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September 20, 2018

Rules and Terrible Twos

In Kenya today there are at least 990,000 persons who cannot talk. And the number continues to increase. Such persons are totally reliant on the goodwill and common sense of their immediate family and the wider society to survive. These persons are the babies born after July 2013. The date is the mid-point of the year when conventionally the average population estimate is calculated. As at July 2013 the Kenyan population stood at 44 million. An eight-month-old baby is amazing. She can copy the sounds and gestures of others, use fingers to point at things, make lots of different sounds that sound like ‘mama’ and ‘baba’ and understands the word ‘no’. Within another month or two she will have improved understanding of objects and persons, able to find hidden objects and if you leave the room able to realise that you will return and so doesn’t have to cry her lungs out when you walk out briefly. But it takes almost another ten months before she can say and shake her head emphatically ‘NO’ and point to what she wants, the beginning of what harassed parents know as the terrible two stage of life. If life development stopped at this stage, society would be in a word, chaotic.

The dependency ratio in Kenya is about 80 per cent, which is very high. Practically it means that there are eight people under the age of 15 compared to ten of working age (15 – 64 years). But the figure misleads because most of those considered to be of working age, above 15 are also below 19 years, further unemployment is extremely high with many youth engaged in nothing more than being not engaged in anything economically productive. So there is a large population who even though they have advanced from being babies do not have the means to protect themselves from possible harm. All of us want to live a healthy and happy life. The structure of the Kenyan population places the burden of maintaining a healthy and just society on relatively few people; those who are of age, educated and have an income; outnumbered by those who are underage, uneducated and with no income. 

Public health refers to all organised measures (whether public or private) to prevent disease, promote health, and prolong life among the population as a whole. It is done through the efforts and informed choices of society, organizations, public and private, communities and individuals. According to the World Health Organisation the three main public health functions are: The assessment and monitoring of the health of communities and populations at risk to identify health problems and priorities; The formulation of public policies designed to solve identified local and national health problems and priorities; and to assure that all populations have access to appropriate and cost-effective care, including health promotion and disease prevention services. While the first and third functions are mainly done by various health professionals, the second is a function of society itself through the government and elected leaders.

One of the major ways in which public health is conducted is through enactment of public health laws. Laws are there to govern behaviour through social institutions. Public health laws are there to ensure that the conditions necessary for people to be healthy are there. These include providing the mechanisms to identify, prevent and reduce the risks to population health while drawing a line that protects the individual’s rights. Where the risk to population health is great, individual rights are clipped for the better good. For laws to work they must be obeyed consistently and not selectively. There are many reasons why we might not obey a law. Where a written law exists but is not publicized enough, people are likely not to obey it. Complicated laws that are difficult to interpret or contradict other laws or even common sense are difficult to comply with. Laws that are subject to frequent changes are difficult for creatures of habit to internalise.  Finally a law where the intention announced and actual implementation is different is treated with disdain at worst, confusion at best. Corruption a big word, wears everyone out.

Given the above, it is difficult to understand why government of Kenya vehicles carrying from the lowest to the mighty persist in disobeying laws set to protect public safety. The Americans cite motor vehicle safety as one of the most successful public health responses to one of the biggest technologic advances of the 20th century, the motor vehicle. They began systematic motor vehicle safety efforts in the 1960s appointing a public health doctor to be the first director of what became the National Highway Traffic Safety Administration.

The doctor applied public health methods including epidemiology to preventing crashes and injuries arising from crashes. In the USA in the period 1963-2012 the population has increased by two-thirds, vehicle miles travelled more than tripled yet deaths per vehicle miles travelled has reduced five times. The urgency for Kenya is that the very population that needs saving from these needless deaths are the ones supporting those who cannot talk for themselves. Marcus Tullius Cicero a Roman lawyer, orator and politician once said that one of the mistakes mankind keeps making century after century is neglecting development and refinement of the mind. We cannot remain in the terrible two stage all our lives.

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