Rapid Responses to:

PRIMARY CARE: Christine Powell, Helen Baker-Henningham, Susan Walker, Jacqueline Gernay, and Sally Grantham-McGregor Feasibility of integrating early stimulation into primary care for undernourished Jamaican children: cluster randomised controlled trial BMJ 2004; 329: 89 [Abstract] [Full text]

Rapid Responses: Submit a response to this article

Rapid Responses published:

The singular role of women and poverty

Jim Black, Helen Potts, Bebe loff   (9 July 2004)

The singular role of women and poverty 9 July 2004
Jim Black, Head - Epidemiology Victorian Infectious Diseases Service Grattan Street Parkville 3050, Helen Potts, Bebe loff Send response to journal: Re: The singular role of women and poverty	Child malnutrition is the end point of a complex chain of causation, including infectious disease, traditional weaning practices, maternal (and paternal) knowledge of child development, standards of hygiene, and much more. Underlying all of these is the real root cause - the unjust distribution of wealth and other resources both within and between countries. Government health workers are caught between a rock and a hard place. They are commonly the only professionals actively interested in child malnutrition, and yet they are hampered by the health service's paradigm, which tends to see only the proximate causes and does not see a role for itself in tackling the deeper problems. A study such as Powell et al's might come about in two ways. It might be part of a community development process, in which parents and carers are in the process of identifying the factors preventing their children from developing their full potential, and are taking steps to tackle their situation and take more control over their lives. If so, this study is to be commended, and we would like to see more discussion of its community development aspects. If, on the other hand, this is just another study of proximate causes, with health workers once again deciding what is good for mothers and children without involving them in the process, then it will probably largely be wasted effort. In addition the study on its face seems to accept culturally conditioned assumptions about the singular role of women as child rearers. Studies of this nature can lead to the belief that it is not food that is the problem but mothers who lack the requisite skills. (See Lynn Freedman “Reflections on emerging frameworks of health and human rights” Health and Human Rights Vol 1. No 4 pp 314- 50). Regardless of the results of the study, the problems it addresses are not susceptible to a public health solution that simply addresses behaviour. We sympathise with the health workers working within the limitations of their position, but wish they and their sponsors would look into ways to help local people take control of their lives, rather than again being the passive subjects of a top-down intervention. Public health advocates must also tirelessly reinforce the message that poverty is not consistent with good health. Competing interests: None declared