An MPH student studied abroad in Brazil, India, and South Africa in a global health program for three months. Three Countries. Three Public Health Areas. Three Themes. One Takeaway.
Capturing Life on the “Go”:
While abroad, I lived in Delhi and visited Jaipur. During my stay, I took many rickshaws for transport. Rickshaws are relatively popular, and there was even an Uber option to request rickshaws. It is estimated that rickshaws are used by up to 60 million people perday in India (Goel 2019).
Road traffic accidents in India are a public health crisis (Pal 2019). Motorized rickshaw crashes, either when an occupant is injured or hit by a rickshaw, demonstrate motor injury and the pressing need for enhanced safety (Schmucker 2009). Since rickshaws often have open sides, there is an increased risk of occupants falling out or being exposed to dust, pollution and other matter. In addition, rickshaw drivers often travel against traffic in compromising positions; which places the driver and the occupants in vulnerable health positions.
An Environmental Lens:
I resided in Sao Paulo, Brazil and learned about importance of how the environment shapes community.
I stayed in an agroforest that illustrated the concept of ‘BuenVivir’ which “emphasizes community, well-being, reciprocity, solidary and harmony with Mother Earth” (Wiliford 2018). These sustainability practices transformed the agroforest and communities in this space because of the the relationship with the land or environment (food production, diet, exercise, connection with others, etc). I also explored how Buen Vivirwas exemplified in street art. Street Art, while not legalized in Brazil, is a method for communities to share their voice and stories (Young 2017). Street Art shows how the growth cycle of plants is connected to personhood. This connectivity of people and the environment, (that I both experienced in the agroforest and saw in Street Art), demonstrates this symbiotic and synergistic relationship.
Health outcomes are significantly shaped by one’s environmentwhich influences access, opportunities and potential barriers. Built and social environment in Brazil causes differing experiences for communities in rural and urban areas(Velásquez-Meléndez 2013). This coincides with the social determinants of health where one’s community and environmentimpact the quality of life, and lived health experiences.
Apartheid Focus: Sunset Series
While I was in South Africa, I stayed in Cape Town and Zweletemba, which are both located in the Western Cape. The sunsets in the Western Cape were beautiful.
These photos illuminate how built environments, situated from hegemonic norms and race relations, differ in varying contextsand exacerbate health disparities. In South Africa, townships emerged in the Apartheid regime where individuals of color were systemically segregated and disenfranchised. The architecture of townships and ideologies surrounding these communities illustrate how space and environment embody oppressive norms (Mills1989). Apartheid continues to have a lasting legacy in structures where power and control mechanisms further intensify health disparities (Hocoy 1998, Kon 2008, Warren 2016). The social, economic, and political ramifications of Apartheid hinder equitable health outcomes and quality of life.
Public health encapsulates many aspects of our lives. Whether it be safety, oppressive historical rooted contexts, or built environments. As public health incorporates sustainability and social justice lenses, it’s vital that public health professionals serve as advocates. There is a global action call for us, as public health professionals or those interested in health, to understand communities’ social contexts and practice cultural competency, in order to amplify communities’ voices and enhance their health experiences.
I do acknowledge my privilege of being an outsider. I do not seek to speak for these communities. Rather, I seek to vocalize my perceptions and illuminate their stories.
– Goel, Vindu. “Inside India’s Messy Electric Vehicle Revolution.” New York Times. 2019
– Hocoy, D. “Apartheid, racism, and Black mental health in South Africa, and the role of racial identity.” Dissertation Abstracts International: Section B: The Sciences and Engineering, 58(10-B), 1998, pp 5699.
– Kon, Zeida R, and Nuha Lackan. “Ethnic disparities in access to care in post-apartheid South Africa.” American journal of public health vol. 98,12 (2008): 2272-7.
– Mills, Glen. “Space and Power in South Africa: The Township as a Mechanism of Control.” Ekistics, vol. 56, no. 334/335, 1989, pp. 65–74. JSTOR.
– Pal, Ranabir et al. “Public health crisis of road traffic accidents in India: Risk factor assessment and recommendations on prevention on the behalf of the Academy of Family Physicians of India.” Journal of family medicine and primary care vol. 8,3 (2019): 775-783. doi:10.4103/jfmpc.jfmpc_214_18
– Schmucker, Uli et al. “Crashes involving motorised rickshaws in urban India: characteristics and injury patterns.” Injury vol. 42,1 (2011): 104-11. doi:10.1016/j.injury.2009.10.049
– Velásquez-Meléndez, Gustavo, Mendes, Larissa Loures, & Padez, Cristina Maria Proença. (2013). Built environment and social environment: associations with overweight and obesity in a sample of Brazilian adults. Cadernos de SaúdePública, 29(10), 1988-1996.
– Warren Smit, Ariane de Lannoy, Robert V.H. Dover, Estelle V. Lambert, Naomi Levitt, Vanessa Watson,Making unhealthy places: The built environment and non-communicable diseases in Khayelitsha, Cape Town, Health & Place, Volume 39, 2016, Pages 196-203.
– Wiliford, Beth. “Buen Vivir as Policy: Challenging Neoliberalism or Consolidating State Power in Ecuador. Journal of World-Systems Research.” University of Pittsburg. 2018.
– Young, Michelle. “The Legalization Of Street Art In Rio de Janeiro, Brazil.” Huffington Post. 201About The Creator:
The creator is a second-year MPH student in the Epidemiology track. She graduated from Grinnell College with a BA in Biology of Global Health in May 2020. During their time at Grinnell, They studied abroad in Brazil, India and South Africa, in an honors global health program, that focused on infectious diseases research including TB, HIV/AIDS and Zika. Her experiences abroad inspired her to conduct her senior thesis on women’s cancer as a health disparity in Sub-Saharan Africa. She also is pursuing a research study, with the Harvard Global Health Institute focused on HIV+ men’s engagement in care in sub-Saharan Africa. Also, has interests in policy and photography, as she worked on Capitol Hill for Congressman John Lewis and at Photovoice Worldwide.