In the United States this past Monday Americans celebrated the birthday of African-American civil rights leader Martin Luther King, Jr. King remains an essential icon of the Civil Rights Movement that fought from the white power structure basic human rights for African-Americans. The Civil Rights Movement won for African-Americans such basic civil liberties as the right to vote, equal education and work opportunities, and the official ban of individual and institutional discrimination. But there was also another important civil liberty victory: the fair and equal access to basic health care.

Unfortunately, celebrations like Dr. king’s birthday, and a greater right to basic health care, hasn’t yet been achieved everywhere in the world. Similar movements for universal or equal access to health care haven’t yet succeeded elsewhere in the world for a variety of reasons ranging from oppression and racism to lack of resources and extreme poverty.  African communities are especially hard hit by intractable health problems and the lack of access to basic health care.

The African-American Civil Rights Movement started in small communities in the southern United States. With the help of inspirational leaders like Martin Luther King, Jr., the grassroots campaign swept across the country ultimately leading to a systematic and institutional change in the treatment and experience of African-Americans. The term “grassroots” is usually associated with approaches to community development in developing countries. However, Dr. King utilized grassroots strategies to build a society-altering movement.

Dr. King’s efforts behind the Civil Rights Movement are great examples of how cooperation between small communities and grassroots efforts can lead to comprehensive societal changes. Movements like these can be applied to small communities in African countries. They have the potential of making the same huge strides forward in access to basic health care (among other basic human rights) as Dr. King did beginning more than fifty years ago in the United States.

Of course Martin Luther King Jr. Day is a tribute to one of the greatest civil libertarians in American history. But it can also serve as a lesson for social development, movement politics and social change and progress. Dr. King and the other heroes of the Civil Rights Movement prove the power of a strong grassroots movement.

Whether they are starving or eating too much, children around the world are malnourished. A full belly doesn’t necessarily mean that a child is getting proper nutrition from the food that they eat. Obese children are just as nutritionally deficient as children who have bloated bellies from hunger. The result is a global generation of unhealthy children who will experience a shorter life expectancy than normal from complications with their health and related diseases. The double burden of malnutrition is seen in both a complete lack of access to food and an overabundance of unhealthy foods.

A recent World Health Organization (WHO) report stated that combating five major health factors could eliminate millions of premature deaths. Among those top five is childhood nutrition. Lacking nutritious food has serious implications for health, but consuming too much food without nutritional value, which contributes to obesity, is more likely to lead to a premature death. For the first time in 15 years, children in the US have a lower life expectancy than their parents. By the same token, children in countries defined as “developing” have faced low life expectancies for many years, but what they eat (or don’t eat) is less likely to kill them. Who would have imagined that being overweight is more likely to kill you than being underweight?

On the flip side of childhood nutrition is the near complete lack of access to food in developing countries. There were any number of crises this past year that qualified the “need” for food aid from “developed” countries. Floods, earthquakes, droughts, famines, etc. – but what is the state of food aid? Is it excellent nutritious assistance in difficult times? Bill Easterly and the Aid Watch blog ask: “Can the story on US food aid get any worse?,” noting that the US continues to support relief agencies that use a corn-soy food blend that doesn’t even meet the 1960s international nutrition standards of food aid. Children in developing countries don’t necessarily die from a lack of nutritious food, but rather from the diseases that attack their weakened immune systems. The food we eat is a first line of defense by keeping the rest of our body systems healthy. Some of the best examples of the importance of food and health come from Paul Farmer, who often says that, “the treatment for hunger is food.” Many times food is overlooked as a critical treatment in health crises, which makes it that much more important to invest in nutritious alternatives for food aid and support local farmers around the world.

Unfortunately here in the US, corporations have a firm grip on what we eat. There are a small number of major factory farming corporations that produce our food. They use coercive actions and their money to keep control of farmers and the food industry. This hurts our families and communities here in the US and contributes to the nutritional inadequacy of what Americans eat, but it also has far reaching implications in developing countries. Because of the control by US corporations of the food industry and the US government’s subsidies for farmers, food prices have been rising steadily around the world. This impact is hitting small farmers in developing countries hardest as they struggle to find markets to sell their produce and support their families. These small farmers can’t compete with US farmers who are government subsidized or the US corporations who are mass producing and shutting them out. Even as people in developing countries struggle to buy food to eat, one in six Americans are struggling with hunger. This is largely a result of the economic downturn and has affected more than just those already considered poor in the US. It is estimated that nearly one billion people do not have access to a secure source of food around the globe.

While the fact that many Americans struggle with food security is shocking, the spike in rates of obesity demonstrates the pressing need for communities to rethink how they eat and live. Obesity gives a blatant visual representation of how much control we have lost when it comes to our food. The WHO states that “globesity” is spreading across the globe and millions will suffer if we don’t make changes. A recent study conducted by Wayne State University showed that one third of infants in the US are obese or at risk for obesity. This allows us to easily assume that an obese infant will become an obese adult. Hunger and food security are extremely important issues when it comes to talking about health and nutrition. Many who suffer being underweight have suffered through natural disasters, but the immediate threat to children and the global population is the man-made disaster of being overweight.

Thankfully there are many people who are working to fix the food industry, support local farmers, and promote healthy eating to children in schools. President Obama recently signed the Child Nutrition Bill to increase access to healthy foods in schools. Where there have been numerous policy barriers nationally and internationally, this is a step in the right direction to bring policies in line with the health needs of our global population. We must commit to supporting the basic health of our children if we care about a building a healthy future.

Previously posted on Americans for Informed Democracy Blog where I am writing as a Global Health Analyst.

Doctors Without Borders (Medecins Sans Frontieres) posts regular “frontline reports” about their work. This is a great example of some of the critical health work being done to prevent mother to child transmission (PMTCT) of HIV in Kenya. MSF is working at the frontlines of pediatric HIV prevalence. There have been amazing medical steps forward to prevent PMTCT, but these innovations are not as easy or accessible in rural regions. Yet another example of the importance of investing in health infrastructure where access is limited and needs are great.

The health care system in Uganda is overrun with problems.  As a community health volunteer for Peace Corps, I have been working with a Health Center II (a basic-services clinic) and have been assessing the state of health care here in Uganda.

While government health care is intended to be free, there are so many hidden costs that patients are often still unable to afford health care.  The government provides free drugs and care, but when those drugs run out (which is all-too-often), the patients are responsible for going to a private drug shop and buying their medicines.  Women who want to deliver at a government health center are often required to bring their own “mother kit”, a set of supplies which can include such things as cotton, gloves, needles, etc.  At our small Health Center II, we have no capability of running tests such as urinalysis, blood smears for malaria, or even taking blood pressure, and often have to refer patients to either a larger government health center or a private clinic for the care they need.  Many people cannot afford even 4,000 Ugandan shillings roundtrip (less than $2) to the Health Center III, a few kilometers away, for testing or maternal care, let alone a trip to a private clinic where all costs are out-of-pocket.  Some of our patients walk several miles to get to our clinic.

Malaria is one of the leading causes of morbidity and mortality, and is severely over-diagnosed.  Practically everyone with a fever is given anti-malarial drugs, and subsequently health centers often run out of the drugs before the next shipment arrives from the government.  The cost of these drugs in a private drug shop can be 15,000/- (about $7), which is too expensive for the average rural Ugandan.  The nurses at the health centers have little choice when they have no way to test for malaria before dispensing drugs – if the patient does have malaria and is not treated, he or she could die.  Better to be safe than sorry, but being safe in this situation causes its own host of problems.

There is also a big problem with motivation among health workers.  Salaries are very low, and some workers feel no obligation to give good ‘customer service’, which is a huge concern in privatized health care systems such as the U.S.  Health workers often show up whenever they feel like it, and leave the clinic hours before the official closing time, leaving some patients to wait for hours to be seen.  A small aspect of this stems from the culture where family comes first – if the nurse has to harvest millet or help a family member out, they don’t see a big problem in staying home.

So what, as a Peace Corps Volunteer (PCV), can I do?  It’s a difficult question to answer – if there were an easy fix, Uganda would have great health care.  PCVs don’t come with any funding or external assistance, we come to act as change agents and co-facilitators to mobilize local resources and work with what is already available.  While it’s difficult to make system-wide changes or improve facilities and equipment without funding, I am working to encourage healthy behaviors, build capacity among health workers, and provide people with the knowledge they need to keep themselves and their families happy.  Another PCV I know is working at the district health office, so he can encourage health officials to improve efficiency and make positive changes in the health care system.  These are small steps, not a big NGO project with millions of dollars backing it, but these small steps are (hopefully) sustainable, using local resources and requiring the community to get involved to make changes in their own lives.