against rodents and other pests. Should we punish such people?

Some might argue yes. Here are resources donated to help people fight a disease and instead they find some other use for it. But perhaps they are privy to a study that showed that around Lake Victoria especially where the water hyacinth is predominant, lake flies are the most common flying insects there.

Further studies of the mosquitoes found just 0.4 per cent carried the malaria parasite.

Much more common are snails associated with schistosomiasis or bilharzia. To effectively prevent schistosomiasis you need to wear shoes. So should we punish the person who sleeps under a mosquito net who is possibly malaria free but is hungry, poor and has schistosomiasis? The answer has to be no.

In the same way, we need to look at non-communicable diseases. It cannot be my sole fault that I get injured in a road traffic accident. It may be my immediate behaviour that precipitates the crash but there are factors prior that will influence the event. It is the same as not sleeping under a mosquito net last night. Having huge fines as punishment cannot be the solution.

To tackle non-communicable conditions people need information, but that is not enough; they need to have the capacity to interpret that information and use it to improve their own health. That should be the government’s role collectively and not left to individuals to profit from.


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