Global Education Magazine: World Health Day (April 7th 2013)

Daniel Lpez
IN MEMORIAM...
La sant humaine est le reflet de la sant de la Plante. Il est fondamental le fait de partager les connaissances et de fortifier les alliances pour renouveler l'esprit-conscience dans tous les coins du monde. D'aprs Global Education Magazine nous plaidons pour la Sant Globale comme un lment essentiel pour obtenir le bonheur de la citoyennet. Human Health is a reflection of Earth Health. It is essential to share knowledge to uplift our bonds and renew the spiritconsciousness in every corner of the planet. In Global Education Magazine we stand up for Global Health as a fundamental way to reach human happiness. La salud humana es un reflejo de la salud de la Tierra. Es fundamental compartirconocimientos y fortalecer alianzas para renovar el espritu-consciencia en todos los rincones del mundo. Desde GEM abogamos a favor de la Salud Global como elementoesencial para lograr la felicidad ciudadana. . . " " (" ") . La sanit umana un riflesso della sanit della Terra. essenziale condividere le conoscenze e rafforzare le alleanze per rinnovare lo spirito-coscienza in ogni angolo del mondo. Noi di GEM riteniamo che la Salute Globale sia elemento essenziale per raggiungere la felicit dei cittadini.
Daniel Lpez
UBUNTU Cosmic Energy: The Ethical Basis For Future Worldists

Namaste! The main goal of the Global Education Magazine is to unite the cooperative efforts of the individual-society-specie for the creation of interethnic dialogues that derive in the construction of a collective intelligence focused on achieving the Millennium Development Goals (MDGs). Like an isolated neuron or an ant, which cannot contribute categorically to the network structure to which it belongs, mankind must develop a social learning, based on peaceful coexistence and respect for biodiversity of different ecosystems.
The architects of the future of education should expand existing cognitive horizons through a multidimensional epistemological revolution that includes Earth-homeland as commons home and garden of the humanity. Thus, the knowledge construction of the 21 st century entails the inclusion of morphogenesis and cosmological perspective for metaphysical understanding of the human species, because our particles were born in the first few seconds of the Cosmos, our carbon atoms were created in a previous sun and our molecules were formed on Earth. The human species is a cosmic entity interlinked with the same future destiny, whose estigmergic evolution is the result of a nutrigenomic colloquium of thousands of years between our genome and our interaction with environmental and nutritional resources. For this reason, it is necessary to reform human communications through an intellectual, moral and emotional metacognitive effort that warns the complexity of the MDGs as a solidary super-organism interconnected by quantum electrodynamic which is manifested in the interactions of cosmic particles. To do so, we must promote the humanist philosophy UBUNTU, as thought, awareness, and understanding metastructure of the sociobiology and antropoetic evolutionary convergence. In this sense, the Ubuntu ethological polymorphism represents wisdom to learn to grow together as a world-society, because the ontologic pluricultural simbiosophy adjacent in its spiritual essence is an emergent element for ethical management of the future. Cultivating a better future is possible and we can do it in a collective, justice and solidarity way through a responsible and creative participatory democracy. We must be self-critical of the current metasystem driven by economic irrationality of globalization and we must reform international politics bioethically: including food supply, access to medicine and the right to health among the fundamental human rights. So, think about starting a new axiological human consciousness, based on a pluralistic and polylogic conception of the ethic that inspires new directions for navigating the waters of socio-educational work. The seed of love represents, in this sense, the epigenetic and ecological phenomenon of vital action to achieve a unified ethic understanding among mankind. Teaching in the 21 st century involves resetting democratically multicausal relationships between education and culture, toward new cosmopolitan and cyber-ethical pedagogic practices that integrate a moral view in a global scale. This reconsideration demands, effectively, training authentic worldists with a thoughtful civic consciousness capable of ensuring sustainable development in harmony with nature. Thus, the paradigm shift implies a holistic view of the human being and the universe itself from the perspective of consciousness, where we are all interconnected. Dear readers, I invite you to drink the elixir of cosmopolitan hope charged by cosmic energy to achieve the objectives agreed in the Ottawa and Bangkok Charters on global health. We must empower our imagination in order to feel ourselves as creators of our own lives and conceive the humanity as a starry sky in which, contemplating this, they enlighten our hearts.
Javier Collado Ruano
Director of Edition
La Energa Csmica UBUNTU: La Base tica De Los Futuros Mundlogos

unir los esfuerzos cooperativos del individuo-sociedad-especie para la creacin de dilogos intertnicos que deriven en la construccin de una inteligencia colectiva enfocada en la consecucin de los Objetivos de Desarrollo del Milenio (ODM). Al igual que una neurona o una hormiga aislada no puede contribuir categricamente a la estructura de red a la que pertenece, el gnero humano debe desarrollar un aprendizaje social basado en la coexistencia pacifica y el respeto a la biodiversidad de los distintos ecosistemas. Los arquitectos de la educacin del futuro debern ampliar los horizontes cognitivos actuales a travs de una revolucin epistemolgica multidimensional que contemple la Tierra-Patria como casa y jardn comunes de la humanidad. As pues, la construccin del conocimiento del siglo XXI conlleva la inclusin de la perspectiva morfogensica y cosmolgica para el entendimiento metafsico de la especie humana, ya que nuestras partculas nacieron en los primeros segundos del kosmos, nuestros tomos de carbono se crearon en un sol anterior y nuestras molculas se formaron en la Tierra. La especie humana es una entidad csmica interligada con un mismo devenir futuro, cuya evolucin estigmrgica es fruto de un coloquio nutrigenmico de miles de aos entre nuestro genoma y nuestra interaccin con los recursos ambientales y nutricionales. Por este motivo, es necesario reformar las comunicaciones humanas a travs de un esfuerzo metacognitivo intelectual, moral y afectivo que advierta la complejidad de los ODM como un superorganismo solidario interconectado por la electrodinmica cuntica que se manifiesta en la interacciones de las partculas csmicas. Para ello, debemos promover la filosofa humanista UBUNTU como metaestructura de pensamiento, sensibilizacin y entendimiento de la convergencia evolutiva sociobiolgica y antropotica. En este sentido, el polimorfismo etolgico Ubuntu representa la sabidura de aprender a crecer juntos como sociedad-mundo, pues la simbiosofa pluricultural ontolgica adyacente en su esencia espiritual constituye un elemento emergente para la gestin tica del futuro.
Namaste! El objetivo principal de Global Education Magazine es
Cultivar un futuro mejor es posible y podemos hacerlo de forma conjunta, justa y solidaria a travs de una democracia participativa responsable y creativa. Debemos hacer autocrtica del metasistema actual guiado por la irracionalidad econmica de la globalizacin y debemos reformar la poltica internacional bioticamente: incluyendo el abastecimiento alimenticio, el acceso a la medicina y el derecho a la salud entre los derechos humanos fundamentales. Por lo tanto, hay que pensar en iniciar una nueva consciencia humana axiolgica, basndonos en una concepcin pluralista y polilgica de la tica, que inspire nuevos rumbos de navegacin por las aguas del trabajo social-educativo. La semilla del amor representa, en este sentido, el fenmeno epigentico y ecolgico de accin vital para alcanzar una comprensin tica solidaria entre el gnero humano. Ensear en el siglo XXI implica reajustar democrticamente las relaciones multicausales entre la educacin y la cultura, a travs de nuevas prcticas pedaggicas cosmopolitas y ciberticas que integren una mirada moral a escala global. Esta consideracin supone, efectivamente, la formacin de autnticos mundlogos con una consciencia cvica reflexiva capaz de garantizar un desarrollo sostenible y armnico con la naturaleza. As pues, el cambio de paradigma implica una mirada holstica del ser humano y del propio universo desde la perspectiva de la conciencia, donde todos estamos interconectados. Estimados lectores y lectoras, les invito a beber el elixir de esperanza cosmopolita cargado de energa csmica para lograr los objetivos pactados en las Cartas de Ottawa y Bangkok sobre la salud mundial. Empoderemos nuestra imaginacin sintindonos creadores de nuestras propias vidas y concibamos a la humanidad como un cielo estrellado en el que, al contemplarlo, nos ilumine nuestros corazones.
Javier Collado Ruano
Director de Edicin
6. WORLD HEALTH DAY. by WHO Regional Director for the Eastern Mediterranean. Dr. Ala Alwan. 8. Health in United Nations: Millennium Development Goals. 11. "El Oasis de la Memoria". Entrevista con Aminatou Haidar.
17. UNHCR's work on HIV in the Americas.
Articles with are available for blinds!
19. Critical Pedagogy Against Capitalist Schooling: Towards a Socialist Alternative. An Interview with Peter McLaren. 35. Research Papers. 36. MDGs 58. Global Education. 85. Transversal Studies. 120. Letters to the Editor.
15. Proyectos de la UNESCO para comienzos de ao.

Daniel Lpez
Editada en Almansa (AB), Espaa, por Educar para Vivir e com a parceria do DMMDC (Salvador, BA, Brasil)
Disseminate GEM to raise awareness!
Follow us!
N3
www.globaleducationmagazine.com
Dr. Ala Alwan
In the Name of God, the Compassionate, the Merciful
Who Regional Director for the Eastern Mediterranean
on the occasion of WORLD HEALTH DAY 7 April 201 3
Today we are observing World Health Day. Every year WHO uses this occasion to highlight an important health issue. This year the theme of World Health Day is high blood pressure, or hypertension. High blood pressure is a major health issue which affects the lives of nearly 40% of adults over the age of 25 years. Around the world, including in this region. It is known as a silent killer because in many cases it is detected too late to avoid complications. If not detected early and controlled high blood pressure leads to stroke, heart disease, heart and kidney failure and blindness. High blood pressure causes around 8 million deaths in the world every year, which is about 13% of all deaths. Around 50% of all global deaths from stroke and heart disease are attributed to high blood pressure. Our message to you on World Health Day is Control your blood pressure prevent it? Control your life. You can prevent high blood pressure and you can get it treated. How do you
Among the major factors that cause high blood pressure are unhealthy diet, excessive use of salt, being overweight and being physically inactive. In our region, with a population of 600 million people, the rates of physical inactivity are higher than in any other region in the world. Overall, more than a third of men and nearly half of women in the Region are physically inactive. Around 50% of adults in our region are overweight and in some countries more than 70% of women and an increasing number of children are overweight. High blood pressure and tobacco use is a lethal combination since they both cause cardiovascular disease. In some countries of the Region more than 50% of men use tobacco. So what should we do? We need to change our lifestyles. This means eating a healthy balanced diet rich in vegetables and fruit. It means reducing the amount of salt we eat and avoiding food rich in fat and sugars. And it means maintaining normal body weight and taking regular exercise. Just 30 minutes a day of moderate physical activity will reduce blood pressure and help prevent heart disease, diabetes and even some cancers, such as breast and colon cancer. It also lowers the risk of stroke and depression. Many countries have managed to reduce the prevalence of high blood pressure by encouraging and promoting lifestyle changes, driving down the number of deaths from heart disease. We in this Region should
N3
do the same.
I call upon communities and individuals to rise to the challenge and take action against this silent killer. Simple, practical and cost-effective steps can save you, and millions like you, from falling victim to this health problem: healthy diet, weight reduction, reduction in salt intake, increased physical activity, and stopping smoking. Of course, we know that asking people to change their lifestyles is not enough. It needs to be backed up by action at other levels also. For this reason, we call upon governments, policy-makers, the regional and international community and other stakeholders, including the food industry, to take concrete action to create an environment that is conducive to healthier living. Improving the availability of healthy foods, reducing salt in processed and manufactured foods, correct labelling of food products and providing accessible facilities for exercise are all important to creating such an environment. All sectors of government and the private sector have to be involved in this effort, not just the Ministry of Health. As I have already mentioned, a large proportion of our population already has high blood pressure. Many people, in some countries more than 50%, do not know they have high blood pressure, and so it is not controlled and they are at high risk of developing heart attacks, strokes and kidney damage. What can we do to help them? As individuals we need to know whether we have high blood pressure and as health care providers we need to provide adequate services to ensure early detection and appropriate treatment of hypertension, especially among those at high risk, like overweight people and smokers. Affordable and effective medicines are available to control blood pressure and help people to lead a normal and productive life. We need to ensure that early detection and management of hypertension are integrated in national policies, programmes and activities and are available through primary health care. So, let us all take action to reduce our risks, control our blood pressure, and control our lives. Not in the future, not tomorrow, but now. I wish you a healthy World Health Day.
Dr. Ala Alwan
Who Regional Director for the Eastern Mediterranean

7
N3
Special World Health Day
Health in United Nations: Millennium Development Goals

The Millennium Declaration, sets out an historic commitment to eradicate extreme poverty and improve the health of the worlds poorest people by 201 5. The Declaration and the resulting internationally agreed targets for the Millennium Development Goals (MDGs) place health squarely at the centre of the international development agenda and champion it as a key driver of economic progress. The United Nations Millennium Development Goals are eight goals that all 1 91 UN Member States have agreed to try to achieve by the year 201 5. The United Nations Millennium Declaration, signed in September 2000 commits world leaders to combat poverty, hunger, disease, illiteracy, environmental degradation, and discrimination against women. The MDGs are derived from this Declaration, and all have specific targets and indicators. Health is represented in three of the eight MDGs and makes an acknowledged contribution to the achievement of all the others, in particular those related to the eradication of extreme poverty and hunger, education and gender equality. Goal 8, which calls for a global partnership for development, is a unique feature of the MDGs, because it recognizes that there are certain actions that rich countries must take if poor
countries are to achieve all the other Goals. MDG 8 is a reminder that global security and prosperity depend on a more equitable world for all. The Goals related with health are the next:
-Millennium Development Goal 1 : eradicate extreme poverty and hunger.
The target called 1 .C. as part of this goal is halve, between 1 990 and 201 5, the proportion of people who suffer from hunger. to reduce by two-thirds, between 1 990 and 201 5, the under-five mortality rate.
-Millennium Development Goal 4: reduce child mortality. In this goal the target 4.A. tries -Millennium Development Goal 5: improve maternal health . At this point the target 5.A
wants to reduce by three quarters, between 1 990 and 201 5, the maternal mortality ratio and target 5.B. achieve, by 201 5, universal access to reproductive health.
-Millennium Development Goal 6: combat HIV/AIDS, malaria and other diseases. As
part of this Goal the Target 6A. Have halted by 201 5 and begun to reverse the spread of HIV/AIDS, also the target 6B. Achieve, by 201 0, universal access to treatment for HIV/AIDS for all those who need it. And finally the target 6C. tries to have halted by 201 5 and begun to reverse the incidence of malaria and other major diseases.
-Millennium Development Goal 7: ensure environmental sustainability. Target 7C: By
Daniel Lpez
201 5, halve the proportion of people without sustainable access to safe drinking water and basic sanitation.
8
N3
Target 8E. In cooperation with pharmaceutical companies, provide access to affordable essential medicines in developing countries. For example working in theses goals the world has met the Millennium Development Goal (MDG) target of halving the proportion of people without sustainable access to safe drinking water, well in advance of the MDG 201 5 deadline, according to a report issued today by UNICEF and WHO. Between 1 990 and 201 0, over two billion people gained access to improved drinking water sources, such as piped supplies and protected wells. The report, Progress on Drinking Water and Sanitation 2012, by the WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation, says at the end of 201 0 89% of the worlds population, or 6.1 billion people, used improved drinking water sources. This is one per cent more than the 88% MDG target. The report estimates that by 201 5 92% of the global population will have access to improved drinking water.
-Millennium Development Goal 8: develop a global partnership for development.
Today we recognize a great achievement for the people of the world. This is one of the first MDG targets to be met. The successful efforts to provide greater access to drinking water are a testament to all who see the MDGs not as a dream, but as a vital tool for improving the lives of millions of the poorest people said United Nations Secretary-General Ban Kimoon. But that victory could not yet be declared as at least 11 % of the worlds population 783 million people are still without
access to safe drinking water, and billions without sanitation facilities. In 2007, the global burden of under-five mortality has fallen for the first time below 1 0 million deaths and is now estimated at 9.7 million per year. Increased coverage of interventions, such as exclusive breastfeeding, measles vaccinations, vitamin A supplements and insecticide-treated bed nets, have contributed to this decline. In 2005, it was estimated that seven high-burden countriesBangladesh, Brazil, Egypt, Indonesia, Mexico, Nepal and the Philippineswere on track to achieve the MDG 4 target of reducing child mortality, and the number of countries is increasing. Recent surveys have shown a steady mortality decline in other countries, for example, in Madagascar, Malawi and the United Republic of Tanzania. In addition, 6 of 11 African countries heavily affected by HIV reported a decline of 25 per cent or more in HIV prevalence among the 1 5- to 24-year-olds in capital cities. Between 2001 and 2006, the number of people on antiretroviral therapy in low- and middle-income countries increased from 240,000 to approximately 2.1 million. About improve maternal health we have to say that despite a significant reduction in the number of maternal deaths from an estimated 543 000 in 1 990 to 287 000 in 201 0 the rate of decline is just over half that needed to achieve the MDG target of a three quarters reduction in the mortality ratio between 1 990 and 201 5. The proportion of births attended by skilled personnel crucial for reducing perinatal, neonatal and maternal deaths is above 90% in three of the six WHO regions. However, increased coverage is needed in certain regions, such as the WHO African Region where the figure remains less than 50%. To get these goals Increases in the amount of aid are necessary, but more effective aid is also required if progress towards the MDGs is to be sustained. The need for greater
9
Daniel Lpez
N3
harmonization between donors, and for stronger alignment around national policies and plans, is repeatedly being voiced by countries. The reality on the ground is complex, with several initiatives and partnerships, many of which have their own mandate, priorities and administrative processes. Additionally, about 20 per cent of overall health aid is given as general budget or sector support, while as much as 50 per cent is offbudget. Making the Paris Declaration on Aid Effectiveness a reality on the ground is critical if resources for health are to be deployed and used effectively. Also the Mechanisms that are transparent and inclusive need to be created to hold all partners accountable for their performance against international agreements. The importance of mutual accountability and responsibility has been emphasized in several new initiatives focusing on the MDGs, such as the International Health Partnership in which Governments and development partners define country-level compacts that represent a close-to-binding commitment by all, and provide a framework for monitoring performance. The international community shares a strong commitment to reaching the health-related MDGs. Several newly launched health initiatives by major donors and development agencies acknowledge the explicit need to invest in the health systems and better coordinate development assistance, and to introduce a framework of mutual accountability that recognizes the need for country-owned and country-led initiatives. In another hand As the 201 5 target date for achieving the Millennium Development Goals approaches, there is wide debate as to what development goals the global community should set next. The United Nations Secretary-General (UNSG) Ban Ki-moon has appointed a High-level Panel to advise on the global development agenda beyond 201 5. The Panel will deliver a report to the 201 3 September General Assembly. In support of this process, the United Nations Development Group is leading efforts to catalyse a global conversation on the post201 5 agenda through a series of global thematic consultations and more than 50 national consultations.
The Governments of Sweden and Botswana, UNICEF and WHO co-convene the health thematic consultation. The UNs global consultation on health will take place between October 201 2 and February 201 3. It will include a web-based consultation; the development of a series of background papers (both on lessons learned from the current MDGs as well as future directions); and a series of consultative meetings with Member States, non-governmental organizations (NGOs), private sector partners and academic and research institutions. The process will culminate in a high-level meeting on March 5-6 in Botswana, involving governments, NGO coalitions, key UN partners and members of the UNSGs HighLevel Panel. It will seek to incorporate ideas and lessons from other regional and country consultations, thereby building a powerful consensus around key issues and recommendations on health to feed into the inter-governmental process that will start later in 201 3. An informal Member State Consultation on Health in the Post 201 5 Development Agenda, was held in the WHO Executive Board Room in Geneva on December 1 4, 201 2. The meetings discussions focused on the first four of the five questions that are being used to guide the health thematic consultation. This report provides a summary of the interventions made by the Member State representatives.
Daniel Lpez
10
El Oasis de la Memoria
Entrevista con
Aminatou Haidar
por Jose Mara Barroso Tristn
kalvellid o
"La verdad sigue estando oculta en el Sahara Occidental"
N3
Traducido al:
El Oasis de la Memoria. Entrevista con Aminatou Haidar.
Occidental. La verdad sigue estando oculta en el Sahara Occidental.
Aminatou Haidar
Activista Pro Saharaui y de los Derechos Humanos. Fue nominada para recibir el Premio Nobel de la Paz en el ao 2008.
Jose Mara Barroso Tristn: Buenos das Aminetu. Lo primero que quiero es agradecerle su estancia aqu para presentar este informe sobre la situacin de los Derechos Humanos en el Sahara Occidental. Agradecerle tambin a la Asociacin de Amistad con el Pueblo Saharaui de Sevilla (AAPSS) que me ha concedido la oportunidad de entrevistarla. Ha venido a presentar el informe El Oasis de la Memoria, un informe sobre los Derechos Humanos en el Sahara. Podra decirnos a grandes rasgos que se incluye dentro de este informe? Aminatou Haidar: Es un informe de testimonios,
extrados por el Doctor Carlos Beristain, realizado sobre terreno. Ha ido para hacer las investigaciones a El Aain, tambin ha sacado testimonios de familiares desaparecidos de Smara y los ha puesto con cifras y detalles. Ha arrojado luz sobre las violaciones de los Derechos Humanos y los crmenes de guerra de lesa humanidad que Marruecos ha cometido en el Sahara
Occidental. Don Carlos Beristain ha tomado testimonios de la poblacin saharaui que estn como refugiados, sobre todo las vctimas del bombardeo de Um Draiga y tambin de los familiares de los desaparecidos saharauis en paradero desconocido. El informe trata varios casos de desaparicin: el grupo de detenidos en la crcel secreta marroqu de Kalaat Mgouna; mi grupo, que es el grupo conocido con el nombre de grupo de la comisin porque fuimos vctimas de desaparicin durante la visita de una comisin de las Naciones Unidas. Ha tratado casos que nosotros, como activistas, los llamamos casos individuales porque todos los aos desde 1 975 hay detenciones colectivas, pero tambin individuales contra saharauis, sobre todo en las fiestas nacionalistas del Frente Polisario o tambin por ser familiar de un dirigente del Polisario o por reivindicar algn Derecho. Ha tratado tambin el tema de las indemnizaciones que hizo Marruecos con las vctimas, la discriminacin por la cual ha tratado de forma diferente a las victimas marroqus y saharauis. Ha tratado el IER (Instancia de Reconciliacin y Equidad), que es la instancia de reconciliacin establecida por el reino de Marruecos. Es un informe que nosotros, como vctimas y ONG de Derechos Humanos, lo valoramos mucho porque es muy importante ya que hace parte de la proteccin de la memoria colectiva de todo un pueblo y tambin puede ayudar a la Comunidad Internacional a crear una Comisin de la Verdad en el Sahara
JMBT: Parece sorprendente que despus de 37 aos de ocupacin ilegal por parte del rgimen marroqu sobre el Sahara Occidental hayan tenido que ser una serie de instituciones privadas las que han elaborado un informe sobre la situacin de los Derechos Humanos dentro del Sahara Occidental Qu considera usted de este Delito de Silencio por parte de las Naciones Unidas en la ausencia de observatorios sobre los Derechos Humanos que informen sobre la violacin de estos en territorio saharaui? AH: Esto confirma la complicidad de algunas potencias
de la Comunidad Internacional y la indiferencia de otras hacia el caso del Sahara Occidental, no hay una buena voluntad poltica para resolver el problema. Lo que ya no es aceptable es que la Comunidad Internacional siga con esa indiferencia y negndose los Derechos fundamentales de la poblacin saharaui que sufre diariamente la represin marroqu en su propia patria y tierra cuando el nico delito es reivindicar el respeto a sus Derechos elementales, encabezados por el Derecho a la libre determinacin. La MINURSO, que es una institucin, un mecanismo de las Naciones Unidas que est instalado en el Sahara Occidental desde hace 22 aos, no ha podido nunca jugar el papel de respetar los Derechos Humanos porque no tiene las competencias en su mandato para vigilar, observar y proteger los Derechos Humanos en el Sahara Occidental. Esto no es aceptable. De una lado estn las negociaciones entre el Frente Polisario y el Gobierno de Marruecos, pero por otro lado, nosotros somos las vctimas directas. Esas negociaciones no han trado todava unas medidas que puedan garantizar el respeto a los Derechos Humanos mientras se espera a que se haga el Referndum de 12
N3
Autodeterminacin.
El Oasis de la Memoria. Entrevista con Aminatou Haidar.
verano ella y su hermano han sido vctimas de violencia por parte de una familia marroqu en un autobs. En vez de juzgar a los violentos, a la familia que les ha atacado, ellos tambin estn acusados, los dos, mis hijos y los violentos. Esto es una parte del sufrimiento que nosotros estamos viviendo a diario en los territorios ocupados. Los estudiantes saharauis en las universidades marroqus siempre son objeto de discriminacin, de violencia, de tortura y de detenciones arbitrarias.
JMBT: Hablando de la represin y de la opresin que supone la constante violacin de los Derechos Humanos, hay una especialmente singular y que me sorprende que no lo sepa el mundo entero. Es que el Sahara Occidental es rodeado por la segunda muralla artificial ms grande del mundo, hecha por el Ser Humano, por Marruecos, el Muro de la Vergenza de 2700 kms de longitud. Cmo afecta a la poblacin saharaui ese aislamiento frente al mundo entero, ya no solamente fsico sino todo lo que supone las dificultades a la hora de entrar o salir del territorio saharaui? Cmo afecta ello a la poblacin en el da a da? Cmo afecta a la relacin con organizaciones y/o entidades que trabajan con el Sahara? AH: Este es otro sufrimiento porque el
muro divide al pueblo saharaui en dos. Una parte que est bajo ocupacin y otra parte que est en el exilio. Este muro impide la comunicacin entre las familias, impide la posibilidad de que las familias puedan encontrarse, por ejemplo, en el desierto. Es poca gente la que ha podido encontrarse con sus familiares, en Mauritania por ejemplo para hacerlo hay que tener un pasaporte y un visado que hay que conseguirlo en Espaa. Esto es
imposible, es poca gente la que ha podido salir a Espaa. Claro que hay medidas del ACNUR pero tampoco son suficientes, cuatro das despus de una separacin de 37 aos, es muy poco. Este muro afecta mucho y de una forma psquica porque sabes que hay un muro que te est impidiendo ver a los tuyos. Esto afecta sobre todo a la nueva generacin y sobre todo a los jvenes que estn al otro lado, en el exilio, al ver que este muro es algo que est bloqueando la libertad de la llegada a su patria. Esto es muy fuerte e inaceptable y nadie habla de este muro. Adems de los riesgos ya que a lo largo del muro existen minas antipersonales.
Occidental. Cules son los mayores problemas e inconvenientes que se estn encontrando la poblacin saharaui en el aspecto educativo? AH: El Derecho a la Educacin est
amenazado porque los alumnos, incluso los ms pequeos, no pueden estudiar tranquilamente de una forma normal porque siempre son amenazados por parte de los maestros mismos y, a veces, por la polica. Nadie puede creer esto, pero es la verdad. La polica entra donde estn los nios en clase pegando a los nios. La polica est casi permanentemente alrededor de las escuelas e incluso hay 3 escuelas en El Aain que son rodeadas por militares con tanques. Esto es peligroso. No dejan estudiar a los nios tranquilamente, siempre tienen temor o miedo al ver a la polica o los militares al lado de la escuela. Hay otro obstculo que es la discriminacin que sufren los alumnos saharauis, sobre todo los nios de los activistas de Derechos Humanos. Yo, personalmente, puedo ser testigo porque mi hija ha sido vctima el ao pasado de una discriminacin por parte de un profesor marroqu y hasta hoy da no ha podido estudiar en las universidades marroqus. No hay ninguna Universidad en el Sahara Occidental para terminar sus estudios superiores tiene que ir hacia Marruecos que la ciudad ms cercana es Agadir que esta a 600kms. Pero yo no puedo enviarla a estudiar all. Este
JMBT: Por ltimo, si quiere decir algo a nuestros lectores de Global Education Magazine acerca del tema saharaui o acerca del Desarrollo Humano Global. AH:
Quiero agradecer a los organizadores de la revista por la difusin de la causa saharaui. Nosotros necesitamos este trabajo y este tipo de actividades porque difundir la informacin es muy importante para la sensibilizacin respecto a la causa saharaui.
JMBT: Global Education Magazine es una revista dedicada a la Educacin para el Desarrollo Humano. Creemos en la Educacin como firme herramienta para conseguir el Desarrollo Humano Global. Entonces nos interesa mucho conocer cul es la situacin educativa dentro del Sahara
JMBT: Muchas gracias Aminatou. Desde Global Education Magazine esperamos que se haga imperativo el Derecho de Autodeterminacin saharaui y as poder recuperar la dignidad de todas las personas que luchan por ello.
13
SHARE YOUR REFLECTIONS IN THE NEXT EDITION
JUNE 20th:
WORLD REFUGEE DAY
Paul Hutchinson
N3
mundo de retos inminentes y recursos cada vez ms limitados. El desarrollo sostenible ofrece la mejor oportunidad para ajustar nuestro rumbo. La intencin del seminario fue el intercambio de buenas prcticas y experiencias entre los pases de la regin en el rea. En ella se identificaron los desafos y oportunidades para darle un nuevo enfoque a los cursos de Educacin y formacin tcnica y profesional (EFTP) hacia los llamados empleos verdes, donde se desarrollaron recomendaciones para fortalecer el programa para empleos verdes en la regin.
Proyectos de la UNESCO para Comienzos del Ao

Compartiendo los valores de Global Education Magazine la UNESCO ha lanzado esta primavera una serie de proyectos para seguir contribuyendo con sus objetivos de paz y entendimiento a travs del fomento de la cultura y la educacin. La primavera siempre ha sido vista en el imaginario de cada cultura como un nuevo renacer o comienzo que lleva a nuevas empresas de renovado optimismo y espritu constructivo. En este sentido la dedicacin y el trabajo hacia la orientacin de los pueblos en una gestin ms eficaz de su propio desarrollo y autonoma, a travs del uso responsable de los recursos naturales as como de los valores culturales, teniendo como finalidad la modernizacin y progreso conjunto solidario entre las naciones del mundo, sin que por ello se pierdan la identidad y la diversidad cultural son las directrices que se han seguido en estos nuevos proyectos. Las actividades culturales buscan la salvaguarda del patrimonio cultural mediante el estmulo de la creacin y la creatividad y la preservacin de las entidades culturales en este mbito pasamos a comentar los diferentes programas y proyectos. Entre el 11 y el 1 5 de marzo se llevo a cabo un provechoso taller llamado Re-orientando la educacin y formacin tcnica y profesional hacia el cuidado del ambiente en San Jos, Costa Rica. Como ya seal Ban Ki-Moon, Secretario General de las Naciones Unidas, en enero de 201 2 Los indicadores ambientales, econmicos y sociales nos dicen que nuestro actual modelo de progreso es insostenible. El cambio climtico est destruyendo nuestro camino a la sostenibilidad. El nuestro es un
Orientados hacia un desarrollo sostenible la inclusin de estos cursos en la formacin de futuros trabajadores es tambin inculcar una educacin de respeto a la naturaleza y responsabilidad cvica claves para el futuro. Como seala Jorge Sequeira, director de la Oficina Regional de Educacin de la UNESCO para Amrica Latina y el Caribe La transicin hacia una economa verde en el contexto del desarrollo sostenible y la erradicacin de la pobreza, tiene un potencial significativo de creacin de empleos y puede contribuir a cerrar la brecha de inclusin social continuando en un camino a largo plazo al enverdecer la EFTP [ya que] significa ensear a los futuros tcnicos a cuidar el medio ambiente en sus procesos de trabajo segn Astrid Hollander, especialista del programa en Educacin para el Desarrollo Sostenible, Educacin Tcnica y Profesional y Educacin en Situaciones de Emergencia. La intencin es llegar al punto de convertir todos los empleos en empleos verdes, as al mismo tiempo irn apareciendo nuevos perfiles laborales que respondan las necesidades de la economa verde, siendo en estos momentos el ecoturismo y la agricultura orgnica los grandes exponentes. El mismo Jorge Sequeira explic que enverdecer la EFTP es crucial para hacer una transicin desde los patrones de produccin y servicios intensivos de emisiones y gasto de energa hacia una produccin ms limpia y ms verde. En el siguiente enlace se puede observar en formato PDF el cronograma y como fue la organizacin del taller y en este otro, en el mismo formato, el fomento de competencias para el desarrollo sostenible. Con el mismo objetivo de desarrollo sostenible y mirando a la conferencia mundial sobre el tema (Japn 201 4) se est trabajando en un nuevo marco global a definir un el seguimiento al Decenio. En este sentido la Oficina Regional de Educacin para Amrica Latina y el Caribe (OREALC/UNESCO Santiago) apoyar la organizacin de dos consultas subregionales, con el fin de continuar trabajando en el 15
N3
informe final de monitoreo y evaluacin del Decenio de las Naciones Unidas de la La XXX Reunin de Coordinadores Nacionales del Laboratorio Latinoamericano de Educacin para el Desarrollo Sostenible (2005-201 4). Evaluacin de la Calidad de la Educacin (LLECE) donde participarn representantes de los 1 5 pases miembros de esta institucin se realizar el 24 y 25 de abril, en Las consultas tendrn Ciudad de Panam. Los socios implementadores del TERCE (MIDE Universidad lugar los das 1 6 y 1 7 de Catlica y Universidad Diego Portales), as como el Instituto de Estadsticas de la abril en Costa Rica, donde UNESCO y el equipo de coordinacin tcnica del LLECE desarrollaran la ltima solo estarn orientadas a los instancia previa con la entrega de los instrumentos de investigacin, lo que representa Estados Miembros de el inicio del estudio ms importante de la regin de America Latina y el Caribe sobre Amrica Latina y estarn logro de aprendizaje. Comienza el 26 de abril con la aplicacin definitiva del Tercer acompaadas por un Estudio (TERCE). proceso de consulta online totalmente abierto hasta el Estamos en una fase 31 de marzo a todos los crtica para la interesados en la Educacin planificacin estratgica para el Desarrollo Sostenible del LLECE. No (EDS). Estas consultas solamente porque regionales son clave para estamos en el proceso de afianzar una planificacin sustancial ms all de 201 4 ideas y apoyos procedentes de aplicacin definitiva del toda la regin TERCE, tambin porque es necesario visualizar El objetivo por tanto ser asegurar un proceso innovador donde primarn la dnde estar el LLECE transparencia y participacin dentro de un marco programtico de la EDS que en 5 aos y cmo se continuar ms all del 201 4 a travs de la coleccin de ayudas de los actores adaptar a los nuevos relevantes de los Estados Miembros. Como afirm el ya nombrado Astrid Hollander desafos y tendencias, Las consultas regionales permiten rescatar los intereses y necesidades de los pases regionales y mundiales, en educacin afirm Atilio Pizarro, Jefe de la Seccin de para disear los lineamientos y acciones para el desarrollo de una Educacin para el Planificacin, Gestin, Monitoreo y Evaluacin de OREALC/UNESCO Santiago. Desarrollo sostenible de alto impacto en Amrica Latina y el Caribe. Adems, nos permite de conocer las experiencias de los pases, identificar factores de xito y En esta reunin adems se difundirn cuatro informes claves del LLECE, como lecciones aprendidas que puedan orientar el diseo de actividades de EDS en el por ejemplo informe sobre polticas educativas en la regin junto con el Anlisis futuro. Curricular del TERCE, el trabajo de la Comisin Especial sobre Mtricas de Aprendizaje (sobre calidad de la educacin) de la agenda mundial Educacin para En el siguiente enlace se puede acceder a la web de consultas subregionales. Todos de la UNESCO y tambin los resultados de la 2 reunin del Consejo Tcnico Consultivo de Alto Nivel del TERCE (CTAN), que se celebr en Santiago en diciembre Y por ltimo, sealando los proyectos interesantes para este comienzo de ao del ao pasado. por parte de la UNESCO hablamos sobre la aplicacin de evaluacin regional de aprendizaje TERCE que comenzar en abril de 201 3, despus de la reunin de los 1 5 pases participantes.
16
N3
UNHCR's Work on HIV in the Americas

In Latin America and the Caribbean there are around 3.6 million internally displaced persons and about 445,000 refugees / asylum seekers facing a series of challenges due to their displacement, a situation that exposes them to a risk and vulnerability to HIV. Border areas reports in most cases a higher HIV prevalence due to the presence of sex work networks, high levels of violence and lack of timely medical services related to HIV prevention, treatment, care and support. During their transit, our population of interest may be a victim of sexual exploitation and violence, situations that can lead to acquiring HIV infection. Besides, their legal status often hampers timely and equal access to existing health services in these areas. Poverty, broken family structures, social obstacles to local integration, precarious education services, and situations of stigma and discrimination due to their refugee status, also expose them to factors that facilitate HIV transmission in their host communities. UNHCR seeks to ensure that our target population has access to information on HIV prevention and transmission and that people living with HIV could have full access to HIV treatment, care and support services without becoming victims of stigma and discrimination, or that their refugee status may affect the provision of these services. In a broader way, UNHCR conducts advocacy interventions before governments and international agencies aiming at the inclusion of our population of interest in the design and implementation of HIV national and international programmes. Projects and actions designed by UNHCR HIV focal points from each country operation with the support of the HIV Regional Coordination, corresponds to strategic planning that seeks to develop and apply the 1 0 Key Points on HIV/AIDS and the Protection of Refugees, IDPs and Other Persons of Concern and the latest UNAIDS recommendations on the subject for our region. During 201 2 countries as Mexico and Brazil implemented a series of HIV and Reproductive Health trainings to stakeholders working on refugee issues. In Ecuador, a project was implemented in the provinces of Sucumbios and Orellana (northern border with Colombia) for strengthening the sex work network in the area of HIV prevention amd other sexually transmitted. Venezuela implemented a project aimed at promoting human rights and the reduction of stigma and discrimination against people living with HIV in border communities with Colombia (Tachira, Zulia and Apure). Dominican Republic implemented a set of actions on HIV prevention and reproductive health issues in rural areas (Monte Plata) and urban areas (Boca Chica) of Santo Domingo. Costa Rica and Haiti implemented projects related to HIV and Sexual Gender based Violence in urban areas. Finally, Panama developed a series of trainings in the border area with Colombia (Darien) on HIV prevention measures and reproductive health addressed to population of concern and local population. Although our region has made significant progress in terms of access to antiretroviral therapy, unfortunately there is an increase in the report of new HIV infections. Taking into account these circumstances it is essential that UNHCR continues to implement HIV and Reproductive Health projects and actions in benefit of our population of concern. Despite all the progress that has been achieved since the first AIDS case was detected more than 30 year ago, there is still much to do to in order reach a world vision in which there is no a single HIV infection, where nobody dies as a results of aids and free of stigma and discrimination. Meanwhile, the battle continues.
Associate Regional HIV & Reproductive Health Officer for the Americas Regional Office Panama 17
Rosalina Cermeo Vargas
What is the Role of the Pharmacist in the Health Care System?
Critical Pedagogy Against Capitalist Schooling:
Towards a Socialist Alternative

"Together, we can turn possible futures into tangible realities that can liberate us from the chains that make us as much as we make them. We have the power to break our chains."
An Interview with
Peter McLaren
by Jose Mara Barroso Tristn
N3
PETER McLAREN is the inaugural recipient of The Social and Economic Justice in Public Education Award by the Marxian Analysis of Society, Schools and Education, The American Educational Research Association, 201 2; the Central New York Peace Studies Consortium Lifetime Achievement Award in Peace Studies; the 201 3 Award of Achievement in Critical Studies by the Critical Studies Association (Athens, Greece); the "Friend in Solidarity with the Struggle of Mexican Teachers" award by the National Union of Educational Workers (Michoacan), and the First Annual Social Justice and Upstander Ethics in Education Award presented by the Department of Education, Antioch University, Los Angeles. He is also the recent recipient of the Ana Kristine Pearson Award in Equity in Education and Economy presented by The Center of Education and Work, the University of Toronto, 201 2. The government of Venezuela recently honored Professor McLaren with the International Award in Critical Pedagogy, while the Universidad Nacional Autnoma de Mxico recognized him with the Distincion Academica Educacin, Debates e Imaginario Social. Professors McLaren's work has been translated into 20 languages. One of his books, Life in Schools, was chosen in 2004 as one of the 1 2 most significant education books worldwide by an international panel commissioned by The Moscow School of Social and Economic Sciences and by the Ministry of Education of the Russian Federation. As a political activist, he lectures worldwide and works with revolutionary, community and educational groups around the globe. Peter McLaren is Professor of Urban Schooling, the Graduate School of Education and Information Studies, University of California, Los Angeles. He is also currently Distinguished Fellow in Critical Studies at Chapman University, California.
Critical Pedagogy Against Capitalist Schooling: Towards a Socialist Alternative. An Interview with Peter McLaren.
their capacity to transform it, to challenge racism, sexism, homophobia, ableism, to fight against white supremacy, etc. But I believe that around the mid1 980s, when corporations began to become more powerful that some nation states, that the battle for critical democratic citizenship became just a smokescreen for the production of consumer citizenship and critical pedagogy as it was then conceived became more like a dying star about to go into a supernova stage and incinerate any hope we had for real educational transformation, locked as we were within a neoliberal state that was quickly consolidating itself (and that a few decades later would have transformed itself into a security state akin to fascism). Hence I looked for a navigatable transit route beyond liberalism in the direction of a Marxist humanism. At the time, when the wet-sock formlessness of postmodern theory was becoming an unwitting companion of neoliberalism, I was mocked by some in the field for returning to a discredited Marxism. But the more our daily toil and struggle in the sloughs of ordinary human existence and human suffering increased, and the more our journey within in the fearful paradoxicality of everyday life contrasted with the neat and seemless principles of neoliberal logic of privatization, the more rational Marxism sounded to me. Critical pedagogy has a transnational heritage. There is no final resting place in the vault of the critical pedagogy pantheon, since critical pedagogy is constantly reinventing itself to meet the challenges of the present. The work of Freire remains central and we need to remember the initiatives of popular educators and socialist Sunday schools, liberation theologians, schools for factory workers, socialist collectives, and other groups in various parts of the world. We not only need to build a collective memory of the field, but a shared memory. So we need to learn the history of struggles for educational transformation as it has occurred throughout the globe. I see my role in very modest terms-to push critical pedagogy in North America in the direction of appreciating socialism as a 20
pedagogy. In the field of critical education there is an entanglement of visions, locations, practices and these understandably vary from individual to individual, neighborhood to neighborhood, district to district, region to region, country to country, etc. Critical pedagogy is, after all, part of a geopolitics of knowledge. For me, the fundamental goal of critical pedagogy is the struggle for a socialist alternative to capitalismwith capitalism understood as a global ecology of exploitationand the approach I take builds on conventional approaches to critical pedagogy. I include in my recent work insights from the decolonial school that contests the coloniality of power, I include advances in critical race theory, feminist theory, and ecopedagogy, to name several areas of interest that I feel are important. My approach to critical pedagogy is therefore radically heterodoxor if you prefer, fundamentally orthodoxdepending upon where you stand, or your positionality. But it is safe to say that my approach cannot be essayed by traditional liberal efforts to reform dimensions of capitalist society that most impact teaching and learning. There would be critical educators that would contest my own approach to critical education, and that is part and parcel of being a critical educator, and their (frequent) opposition to my position is not something that I condemn but engage in the spirit of critical dialogue. Of course I fully agree with many of the more accepted goals of the liberal variants of critical pedagogy whose arch-categories include the followingto foment dialogue, to deepen our appreciation of public life, to create spaces of respect appreciation for diversity, to encourage critical Jose Mara Barroso Tristn: The first question and thinking, to build culturally sensitive curricula, to create a I would like to ask you is: Considering the vibrant democratic public sphere, to try to change the fact that you are a critical educator, which hardened hearts and of our increasingly parasitic would you say are the main components that financial aristocracy, minds to build knowledge from the distinguish a critical education from a experiences and the histories of students themselves, to traditional one? make knowledge relevant to the lives of students, and to students to theorize and make sense of their Peter McLaren: While I am a critical educator and encourage have the utmost respect for the field, I do not work in the experiences in order to break free from the systems of arena of what might be considered conventional critical mediation that limit their understanding of the world and
N3
collective goal. And here I am not referring to the European tradition alone, but to autonomous social movements of indigenous communities in Las Americas and elsewhere. The revenants of critical pedagogy will return to haunt us, should we forget what first animated its mission, which was the struggle against the ravages of capitalism, and to bear witness to a better future. The little maledictions of daily political life over time abrade the flesh of our hope so that we resignedly give over our agency to others to run the engines of democracy. The popular majorities have a pent-up cargo of vitriol aimed at the nations corporate bloodsuckers: the rentextractors, rich financiers, money-for-nothing bankers, kleptocrats, rogue traders, subprime malefactors, neo-feudal overlords of commerce headquartered in Wall Street, Paleolithic demagogues working as CEOs, and hedge fund slime masters, whose corporate machinations collect like massive gobs of rancid spittle in the melting pot of capitalism we call America. Those are the 99 percent, who do not control most of the countrys wealth, who have become the victims of the great recession, and have organized themselves as the Occupy Wall Street movement (and various other Occupy movements). But the anger directed at the banking and finance establishment, or at the governments bailout of these institutions, while understandable, is nevertheless misdirected. The social relations that have victimized the poor are not simply the result of greedy bankers who over the last few decades have decided to overreach themselves in the squalid frenzy of market deregulation; rather, the social relations that are largely responsible for the current economic crisis are those produced by the regime of capitalism itself. Paulo Freire would have clearly understood this. And while the anger of the 99 percent may be misdirected, this historical moment presents itself as an opportune time to reflect upon capitalism and to explore alternatives to it.
ourselves and our relation to the ecology of capitalism, but it is those ideas that are located in the routines and rituals of everyday life that are more likely to have an impact on transforming society. Critical consciousness is more of an outcome of certain social practices, cultural formations, habits of mind and the institutional arrangements that help shape them, as well as the rituals and routines that give them legitimacy, than a precondition for them--but there is no question that they are dialectically related. But let me discuss epistemology first, and then try to make a case for why a transformation of our thinking, or our logic, is only one part--albeit an important part -- of the dialectical struggle for a democratic socialism. And why such a struggle is enriched by a Marxist humanist analysis as we seek to overcome the current empire of finance capitalism. Im interested in the evolution of neoliberalisms cultural logicor what you refer to as supranational superstructural logicand also how it has manifested itself throughout regional or national contexts. Ive been interested in this topic since the early 1 960s. Those were wide-awake days of wide-wale corduroy pants, Maynard G. Krebs beards (as opposed to todays popular shadow beards), fake turtleneck sweaters (known as dickies), fake turquoise Navajo necklackes, milk-crate-living roomdcor, and neighborhoods where you could count on your mom-and-pop stores being in the same location for at least the next five years; that was before the days when your favorite empty back lot would suddenly give birth to a Walmart, a Costco, a Home Depot or your local ravine transformed in a month into a suburban business park or cookie cutter strip mall. Then came the nerd-cool days and the high tech revolution, a status-obsessed culture of consumption, more sophisticated and devastating U.S. imperialist wars, purblind postmodern doxa, and, of course, the trend towards cultural studies in the academy. And along came advances in information technology and the social media that were able to pry 21
Picture by Laura Herrera
JMBT: Please correct me if I am wrong but I get from your words that this issue goes beyond every educators paradigm. Without playing down its importance, this problem is actually rooted in nowadays neoliberalcapitalist supranational superestructure that imposes its logic over every institution that depends on it. Which epistemology and educative methods do you avail yourself to achieve progress towards a Marxist humanism? PM: That is an important question. I do agree that
neoliberalism is animated by an identifiable logic or system of intelligibility. Neoliberalisms epistemological imperatives are burningly relevant for every critical educator; they must be engaged, critiqued and contested, but the issue for me goes beyond epistemology. Ideas and paradigms and worldviews are important, and so are new ways of thinking about
N3
open some cracks in the corporate pavement and the petrified slough of everyday life, where internet culture was able to fertilize some of Tupac Shakurs famous roses springing from the cracks in the pavment in the form of talk-back forums and on-line petitions. Yet, even with new forms of resistance ushered in by technological innovation, the stiff-gestured ideology of neoliberalism has arched towards a state of human exceptionalism where all of humanity is now supposed to feel free to exploit at will the relations between nature and society any way that it chooses, as long as profits can be squeezed out. You really cant describe the situation we are in today as an estrangement between the bankers and corporate CEOs and the rest of the 99 percent that brings out the worst in bothbarefaced greed and a hateful relish in the suffering of others in the first and a dystopic and quiescent resignation to the inevitability of capitalism in the second. Because there is no possible future for capitalism that doesn't reproduce the immense suffering of the popular majorities--the 99 percent-- in the present because capitalism is premised on the free development of the few at the cost of the exploitation and immiseration of the many. The epistemological presuppositions that undergird neoliberal capitalism can be unraveled like an unspooled film; each application of neoliberal prescriptions to knowledge formation can be scrutinized in the context of the larger mise-en-scne. Cultural theorists have done an excellent job of understanding the impact of neoliberal ideology on the production of space, place, scale, historical time, and race, gender and class identity and human agency. I agree that this is important work and we need to look at such production in relation to the commodification of everyday life. Among other things, neoliberal logic is a logic of the lowest common denominator, a technocratic rationality in which value is accorded to how much surplus value can be extracted and accumulated. Finance or asset
futures. Marx believed in the primacy of material relationships as against the primacy of "spirit" and made us aware that profit does not come from market relations (buying low and selling high) but from human labor power and the sweated labor of the toiling class. Now I am not saying that I believe spiritual values are unimportant. What I am saying is that we need certain material conditions to obtain in society before the quest for spiritual values can be pursued effectively. If we want a simple formula to examine humanity, we could say that those who have to sell their labor power to earn a living (those who produce the profit for the capitalist) are part of one class--the working class. Those who purchase human labor and take the profit away from labor are part of another classthe capitalist class. I follow Marxs focus on the development of human productive forcesa very complex process that is historically related to the material conditions of production and the class struggle. Every given stage of development of the productive forces of societythat is, of the human species, and of the division of laboris bound up historically with certain social relations of production, particularly class relations. Once a particular form of class domination comes into existence as a result of this complex process of historical development, the dominant element in the relations attempts to freeze it into place, and the existing society loses its progressive character. Despite changes in the material conditions of production, any ruling class will seek to preserve its rule at all cost, thus becoming a fetter on further social and economic development. The state, law, religion, and the entire realm of ideas, to the extent that they represent the overarching interests in society and are conditioned by the underlying set of socioeconomic relations, will all be enlisted for the purpose of defending the status quo and of patching up societys contradictions, often through the disheveled fantasies of Hollywood or the brittle enchantments of popular culture. Now what does this all mean for education? Well, it means trying to push capitalists to address the suffering of the poor and the oppressed, as 22
capitalism, accumulation by dispossession, disaster capitalism, crony capitalism--all of these incarnations of capitalist exploitation are an outgrowth of neoliberal ideology. I would not be able to think outside of neoliberalism's own limits without the fertilizing influence of Marx. Utilizing a historical materialist critique has helped me to think more deeply about how we might live differently in the present and imagine futures of concrete possibility outside of neoliberalism and the logic of value production and where we can break free from the production of time, space and self which exists under the servitude of capital. Historical materialists generally believe that it is possible to grasp the object of knowledge, that a world exists independent of our existence, and that this world can be directly grasped (although not fully grasped) in itself. They wager that the objective world needs to be understood in relation to others, to the social character of both our being human and our becoming more fully human. I call this a transformative volition, or protagonistic intent, a praxis of the possible that moves in and on and through the world designed to transform the material and social conditions that shape us (and are shaped by us) so that our capacities are enhanced and our humanity enlarged. Here, the world can be conceived as a concrete totality , a reality that is already a structured, self-forming dialectical whole in the process of coming into existence. Here the challenge is to avoid solipsism and idealism through a method of analysis and a conception of the world that involves a dialectical analysis of reality and a dialectical unity with the oppressed. Here I try to be consistent with the holistic human science developed by Marx, who, by the way, was no economic determinist. Historical laws of tendency of capital are not the same for Marx as natural laws. Marx did not ascribe to the idea that capitalism follows universal evolutionary laws. History does not follow a single trajectory, there are many contingencies and regularities, broadly predictable tendencies and possible
N3
long as capitalism continues to operate, but we must recognize that we need to move beyond capitalism if we ever hope to bring about genuine equality and a greater unfolding of human powers and capacities. While well-meaning progressive educators might be willing to criticize the manner in which humans are turned into dead objects that Marxists refer to as fetishized commodities, they are often loathe to consider the fact that within capitalist society, all value originates in the sphere of production and that one of the primary roles of schools is to serve as agents or functionaries of capital. Furthermore, they fail to understand that education is more reproductive of an exploitative social order than a constitutive challenge to it precisely because it rests on the foundations of capitalist exchange value. Reading Marx and Freire may not alchemize us into revolutionaries capable of transcending capitalism but ignoring what they had to say about transforming education in the context of class struggle would be a huge loss to our efforts. Much of my work has tried to demonstrate that many liberal progressive educational reforms are embedded in a larger retrograde, opportunistic and banalizing politics that situates itself a culture of liberal compassion and a polyglot cosmopolitanism that does more to impede educational transformation than advance it.
Communication and the Media that examined the theories and ideas of Marshall McLuhan. He was also a Catholic convert and largely as a result of his influence I became interested in theology (although Hutch became a conservative Catholic in his later years while I ventured into the chilly hinterlands of the Jesuit mind to explore abstruse books deemed by the guardians of the faith as heretical, works by liberation theologians and apostates). Wanting to join the priesthood, but not having much religious faith, I abandoned the idea, destining myself to live on the secular fringes of what was considered at the time the normal world (where the men no longer were required to wear fedoras, but where sterile office cubicles in some cold stone building became the bleak destiny of so many of my contemporaries). Often I found myself lost in a world of reading-- Nietzsche, Camus, Sartre, Hesse, Genet, Proust, Northrop Frye, Marshall McLuhan, Harold Innis, Gregory Baumwhere I tried in vain to dislodge myself from everyday life in the Toronto suburb of Willowdale, what was to me a Cimmerian land of gloom and despair. The work of Dylan Thomas, Vachel Lindsay, Leonard Cohen, Irving Layton, and then, of course, the Beat Poets, helped de-anchor me temporarily from my malaise but the intemperate despair of youth would inevitably overwhelm me. I grew up in a conservative working-class family who had left its roots in farming communities of Ontario to travel to Hamilton, Toronto and other large metropolitan areas (where my dad landed a job as manager of Eastern Canada for Philips Electronics and brought us temporarily into the middle class). I was told that my ancestors worked the shipyards in the docks of Glasgow as riveters and welders, but I havent really gone deeply into my family tree, all that I remember are pictures of my great uncle on the farm, photos of my maternal grandfather in a kilt and carrying a riding crop, and photos of my paternal grandfather selling soap out of the back of a car. My paternal grandmother lived with us until she died when I was about sixteen and I remember 23
educator? PM: Okay, let me begin, then, with your question about
my own history, just briefly. Like many young people growing up in Canada during the 50s and 60s, I felt increasingly like I was being swallowed up in some viscid mass of dull, mind-numbing convention, particularly my experience of being schooled, since I like to make a distinction between being schooled and experiencing an education. Education requires the cultivation of critique, or critical consciousness, and in my teenage high school years, being intelligent or able to conscript concepts into the service of sustained analysis was not something that earned one a lot of attention with ones peers, and I was culturally shallow enough to want to be part of the popular crowd, so I would often hide my intellectual curiosity about life, mostly during moments of grinding loneliness. In those moments I would expostulate with myself about why my life at school seemed so ruinously vacuous, why I was so interminably miserable, why acts of creativity, and why displays of ingenuity and wit seemed to be off-limits and treated by so many teachers as unjudicious, as a type of impolitic epistemological breach. I did have two wonderful and exceptional teachers my last year of high schoolDennis Hutcheon and Harold Burke. Mr. Burke would do dramatic readings in class. With lungs as unfillable as St. Peters Basilica, he would bellow samplings from Shakespeare and contemporary plays, which he scrupled to be an indispensable part of a good education, and of course he was right. In his classes we made earnest, if not halting, attempts to fathom the doxa and paradox, the stereotype and the novation of everyday life. From Mr. Burke I would learn to appreciate the power of rhetoric, and often engaged in debates with a shameless extravagance. Such profligacy could be tolerated in a young sprat in those days, and the gasconade that flushed out of my mouth no doubt made me insufferable among many of my more learned peers. Hutch developed a course on
JMBT: We agree that Education acts as a social reproducter of the Neoliberal system. And so, it is imbued with its Neoliberal logic and perpetuates the extreme wealth of a negligible minority against the vast majority of people that struggles to reach a respectable life. What can Educators do to change this situation and move forward a Global Humanist development? How did you start out in your life to become a critical
N3
she could kick over her head well into her eighties. An only child, who watched my father, a WWII veteran in the Royal Canadian Engineers, enter the reserve army of labor after he was fired from Philips and my mother-a homemaker-venture out to work to support the family as a telephone operator when my fathers emphysema made it impossible for him to continue working in parttime electronics stores, I grew up angry, suspicious of giving my life over to a corporation, or what we called "the suits." Prior to my dads illness, our house was a fusty solarium of normalcy: television detective stories and westerns in the evening, televised hockey games, televised comedy shows; in short: televised happiness for a life unexplored (although I did long to travel, Kerouac-style, with Buzz Murdoch and Tod Stiles in the excellent Route 66 series, and later, down the long and lonesome highway with Jim Bronson [Michael Parks] in the hit television series, Then Came Bronson). In the late 60s, I had joined the Yorkville Village hippie community as a part-timer, as what was called a weekender and Yorkville as I remember it was as much a state of mind as it was a cluster of streets downtown where we used to hang out, try every drug imaginable, and sometimes, if we were lucky, get turned on to good books and albums and meet Pre-Raphaelite-looking young women who knew members of the Toronto artist and literati circles and would invite us along to parties and gatherings where we would pretend to fit it. Yorkville was a place where, potentially, you could develop a more discerning eye for understanding the production of culture and sometimes come to recognize the coincidence between mass cultural production and the regression of one's own intellect, as bikers, greasers, hippies, teenyboppers, and sometimes political organizers, congregated in the coffee shops and flop houses, or just hung out on the streets, all pretending that we were creating a new society free from the normative shackles of conventional morality and lifestyle but basically we were looking for drugs, sex and rock and roll and our twenty minutes of fame. That I was
about what happened nextthe beating I took with flashlights administered by the Metropolitan police in a dank North York jail, meeting Alan Ginsberg, my trip to the US, my psychedelic evening with Timothy Leary, the exhilarating craziness of San Francisco and Los Angeles in the summer of 1 968, so I wont recount those days here. How was any of this distinctly Canadian, Im not sure because I didnt really reflect upon my Canadian roots until I ended up in the United States, what began as a desperate sojourn but what has lasted 28 years and counting, having lost my university teaching post in Canada due to my increasingly politicized teaching, and being rescued by Henry Giroux, who brought me to Miami University of Ohio and helped me figure out how to do political work and remain in the academy. Living in Ohio, I was often told by students that I reminded them of a Northern American, a decaffeinated American, rather than a Canadian, an observation, frankly, I found disturbing, and very telling about the US students and culture. While geo-specifically Canadian, and working within a coloniality of power that I often felt obliged to critique, I think my identity growing up in Canada was more mobile than nationalist, if not badly mangled, bleeding through the figurative membranes of its Canadian-ness, as something that was always already foreign to itself, as I really didnt have a sense of what it meant to be a Canadian but at the same time I tried to account for the people I met and the ideas I encountered in the context of living a life in the service of something larger than ones nation state, trying to understand what it meant to be of service to society. I felt I belonged everywhere, and nowhere, everywhere an aberration, and nowhere did I feel remotely comfortable--I suppose I grew comfortable in my discomfort. Moving away to the US, however, motivated me to claim a Canadian identity (as opposed to re-claiming an already well sutured Canadian identity) inasmuch as I grew to loathe the US political scene, its American exceptionalism, its imperialist wars, its phony democracy, its incipient and then blatant fascismand I wanted to claim something 24
living in the latest phases of capitalist globalization was not something that arrested my attention, even momentarily. It had not occurred to me that such a exploration of the "integral society" was importantor even significantor that it was necessary to fathom the means and ways that I was situated in the larger social order, immersed in an internally differentiated yet dialectically unified nation state called Canada, living in the fringes of a civil society consisting of an ensemble of practices and relations of power dialectically interpellated by and integrated within the state. That was life before critical theory, sociology, anthropology, hermeneutics and existential phenomenology. Life was lived as a crude binarism: We were cool and everybody else was suspiciously uncool, especially anyone over thirty. There was even an adversarial relationship at that time between youth-based politics and social movements advocating class struggle. Yorkville was more about lifestyle and counterculture as opposed to the political transformation of society, and the Maoists that you might infrequently encounter appeared to us as too militant or dogmatic to be taken seriously if one wanted to enjoy the bohemian lifestyle and that's what we were looking for in those days. I became politicized later on, mainly by Americans who had left the US as a result of the Vietnam war and ended up my professors at Waterloo University and the University of Toronto, although admittedly this was a New Left politicization, with identity politics, civil rights and new social movements (feminism, gay rights, immigrant rights) displacing rather than integrating into much of the previous class-based political formations. I recall that there was a City Controller, Herb Orliffe, who suggested, ominously, in the Spring of 1 967 that Yorkvilles hippies should be warehoused in work camps where they would learn a trade. I recognized that a desinence had arrived in the trajectory that my life was taking, and that the Yorkville scene was dying, and by 1 968, I had come to the inevitable realization that a change in my life was sorely needed. Well, Ive written
N3
outside of that, which at times I would label Canadian. Especially during my visits to Latin America, I highlighted my Canadian identity but, to be fair, I have been impacted in many ways by American activists and thinkers and I feel I am all the better for that. I am more interested now in a politics of solidarity and communalidad than I am in conventional identity politics. What drives me today is not narrating the many trajectories of selfhood as much as committing myself to a protagonistic politics, forging a united front against capital and its attendant hydra-headed antagonisms: racism, sexism, homophobia, ageism, abelism, speciesism, and the like. What I can tell you now is that I do feel much more comfortable among workers and the popular majorities than I do among the transnational capitalist class, the bourgeoisie, and that is the case in all the countries in which I am regularly privileged to spend time. Well, on to the next parts of your question. If there exists a structured silence and motivated amnesia surrounding the urgent task of historicizing power relations in concrete material conditions of production and reproduction, and if, following this, there exists a grand refusal to disclaim the limitations of bourgeois ethics in the project of social transformation and, finally, if there remains a studied reluctance to engage the concrete multilayered totality of everyday life in which use value is subordinated to exchange value, then we cant simply blame the education system or teachers for churning out capitalist dupes. We are all dupes to some extent and each day I am striving to become less so, as I continue to take advantage of my potential to be a learner. As I tried to point out in my discussion of my experiences as a youth growing up in Canada, teachers are not immune to the ruling ideas of their society, which, as Marx noted, are usually the ideas of the ruling class. And, so, as we know, the educators themselves must be educated. As Marx opined in his Theses on Feuerbach, The materialist doctrine that men are products of circumstances and upbringing, and that,
educational formations. The question we need to ask is: How do you abolish value production, wage labor? We need to go beyond state intervention into the economy, since this is not socialism. State intervention into the economy doesnt prevent value-producing labor, alienated labor. In fact, capital is a social relation of abstract labor, and it is precisely capital as a social relation that must be transcended. Of course, this is the challenge for all of us. To go up against the ideological state apparatuses (that also have coercive practices such as non-promotion and systems of privilege for those who follow the rules) and the repressive state apparatuses (that are also coercive in that they secure internal unity and social authority ideologically via patriotism and nationalism) is not an easy task. There are disjunctions and disarticulations within and between different social spaces of the superstructure and we must work within those, in spaces of the legal and ideological systems that can be transformed in the interests of social and economic justice. The struggle is multi-pronged. Revolutionary critical pedagogy is a mode of social knowing that inquires into what is not said, into the silences and the suppressed or the missing, in order to un-conceal operations of economic and political power underlying the concrete details and representations of our lives. It reveals how the abstract logic of the exploitation of the division of labor informs all the practices of culture and society. Materialist critique disrupts that which represents itself as natural and thus as inevitable and explains how it is materially produced. Critique, in other words, enables us to explain how social differencesgender, race, sexuality, and classhave been systematically produced and continue to operate within regimes of exploitationnamely within the international division of labor in global capitalism, so that we can fight to change them. Thus, a pedagogy of critique is about the production of transformative 25
therefore, changed men are products of changed circumstances and changed upbringing, forgets that it is men who change circumstances and that the educator must himself be educated. Even the teachers unions have been in the grip of neoliberal education policies, although for years I have advocated a social movement unionismthat is dedicated to engage beyond workplace concerns, but also in terms of wider political struggle for social and economic justice, for human rights, and for participatory and direct democracy. Social movement unionism works with affiliates in workers movements, womens movements, student movements, other human rights organizations to and integrates them into a broader network or popular front against injustice and exploitation by the ruling class. Revolutionary critical pedagogy is part of an ecosystem of political activism that includes community organizations, teachers organizations, and larger human rights groups advocating for multicultural education, gay, lesbian, transgender and bisexual rights, living wages, ecological justice, and disability rights, and anti-racist and anti-imperialist organizations. Here we find curriculum organizations, teacher education organizations, and educational policy organizations working together against standardized testing, the privatization of public schooling, the school to prison pipeline, advocating for parent and community involvement in schools. The overall agenda that I have been trying to develop since the mid-1 990s is captured in the description of what Istvn Mszros calls socialist education: the social organ through which the mutually beneficial reciprocity between the individuals and their society becomes real. My concern has been with marshaling critical pedagogy as a broad, non-sectarian coalition or social movement into the service of altering historical modes of production and reproduction in specific social formations, including if not especially
N3
knowledges. It is not about liberty as the freedom of desire, because this liberty, this freedom of desire, is acquired at the expense of the poverty of others. A pedagogy of critique does not situate itself in the space of the self, or in the space of desire, or in the space of liberation, but in the site of collectivity, need and emancipation. To sum up, teachers need to support sustainable alternatives to neoliberal capitalism with its emphasis on economic growth; protect natures resources for future generations; protect ecosystems and help support biodiversity; support a community based economics, and a grassroots democracy that includes participatory and direct forms, embody anti-racist, anti-ableist, anti-sexist, and anti-homophobic pedagogies that respect diversity and work from a post-patriarchal perspective. I wont summarize here the imperatives and practices of critical pedagogy, or popular education, except to say that these approaches build from the experiences of students, and employ languages that help students interrogate the transparency of their own experiences, that is, languages that enable students to challenge the interpretation of their experiences and that assist students in connecting their own experiences and histories to broader situations that are local, regional, national and global in scope. I think its important to give students the opportunity to think dialectically and employ an historical materialist perspective in analyzing their own communities and relationships in their neighborhoods and schools. Not only do teachers need to become critical researchers but they should give students the opportunity to acquire research skills. There are lots of theoretical perspectives that teachers can draw fromcritical disability studies, critical ethnography, feminist theory, critical race theory, postcolonial theory and the work of the new decolonial school who work from the premise that we need to fight the coloniality of power. Also, liberation theology offers a tremendously rich source of understanding state power as a form of social sin. What this comes down to is
up in the name of the never-ending search for diversity, or human rights or freedom of choice, or whatever is the flavor of the month, thereby undermining the whole notion that we can have any real political equality in a capitalist society. The popular majoritiesthose who are forced to survive on wage labor, sometimes known as the 99 percentare never able to win great substantial victories for democracy, but are forced to accept incremental steps towards achieving some small victories in the areas of progressive taxation, health care, universal education, retirement pensions, and environmental and consumer protections and civil rights. Even though these small victories are reversing themselves, drastically in some case, the transnational capitalist class makes sure the situation doesnt get so bad that the 99 percent takes to the streets like they did during the Occupy Wall street movement heyday, so they will sell hope for the future for those that agree to be patient. But such hope is really snake oil in disguise. The rich dont need government social assistance, they can buy all that they need of anything, privately. With so much structural dependence on corporate dollars, real democracy is out of reach in the United States. What about the worldproducing power of the media? In these days of finance capital and banking deregulation, the media are going to remain in the hands of private corporations that work hand-in-hand with the government. Powerful commercial media owners who are 26
encouraging teachers to become transdisciplinary public intellectuals who are engaged in what Henry Giroux has called public pedagogy. Teachers can learn a lot from the Bolivarian Revolution in Venezuela in becoming public pedagogues, and the work being done in the misiones Bolivarianas. Here students connect their learning to working on community projects. All learning is connected to improving the lives of families and social groups. All of this activity requires adopting a philosophy of praxis. It is a disposition that one acquires. It does not come from becoming critically conscious and then entering into revolutionary activity, in fact critical consciousness is more of an outcome of revolutionary activity than a precondition for it. The revolution makes critical educators as much as critical educators make a revolution. As Che taught us, revolutions produce subjectivity and agency (aesthetically, ethically and ideologically) simultaneously with new social relations of production. I call this protagonistic agency. An agency for building a radically new future.
JMBT: We know the importance of the production of knowledge because it imposes the established "truth" inside schools. The most inhumane consequences of the capitalist system are behind this truth" that perpetuates human inequality. What role do media and textbook publishers play in this issue? What can be done to establish mechanisms that ensure that the knowledge taught in schools is reliable? PM: Since capitalist democracy is really an oxymoron,
capitalism's relationship to democracy has always been a "sweetheart deal", with one partner playing off the other. One plays the comic, while the other plays the 'straight' man who sets the comic up for the joke. One plays the good cop, and the other plays the 'bad cop' and then they switch roles. Capitalism produces economic inequality and extreme poverty while democracy covers it
N3
sanctioned by the government control the production of knowledge, and set the limits on what gets said and what doesnt get said, and create the contexts in which information is valued or perceived as unimportant. The military/industrial/digital sectors of the media are all part of the power complex we associate with finance capitalism. Robert McChesney has written about how the media operate as an oligopoly through corporate lobbyists, political campaign contributions, government media policies, the control of news coverage by corporate elites, and the enforcement of monopolistic rights for those broadcasters who can make the most profit. Media reform almost impossible in this context. The potential of the internet for the deepening and enhancement of democracy has been destroyed by the success of monopoly capitalism and the internet has actually contributed as much to inequality as it has to fostering equality and here I am particularly concerned about the potential of the media to aid in the surveillance of citizens and well as the propagandizing against socialist alternatives to capitalism. Google, for instance, spent 5 million dollars lobbying in Washington in the first three months of 201 2. Political participation as a means of creating a more democratic future is limited by the internets commercialization. We are seeing antitrust laws being overlooked, we are seeing an increase in digital technology patents, and the monopoly of corporations such as Google, Amazon and Microsoft. You cant have a real democratic public sphere that advances the interests of community and public participation as long as it is monopolized by corporate greed, fueled by indirect government subsidies and made to bow to commercial interests through an increase in copyrights, patents, and proprietary systems. It is interesting to me how the corporate media in the United States helps to disguise itself as being "free" by attacking Hugo Chavezs treatment of the media in Venezuela. Most media outlets here in the United States criticized Chavez for restricting and manipulating the
media in Venezuela. But the Venezuelan government does not control its media. Many people in the U.S. believe that all the television channels and newspapers are pro-Chvez. The truth is that most of Venezuelas media is anti-Chvez. Yes, Chvez took action against anti-Chvez network RCTV (Radio Caracas Televisin Internacional) but the U.S. media does not provide the historical context.
Briain, This Revolution Will Not Be Televised. Or watch Oliver Stone's documentary, South of the Border. Again, President Hugo Chavez did not "shut down" RCTV on May 27th. The Venezuelan government decided not to renew the broadcast license that granted RCTV a monopoly over a section of the publicly-owned frequencies. It is the case that RCTV still reaches half the population through its cable and satellite operations. That's not bad for a television station that committed As reported in only a few alternative media treason against a democratically-elected President, outlets, Venezuelan television has four major networks: whose many election victories were considered Venevisin, Televen, Globovisin, and Venezolana de extremely fair by President Jimmy Carter. Televisin (VTV). Of these four networks, Venevisin and Televen are moderately anti-Chvez, Globovisin is very Sure, it is true that government television is anti-Chvez, and VTV is extremely pro-Chvez. There is overwhelmingly favorable towards Chvez but only six the notorious RCTV (Radio Caracas Televisin percent of Venezuelans watch government-owned VTV. Internacional) which faked film footage to make it look And yes, Chvez did interrupt news programming with like pro-Chavez gunmen were shooting down hours of cadenas (political viewpoints) but this hardly demonstrators on the streets of Caracas when in fact it counteracts or balances out the 23 other hours of antiwas anti-Chavez gunmen. This is one of several reasons Chvez broadcasting. Okay, what about the that the government of Venezuela declined to renew newspapers? Venezuela has three major newspapers: RCTV's broadcast license. About 60% of the television ltimas Noticias, El Nacional, and El Universal. ltimas audience in Venezuela watches Venevisin and Televen. Noticias is pro-Chvez; El Nacional and El Universal are Only about 6% of Venezuelans watch VTV. Most anti-Chvez. El Nacional, as is commonly known, is Venezuelan media is owned by right-wing business elites owned by Miguel Henrique Otero, a founder of the antiwho are strongly mobilized against the socialist politics Chvez organization Movimiento 2D. There are also and policies of Hugo Chvez that support Venezuelas more anti-Chavez radio stations in Venezuela than propoor and powerless. The majority of the Venezuelan Chavez stations, since only 1 4 percent of radio is publicly media notoriously conspired with the coup leaders in owned. their failed 2002 attempt to oust Chavez from power. The media refused to show statements by the Chavez That this ardent visionary who fought austerity government condemning the coup dtat. When the coup measures , who agitated for the poor and the powerless, dtat failed, the private Venezuelan networks refused to who founded the movement for the fifth republic, who broadcast the news that Chvez had been restored back integrated the downtrodden and marginalized into the to power as a result of hundreds of thousands of pro- mainstream of Venezuelan society, and who helped Chavez supporters surrounding Miraflores Palace make his country one of the most equal in Latin America, demanding him back and as a result of sectors of the would be so demonized in the capitalist press is not so military turning to support Chavez. You can see the surprising. This son of rural schoolteachers created a footage of this in the fly-on-the-wall documentary crack in the concrete wall of finance capitalism where directed by Irish filmmakers Kim Bartley and Donnacha some roses were able to push through. The wall is 27
N3
growing, unfortunately, and getting thicker. I look at media, surveillance technology, and military technology now, such as drones, and really do believe we are living in the midst of some kind of Orwellian dystopia. Amidst this chiliasm of doom, there are courageous people speaking outthe journalist Chris Hedges is one, Noam Chomsky is another, and there are others. And they are certainly true heroes. But what can we say, as educators, about living in the United States today when Congress unanimously passes The National Defense Authorization Act (NDAA), where Section 1 021 (b)(2) of NDAA gives the military having the power to detain you on American soil, without due process, indefinitely, at the discretion of the President? On December 4, 201 2, the new NDAA passed the Senate with a 98-0 vote. That is the date that fascism was formally installed in the United States. When I was a young man, I read Orwells novel, 1 984. In fact, I have the first Signet Books edition, published in 1 950 by the New American Library. The cheap, pulpfiction book cover shows a sexy woman in a low-cut dress, standing back-to-back with a man wearing a sleeveless work shirt. To the left there is a man in a black cap and black jumpsuit and he looks like he is holding the handle of a whip. The advertisement at the top of the front cover reads, A Startling View of Life in 1 984. Forbidden love .Fear .Betrayal. And on the back, there appears a question: Which One Will YOU Be In the Year 1 984? There are four choices: Proletariat, Police Guard, Party Member, Male and Party Member, Female. Ill just read you the description of the Party Members. Party Member, Male: Face-less, mind-less, a flesh-andblood robot with a push-button brain, youre denied love by law, taught hate by the flick of a switch! Party Member, Female: A member of the Anti-Sex League from birth, your duty will be to smother all human emotion, and your children might not be your husbands! Now the book was obviously marketed to depict the impending communist threat of the Soviet Union. But look around today and consider who is executing enemies by flying drones, who is practicing
www.globaleducationmagazine.com JMBT: We believe that it is necessary to show in every educational curricula issues such as water poisoning by extraction of heavy crude oil, child exploitation or deforestation for commercial reasons. We believe that to teach about the reasons and the consequences of those sad situations should be the first step to raise awareness and walk towards social justice. Do you think it is possible to introduce this type of knowledge in education? PM: This is an excellent group of questions, Jose. What
can we do as educational and cultural workers, at this crucial moment in history, when corporate revenue expands as the job market shrinks, when there is such a callous disregard for human suffering and human life, when the indomitable human spirit gasps for air in an atmosphere of intellectual paralysis, social amnesia, and political quiescence, when the translucent hues of hope seem ever more ethereal, when thinking about the future seems anachronistic, when the concept of utopia has become irretrievably Disneyfied, when our social roles as citizens have become increasingly corporatized and instrumentalized in a world which hides necessity in the name of consumer desire, when media analyses of military invasions is just another infomercial for the US military industrial complex with its huge global arms industry, and when teachers and students alike wallow in absurdity, waiting for the junkyard of consumer life to vomit up yet another panacea for despair? Just what can we do as inmates in the prison-house of capitalism, ensepulchured in the cold vault of commodity culture? You mentioned in your question about the exploitation of children. What about the murder of children? What about the justification of torture? As Americans flock to the movie, Zero Dark Thirty, by the brilliant and gifted director, Kathryn Bigelow (whom Naomi Wolf appositely named the new Leni Riefenstahl, 28
extraordinary rendition and arresting people without due process and moving them into secret detention centers, who has created a national security state with cameras at every corner? In the year 2006, during the Bush administration, the FBI were investigating the library at UCLA to see what books students were checking out, the same year I was placed at the top of the Dirty Thirty list of leftist professors by a right-wing group who offered to pay students one hundred dollars to secretly audiotape my seminars, and 50 dollars to provide notes from my classes. When I scan the cover of 1 984, it does not surprise me that it was meant to titillate the reader. Today it is clear that it is so-called capitalist democracy that has ominously spawned a complacent populace (outspoken, yes, but never the less complacent), complacent enough to purge the collective psyche and keep it at bay long enough to enable us to commit the most heinous of crimes. Just like in 1 984, we invent enemies and then build a war economy trying to fight them. Take the war on Iraq. The company, Halliburton, which was run by former Vice-President Dick Cheney, was given $39.5 billion in Iraq-related contracts over the past decade, with many of the deals given without any bidding from competing firms. While the financial cost of the war was in excess of $1 .7 trillion dollars, the cost in human misery knows no price. Today it seems that human relationships are more than ever self-interested; loyalty among friends is disappearing; people who claim a friendship with you will betray you in acts of selfrighteous indignation if it gives them an advantage; love has been reduced to chemicals swarming through the body while the heart has been replaced by a hornets nest. I believe that imperial capitalism has served as the incubus in creating a collective U.S. Psyche, whose structural unconscious is indistinguishable from the character in American Psycho. By the time that the Psycho finds out who he is, will it be too late?
N3
tortures handmaiden and apologist for evil) to rejoice in the apparent success of the U.S. governments plan for sodomizing and water boarding suspected Muslim terrorists, no U.S. citizen, whether living within or outside the U.S., is safe from drone surveillance or assassination. President Obama can protest all he wants about the availability of guns in the United States (300 million guns are registered to private owners), but he does not seem to care a whiff about all the children dying in his drone strikes around the world. According to the Bureau of Investigative Journalism, there have been approximately 399-500 drone strikes to-date, and approximately 3,000 individuals have been killed by these strikes, many of them innocent civilians, including women and children. In Pakistan alone, 891 civilians have been killed by U.S. drones since 2004. These airborne assassination operations are taking place at the behest of those leaders who seek no alternative to profit-driven imperial rule and are occurring with increasing regularity throughout the Middle East, South Asia and Africa. Innocent men, women and children in countries that the U.S. is not even at war with are being killed by U.S. hellfire missiles, attacks which go unchallenged by Congress or the Judiciary, and most of which are approved by President Obama. Of the over 3000 people killed so far, the vast majority of them are non-combatant "collateral damage" deaths and of these, 1 72 have reportedly been children. Of course, the so-called 'permanent' war on terrorism can be waged on sovereign countries with the use of drones, for surveillance, or weaponized in the case of the grunts of the drone world, the Predator and the Reaper. Here the military fist goes airborne to extend its lethal reach, in the form of cog-eyed droogs affixed with the sandals of Hermes, their brass knuckled missiles covered with lightweight latex autopsy gloves. But, alas, there will be no silverbodied Marias from Fritz Langs Metropolis to man the anti-aircraft guns and lead the oppressed to victory over
the labor unions. We need in our schools to excavate the relationship between capitalism and ecological sustainability. We should have as an important theme in our classrooms the great financial crisis that erupted in the fall of 2008 and the deep global recession that followed in its wake. But do you think this would go well with the oligarchic bourgeoisie, who are currently profiting from the fusion of banking and monopoly capital and who are consolidating their power through an intersection of economic and political forms of domination? As capital moves freely, investing in production or in fictitious forms of capitalism, and as speculators, financier capitalists, stock and bond traders, investment bankers, hedge fund mangers, and others help to unleash the forces of capital accumulation globally, and as neo-liberalism with its aggressive promarket state policies allows this finance capital to restructure itself, to diversify its forms, to expand its accumulation opportunities through the growth of retail, financial and service industries, and enhance its global reach, then it is safe to assume that our ecosystems have been harnessed exploitatively in a system of capitalist commodity production such that we cannot talk about capitalism at all without talking about capitalism as a world ecology. The whole physiognomy of capitalism has changed, with finance capital requiring a parallel accumulation of political power, with financiers married to an unchecked political oligarchy spawning highly parasitic fanancialized forms of capitalism such as assetstripping. The vampire of capitalism has grown a second set of fangs. The long shadow of Nosferatu falls across a systematic and ongoing attack on the living standards of the vast majority of the population.
their oppressors. We live at an ignominious time in history, when the president of the United States has the power to make targeted killings of American citizens. A U.S. airstrike in eastern Afghanistan not long ago killed 1 0 civilians, including five children. The deadly attack came just hours after the State of the Union speech in which President Barack Obama falsely claimed that the more than decade-long U.S. war and occupation in Afghanistan will be over by the end of next year. Okay, on to the next part of your question.
You mentioned deforestation and the poisoning of water. Yes we should be examining these issues at all levels of the school system. When we think of questions such as "how to provide a stable growth of the global economy so as put the aggrieved communities of the world back to work," we make the mistaken assumption that just getting people to produce and consume more commodities is the answer to the problems we are facing during this horrific economic crisis. We think that if we become more creative and more efficient producers, then we could also pay off the debt, create jobs, increase economic equality, find ways to protect the integrity of the planets ecosystems and dramatically increase biodiversity, and the like. This is a collective flight of fancy that only helps reproduce the geopolitical and economic logics of the existing corporate oligopoly. Because increasing the size of the economy does not necessarily mean there will be more jobs. And the larger the economy, the more danger we pose to the planets biodiversity since we will be using a greater number of resources, and releasing more carbon dioxide into the atmosphere. The problem is that our economy is already too reliant on growth as it isthe goal of the economy should not be continuous growth, it should not be reliant on aggregate growth as a model for generating jobs. All this talk about expanding the economy at all costs really We need economic policies that dont rely on is a smokescreen for raising taxes on workers, cutting benchmarks such as increasing the Gross Domestic taxes on corporations, undermining worker safety, and Product. We need to improve the well-being of workers paying less wages to workers, not to mention weakening and bring to a grinding halt long-term environmental 29
N3
damage. We need to shorten the working day, not increase it, and distribute evenly the available work. We need to abandon our debt-based money system because if you have a debt-based monetary system you will have to generate constant economic growth in order to pay back your debts. We need to adopt a vision of sustainability and self-reliance animated by socialist ideas and ideals such as egalitarianism and social justice. I have labeled such an effort revolutionary critical ecopedagogy which is a combination of an historically focused application of Marxs theory , revolutionary critical pedagogy and theoretical advances made in ecopedagogy work, such as the admirable accomplishments of Richard Kahn, David Greenwood, Tina Evans, Donna Houston, Sam Fassbinder, Anthony Nocella, Steve Best, and others. We have entered a post-genomic era in which we yearn to create some kind of bio-scientifically engineered paradise where all sentient life can languish in some bovine stupor, in some chemically altered pseudo reality stage-managed by transnational psychotropic drug dealers who offer to chemically separate us from the emotional squalor of our Precambrian brain through a vast array of designer lifestyle drugs, where we sit in uninterrupted epiphanic bliss at the feet of a statue of a Quarter Pounder in some prosaic cobblestone courtyard at a secluded Ronald McDonald House next to an 1 8hole golf course, or in some kind of edenic trans-human extended epiphany in a university seminar room overflowing with just the correct mixture of a Leibnizian optimism and Nietzschean Dionysian pessimism. Or where we can be perpetually on the road in some bohemian fantasy redolent of the 1 960s San Francisco Renaissance. But is all this necessary if we have already embraced the Hobbesian vision of complete submission to total authority, if we have become willing supplicants of a communications post-industrial complex in which our feelings are already given structure by the
labeling 'terrorists.' Bill McKibben makes a crucial point that climate change is an issue that does not have the luxury of lengthy debates such as those that address, say, educational policy or immigration, debates that often spawn only incremental changes. Climate change is about physics and if we dont act now, it will be too late. The fossil fuel industry creates carbon dioxide and transforms it into heat. And its the most lucrative business on the planet. If we want to stop the arctic ice from melting, we need to cut toxic emissions by about 5% globally each yearstarting immediately. The fossil fuel industry has already bought off Congress. The White House has overruled the EPA on its proposals for stronger smog and ozone regulations and the mining industry is already buying off vast tracts of Wyomings Powder River Basin. Its almost too late to say its too late. Jason W. Moore argues persuasively that we cannot separate political economy, sociology, ecology, biology, and other disciplinary approaches involved in understanding humanity from extra-human nature. This is because humans and the rest of nature mutually constitute each other. According to Moore, capitalism is a way of harnessing the endless accumulation of capital, it is, in effect, a world-ecology. Neoliberalismwhich relies on a coercive statefinance nexus as its lodestonehas reordered the global relation between humans and the rest of nature. Human nature is reduced to labor productivity. Unlike the case in former crises of capitalism, there is no sign today of a new labor productivity revolution anywhere, not here in the U.S., in Latin America, or in China. According to Moore, the four cheapscheap energy, cheap raw materials, cheap labor power and cheap food were necessary for post-1 983 capitalist profitability. This is no longer the case, as we are seeing a reversal of cheap 30
primordial rants and faits et gestes of intrepid talk show hosts with their bone-hard patriotism? Where pundits bloviate incessantly about God and country, corporate gasbags and blathering propagandists who would be more appropriately rendered if all but their voices were replaced by animated characters. Only a cartoon character without a soul could actually defend large corporations and the wealthy who avoid more than $1 00 billion in taxes every year by setting up offshore tax shelters in places like the Cayman Islands (home to more than 1 8,000 corporations), Bermuda and the Bahamas that help giant multinationals like General Electric avoid billions of dollars in corporate income taxes. Or defend the Supreme Court in Citizens United v. Federal Election Commission in 201 0, which found that the first amendment to the U.S. constitution, on freedom of speech, prohibits the government from restricting independent political expenditures by corporations and unions, a ruling which effectively gives corporations the same status and rights as people, thus coining the term corporate personhood. Or defend the reauthorization of the FISA Amendments Act of 2008, a spying bill that violates the Fourth Amendment and gives vast, unchecked surveillance authority to the government, and extends the powers of the National Security Agency to conduct surveillance of Americans international emails and phone calls. Or support the news laws that make it an act of terrorism to investigate animal cruelty, food safety or environmental violations on the corporate-controlled farms that produce much of our meat, eggs and dairy products. With many Tea Party supporters maintaining that legislation aimed at reducing gun violence is a violation of the God-given right of 'man' to have access to assault rifles, that state action against the right of self-defense is by default a violation of the natural rights of man, and that the only way to stop violence like the recent Newtown school massacre is to have more male teachers armed in class with guns, we might want to consider this country as filled with religious extremists of the same ilk as those we are currently
N3
food, energy and raw materials, and labor power. Moore warns that we are facing seemingly insurmountable problems: rising energy costs, escalating competition for arable land for agrofuels, the grow of invasive species, the herbicide/glyphosate-resistant superweeds effect, aquifer depletion, and end of cheap water as global warming melts glaciers, and the weakening effectiveness of fertilizers on yield growth. Neoliberal capitalism has exhausted all the free wealth of natureuncommodified energy, water, resources and laborin short, it has exhausted the very conditions of its reproduction. The world-historical collapse of capitalisms longue duree regime of profitability and the epochal rupture of neoliberal accumulation by dispossession, is signaled by an endemic decline on the profit rates that has haunted the specter of capitalism for decades. Capitalism has voraciously sucked the productive system of the world drynatures available bountyby replacing living labor at the point of production by more and more innovative forms of labor-saving devices. Capitalismwhich we view as a world ecology rather than an economic systemis responding to this crisis by redistributing value from labor to capital, with value here referring to the elements of production, labor power, means of production, and profit. This extraction of value undermines opportunities for productive investment and this can be seen in the degrading practices of outsourcing, casualization, dehumanizing working conditions and union busting. For the past four years almost nothing meaningful has been done to stop the rampant production and release into the atmosphere of ever greater amounts of carbon dioxide, and there have even been more frantic calls for more production of oil and expanded use of coal as a fuel. We have entered a new era of nature-society relations with the advent of the penetration of finance capitalwhich is ushering in the end of cheap food, resources, water, and everything else. All of global nature has become dependent on a circuit of capital premised on accumulation by financial
type of difference necessary to protect the planet. Green Gone Wrong explores how the conversion from a petro to a green society affects the most fundamental aspects of life: food, shelter, and transportation and includes unintended consequences such as massive clear-cutting, destruction of native ecosystems, and grinding poverty. Rogers exposes eco-friendly consumption and market-friendly buzzwords like green, organic, and fair trade and shows us that they are, in effect, mostly disingenuous scams. We cant save the earth by purchasing compact fluorescent light bulbs, hybrid gas-electric cars and carbon offsets or by buying the correct environmental friendly products. Organic food shoppers may be unwittingly subsidizing big farm companies that are eradicating forests and defiling the soil in some developing countries because their governments are often not concerned about environmental problems. And many well-intentioned NGOs just dont have much power. The production of "green" goods is actually contributingalthough not intentionallyto the escalation of environmental ills. What is offered to consumers by the Green Marketplaceorganic and fair-trade foods, ecoarchitecture, bio-fuels, hybrid automobiles, and carbon offsets, etc.,just will not work within the social universe of capitalism and the consumer marketplace and often leads to problems that green capitalism was designed to alleviate. Small farmers who use "unconventional" or "beyond organic" agricultural practices are often unable to make a living wage and have to rely on off-farm sources for the majority of their income. Those who are cashing in on the green revolution are corporations such as Walmart and General Mills. Keeping up with the demand for organic foods has led to deforestation in places like Paraguay where stretches of rainforest are turned into organic monocrops like sugar cane. Ecoarchitecture can help reduce the 40 percent of all CO2 gas in the United States that comes from buildings but such architecture is limited to wealthy Americans. Demand for palm oilwhich is increasingly used in 31
means rather than on industrial or agricultural production. These are all messages coming from Jason W. Moore, John Bellamy Foster, Joel Kovel, and other Marxist thinkers who are talking ecology seriously. Now it is up to critical educators to bring this message into the classrooms. We also need to listen to authors such as Heather Rogers, who has undertaken a devastating critique of ethical consumerism and todays muchtouted green solutionscarbon offsets, organic food, biofuels, and eco-friendly cars and homesin her book, Green Gone Wrong . According to Rogers, Wal-Mart and General Electric are just two of many firms that are pushing green capitalism. Rogers reveals how recent efforts to go green by swapping our dirty goods for clean ones are mired in contradictions and false assumptions, as these earth-friendly products do little to minimize damage when they fail to break the mold of consumption and waste. Rogers expertly admonishes what she calls lazy environmentalism and also "greenwashing"corporate public relations campaigns designed to soothe and prevent public criticism of corporations over pollution, waste, environmental decimation and health threats. These approaches still rely on market forces and therefore cannot make the
N3
biodieselis growing and to meet this demand tropical rainforests and peatlands in South East Asia are being torn up to provide land for oil palm plantations. Cropbased biofuels are also destroying food supplies and pushing up the price of corn and other crops up to 80 percent. In India, Rogers discovered that carbon offset ventures were doing more harm than good because carbon offset money discourages certain countries from investing in wind or solar power and continues their reliance on fossil fuels. Greenwashing by the public relations industry has all but camouflaged the unprecedented historical outcomes of planetary genocide, ecocide, zoocide and epistemicide. We cant trust sustainability efforts to be placed in the hands of STEM (science, technology, engineering and mathematics). What we need, according to Richard Kahn, Sam Fassbinder and Anthony Nocella, is a critical intervention by visionary educational leaders who are willing to going together with social movements, in order to transfigure the relationship between the school and the society as part of a larger struggle for liberation.
of a culture of contestation can we hope to transform the world. I would only say, stand steadfast in what you are already doing and try not to lose resolve. Capitalism is trying to restore the conditions of its reproduction by destroying you, by destroying the value of your labor power. The rate of global exploitation is increasing exponentially. We cannot sanitize the present. Peasants are being driven from the countryside of their ancestors into the cities to be used as cheap labor. Stand with them. Factories are being shut down and recuperated by workers. Stand with them. Throughout the advanced capitalist world, unions are under assault. Stand with them and encourage them to be truly 'tribunes of the oppressed.' Indigenous groups are fighting to reclaim their land and their rights. Stand with them. Prisons are filling up with capitalism's racialized 'surplus' population. Stand with these victims of injustice. Women are are being raped with impunity and forced to bear the worst burdens of capitalist super-exploitation. Stand with them. Stand with the victims of war, with those who are disabled, with those who are losing hope, with those are losing faith that another world is possible. Capitalism cannot escape the gravity of its hubris, and if it is busy reconstituting itself, so must the revolutionary self-activity of the oppressed meet it in stride by rekindling the socialist imaginary. Luchar hasta vencer.
university antiseptically cleaved from issues of cultural and linguistic democracy, indigenous sovereignty and human rights. The critical ecopedagogy of scholar/activists such as Richard Kahn, Sam Fassbinder, Tina Evans, and David Greenwood operates within an overall dialectics of justice in which environmental justice and ecological justice (the former relating to the unequal distribution of harmful environments between people and the later referring to the relationship between humans and the rest of the world). Kahn rips a U.S. Environmental Protection Agency report that lists a representative sample of 1 75 academic institutions that regularly violate the Clean Air Act, the Clean Water Act, the Emergency Planning and Community Right-to-Know Act, the Resource Conservation Recovery Act, the Toxic Substance Control Act, the Federal Insecticide, Fungicide, and Rodenticide Act, to name just a few. Kahn, Nocella and Fassbinder also argue that gross industrial pollution is both a major social and biological harm that disproportionately affects the poor and people of color, as well as being a primary contributor to the ruination of the land and destruction of species diversity. Kahn, Nocella and Fassbinder argue forcefully So definitely, pollution needs to be a thematic focal point that education for sustainability must take on the of school curricula. So yes, we do need ecopedagogy. insurgent standpoints of militant research that are demanded by ecopedagogy. Ecopedagogy, in turn, is JMBT: In Global Education Magazine we work viewed as an affiliated movement-of-movements that every day to achieve worldwide social justice. aims to explicate the qualitative differences within the It enables us to initiate an era of brotherhood academy between capitalist and related oppressive between all human beings in order to enrich forms of disciplinary greenspeak and democratic and mutually and in which any person in the world disruptive forms of ecological disciplinarity. Kahn, Nocella will be snatched away their dignity. Can you and Fassbinder do an excellent job of critiquing the give us any advice? predominant forms of sustainability taught in universities which have to do with environmental sustainability taught in departments of environmental science and PM: History is a mirror that reflects who we are by how environmental studies and dealing with ecology, resource we engage and interact with others. History reflects our management and environmental economics. Here we own agency back at us and calls into question our ability see a polarization emerging between sustainability as to transcend ourselves. Your goal of creating a global science and sustainability as justice and equity. So, as brotherhood and sisterhood is a necessary means of Kahn notes, we have environmental literacies in the forming structures of dissent. Only through the creation
JMBT: And finally, do you have any additional comments for our readers? PM: It is gratifying for me to have the pleasure of making
your acquaintance through the pages of this courageous magazine. We all share more than what divides us. We can be a unifying force for change. Together, we can turn possible futures into tangible realities that can liberate us from the chains that make us as much as we make them. We have the power to break our chains. But it will take more than one fist to hold the hammer. And more than 32
N3
one heart to give us the courage to grip the handle firmly. opposite. And this is precisely why we need to think I believe it is important to remember that with every cul- critically about where we should be headed and how we de-sac we face in human history, we have the possibility shall get there. of creating a new horizon of hope and the chance to move foreword. Thinkers such as Istvn Mszros, Paulo Freire, Peter Hudis, Michael A. Lebowitz, Marta Harnecker, John Bellamy Foster, Carl Boggs, Ramon Grosfoguel, E. San Juan, Joel Kovel, Jan Nederveen Pieterse, William I. Robinson, Kevin Anderson, Henry Giroux, Bertell Ollman and many others have been theorizing about changes that need to be made to make the world a more livable and humane place. As Michael Lebowitz put it so aptly, socialism requires social ownership of the means of production and social production organized by workers for the purpose of meeting the needs of society. In other words, real human development will require socialist production organized by workers and this, of course, requires a society that undertakes production directly and consciously for the needs of society. It is up to us to begin the task of building such a society. My role has been to excavate the ways in which educators can play a part in this process. I am not interested in making education more effective, or efficient, or smooth-running, or successful. It is already too successful. But what is it successful at doing? That is the question that haunts this generation and all preceding generations. In its present form, education is successful at creating the conditions of possibility for capitalism to reproduce itself. My job is to disturb this process and help re-direct the purpose of education to rebuilding a democratic socialist alternative to capitalism. Rebuilding such an alternative is not the call for a blueprint. Especially not one forged in the crucible of Western imperial culture. I am reminded of a story about Gandhi. In 1 931 , during a conference held in London, Gandhi was asked by a British journalist what he thought of Western civilization. I think it would be a good idea, he replied. What a socialist future will look like is to be determined by those who are struggling for it. The struggle for socialism can always turn into its
"Peter McLaren and Paulo Freires statue at Chapman University, California, USA."
33
Salud para la Educacin

La definicin de salud se refiere a un estado en el que el organismo ejerce normalmente todas sus funciones. Es por este motivo por el que venimos a pedir salud, si, pero Salud para la Educacin. El diagnstico actual de la educacin es enfermizo y, lo que es ms duro, crnico. Las funciones principales que se le atribuyen de preparacin para los futuros ciudadanos y de facilitar una cohesin social para lograr un desarrollo armnico de la humanidad se encuentran tremendamente debilitadas debido a los malos hbitos que ha adquirido. Los sntomas que presenta son estremecedores. Incongruencia endmica entre los supuestos tericos de democracia dentro del organismo y su prctica cotidiana de imposicin a los principales protagonistas de la educacin. Depresin en los integrantes de la institucin, unos por aburrimiento despus de aos sin encontrar aprendizajes que les apasionen y los otros abatidos por un sentimiento de esterilidad en su cometido de ensear. La lista de trastornos y dolencias es muy larga entre ellas, una muy extendida y daina, las fobias. Fobias perpetuadas hasta convertirse en pandemias como las inmiscuidas Tpor la segregacin sexual en las aulas o los miedos al desconocido por ese exceso de etnocentrismo, desde el nacional hasta el local, tan presente dentro de las aulas y, particularmente, en el interior de los libros de texto. A los actuales sistemas educativos tambin les ha sido inoculado el virus de la competitividad. Una bacteria muy nociva para la sociedad ya que convierte a sus hermanos en enemigos con los que pugnar por alcanzar la meta soada cueste lo que cueste. La competencia implantada arremete contra el humanismo, imponiendo valores excesivamente individualistas y donde el resultado es el principal objetivo, olvidando la importancia de los procesos y las sinergias. Es la competicin del todo vale, donde la palabra pierde valor y las relaciones sociales se establecen en base a intereses personales. La competicin se convierte en un trastorno que devora al propio ser humano. Cuando el organismo no funciona y la enfermedad empieza a apoderarse de l, es necesario iniciar un tratamiento que sane, ya que si no, podra hacerse fuerte la enfermedad y convertirse en la cotidianidad. No hay un mtodo preciso para cada enfermedad. Este ha de concretarse al analizar al paciente y emprender un dilogo que ofrezca los posibles tratamientos para su recuperacin. Un debate entre todos los participantes del proceso educativo debe llevar a una reformulacin coherente y armnica de la organizacin y las finalidades pedaggicas. Los pacientes tienen que sentirse parte importante, puesto que en toda enfermedad este factor psicolgico inyecta grandes dosis de motivacin para la superacin de las adversidades. El establecimiento de relaciones horizontales basadas en la confianza, el crecimiento y el amor son fundamentales para adquirir un estado saludable que nos permita avanzar sin sufrimientos. Y por ello hemos de luchar cada da. Una educacin enferma contagia a la sociedad ya que en ella son formados los futuros ciudadanos. Hagamos imperativo que la educacin pida cita para comenzar con su cura. El progreso humano parte de su educacin y por ello desde Global Education Magazine pedimos
Salud para la Educacin!
Jose Mara Barroso Tristn

Secretario de Alternativas Educativas
N3
Millenium Development Goals Global Education Transversal Studies
Research Papers
El VIH/SIDA como Objetivo de Desarrollo del Milenio: el caso de Nicaragua y su ndice de Desarrollo Humano. Tending to the Whole Person: Healthcare Chaplaincy and the United Nations Millennium Goals 201 5.
Itahisa Prez-Prez.
Rabbi DVorah Rose.
Education: an essential component in guaranteeing the right to health?
Cristina Sirur y Mariana Ruiz de Lobera. Emanuela Bezerra Gueiros.
A importncia de hbitos saudveis na luta contra o cncer. Educacin para la Salud y VIH/SIDA: una respuesta desde la participacin comunitaria.
Itahisa Prez-Prez y Juan Agustn Morn Marchena. Juan Carlos Melero.
Habilidades para la vida: una estrategia para promover la salud y el bienestar infantil y adolescente. Medioambiente y ciudadana: Educacin para la participacin como base de una educacin ciudadana planetaria. Medios abiertos de Amrica Latina: Apuntes sobre la aplicacin de los indicadores meditico-culturales.
Francisco F. Garca Prez y Olga Moreno Fernandez. Ruth De Frutos Garca.
Importancia del psiclogo en pacientes infectados por VIH/SIDA. Estudio del caso de Dajabn, Repblica Dominicana. Prevenir o educar? Una aproximacin a la gestin de placeres y riesgos. A.B.S. Azioni di Bassa Soglia. Lesperienza della citt di Firenze. Reflections on the HIV Program in India. Acesso a gua: desenvolvimento humano, sade e educao. Valdir Lamim-Guedes.
Francisco Orgaz Agera y Eugenia Cruz. Jos Ignacio Bozano Herrero.
Eleonora Moscardi, Mara Marchitelli e Valentina Menzella. Anita Rego.

35
N3
Section 1
Millennium Development Goals
The goal of the world is economic efficiency?
36
N3
Research Papers. Section 1 . Millennium Develpoment Goals.
El VIH/SIDA como Objetivo de Desarrollo del Milenio: el caso de Nicaragua y su ndice de Desarrollo Humano
Resumen: Nicaragua se sita en el puesto 1 29 de los 1 87 pases que forman parte del
Informe de Desarrollo Humano (2011 ), retrocediendo 1 4 puestos al estar situado en 201 0 en la posicin 11 5 (de 1 69 pases). Su ndice de Desarrollo Humano en 2011 es de 0.589 ubicndose en la zona de desarrollo humano medio.La Declaracin del Milenio en el ao 2000 establece una serie de objetivos y metas a alcanzar en 201 5. Una de las metas de los Objetivos de Desarrollo del Milenio (ODM) es haber detenido y comenzado a reducir la propagacin del VIH-SIDA. La propagacin del VIH parece haberse estabilizado en la mayora de las regiones, y ms personas sobreviven ms tiempo.Se sigue confirmando el aumento del acceso al tratamiento para personas con VIH en todas las regiones. En el ao 201 0 haban 6,5 millones de personas que reciban tratamiento con antirretrovirales para el VIH o SIDA en las regiones en desarrollo, lo que significa que ha habido un aumento en ms de 1 ,4 millones de personas desde diciembre de 2009, convirtindose en el incremento ms alto jams logrado en un ao. A pesar de estos datos tan alentadores, no se alcanz la meta de lograr en 201 0 el acceso universal.El presente artculo se centra en las conclusiones del Informe de Desarrollo Humano (201 0 y 2011 ), haciendo hincapi en el ndice de Desarrollo Humano, centrndonos en el contexto de Nicaragua. Asimismo, aportamos datos sobre la consecucin de los ODM, sobre todo referente a nuestro objeto de inters que es el sexto objetivo sobre VIH/SIDA.
HIV/AIDS and the Millennium Development Goal: the case of Nicaragua and its Human Development Index
Abstract: Nicaragua is located at the position 1 29 of the 1 87 countries that are part of the
Human Development Reports (2011 ), 1 4 seats back in 201 0 to be located at position 11 5 (of 1 69 countries). Its Human Development Index of 0.589 in 2011 is being located in the area of human development. The Millennium Declaration in 2000 set a series of objectives and goals to be achieved in 201 5. One of the goals of the Millennium Development Goals (MDGs) is to halt and begin to reverse the spread of HIV-AIDS. The spread of HIV appears to have stabilized in most regions, and more people survive longer. In cotinues to confirm the increased Access to treatment for people living with HIV in all regions. In 201 0 6.5 million people were receiving antirretroviral treatment for HIV or AIDS in developing regions, which means that there has been an increase in more tan 1 .4 million since December 2009, becoming the highest increase ever achieved in a year. Despite these very encouranging data, not achieved the goal of universal Access by 201 0. This article focuses on the findings of the Human Development Report (201 0 and 2011 ), with emphasis on the Human Development Index, focusing on the context of Nicaragua. Also provide data on the achievement of the MDGs, especially concerning our object of interest is the sixth goal on HIV/AIDS.
Keywords: Millennium Development Goals, HIV/AIDS, Human Development,

Nicaragua.
Palabras clave: Objetivos de Desarrollo del Milenio, VIH/SIDA, Desarrollo

Humano, Nicaragua.
Itahisa Prez-Prez
Universidad Pablo de Olavide, Facultad de Ciencias Sociales. Departamento de Ciencias Sociales e-mail: itahisaperez@gmail.com / twitter: @Itahisa_perez
37
N3
1. Datos de consecucin de los ODM: el VIH/SIDA
La propagacin del VIH alcanz su mximo en 1 996 cuando se infectaron 3,5 millones de personas. Doce aos ms tarde, en 2008 la cantidad de nuevos infectados disminuy a 2,7 millones. En cuanto a la mortalidad por SIDA, el mximo se alcanz en 2004 con 2,2 millones de muerte y en 2008 se reduce a 2 millones aunque el VIH sigue siendo la principal infeccin mortal del mundo. El presente trabajo se ubica en el Sexto Objetivo de Desarrollo del Milenio (ODM) Combatir el VIH/SIDA, el paludismo y otras enfermedades, y ms concretamente en las metas especficas 6.A: Haber detenido y comenzado a reducir, para el ao 201 5, la propagacin del VIH/SIDA y la meta 6.B: Lograr, para el ao 201 0, el acceso universal al tratamiento del VIH/SIDA de todas las personas que lo necesiten. En 2003 se empez a proveer, hasta 2005, terapia antirretroviral a 3 millones de personas con ingresos bajos y medianos. En ese momento, eran 400.000 personas las que reciban este tratamiento que prolonga la vida. En 2008 se multiplica por 1 0 la cifra llegando hasta 4 millones de personas, aproximadamente. Los mayores logros tuvieron lugar en frica Subsahariana. En el ao 2007, an a 7 aos de la meta propuesta y tras los datos disponibles de 2005 donde stos eran insuficientes y se abogaba por intensificar los esfuerzos, Economistas sin Fronteras desarrolla un trabajo a mitad de camino, para conocer los avances conseguidos desde 1 900, desde su punto de partida, para conocer el grado de cumplimiento de los 7 primeros ODM, para finalizar centrndose en analizar el 8 ODM, referente a la ayuda al desarrollo. En el caso de la meta 6.A Haber detenido y comenzado a reducir, para el ao 201 5, la propagacin del VIH/SIDA, el indicador analizado es la prevalencia de VIH entre la poblacin de 1 5 a 49 aos. El motivo de esta eleccin ha sido el grado de afeccin de esta enfermedad, que no se circunscribe a zonas concretas del globo, como pudiera ocurrir con el paludismo. Segn el estudio de Economistas sin Frontera (2007), y los resultados obtenidos , el frica Subsahariana sera la regin que mostrara un menor grado de cumplimiento. En el caso de nuestro objetivo, existe una prevalencia del VIH entre personas de 1 5 a 49 aos que se situaba en 2006 en el 5,7%, y se prev aumentar en 201 5 hasta el 7,4%, mostrando una tendencia inversa a la deseable. Sin embargo, en el caso de nuestro contexto de inters, la regin de Latinoamrica y el Caribe
presenta una evolucin favorable en lneas generales, aunque considerablemente lenta en algunos indicadores. La prevalencia de VIH se situaba en 0,3% en 1 900, cuando empez esta iniciativa, y alcanz el 0,6% en 2005, por lo que se prev alcance el 0,8% al finalizar 201 5 (Gil, M. L; Fernndez, A. C; Callejn, M E., 2007). Un ao ms tarde, Economistas sin Fronteras, la Plataforma 201 5 y ms publican otro avance de los ODM. Este informe cobra mayor relevancia porque se ha superado ya el ecuador del plazo establecido y la economa mundial ha experimentado un deterioro importante en un corto periodo de tiempo. Estos autores sealan la importancia de la salud para el desarrollo de la persona y afirman el cumplimiento de los ODM relacionados con la salud deja mucho que desear, especialmente en las regiones ms empobrecidas del planeta. En frica Subsahariana el SIDA se ha convertido en la principal causa de muerte prematura y en la cuarta causa de muerte a nivel mundial. En esta regin el 60% de las personas que viven con el SIDA son mujeres y no muestra expectativas de remitir ni de comenzar a reducir su propagacin. Segn ONUSIDA, en su informe de 2008, en todas las regiones del mundo los casos han seguido aumentando segn una tendencia estable en los ltimos cinco aos. Entre las tendencias destacables subrayamos que el VIH/SIDA afecta cada vez a ms mujeres y nias. Las desigualdades por razn de sexo, la violencia sexual, el acceso limitado a servicios de salud sexual y reproductiva, algunas normas sociales y culturales, unido a una mayor vulnerabilidad biolgica a la infeccin agudizan la feminizacin de la enfermedad. En 201 0 ONUSIDA publica el mapa de prevalencia mundial del VIH donde refleja una visin global de la prevalencia del VIH en 2009, y donde en el caso de Nicaragua, se estima que existe un 0,2% de prevalencia de VIH en adultos de 1 5 a 49 aos . La Organizacin Mundial para la Salud (OMS) publica en 2011 el avance que ha habido en los temas de salud, donde afirma que la situacin con respecto a la mortalidad por VIH/SIDA ha mejorado ya que se ha avanzado sustancialmente en la reduccin de la mortalidad materno-infantil, la mejora de la nutricin y la disminucin de la morbilidad y la mortalidad debidas a la infeccin por el VIH, la tuberculosis y el paludismo (OMS, 2011 : 1 ).
38
N3
Segn este informe del Consejo Ejecutivo de la OMS,
en trminos generales, la epidemia mundial de VIH parece haberse estabilizado: el nmero anual de nuevas infecciones por el virus cay de modo uniforme en un 25% entre 2001 y 2009. En 22 pases del frica subsahariana las tasas descendieron a un ritmo parecido en el ltimo decenio, pero esta regin sigue soportando alrededor de un 68% de la carga mundial de infecciones por el VIH En 2010, 34 millones de personas vivan con el VIH, lo que supone un incremento con respecto a los aos anteriores: la mejora del acceso a tratamientos antirretrovirales en los pases de ingresos bajos y medios (el nmero de personas atendidas en 2010 fue 16 veces mayor que en 2003) se acompaa del aumento de la poblacin que vive con el VIH. Pese a que cada vez reciben tratamiento ms personas, an hay un dficit importante: se calcula que, en 2010, nueve millones de personas que cumplan los requisitos para recibir tratamiento no tuvieron acceso a l (OMS, 2011: 4).
El Departamento de Asuntos Econmicos y Sociales de las Naciones Unidas publican en 201 2 la situacin en la que nos encontramos con respecto al 6 ODM, segn datos disponibles en junio de 201 2, correspondiente a los indicadores comprendidos entre el ao 201 0 y el 201 2. Tabla 1 . Tendencias alcanzadas en 201 2
supuesto el mayor incremento anual hasta la fecha. Desde diciembre de 2009 ms de 1 ,4 millones de personas estaban recibiendo tratamiento (Segn www.corresponsables.com, el 03/07/201 2). A continuacin exponemos una tabla sobre la evolucin en la consecucin de las metas, segn los indicadores seleccionados por la plataforma Podemos erradicar la pobreza 201 5. Tanto las tendencias como los niveles se evalan en funcin de la informacin disponible en junio de 2011 . Tabla 2. Evolucin de consecucin de las metas
Fuente: Naciones Unidas (2011 ). Se sigue confirmando el aumento del acceso al tratamiento para personas con VIH en todas las regiones. En el ao 201 0 haban 6,5 millones de personas que reciban tratamiento con antirretrovirales para el VIH o SIDA en las regiones en desarrollo lo que significan que ha habido un aumento en ms de 1 ,4 millones de personas desde diciembre de 2009, convirtindose en el incremento ms alto jams logrado en un ao. A pesar de estos datos tan alentadores, no se alcanz la meta de lograr en 201 0 el acceso universal. Sin embargo, con respecto al resto de las metas Ban Ki-moon , en la presentacin del citado informe, incide que aunque un reto, es todava posible pero slo si los gobiernos no eluden los compromisos contrados hace ms de una dcada.
2.
Fuente: Naciones Unidas (201 3). Tres aos antes del 201 5, fecha mxima para alcanzar los ODM, se publica Objetivos de Desarrollo del Milenio. Informe 201 2, recogiendo las tres metas alcanzadas: reduccin de la pobreza, las condiciones de vida de los tugurios y el acceso a agua potable. A finales de 201 0, 6,5 millones de personas en las regiones en desarrollo reciban tratamiento antirretroviral para el VIH o SIDA, lo que ha
El Informe de Desarrollo Humano: el caso de Nicaragua
Una vez contextualizada la situacin de los ODM y su avance en los ltimos aos, vamos a focalizarnos en los datos que aportan el Informe de Desarrollo Humano y el ndice de Desarrollo Humano en Nicaragua. Nos centramos primero en el Informe de Desarrollo Humano de 201 0 porque es el ltimo en ir ms all del paradigma de desarrollo, visualizando tendencias y patrones de las ltimas dcadas, mostrando una diversidad de caminos hacia el 39
N3
desarrollo humano. Esta diversidad de caminos manifiesta que no existe una frmula nica para el progreso sostenible, y que es posible, y de hecho se han logrado, avances extraordinarios a largo plazo, an sin un alto nivel de crecimiento econmico. El primer Informe sobre Desarrollo Humano del PNUD se public en 1 990 cuyos autores principales fueron Mahbub ul-Haq y Amartya Sen. La caracterstica principal del mencionado Informe fue la inclusin del ndice de Desarrollo Humano (IDH) donde se estudian las variables que, una vez agrupadas y ponderadas, reflejan la situacin comparativa de la mayor parte de los pases del mundo. En el ao 201 0, se analizaron un total de 1 69 pases. El IDH se define a partir de tres elementos: salud, educacin y renta. Se calcula a partir del Producto Interior Bruto (PIB) per cpita medido en paridad de poder adquisitivo y se mide en una escala de 0 a 1 , a partir de la cual se consideran tres rangos de desarrollo humano: desarrollo humano alto (cuando el valor del IDH en una regin o pas es mayor o igual a 0,80), desarrollo humano medio (cuando el valor del IDH est entre 0,50 y 0,79), y desarrollo humano bajo (cuando el valor del IDH es menor a 0,50). Por ser promedio de la renta nacional no recoge informacin sobre la distribucin de la misma dentro del pas.
Desarrollo Humano. El IDH no considera la variable de la desigualdad. El trmino de la desigualdad aparece en el Informe siete aos ms tarde, en 1 997, y en 2003 aparece el concepto de pobreza. Lo mximo que se ha hecho es construir un IDH modificado, que es introducir el ndice de Gini (sesgar, condicionar el clculo del IDH, introduciendo el Gini) que es el PIB per cpita entre la poblacin. Hemos pasado del debate y cuestionamiento complejo del Desarrollo Humano, a la simplicidad de un nmero, reduciendo la realidad a tres variables. Segn el Informe de Desarrollo Humano de 201 0, dentro de los pases desarrollados, el que presenta un ndice de desigualdad menor es Dinamarca, mientras que Portugal es el pas desarrollado que presenta mayor atraso. No obstante, estn en mejores condiciones que los pases de Amrica Latina. En cambio, segn el Informe de 2011 , Nicaragua retrocede 1 4 puestos en comparacin con el ao pasado, pasando del puesto 11 5 (de 1 69 pases) al 1 29 de la lista de los 1 87 pases de 2011 . El Informe de Desarrollo Humano de 2011
Grfico 1 . Las tres dimensiones y los cuatro indicadores del IDH Sostenibilidad y Equidad: un mejor futuro para todos, Fuente: PNUD. aporta datos comprendidos entre 2005 y 2011 y
Segn Helen Clark , la clave o premisa de este indicador era el hecho de que el desarrollo de un pas deba medirse no slo a travs del ingreso nacional sino tambin segn la esperanza de vida y la alfabetizacin. Resulta casi imposible, y ya se ha demostrado, medir el xito de un pas o su bienestar nicamente a partir de su ingreso, sino que existen otras variables como si la persona puede llevar una vida saludable y prolongada, si tiene oportunidad de recibir una educacin y si es libre de aplicar sus conocimientos y talentos para configurar su propio destino. Para Sen (201 0), en la introduccin que elabora para el Informe de Desarrollo Humano de 201 0, el enfoque del desarrollo humano es lo suficientemente flexible para tomar en cuenta las perspectivas futuras de la vida humana en el planeta. El IDH es un ndice, un valor a partir de tres dimensiones: salud, educacin y economa (vase grfico 1 ). Cada ao el Informe del PNUD analiza una arista del
apunta que los avances en los pases ms pobres del mundo podran frenarse o retroceder si no hay cambios en las desigualdades, el cambio climtico y la degradacin del medio ambiente. En cambio, en los extremos de la lista se encuentra Noruega como el ms desarrollado y la Repblica Democrtica del Congo en el ltimo escalafn. Teniendo en cuenta estos datos, es destacable y a la vez desolador que Nicaragua se encuentre a 1 29 posiciones de Noruega y tan slo a 58 del Congo.
3.
EL IDH en Nicaragua
En Amrica Latina y el Caribe hay mejoras generalizadas de IDH desde 1 970. Entre las ms destacadas se encuentra el progreso a largo plazo registrado por el ndice de Desarrollo Humano de Guatemala, Bolivia y Brasil, que han conseguido los mayores avances, a pesar de que en 201 0 Guatemala sigue siendo el pas de Latinoamrica con peor posicin en la tabla de IDH. Amrica Latina sigue siendo la regin ms desigual del mundo. Segn 40
N3
datos del 201 0, se encontraba Chile en el puesto 45 como el pas con IDH ms alto y Hait con el IDH ms bajo en el puesto 11 6. Sin embargo, la frontera ms extrema es la existente entre Nicaragua y Costa Rica, que les separan 53 puestos, del 62 al 11 5 (vase tabla 3).
ya que la poblacin en riesgo de sufrir pobreza creci del 1 5,7% al 1 7,4% (de nueve personas pobres por cada 20, a 11 por cada veintena). El IDH estima que en Nicaragua sigue habiendo una persona en pobreza extrema por cada diez. Por otra parte, el PIB por persona en Nicaragua baj a 2,430 dlares anuales, con respecto a 201 0, que indicaba 2,567 dlares. Esto se traduce en 1 37 dlares menos, suficiente para doblarle los ingresos durante casi cinco meses a los que viven con 1 ,25 dlares diarios. En cuanto a desempleo, el 62,7% de la poblacin depende de los que trabajan; siguen trabajando 8 de cada 1 0 hombres y 4 de cada 1 0 mujeres. Segn la Fundacin Internacional para el Desafo Econmico Global FIDEG(2011 ), a 4 aos de la culminacin del periodo de cumplimiento de los ODM se convierte en una prioridad la reduccin sostenible de la pobreza, situacin que afecta a todos los pases y regiones de pases que participan en la Declaracin del Milenio. Sin embargo, la situacin en Latinoamrica es importante ya que, segn el Panorama Social de Amrica Latina en 201 0, realizado por la Comisin Econmica para Amrica Latina (CEPAL), solamente se ha cumplido el 82% de la meta 1 .A, de los ODM relativo a la reduccin del 50% de la pobreza extrema, a nivel regional, a un 72% del tiempo previsto. Los resultados del Informe de Desarrollo Humano de 2011 sita a Nicaragua entre los pases centroamericanos que presenta el ms bajo desarrollo humano desde 1 980. Segn el Nuevo Diario (2011 ) el Informe presenta el IDH ajustado por desigualdad IDH-D- para 1 34 pases, el ndice de desigualdad de gnero IDGpara 1 46 pases e ndice de pobreza multidimensional IPM- para 1 09 pases. En el Informe de 2011 se utilizan los indicadores de: esperanza de vida al nacer, ao promedio de escolaridad, aos esperados de escolarizacin e ingresos brutos nacionales per cpita. Sin embargo, y a pesar de la posicin de Nicaragua en el Informe, segn los expertos estos datos no son comparables con los datos de otros informes anteriores debido al incremento del nmero de pases que entraron en este ltimo informe, de 1 69 pases en 201 0 a 1 87 en 2011 . De acuerdo al Informe de 2011 , el IDH para Nicaragua es de 0,589 correspondiendo a la categora de desarrollo humano medio. En relacin a la escala del IDH, mientras ms se acerca a 1 la calificacin de desarrollo humano, es superior la calidad de vida, y significa lo contrario mientras ms se acerque a 0 (El nuevo diario, 2011 ). Para mejorar el IDH y disminuir la desigualdad entre la poblacin, es 41
Tabla 3. Datos desiguales de Pases de Amrica Latina
Fuente: elaboracin propia, extrados los datos del PNUD.

Nicaragua, que es nuestro contexto de estudio de la investigacin, ocupa el puesto 11 5 de los 1 69 pases que forman parte del Informe de Desarrollo Humano 201 0. La mortalidad infantil en dicho pas del quintil inferior (ms pobre) es tres veces mayor que la del quintil ms rico. El 48% de la poblacin no tiene acceso a saneamiento mejorado y la incidencia de la desnutricin (2004-2006) es del 21 % del total de la poblacin del pas. En 2011 , Nicaragua se sita en el puesto 1 29 de los 1 87 pases y territorios. Segn la explicacin tcnica del informe local, el cambio de posicin en el IDH de Nicaragua no significa una cada del ndice, sino que el cambio de la posicin entre los dos ltimos informes se explica a los cambios en los datos de las fuentes internacionales utilizadas y, sobre todo, a la inclusin en la clasificacin de 1 8 nuevos pases, de los cuales 1 5 presentan un IDH mayor al de Nicaragua (La prensa, 2011 ). De esta manera, entre 1 980 y 2011 el valor de IDH pas de 0,457 a 0,589, registrando un aumento del 29% con un promedio anual de 0,8%. Este crecimiento anual es ms bajo sin embargo que El Salvador (1 ,2%) y Guatemala (0,95%). As, hay que destacar que el avance en el IDH de Nicaragua en este perodo correspondi a las mejoras en los componentes de educacin y salud. La lnea de pobreza se acentu del 45,8% que mostraba el IDH en 201 0 al 46,2% un ao ms tarde. Es decir, uno de cada dos nicaragenses continan viviendo en la pobreza. Sin embargo, el dato ms desalentador es que las probabilidades de que el nmero de pobres aumente est latente, segn el informe,
N3
necesario la obtencin de recursos pblicos para promover el desarrollo (ms escuelas, educacin de calidad, trabajos dignos, buen sistema de salud, etc.). Segn palabras del propio informe las naciones necesitan generar ingresos y crecer, pero los gobiernos primero deben recaudar recursos antes de gastarlos.
Segn el Informe de ODM (201 2: 4):
Tabla 4. Tendencias de Nicaragua desde 1 980 hasta 2011 Fuente: elaboracin propia, extrados los datos del Informe de Desarrollo Humano
2011 . Desde 1 980 hasta 2011 el valor del IDH de Nicaragua pas de un 0.457 a 0.589, registrando un aumento del 29%. En 2011 la tasa de esperanza de vida al nacer se increment a 74 aos, superior a la expectativa de vida del ao 2000, cuando era de 69.7 aos. Asimismo, los aos esperados de instruccin educativa en el 2000 eran de 9.8 mientras que en 2011 fue de 1 0.8. Amrica Latina sigue siendo la regin ms desigual del mundo en la distribucin del ingreso, distribuyndose sus pases en todos los estratos de la tabla de desarrollo humano: Chile, Argentina y Barbados se sitan en la zona de desarrollo humano muy alto; Hait el nico pas de Amrica Latina que est en la zona de desarrollo humano bajo y el resto de pases se sitan en la zona media. Entre estos ltimos se encuentra Nicaragua en el penltimo puesto en Centroamrica en cuando a desarrollo humano en 2011 . Hay que destacar asimismo que Nicaragua tiene el ingreso nacional neto bruto per cpita (en US$) menor de todos los pases del rea, mientras que Guatemala, que tiene un IDH menor que Nicaragua, tiene un INB per cpita superior en ms de un 80%. A pesar de la tendencia positiva, siguen existiendo grandes diferencias entre pases, y pases muy subdesarrollados en comparacin con la regin. Destaca negativamente sobre todo Hait, pero tambin Guatemala, Nicaragua, y Honduras. Segn el Informe de Desarrollo Humano (2011 : 1 41 ), en la gua para el lector se incide en que los datos sobre IDH no es comparable con aquella publicada en ediciones anteriores debido a que los organismos estadsticos internacionales estn mejorando permanentemente sus series de datos, la informacin presentada en el Informe, etc.
En todas las regiones aument el acceso al tratamiento para las personas con VIH. A finales de 2010 en las regiones en desarrollo haba 6,5 millones de personas que reciban tratamiento con antirretrovirales para el VIH o el SIDA. Esa cantidad constituye un aumento de ms de 1.4 millones de personas desde diciembre de 2009, y es el incremento ms alto jams logrado en un ao. Sin embargo, no se alcanz la meta de lograr en 2010 el acceso universal.
4.
Conclusin
Los desequilibrios sociales son la clave de las posteriores desigualdades, de la Sociedad del Desarrollo y del ansiado Estado de Bienestar. La desigualdad, como fenmeno, en Amrica Latina es compleja debido, como seala el PNUD, en gran parte a la herencia generacional y al mal diseo de polticas pblicas que, en su mayora, se han limitado al combate de la pobreza. En el caso del VIH/ SIDA, debemos resaltar que de acuerdo a los Informes de ONUSIDA, existen unos 35 millones de personas afectadas en el mundo. Cada ao se registran ms de 2,5 millones de nuevos casos de infeccin y se producen alrededor de dos millones de fallecimientos relacionados con el SIDA. Segn las mismas fuentes, en Amrica Latina, el nmero de personas que conviven con el VIH asciende a 2 millones. Segn las mismas estimaciones, aproximadamente 77.000 personas fallecieron a causa de enfermedades relacionadas con el SIDA durante los ltimos aos. Las encuestas de Amrica Central han detectado una prevalencia del VIH entre profesionales femeninas del sexo del 4,3% en Guatemala y del 3,2% en El Salvador. En el comportamiento de la epidemia en Nicaragua se identifican dos poblaciones claves que requieren intervenciones adecuadas para lograr cambios importantes: poblacin ms expuesta debido a prcticas de mayor riesgo y poblacin vulnerable a la epidemia debido a factores externos a su control. En este grupo se encuentran los nios, nias, adolescentes y jvenes. Condiciones sociales como la pobreza, inequidad de gnero, la falta de acceso a informacin, la alta proporcin de adolescentes fuera del sistema educativo, y las barreras de acceso a los servicios de salud por parte de poblaciones rurales y tnicas, explican el aumento de la vulnerabilidad a la epidemia en este grupo poblacional. 42
N3
En Amrica Latina y el Caribe, la epidemia est bien consolidada y existe el peligro de que se propague de forma rpida en ausencia de respuestas nacionales eficaces. En la regin se combinan los factores de desarrollo socioeconmico desigual (en funcin de necesidades bsicas insatisfechas, porcentaje de analfabetismo y concentracin de la riqueza y de la tierra en pocas manos) con la gran movilidad de la poblacin para favorecer la propagacin del VIH. Estos datos deben animarnos a seguir trabajando en esta lnea, en la prevencin y tratamiento de VIH/SIDA para mejorar los datos de prevalencia y, transversalmente, mejorar los datos de desarrollo humano en el rea de la salud.
Referencias bibliogrficas
- Asamblea General de las Naciones Unidas (2000). Declaracin del Milenio. Organizacin de las Naciones Unidas, Nueva York. - CEPAL (2011 ). Panorama Social de Amrica Latina en 201 0, en http://www.eclac.org/publicaciones/xml/9/41 799/PSE-panoramasocial201 0.pdf (consultado el 1 5 de noviembre de 201 2). - Comisin Econmica para Amrica Latina y el Caribe CEPAL. Informes ODM Nacionales pases de Amrica Latina y el Caribe, en http://www.eclac.cl/cgibin/getProd.asp?xml=/mdg/noticias/paginas/2/35552/P35552.xml&xsl=/mdg/tpl/p1 8fst.xsl&base=/mdg/tpl/top-bottom.xsl (consultado el 05 de marzo d201 3). - Economistas sin Fronteras (2008). Los Objetivos de Desarrollo del Milenio en 2008: nuevas amenazas para su cumplimiento, en www.201 5ymas.org/documentos_ver.asp?id=42 (consultado el 8 de noviembre de 2011 ). - El nuevo diario (2011 ). Esperanza de vida pas de 69 a 74 aos, en http://www.elnuevodiario.com.ni/imprimir.php/23201 3 (consultado el 1 de marzo de 201 3). - Fundacin Internacional para el Desafo Econmico Global FIDEG- (2011 ). El desafo de Nicaragua: la diminucin de la pobreza y el desarrollo, en http://www.elobservadoreconomico.com/articulo/11 43 (consultado el 23 de febrero de 201 3). - Gil, M. L; Fernndez, A. C; Callejn, M E. (2007). La situacin de los Objetivos del Milenio a mitad de camino para 201 5, en http://www.201 5ymas.org/IMG/pdf/anuario2007_CAP1 _4_OBJ.pdf (consultado el 25 de octubre de 2011 ). - La prensa (2011 ). Nicaragua retrocede en Desarrollo, en http://www.laprensa.com.ni/2011 /11 /03/ambito/791 60 (consultado el 21 de febrero de
201 3). - Naciones Unidas. Indicadores de los Objetivos de Desarrollo del Milenio, en http://mdgs.un.org/unsd/mdg/Home.aspx (consultado el 22 de febrero de 201 3). - Naciones Unidas (201 2). Objetivos de Desarrollo del Milenio: Tabla de progreso, 201 2, en http://mdgs.un.org/unsd/mdg/Resources/Static/Products/Progress201 2/Progress_S.p df (consultado el 3 de marzo de 201 3). - Naciones Unidas (201 2). Objetivos de Desarrollo del Milenio. Informe de 201 2, en http://www.undp.org/content/dam/undp/library/MDG/spanish/MDG%20Report%20201 2%20-%20Complete%20Spanish.pdf (consultado el 23 de febrero de 201 3). - ONUSIDA (201 0). Mapa de prevalencia mundial del VIH, en http://www.unaids.org/globalreport/HIV_prevalence_map_es.htm (consultado el 20 de abril de 201 2). - ONUSIDA (2008). Informe sobre la epidemia mundial de SIDA 2008. Ginebra: Programa Conjunto de las Naciones Unidas sobre el VIH/SIDA-ONUSIDA. - Organizacin Mundial de la Salud (2011 ). Monitoreo del logro de los Objetivos de Desarrollo del Milenio relacionados con la salud. Progresos logrados en el cumplimiento de los Objetivos de Desarrollo del Milenio relacionados con la salud y objetivos sanitarios mundiales para despus de 201 5, en http://apps.who.int/gb/ebwha/pdf_files/EB1 30/B1 30_1 3-sp.pdf (consultado el 4 de marzo de 201 3). - PNUD (2011 ). Informe de Desarrollo Humano Sostenibilidad y equidad: un mejor futuro para todos. Nueva York, en http://hdr.undp.org/en/media/HDR_2011 _ES_Complete.pdf. - PNUD (201 0). Informe sobre Desarrollo Humano La verdadera riqueza de las naciones: caminos al desarrollo humano. Nueva York, en http://hdr.undp.org/en/media/HDR_201 0_ES_Complete_reprint.pdf (consultado el 1 0 de abril de 201 2). PNUD: Observatorio de Desarrollo Humano, en http://www.americalatinagenera.org/es/index.php?option=com_content&task=view&id =979&Itemid=1 43 (consultado el 5 de marzo de 201 3). -Redes de solidaridad, en http://redesdesolidaridad.wordpress.com/2011 /11 /04/indice-de-desarrollo-humano2011 -nicaragua-y-el-mundo-en-pos-de-la-sostenibilidad-y-la-equidad/ (consultado el 05 de marzo de 201 3).
43
N3
Tending to the Whole Person: Healthcare Chaplaincy and the United Nations Millennium Goals 201 5
Abstract: Healthcare chaplaincy is a young field. The study of the impact of spirituality
and religiosity upon health status is also a newer field. This essay examines in broad strokes what healthcare chaplaincy currently offers, reviews some of the current spiritual care assessment tools in use, introduces some new assessment approaches, and demonstrates how healthcare chaplaincy can help accomplish the UN Millennium Goals.
Introduction
Thanh, a Vietnamese patient in his 40s, is admitted to his local hospitals ICU in Canada. His family brings with them their own food and bedding supplies. The charge nurse explains that they cannot bring in their own items because the patient has lowered immune function and anything not sterilized could make him even more ill. Hearing these instructions, the family becomes deeply distressed and discusses removing Thanh from the hospital. If the hospitals healthcare chaplain uses the robust spiritual care assessment tool and orientation that I will present in this article, she will learn that: In the 1 970s to the early 1 990s in Southern Vietnam, where the patient was born and raised, admission to the hospital was often regarded as the setting of last resort, and was often the place where patients died. Furthermore, a patient had to bring his own supplies if he was to have food or bedding 1 . While this is not an obvious religious or spiritual issue, by eliciting this information, the chaplain can be a reassuring presence to the family, an advocate for them, and help them move from the experience of what the hospital used to mean to what it can mean for them now. This will help the patient and family become partners with the healthcare team and will enable the patient and his family to more readily confront whatever comes next for him, medically. We know our world is becoming increasingly connected via technology and travel. It is also becoming increasingly mixed culturally, religiously and ethnically as migrants, immigrants and refugees enter states and nations within which their peoples have not previously resided, or have resided only in small numbers. One consequence of these population shifts is that there are now interactions in local communities and in local community healthcare institutions of religions, cultures and ethnicities that have never met before but about whom are often held long-standing beliefs and misperceptions; and in some cases, these peoples have met only through being opponents during war or when one group was actively oppressing the other. Further, it is no longer unusual for a healthcare chaplain to work with a patient, family or healthcare provider who is from a culture or religion to which the chaplain has not had prior exposure. Moreover, due to technology and personal interactions, cultures, religions and spiritual traditions the world over are influencing each other more quickly than ever before. Some consequences of these exposures is that personal self-identities and religious communities identities are forming and reforming - morphing, one might say - at incredible rates and in ways that are unprecedented. For instance, in the past, a generation was understood to span around 20 35 years. Now, they can span as 44
Keywords:
spirituality, religion, religiosity, healthcare, chaplain, chaplaincy, UN, United Nations, millennium, goals, development goals, spiritual care, spiritual assessment, healthcare, professional chaplain, ethnography and healthcare, anthropology and healthcare, cultural competency, religious competency, cultural assumptions, religious assumptions
Rabbi Dvorah Rose

Founder, director at Integrating Spirituality with Healthcare Practice e-mail: DLRose@rabbidvorahrose.com web: http://rabbidvorahrose.com/
N3
little as just a few years, in great part due to the influence of new technologies quickly arising and creating new ways of understanding ones self and ones world. With the incredible cultural and religious interactions now occurring, now more than ever we cannot make assumptions about a patients background or needs, just because we have been told the persons religious or cultural identity. I have been in the healthcare field for most of my professional life, first as a registered nurse, and now as a rabbi and interfaith healthcare chaplain. I have seen these changes taking place and have had the delight of serving some of the most culturally and religiously diverse communities in the United States. In serving these communities I have noted these issues directly. In this essay I would like to reflect on two related issues: 1 .) Our world has become so connected that healthcare chaplains need to be familiar with many different cultures and religions/spiritual traditions. While there are good resource materials on Cultural Competency (a good example is the Ethnogeriatic Program at Stanford University), it is not possible to be deeply knowledgeable about every group with which one might interact. Thus, I will propose some supplementary spiritual care assessment tools and approaches for healthcare chaplains to use. These will enable a healthcare chaplain to elicit a more robust picture of a patients cultural and religious background, experiences, and beliefs. 2.) Healthcare chaplaincy, especially when practiced from a multicultural, multifaith and advocacy perspective, can support many of the UN Millennium Goals. The first question might well be, why does healthcare chaplaincy matter? We now have over twenty years of scholarship and anecdotal evidence that spirituality2 and religiosity3 can have significant impact on a patients well-being. In general, this is no longer the primary question in healthcare settings. Rather, we are now focusing on finding best practices, refining assessment tools, integrating this knowledge into healthcare providers training, and looking to move the field forward into new areas of research and application. Healthcare Chaplaincy is still a young field. While there are good working definitions of what it is and how it functions, what this healthcare practice can provide is still being discovered and discussed. We do know that professional healthcare chaplaincy does have a positive impact on the well-being of patients, their families and upon healthcare providers themselves. I believe professional healthcare chaplaincy can also have a positive financial impact upon healthcare systems and
institutions. This is an area not yet explored. Healthcare chaplains in North America were initially primarily male, Caucasian, and from mainline Protestant or Catholic communities. Increasingly, clergy and religious/spiritual lay leaders are entering the profession who are from a wider range of religious and spiritual communities, many who are female, and some who identify on the LGBTQI spectrum. We now have chaplains who serve their own communities as well as chaplains who serve multiple religious and spiritual communities. So, for instance, a professional healthcare chaplain in a hospital may be an ordained female, African-American Baptist minister who is serving those from her own church community as well as Wiccans, Jews, Muslims, Catholics, and Buddhists. Healthcare chaplains are also trained to provide meaningful support to those patients and healthcare providers who identify as atheist or agnostic. In the field of spirituality and health, quite a few spiritual care assessment tools have been developed. Two of the currently best known are FICA and HOPE. These have been created by physicians. There have been some created by nurses and by social workers, but they have not attracted the same degree of popularity as the ones created by physicians. A few have been created by healthcare chaplains, such as the 7 x 7 Model. In general, all of these assessment tools focus primarily on overt religious, spiritual or theological questions. This reflects the overall emphasis within spirituality and health training and research a primary focus on theological beliefs and practices, with a secondary focus upon family systems theory and systems psychology. Since healthcare chaplaincy was initially called pastoral care (and in many places still is), it makes sense that the primary focus was upon overtly theological issues and experiences. But, if these are the only issues for which the provider is looking, then he is going to miss all of the other factors that can be impacting upon the patients experience. Just as the same medicine or identical dosage does not work for all patients, spiritual care is not a one-size-fits-all healthcare tool. Current spiritual care assessment tools most definitely should be used within the practice of healthcare chaplaincy (and the study of spirituality and health). I would argue, though, that there has not been nearly enough focus on how to understand the patients and familys experience outside of that overt theological orientation. We really cannot start working with a patient and her family (or healthcare providers, for that matter) with the idea that they exist only in the present moment, and that we are only looking for the obvious, standard religious or spiritual needs queries such as, what type of religious or spiritual community do you belong 45
N3
to; what gives you meaning in your life; and how have you dealt with difficult situations before? To most fully capture nuanced experiences and beliefs so as to accurately assess the patients/familys/staffs spiritual/religious and cultural needs, the healthcare chaplaincy field needs to develop more robust spiritual assessment tools. be admitted to the local hospital in his town in Iowa because he had distressing experiences with the medical system as a child in the Former Soviet Union, some of which he experienced as directly related to being Jewish. His physician convinces him to allow the admission. Once in the hospital, he becomes increasingly anxious and the patient and his family start questioning everything the healthcare providers are recommending. Ultimately, the patient and his family become non-compliant and leave the hospital Against Medical Advice 4. The chaplain could have elicited information from the patient and his family at the beginning of his admission that might have prevented the above scenario from occurring. Had the chaplain used spiritual care assessment tools that invited the patient and his family to share about their past experiences and their current reactions to the hospital setting, the chaplain could have advocated for their particular needs and explained their historical and religious sensitivities to the healthcare team. The chaplain could have gone on to be a reassuring presence for the patient and family, and helped cultivate a positive experience for the patient, his family, and his healthcare providers. The approach I describe first with Thanh and then with Misha is one of cultural, historical and religious curiosity. The spiritual care assessment skill is framing ones questions from a sociological and anthropological perspective, with a special focus on ethnography. These are some of the core issues to consider from this perspective: 1 .) How does the historical background of the patient and his family influence how they approach and experience the current healthcare event, setting, and healthcare providers? 2.) What communities/cultures has the patient interacted with in the past that might impact how she responds to the current healthcare setting and providers? 3.) What does the patient hear (e.g.: what is the meaning of the words to the
particular patient and family) when certain words are used such as ill, well, cancer, discontinue life support, dead, prayer, blessing, miracle. Does the meaning change based upon the person relaying the information? What impact does the communicators gender, race, ethnicity, age, status, religion, etc. have upon how the message is received, processed and integrated? Using a basic ethnographic orientation is particularly useful here 5. Hispanic names as basically interchangeable, because they are both female, both speak Spanish, and both are Catholic. She assumes that Maria will be simpler to work with and more willing to do what the doctor has ordered, since she appears to be well-educated. Moreover, the nurse assumes that she and her two patients will automatically understand one another as they all speak Spanish, are female, were not born in the U.S., are the same religion, and are approximately the same age. The nurse makes automatic referrals to the hospitals Catholic priest to visit the two patients to offer Communion. If the nurse applies the curiosity and basic sociological and ethnographic approach, she will learn that: Maria is from a wealthy family based in Mexico City. She is fluent in three other languages, has been educated in Britain and Switzerland, and prays to the Virgin of Guadalupe. She has been exposed to enormous violence as a child due to the narcotics cartels in her home town. She has strong symptoms of Post-Traumatic Stress Disorder when she hears certain sounds or hears certain words pronounced a particular way. As a result of this violence, although she is Catholic, her religious and prayer life are now profoundly different from the traditional Roman Catholicism of her parents, and she has significant spiritual distress because of this divergence from her familys traditions, beliefs and practices. She feels very guarded around those whom she regards as placing themselves in authority positions and so has significant distrust of her physicians, especially the ones whom she thinks look similar to the narcotics dealers from her home city. She is nervous around Catholic priests. Rosa is from Guatemala and grew up in a fairly poor farming community. Her family is also Catholic, with a strong faith in the Catholic Saints, especially the local ones (some of whom are not recognized by the Roman Catholic Church). Rosas community has not been impacted by violence, so she has a fairly secure sense about her place in the world and in a beneficent transcendent presence watching over her and her family. She does not feel the need to be guarded around authority figures and easily discusses her health care needs with her nurse and doctor. She is at ease with Catholic priests 6. 46
Example One: Misha, an elderly Russian Jewish patient, does not wish to
Example Two: A Filipina nurse regards her two female patients with
N3
As you can see from the spiritual care assessment tools listed earlier in this essay, they are not well designed to capture the cultural or historical milieu that help shape these patients and families beliefs about the meaning of being in the hospital and the subsequent needs for support and reassurance that are needed. I suggest that the healthcare chaplain will often serve the patient, family and other healthcare providers (and the healthcare institution) more effectively by identifying early on in the admission these types of experiences and the beliefs arising from them. Then, the chaplain can move more easily, with greater rapport and greater relational trust into approaching more standard religious or spiritual issues. One of the current difficulties in the field of spirituality and health research is the attempt to quantify what effective spiritual care looks like, as well as the effects of this care. There is much important research already conducted of this nature and much more in progress. However, we will miss a lot about this work if we do not also employ skillful qualitative research. As more research is conducted in more regions and countries, amongst a wider array of cultures and amongst those who are and those who are not religious, using a meaningful qualitative approach combined with quantitative studies will help the field become increasingly nuanced and rich. The UN Millennium Goals are compelling because of their holistic view of humans needs and rights. Since the UN is transnational, these Goals become a unifying organizational tool for all nations. Professional healthcare chaplaincy can contribute toward the fulfillment of the UN Millennium Goals by striving to make healthcare accessible for everyone. This can be accomplished via the chaplains focus upon the conditions (emotional, spiritual, sociological, economic, historical, etc.) that create barriers for the patient and her family. These UN Goals either are already integrated into regional and national planning, or are in the process of being integrated. I would urge that robust healthcare chaplaincy be recognized as a powerful tool that can help nations address accessible and inclusive healthcare for all their people. For instance, in the United States, as the Joint Commission continues to address standards of care within accredited healthcare institutions, the healthcarerelated UN Goals could become woven into their expectations. Especially in the focus upon patient rights, including the right to non-discrimination based on gender, sexual or gender orientation, age, religion, etc., the UN Goals are already reflected. It might be a powerful support to U.S. healthcare providers to know that these standards are reflected internationally. Professional healthcare chaplains are either ordained clergy or recognized religious/spiritual leaders within their traditions. All religious and spiritual traditions
teach that clergy are to help the poor, the disenfranchised, and those who are without power; in other words, the vulnerable. One can easily argue that the vulnerable include those who are in need of medical support. For the sake of length I will not parse out every goal for which healthcare chaplaincy can be a supportive element, but will instead provide a few examples. As written so eloquently in the UN Millennium Goals
all cultures and civilizations contribute to the enrichment of humankind .
Goal 1 6. We acknowledge the diversity of the world and recognize that
The whole point of meaningful, appropriate and robust healthcare chaplaincy is the recognition of different cultures and religions that diversity is complex and multifaceted and needs to be approached as such.
Goal 23. Adopting policies and measures oriented towards benefiting the
poor and addressing social and economic inequalities .
Meaningful healthcare chaplaincy helps open up the healthcare delivery system so that those who have experienced oppression or barriers to care feel (and are) safe to enter into that system. For instance: An impoverished Muslim Afghan lesbian with a breast lump may have experienced so much judgment about being Muslim and homosexual that she has not tried to enter the healthcare system for diagnosis or treatment. Most likely she will become seriously ill and die an agonizing death neither of which necessarily need occur if she can receive effective medical treatment and management. The healthcare chaplain can be an advocate for the patient and a reassuring, non-judging presence. The chaplain can also become a support and guide to healthcare providers and policymakers who would withhold healthcare access to patients they consider to have become ill due to perceived poor moral character.
Goal 28. We recognize that policies and actions must focus on the poor
and those living in the most vulnerable situations, including persons with disabilities .
Healthcare chaplains act as advocates and a reassuring presence for patients who are the most vulnerable. This includes those who are impoverished and those with disabilities. Not infrequently, if a patient has developmental disabilities, physical 47
N3
or emotional disabilities, or has hearing or vision impairments, they are often unable to access the healthcare system or if in it, are unable to receive the support needed for them to receive appropriate care. If the patient lives in poverty, they may have no access to care or may be unable to afford the care that is available. These are situations in which healthcare chaplains can work one-on-one with the patient/family but also use their clerical authority and community-organizing skills to work toward making the changes necessary in the local community so that all who need healthcare are well-served. Healthcare chaplaincy that recognizes and supports each patient as an individual with full rights to healthcare and support at the end of life is, at its foundation, practicing respect for, promoting, and protecting human rights.
tended to just as strongly as physical needs during and after emergencies and disasters. Providing this care concurrent to physical care diminishes Post-Traumatic Stress Disorder and related stress responses afterward. It promotes faster and more complete recovery physical as well as emotional.
Millennium Development Goal 4 Reduce child mortality

(g) Working to ensure that the next generation is born HIV-free by providing, on an urgent basis, extended and sustainable coverage and improved quality of services to prevent mother-to-child transmission as well as increasing access to paediatric HIV treatment services .
Goal 54. We acknowledge the importance of gender equality and

empowerment of women .
Because HIV infection continues to be regarded by so many as a morallyderived illness, healthcare chaplains can act as advocates, educators and nonjudging presences for individual patients, their families, their healthcare providers and their communities. In general, professional healthcare chaplains are patient advocates, educators, non-judging clerical presences and religious and moral authorities. Chaplains can help remove healthcare barriers, especially when they are culturally, religiously, or morally-derived.
So often, healthcare is still skewed toward only male family members receiving care and acting as the family healthcare decision-makers. Healthcare chaplains can act as advocates for the women and girls in the family or community who are prevented from being regarded as fully deserving of healthcare, or worthy of making healthcare decisions for themselves and their families. Example: The patriarch of an Afghan family declares he wants his wife to be cured as quickly as possible and for as little cost as possible so that she can return to the home to care for him and his children. The physician supports the patriarchs desires. Because both the physician and the patriarch assume the decision-making authority and family structure is accepted and agreed upon by the wife, they fail to learn from the wife that she is fearful of returning home because she feels too weak to tend to the large familys demands.
Conclusion
Healthcare chaplaincy is still a young field and we are constantly learning what this work can offer patients, their families and friends, healthcare providers, and healthcare institutions. We are just learning how it can have a positive impact upon a regions and nations healthcare system and well-being of its citizens. Part of understanding what this discipline can provide is to keep pushing at its edges to see how and where it intersects with other more-established disciplines. Moreover, as introduced in this essay, healthcare chaplaincy can help support the accomplishment of the UN Millennium Goals. This is an important leadership role that healthcare chaplains around the globe should be cultivating.
Promoting global public health for all to achieve the Millennium Development Goals
We commit ourselves to accelerating progress in promoting global public health for all .
Preparation for emergencies should include a well-trained emergency response chaplain team. We know that spiritual and emotional needs must be 48
N3
Notas
1 . Example is a composite with no real names used, derived from my professional

experience.
- McArthur, J.W. (201 3, March/April). Own the Goals: What the Millennium Development Goals Have Accomplished. Foreign Affairs, 1 52-1 62. - United Nations, Sixty-fifth Session, 1 9 October 201 0, Resolutions adopted by the General Assembly, Keeping the promise: united to achieve the millennium development goals (A/RES/65/1 ).
2. There is no agreement on how to precisely define or measure spirituality. It is
typically understood as the inner experience a person has in regard to or in relationship with the divine, sacred or transcendent, or with what provides meaning to that persons life. A person may identify as spiritual but not religious.
3. There is no agreement on how to precisely define or measure religiosity. It is

typically understood as the external activities and practices of a person who identifies with a religious community.
4. Example is a composite with no real names used, derived from my professional

experience.
5. Spradley, James. The Ethnographic Interview. New York: Holt, Rinehart, and
Winston. 1 979. And these are some good resources on using ethnography in the healthcare setting.
6. Examples are composites with no real names used, derived from my professional
experience.
Bibliography
- Craddock Lee, S.J. (2003). In a Secular Spirit: Strategies of Clinical Pastoral Education. - Health Care Analysis, Vol. 1 0, 339356. - Feldstein, B., Rose, D., & Winograd, C. (2008). Judaism. In S. Brangman, M. Grudzen, C. Pan, & G. Yeo (Eds.), Doorway thoughts: Cross-cultural healthcare for older adults (Vol. 3, pp. 99-11 8). Sudbury, MA: Jones and Bartlett Publishers. - Koenig, H.G., MD. (2004). Religion, Spirituality, and Medicine: Research Findings and Implications for Clinical Practice. Southern Medical Association, 11 94-1 200. 49
N3
Education: an Essential Component in Guaranteeing the Right to Health?

A Reflection from Doctors of the World Spain
Abstract: The following article is a reflection on how is the
health situation in the world, in terms of political attitude and development aid, and reference to the Millennium Development Goals. Finally, we will see how education influences the development to ensure the human right to health, and how Doctors of the World works in this way, carrying out different international cooperation projects.
What is the current world health situation?

The joint efforts between international organizations, donor countries, receptor countries, and other organizations working in the health sector have achieved, in the last few years, improvements never before seen in certain global health indicators. Nevertheless, the gap between the poorest and the richest does not show signs of closing, and the international commitments are not being met to the extent that they should be. This situation has been made worse in recent years by a global crisis, a crisis that is not only economic. This is evident in the fact that certain values which should be universal are being questioned, for example, solidarity and the global right to health, the responsibility of every man and woman in the face of global poverty, and even their own state of well-being. This situation can be illustrated if we analyze the evolution of the Official Development Assistance (ODA). Six of the member countries of the DAC (Development Assistance Committee of the OECD) reduced their ODA between 201 0 and 2011 , and of them all, the drop in Spanish aid, for the second consecutive year, has once again been highlighted . It is once again the
Keywords: Health, education, development, cooperation, OAD, ODM, primary care, human
rights, doctors of the world
largest reduction in absolute terms, with a reduction of 1 ,685 million dollars; that is, more than 28% with respect to 201 0. The accumulative
reduction of Spanish cooperation in the last three years is 36%. So, in 2011 , Spanish aid occupied 11 th place of the DAC for the total amount of ODA given, and 1 5th place with regards to effort.
There has been a serious setback in terms of following the path towards a commitment of 0.7% of Gross National Income for ODA, that the government had promised for 201 2 (and that the other political parties with parliamentary representation had supported, through the Spanish National Pact Against Poverty), The ODA estimates established in the plan for 201 3 indicate that this year, we will fall to 0.20%, a percentage which takes us back to 1 990 and which is a great distance away from the agreed 0.7%.
Cristina Sirur.
Volunteer journalist for Doctors of the World Spain. e-mail: cristinasirur@gmail.com
Mariana Ruiz de Lobera.

Management of Knowledge and Learning Officer. Doctors of the World Spain. e-mail: mariana.ruizdelobera@medicosdelmundo.org
50
N3
Goal 5: Reduce maternal mortality. This will possibly be the most difficult goal to
reach its target by 201 5. 56% of deaths (almost 1 61 ,000) occur in Sub-Saharan Africa, where one woman every 200 births dies in this region. The second region is still Southern Asia, with 29% of total maternal deaths. The majority of these deaths are completely avoidable. If the women had access to adequate healthcare with qualified staff and cultural experience, this mortality rate would fall drastically. However, the lack of access is not only due to the lack of technical or human resources. In women's health, a determining factor is gender equality, which affects even whether the woman can receive treatment or not, or her ability to decide whether or not she wants more children. Therefore, to tackle maternal mortality, we cannot simply consider the question as merely a healthcare issue - we need to combine this with analysis and researching solutions to achieve gender equality.
Image 3.1 Development of planned and disbursed ODA 2002-201 1 Source: Own development since the PACI (Annual International Cooperation Plan)
and PACI follow-up reports. The state of Spanish co-operation in health is in a critical state, with its relative weight the lowest it has been in the last 1 0 years. While budget cuts for spending in all departments between 2009 and 201 2 have been on average, 30%, the Government Administration's budget cuts for cooperation have been 50%. But in addition to this, within the cooperation cuts, the heath sector has suffered disproportionate cutbacks: while between 2009 - 2011 the total of ODA was reduced by 35%, health aid has reduced by 62%. These figures show the loss of interest in the health sector of Spanish cooperation, a worrying fact considering that this is a sector whose cuts have consequences in the loss of human lives and in increased suffering. This information gives us an idea of the setbacks in terms of political intentions, and as a reflection of this, the decline in the resources allocated. In order to evaluate the world health situation, we can measure them by the Millennium Development Goals (established in the year 2000, to be achieved by 201 5). Three of these goals (4, 5 and 6) are directly linked to health:
Goal 6: Combat HIV/AIDS, malaria and other diseases. Regarding HIV/AIDS,
although we cannot say that we have the disease under control, we can ensure that the international effort is bearing fruit, and the number of infections is falling all over the world. Mortality as a result of this illness was 1 .8 million in 201 0, compared with 2.2 million in 2005, which shows a steep and constant decline. Nevertheless, the number of people who live with the HIV virus has grown 1 7% since 2001 , and in 201 0, the figure reached 34 million people. This is due to the increase in treatment. The problem is that it is a chronic disease, which means that these people need access to treatment throughout their whole lives. Therefore, precise strategies for fighting the disease cannot be established, but they must be integrated within the health systems, multi-sectoral, free from stigma and discrimination, and with a longterm vision. Malaria continues to be, of the three biggest infectious diseases (AIDS, tuberculosis and malaria), where the focus of the MDGs lies. Of the three, this disease has the most sufferers, especially in children. There are 21 6 million cases of malaria each year, causing 655,000 1 deaths. 91 % of deaths occur in Africa, and 85% of those killed are under 5 years old. As with HIV/AIDS, incidences of this disease has fallen 1 7% since the year 2000, and, most importantly, its mortality rates have dropped by 25%, thanks to the contribution of international cooperation. However, the commitment to reduce the mortality rates by 50% by 201 0 has not been achieved. With regards to tuberculosis, despite the fact that in 201 0, more than one million people (of whom 350,000 were HIV positive) died from the disease, the mortality rate forecasts for this disease indicate that in 2005, it will be half than in 1 990. 51
Goal 4: Reduce under-five mortality rates. This has been reduced all over the world.
Even Sub-Saharan Africa, the region with the highest infant mortality rates, shows improvements in some of its indicators. In the period 2000-201 0, its reduction rate was 2.4%; double that of the previous decade. However, there is still a long way to go. Every day, 1 9,000 boys and girls continue to die from avoidable causes.
N3
There is not long to go until 201 5, a date which the international community set as a target for achieving the results forecasted in the Millennium Development Goals. Since the United Nations is already beginning to work on the scene post 201 5, they have collated some of the important lessons learned. There are those which highlight the need for participation and ownership on the part of southern countries, and the design of the goals and indicators in an independent manner, ignoring the links between different MDGs.
of locally endemic diseases; appropriate treatment of common diseases and injuries; and provision of essential drugs".
What can we do from the perspective of EDUCATION to improve HEALTH throughout the world?
The link between health and education is clear, and this is illustrated in various declarations and international treaties, some of which we will discuss below. The United Nations Committee on Economic, Social and Cultural Rights, in the year 2000, issued its General Comment no. 1 4, relating to the Right to the Highest Attainable Standard of Health, which is explained in article 1 2 of the 1 966 International Covenant on Economic, Social and Cultural Rights. It indicates that the right to health is "An inclusive right...extending...also to the underlying determinants of health, such as access to safe and potable water and adequate sanitation, an adequate supply of safe food, nutrition and housing, healthy occupational and environmental conditions, and access to health-related education and information, including on sexual and reproductive health. A further important aspect is the participation of the population in all health-related decision-making at the community, national and international levels." Human rights are indivisible, interdependent, complementary and equal, that is, they are inseparably inter-related. There are no rights that come above others, and they are complementary. The right to health cannot be achieved without decent housing, without access to education, etc. The Alma-Ata Declaration (1 978), in search of a solution to guarantee health for all, developed the Primary Health Care strategy. The minimum elements a Primary Health Care programme should contain, according to Alma Ata, are: "Education concerning prevailing health problems and the methods of preventing and controlling them; promotion of food supply and proper nutrition; an adequate supply of safe water and basic sanitation; maternal and child health care, including family planning; immunization against the major infectious diseases; prevention and control
How can we include, in our own actions, education to promote the right to health?
Doctors of the World work to defend the global right to health. In our projects, we incorporate the analysis of economic, social and cultural determinants and gender analysis. We identify strengths and weaknesses of the different entitlements (rights, responsibilities and obligations) in order to develop an action strategy which will help bring about a change in the standard of living of the most vulnerable populations. We avoid, in this way, assistance-based cooperation. We do not wish to offer a service which creates dependency and does not develop ability. In this commitment, educational work is fundamental, and assists development in a number of ways. Establishing alliances with the Ministry of Education in order to incorporate, through the curriculum and/or training teaching staff in sexual and reproductive rights; furthermore, incorporating the Information, Education and Communication component into projects. Communication, for health, is "the social, educational and political process which increases and promotes public awareness of health, promotes healthy lifestyles and community action supporting health, providing opportunities and allowing people to be able to exercise their rights and responsibilities to develop environments, systems and policies beneficial to health and well-being." Aside from the premise of educating, informing, persuading and explaining, as well as listening, communication in health provides individuals and communities with the advantages and resources necessary to prevent diseases and improve their quality of life. Below, and to illustrate how, in practice, Doctors of the World connects Health and Education, we will explain in detail some of the projects which are being carried out in the field of International Cooperation, where the 'Education' component is a high priority. In the region of Kilimanjaro,
Tanzania, Doctors of the World have launched

52
N3
activities on "Sexual and Reproductive Health, STI/HIV, Gender-based violence". Within their lines of work, "training of trainers from the Ministry of Education on a regional level, on sexuality, health and sexual and reproductive rights; for the teaching staff and primary managerial staff, health advisors and peer education in primary schools. Since 201 0, Doctors of the World has developed, in the Sahrawi Refugee Camps, an Agreement to reduce maternal and child morbidity and mortality rates,
the most vulnerable populations, in a sustainable and respectful way. Participation and education for emancipation and empowerment of the holders of these entitlements, is the indispensable foundation which can support any act of cooperation for development. An organization which is not assistance-based, but aims to strengthen the capacities of the different agents so that they can lead their own development, naturally incorporates the educational component into its actions.
as well as the risks and the burden of disease in women of a reproductive age through the re-enforcement of public capacities and community participation. The intervention is completed with the creation of a Coordination Round Table. Within its strand of work, the creation of an Information, Education and Communication in SSR should be noted. Finally, one of the most representative projects is that which is being developed in Guatemala City, aiming to strengthen the Health and Education Policies for adolescents and young people in Preventative Programme related aspects through education in two educational centres in zones 1 and 7 of Guatemala City. In this project, the Education factor is present in the majority of the strands of work: approach of incorporating comprehensive sex education in the formal education system and in youth organizations; implementation of the Comprehensive Strategy of Sex Education of the Department of Education in the classrooms at the two education centres; strengthening of the institutional capacity of the health and education sectors, through the provision of health personnel, methodological tools and focusing on gender, human rights and multiculturalism; cross-sector coordination (Health-Education Departments), and with civil society to develop alliances which promote the exercising of the Sexual and Reproductive rights of the adolescents and young people of zones 3 and 7 of Guatemala City. Through the course of these 23 years of experience, we have learned a lot, always searching for the route which will allow us to guarantee the right to health of
Notes 1 . http://www.rbm.who.int/keyfacts.html Reference bibliography

Prosalus, Medicos Mundi, Medicos del Mundo. La salud en la cooperacin al desarrollo y la accin humanitarias. 201 2 Report. Website of the Commission on Social Determinants of Health from the World Health Organization: http://www.who.int/social_determinants/en MDG, official website DEL VALLE ROJAS, Carlos, (2003): "Comunicar la Salud". Temuco Chile, Ediciones Universidad de la Frontera
53
N3
A Importncia de Hbitos Saudveis na Luta contra o Cncer

Resumo: Diante da relevncia do tema sobre neoplasias, no Brasil, esse trabalho de
reviso literria teve como objetivo estudar as neoplasias malignas que tm sido alvo de diversos estudos na atualidade devido ao nmero alarmante de mortalidade que est crescendo a cada ano. Tendo como principais autores nessa pesquisa David Servan,Junqueira e alguns dados levantados pelo INCA. E de acordo com essas pesquisas realizadas, a maior parte de desencadeamento dessas neoplasias se d ao fato de que os indivduos encontram-se cada vez mais exposto fatores de riscos cancergenos ,sendo os principais deles: alimentao inadequada, inatividade fsica, tabagismo e entre outros. A exposio ou no a esses fatores depende do estilo de vida de cada pessoa que pode ser modificado, inibindo a proliferao anormal celular. Diante disso a readaptao a um estilo de vida saudvel de extrema importncia quando se trata de doenas crnicas como o cncer. Pois nos ltimos trinta anos a cincia fez grandes avanos e demonstrou que todos ns tempos a habilidade de nos proteger do cncer e contribuir com nossos prprios meios para ento cur-lo, levando em considerao o fato de que todos carregamos dentro de ns genes cancergenos que podem ser despertados ou bloqueados dependendo do comportamento de cada um de ns. Desse modo foram encontrados os seguintes resultados: a preveno primria uma arma poderosa contra esse tipo de doena e aplicando corretamente em nosso cotidiano surte efeitos milagrosos que vem despertando o interesse de cientistas em diversos lugares do mundo.
The Importance of Healthy Habits in the Fight against Cancer

Abstract: Given the importance of the subject of cancer in Brazil, this work of literature
review aimed at studying malignancies that have been the subject of many studies today due to the alarming number of death that is growing every year. And according to these surveys, the majority of these neoplasms triggering occurs to the fact that individuals are increasingly exposed to carcinogenic risk factors, the main ones being: unhealthy diet, physical inactivity, smoking and exposure sun. Exposure to these factors or not depends on the lifestyle of each person who may be modified by inhibiting abnormal cell proliferation. Given this re-adaptation to a healthy lifestyle is extremely important when it comes to chronic diseases such as cancer. For the past thirty years science has made great strides and showed that all times the ability to protect us from cancer and contribute to our own means to cure him then, taking into consideration the fact that we all carry within us that cancer genes can be awakened or blocked depending on each one of us. Thus we found the following results: primary prevention is a powerful weapon against this kind of disease and applying correctly in our daily freak miraculous effects that has aroused the interest of scientists in various places around the world.
Palavras-chave: Neoplasias. Inibio. Estilo de vida. Readaptao. Cncer
Key-words: Neoplasms. Inhibition. Lifestyle. Rehabilitation. Cancer.
Emanuela Bezerra Gueiros

Formada em ciencias biolgicas pela UPE e mestranda em Ciencias da saude. e-mail: emanuelagueiros@hotmail.com
54
N3
Introduo
O cncer continua sendo uma doena que apavora a sociedade, mesmo com inmeras descobertas da cincia no combate aos tumores malignos nas ltimas dcadas. Isso se deve ao aumento no ndice de mortalidade e em muitos casos ao custo financeiro, fsico e psicolgico que o tratamento causa no apenas aos pacientes ,mas tambm aos familiares. E segundo pesquisas feitas pelo INCA(Instituto Nacional de Cncer)ele tambm responsvel por mais de 1 2% de todas as causas de bitos do mundo e esse nmero tem aumentado gradativamente devido maior exposio dos indivduos a fatores de riscos cancergenos. H muito tempo dizia-se que o cncer teria origem exclusivamente gentica, onde os filhos herdavam os genes cancergenos de seus pais ou avs e assim desenvolviam a doena. Em parte isso uma afirmao verdadeira, pois existem genes causadores de cncer que podem ser passado de pais para filhos, como o caso dos genes tipo BRCA-1 e BRCA-2 que apavoram muitas mulheres portadoras deles, pois sofrem o risco de desenvolver cncer de mama ao longo da vida, porm o que torna essa afirmao em parte falsa o fato de que a gentica no a nica responsvel no que se diz respeito ao surgimento de uma neoplasia maligna, os fatores extrnsecos, nos quais nos expomos diariamente tem mais poder no desenvolvimento do cncer. Esses fatores incluem hbitos praticados que na maioria das vezes deixado de lado pela maioria da populao, hbitos estes, que sendo modificados se tornam uma arma poderosa no combate ao cncer.
que:
E de acordo com pesquisar feitas pelo INCA (2006,p.), importante destacar Os genes so segmentos do DNA siga em ingls para cido desoxirribonucleico, o reservatrio das molculas de informao gentica que controlam as funes normais das clulas. Quando danificada, a clula se divide descontroladamente e produz novas clulas anormais. Se falham os sistemas de reparo e imunolgico na tarefa de destruir e limitar essas clulas anormais, as novas vo se tornando cada vez mais anormais, eventualmente produzindo clulas cancerosas. E ainda segundo Naoum (2009, p.5): Cerca de 90% a 95% dos cnceres ocorrem em pessoas que nasceram com clulas ntegras e molculas de DNA perfeitamente normais. Ao longo da vida, incluindo a prpria qualidade de vida e os cuidados bsicos de proteo, somos afetados de diferentes formas por um conjunto de agresses heterogneas, provenientes do meio em que vivemos.
2- Carcinognese- mecanismo de desenvolvimento de cncer

Carcinognese o termo usado para empregar o surgimento das primeiras clulas cancerosas no organismo. Sabe-se que o nosso organismo constitudo de bilhes de clulas que se unem para formar os tecidos, rgos e sistemas, trabalhando de uma maneira harmnica que nos mantm vivo. Para que isso ocorra, a clula encontra-se em constante diviso e participa de um ciclo que tem a funo de regular todo esse mecanismo e esse ciclo responde s necessidades especficas do corpo, sendo um processo cuidadosamente regulado. As clulas normais iro se dividir, amadurecer e morrer, renovando-se a cada ciclo. As anormais iro deixar de seguir esse processo natural sofrendo mutao que pode provocar danos a um ou mais genes de uma nica clula, dando origem ao cncer.
Sendo assim, mecanismo de controle de crescimento e diviso celular depende de fatores estimulantes e inibidores que normalmente encontra-se em equilbrio at o surgimento de um estmulo de crescimento efetivo, sem a ativao do mecanismo inibidor. Esse estmulo capaz de comprometer todo esse equilbrio pode iniciar de uma forma espontnea, no alterando o desenvolvimento normal da populao celular como um todo. Estes fenmenos incluem, erros de ao das polimerases e das recombinasses, danos oxidativos e reduo e reordenamento cromossmico, sendo capaz de ser reparado a tempo de comprometer o funcionamento celular. Porm, existem outros fatores no espontneos capazes de tambm gerar esse estmulo, sedo provocados pela ao de agentes cancergenos (qumicos, fsicos e biolgicos),que dependendo do tempo de exposio a eles, podem acarretar em erros celulares irreparveis. Concluindo: A carcinognese no um processo apenas desencadeador da doena, mas ela continua depois que a doena ter se declarado. 55
N3
, pois, essencial se proteger das toxinas que estimulam o crescimento dos tumores, quer se esteja em plena sade, quer j afetado pela doena (Servan,2011 ,p.84). Isso implica dizer que os mecanismo que podem chegar a desencadear a carcinognese depende da forma de como nos expomos fatores cancergenos e como estes podem influenciar no surgimento de diversos tipos de neoplasias que podem ser evitadas atravs de um estilo de vida saudvel.
porm com o passar do tempo, as prticas relacionadas as atividades fsicas foram se tornando cada vez menos frequente, dando lugar ao sedentarismo aumentando assim, a perda de qualidade de vida. A falta de atividade fsica, sem dvida pode acarretar no aumento de massa corporal, consequentemente, causando obesidade que definido como o excesso de gordura corporal em relao massa magra. Tendo em vista ,os problemas que a mesma acarreta, considerada uma doena da atualidade que vem trazendo ndices alarmante, preocupando assim as reas envolvidas da sade que tentam de alguma forma alertar a populao do perigo que o sobrepeso oferece.
Alimentao inadequada
A alimentao a primeira questo a se analisar quando o assunto surgimento de neoplasias. Diversas pesquisas realizadas provam o quanto a m alimentao tem sido alvo de tumores cancergenos. O Mdico francs David Servan, que venceu um raro cncer no crebro retrata muito bem em seu livro Anticncer o assunto alimentao saudvel versus cncer. Segundo suas pesquisas, todos carregamos o gene do cncer dentro de ns que pode permanecer desativado por toda nossa vida ou ser despertado com o uso frequente de determinados alimentos, como por exemplo, a carne vermelha, gorduras, comidas enlatadas e entre outras diversidades de alimentao nociva a sade. Por outro lado existe tambm uma diversidade de comidas que combatem o cncer, no qual se inclui bem a essa categoria, as frutas, legumes e verduras. simplesmente incrvel o poder que esses alimentos agem em favor nossa sade. Temos a preveno do cncer ao nosso alcance, mas infelizmente poucos fazem uso disso. A alimentao inadequada parece ter se tornado uma epidemia nas ltimas dcadas, causado consequncias irreparveis em nveis patolgicos. O governo calcula que cerca de 260 mil mortes poderiam ser evitadas todos os anos caso o brasileiro mantivesse uma alimentao saudvel. Portanto, a informao acerca disso preciosa, e cada ao nutricional saudvel pode modificar o processo de carcinognese em qualquer estgio, inclusive o inicial.
Tabagismo
Entre outros fatores de riscos est tambm o tabagismo e grande parte das mortes atribudas ao fumo, est associada aos diversos tipos de cnceres que causado pela nicotina. Os fumantes correm mais riscos do que os nos fumantes de adoecer por cncer e outras doenas crnicas. Sendo a principal causa do cncer de pulmo, considerada uma doena rara no passado, hoje tida como a neoplasia que mais mata em todo o mundo. O tabagismo tambm fator de risco para cncer de laringe, pncreas, fgado, bexiga, rim e leucemia mieloide.
Concluso
Existe uma diversidade de hbitos que podem tanto inibir como tambm causar uma neoplasia e uma nova definio dos padres de vida levando em considerao os hbitos praticados diariamente tem um grande reflexo em se tratando no perfil epidemiolgico da populao, sendo considerado um problema de sade pblica atualmente. Sendo assim, o ndice do cncer est na maioria das vezes relacionado a fatores externos, que dependem do comportamento do indivduo ao longo dos anos que pode ser modificado. A partir do momento em que h essa modificao de comportamento individual ou comunitrio possvel modificar tambm o risco de desenvolvimento do cncer e essas mudanas esto inteiramente ligados aos hbitos relacionados a alimentao, exerccios fsicos, entre outros fatores que praticamos no decorrer de nossa vida desencadeadores de patologias. Isso nos leva a refletir o poder que a informao tem e como ela pode mudar vidas. O problema atual que grande parte da populao ainda desconhecem os riscos que uma vida no saudvel pode causar e no sabem que a preveno primria faz toda a 56
Inatividade fsica
A boa prtica de exerccio fsico tambm est no topo de hbitos saudveis visto que, em tempos mais remotos essa prtica era algo mais presente na vida da humanidade. A histria relata claramente esse fato, visto que estava sempre associada ao estilo da poca, como a caa e os esportes praticados na Grcia,
N3
diferena no combate doenas crnicas. Infelizmente essas informaes ainda so restritas pessoas que esto diretamente ou indiretamente ligadas rea de sade. As polticas de sade pblica que tem o objetivo de oferecer populao as melhores condies para que desfrute muitos anos de vida saudvel precisam se voltar tambm a informao, uma vez que uma populao informao tambm uma populao ciente de seus atos. E temos que nos conscientizar de que a luta contra o cncer no comea no tratamento, comea na preveno que se encontra ao nosso alcance e nos dar a chance de ter uma vida melhor.
Referncias Bibliogrficas
Achutti A, Menezes AMB. Epidemiologia do tabagismo. In: Guia Nacional de Preveno e Tratamento do Tabagismo. Rio de Janeiro: Vitr Comunicao & Editora; 2001 . p. 9-27 SERVAN-SCHREIBER,David.. Anticncer: prevenir e vencer usando nossas defesas naturais. Rio de Janeiro:Objetiva,2011 . BAKOS, L. et al. Sunburn, sunscreens, and phenotypes: some risk factors for cutaneous melanoma in southern Brazil. International Journal of, Dermatology Philadelphia, v. 41 , no. 9, p. 557-62, sep. 2002. BERGSTROM, A. et al. Overweight as an avoidable cause of cancer in Europe. International Journal of Cancer, New York, v. 91 , no. 3, p. 421 -430, feb. 2001 . Estimativa 2008 Incidncia do cncer no Brasil INCA (Instituto Nacional do Cncer); www.INCA.gov.br; acesso em outubro 201 2 IBGE. Pesquisa de oramentos familiares 2002-2003: anlise da disponibilidade domiciliar de alimentos e do estado nutricional no Brasil. Rio de Janeiro, 2004. Ministrio da Sade. Instituto Nacional de Alimentao e Nutrio (INAN). PNSN: estatsticas sobre hbitos de fumo no Brasil. Braslia (DF); 1 989 Resumo - Alimentos, nutrio, atividade fsica e preveno de cncer: uma perspectiva global. traduzido por Athayde Hanson Tradutores / Instituto Nacional de Cncer (Ed.). Rio de Janeiro: INCA, 2007.1 2 p. Traduo de: Food, nutrition, physical activity and the prevention of cancer: a global perspective. 57
Section 2
Global Education
In September 201 3 took place in Lisbon the 2nd European Congress on Global Education: Education, Interdependence and Solidarity in a Changing World. The congress facilitated a reflection and a learning experience on global education policy and practice among international institutions, governments, parliamentarians, local and regional authorities, civil society organisations, educators and academia and research. Participants from 49 countries shared their experiences in advancing global education and identified a number of valuable learning experiences, but also challenges and opportunities emerging from a new context. Thematic dialogue and exchange of ideas and practices together with a reflection on the political dimension of global education contributed to the formulation of a Lisbon Statement and the revision of the proposed Strategic Recommendations for Strengthening Global Education till 201 5. The resume of the thematic dialogues, the Lisbon Statement on Global Education and the Strategic Recommendations represent an integral part of this report. You can also see the video here.
N3
Research Papers. Section 2. Global Education .
Educacin para la Salud y VIH/SIDA: una Respuesta desde la Participacin Comunitaria

Resumen: En los ltimos aos estn cobrando fuerza movimientos globales y locales
sobre participacin comunitaria. La implicacin de la comunidad en pro del bienestar social y el progreso de la sociedad pueden tener xito si se facilitan los cauces necesarios para ello. Con motivo del Da Mundial de la Salud, queremos reflexionar sobre aspectos claves del mbito socioeducativo como es la educacin y promocin de la salud as como la importancia de la participacin comunitaria. sta ltima desarrolla la capacidad de las personas de trabajar en colaboracin con los dems, de identificar prioridades y de lograr que las cosas se hagan y los proyectos se realicen. Estudios realizados por economistas, socilogos y psiclogos, entre otros, han demostrado que las personas que participan en la toma de decisiones son ms felices que los que se limitan a aceptar o aplicar decisiones de otros, debido a que se sienten responsables de la mejora de su calidad de vida. Diferentes instituciones e iniciativas estn trabajando en la facilitacin de la participacin comunitaria desde la educacin para la salud para lograr una intervencin socioeducativa ms ntegra, sobre todo en Amrica Latina y el Caribe, donde se inici la educacin popular y se desarrollan mltiples experiencias de animacin sociocultural que, en definitiva, trabajan por un determinado modelo de cambio y transformacin social.
Health Education and HIV/AIDS: a Response from Community Participation

Abstract: In recent years, global movements are gaining strength and local community
participation. The involvement of the community for social welfare and progress of society can succeed if they provide the necessary means to do so. On the occasion of World Health Day, we reflect on key aspects of socio-educational as education and health promotion and the importance of community involvement. The latter develops the ability of people to work collaboratively with others, to identify priorities and to get things done and projects are carried out. Studies by economists, sociologists and psychologists, among others, have shown that people who participate in decision making are happier than those who simply accept or implement decisions of others, because they feel responsible for improving quality of life. Different institutions and initiatives are working on facilitating community participation from education to health to achieve a more complete educational intervention, especially in Latin America and the Caribbean, where popular education was initiated and developed multiple socio-cultural experiences that ultimately work for a particular model of social change and transformation.
Palabras clave: Educacin para la salud, VIH/SIDA, promocin de la salud, participacin

comunitaria.
Keywords: Health education, HIV/AIDS, health promotion, community involvement.
Itahisa Prez-Prez
Universidad Pablo de Olavide, Facultad de Ciencias Sociales. Departamento de Ciencias Sociales e-mail: itahisaperez@gmail.com / twitter: @Itahisa_perez
Juan Agustn Morn Marchena.

Universidad Pablo de Olavide, Facultad de Ciencias Sociales. Departamento de Educacin y Psicologa Social. e-mail: jamormar1 @upo.es
59
N3
1. Introduccin
Tradicionalmente la salud se conceba como ausencia de enfermedad (carcter ms negativo). No fue hasta 1 948, ao en el que se constituye la Organizacin Mundial de la Salud (OMS), cuando se incluyen palabras como bienestar fsico, mental y social, incorporando as el sentido holstico, positivo y subjetivo de la salud. Definiciones de salud podemos encontrar tantas como autores que se posicionan en ella. A continuacin exponemos algunas de las definiciones de salud a partir de los siguientes modelos (Mdicos del Mundo: 201 0): - Modelo biomdico: la salud puede definirse como la ausencia de enfermedad o minusvala: la salud es la vida en el silencio de los rganos (Leriche). - Modelo biopsicosocial: la salud se define como un estado de bienestar completo: fsico, mental y social (OMS, 1 946). - Modelo dinmico: con capacidad de adaptacin permanente a nuestro entorno: o La salud es el equilibrio y la armona de todas las posibilidades de la persona humana (biolgicas, psicolgicas y sociales), lo que requiere, por un lado, la satisfaccin de las necesidades fundamentales de las personas que son cualitativamente las mismas para todo ser humano y, por otro lado, una adaptacin constantemente cuestionada de las personas a un entorno en constante mutacin (Carta de Ottawa). o Estado fsico y mental razonablemente libre de incomodidad y dolor, que permite a la persona en cuestin funcionar efectivamente por el ms largo tiempo posible en el ambiente donde por azar o eleccin est ubicado (Ren Dubos). La Educacin para la Salud (EpS) est estrechamente vinculada con el desarrollo humano ya que, hablar de desarrollo humano sostenible nos obliga a un esfuerzo globalizador y sistmico, que hermane en un mismo escenario a todos los pueblos del planeta y permita considerar las interrelaciones entre elementos y fenmenos muy variados que operan simultneamente en contextos tambin diversos (Murga, 2004). En este marco de desarrollo humano, la EpS cumplira la funcin de facilitar a sus destinatarios la comprensin de la situacin global, de las implicaciones econmicas, sociales y de todo tipo que existen entre los seres humanos, de manera
que, teniendo en cuenta la cultura de su propio contexto, reforzarn los valores, actitudes y hbitos alimenticios necesarios para su propia salud fsica individual pero tambin comunitaria y global. Cualquier proceso educativo est inmerso en un entorno social, es decir, la sociedad en general y la comunidad en particular, son agentes educativos de gran importancia para la educacin y, cmo no, para la educacin para la salud (Hernando Sanz, 2004). Para entender la importancia de este proceso educativo en el mbito del VIH/SIDA y segn datos de 2011 de ONUSIDA, 34 millones de personas viven con el VIH en el mundo, 2.5 millones de personas contrajeron la infeccin por el VIH y 1 .7 millones de personas fallecieron a causa de enfermedades relacionadas con el SIDA. Segn el ltimo informe presentado en 201 2 con motivo del Da Mundial del SIDA, existen ms del 50% de casos de nuevas infecciones por el VIH en 25 pases, a tan slo 1 000 das para que los pases deban haber cumplido los Objetivos de Desarrollo del Milenio.
2.
Educacin para la Salud o Promocin de la Salud?
La salud es una necesidad bsica de cualquier ciudadano, es ms, la salud representa un indicador de gran relevancia en cuanto a ndice de desarrollo humano y calidad de vida. Sin embargo, y como ha incluido la Organizacin Mundial de la Salud (OMS) en su definicin cuando aade aspectos claves de la salud como bienestar mental y social, nos podemos hacer una idea de la gran relevancia y complejidad de dicho trmino. Nuestro objeto de estudio, desde la investigacin e intervencin socioeducativa, es la educacin en la salud desde una perspectiva pedaggica de la salud y la necesidad de un planteamiento amplio, de su visin social, en el que estn implicados todos los agentes sociales el papel de la comunidad, de la ciudadana, - a la hora de abordar la salud (Morn Marchena, 1 998). La educacin para la salud, segn la OMS, es el conjunto de oportunidades de aprendizaje elaboradas conscientemente que suponen una forma de 60
N3
comunicacin destinada a mejorar el conocimiento sobre la salud y promover el desarrollo de habilidades para la vida que pueden conducir tanto a la salud individual como colectiva. Es, por tanto, una actividad clave en todo programa de promocin de la salud. En este sentido, promocin de la salud es, tal y como la define la Carta de Ottawa, el proceso que otorga a las poblaciones los medios necesarios para garantizar un mayor control de su salud y mejorarla. Con objeto de establecer una cronologa de la definicin de educacin para la salud, consultando distintas fuentes y autores, cabe distinguir dos etapas fundamentales en la evolucin del concepto (Morn Marchena, 1 998): - Etapa clsica: hasta la dcada de los setenta, en la que las acciones educativas se dirigen al sujeto con el objetivo de responsabilizarse de su propia salud, para conseguir la modificacin de sus comportamientos en un sentido positivo. - Posteriormente, se incluye la consideracin que las conductas de las personas tambin dependen de factores externos, de tipo ambiental y social, por lo que las acciones educativas deberan promover cambios en dichos mbitos. Segn Calvo Fernndez y otros (1 996), los mltiples conceptos de EpS podran representar las ideas de los diferentes profesionales y organismos nacionales e internacionales que estn interesados en su estudio y desarrollo, aunque todas tienen como objetivo comn a la modificacin de los conocimientos, actitudes y comportamientos de los sujetos, hacia una salud positiva (Morn Marchena, 1 997). En ocasiones se confunden o mencionan indistintamente trminos afines a la educacin para la salud, como es la prevencin o promocin de salud, entre otros. A continuacin las definimos (Sez, Marqus y Collel, 1 995): - Prevenir: consiste en evitar, prever y preparar. En el caso concreto de las enfermedades, evitar que stas se produzcan, prever que puedan producirse y preparar el terreno para que no se produzcan y para que, si se producen, se disponga de los medios para poder combatirlas. Cuando hablamos de prevenir, nos referimos a no tener que llegar a curar, lo cual es competencia de quien ejerce la medicina, ya sea a nivel individual o colectivo. - Promocin de la salud: tom fuerzas a partir de su aparicin en el Informe de la
OMS en 1 984, aunque haban existido diversos antecedentes donde la preocupacin por el mantenimiento de patrones de vida sanos para el normal desarrollo de las personas, llevaron a los conceptos actuales de salud positiva y a la posterior aparicin de actividades destinadas a desarrollar en la poblacin hbitos de vida saludables y a capacitar a la gente a aumentar su control sobre la propia salud. De esta manera, la Carta de Ottawa para la promocin de la salud la defina como el proceso de capacitacin de las personas para aumentar el control sobre su salud y mejorarla (OMS, 1 986). - Educacin para la Salud: segn la manera que cada autor tenga de entender la educacin y la salud, entender el trmino educacin para la salud. No obstante, partimos de la idea de Sez, Marqus y Collel (1 995) que definir educacin para la salud depender del mbito en el que se realiza la actividad y otros independientemente del mbito de actuacin. Sin embargo, hay una definicin muy clara de entender la EpS como uno de los instrumentos que utiliza la promocin de la salud, y bsicamente pretende facilitar los cambios de comportamiento hacia conductas ms saludables y que eliminen factores de riesgo (Morn Marchena, 1 998). En este sentido, la educacin para la salud se centra en la educacin de las personas a travs de la adquisicin activa de informacin basada en la evidencia, no a travs de la transmisin vertical de dicha informacin; en el fomento de la motivacin, para seguir conociendo y aplicar lo aprendido y, por ltimo, la promocin y entrenamiento de las habilidades personales imprescindibles para adoptar medidas destinadas a mejorar la propia salud. La EPS no aborda solo la informacin sobre condiciones sociales, econmicas y ambientales, subyacentes que influyen en la salud, sino tambin la que se refiere a los factores y comportamientos de riesgo. Para favorecer la prevencin del VIH/SIDA se precisa acentuar el dilogo y el respeto de los derechos individuales (Jesu, 1 994) porque mediante esa labor los individuos estn ms predispuestos a adoptar y mantener los comportamientos preventivos. Sin embargo, an quedan muchas personas, incluso diramos millones de personas, que no tienen informacin o estn mal informadas sobre el VIH/SIDA y sus formas de transmisin. En ocasiones se puede llegar a confundir o utilizar indistintamente la educacin para la salud y la promocin de la salud sin tener muy claro sus 61
N3
diferencias. No obstante, esta diferencia carecera de sentido en cuanto que la educacin para la salud es, funcionalmente, el mejor mtodo de intervencin que conocemos para promover la salud (promocin de la salud en cuanto a funcin de atencin a la salud y la educacin para la salud como categora funcional y metodolgica del proceso de enseanza). Con objeto de justificar la importancia de la educacin para la salud, esbozamos algunas ideas relevantes: - No vale slo con informar. Por todos son conocidos los diferentes mtodos tradicionales de intervencin educativa que han ido fracasando, hemos visto que la sola informacin, que es necesaria, no vale por tener poca influencia en los cambios de actitudes preventivas. Las campaas preventivas, a veces incluso contraproducentes, tienen un problema importante debido a la publicidad que asocia alcohol y tabaco con imgenes atractivas, deporte, riesgo, evasin, seduccin, etc. - Generador de cambios. La EpS debera ser una disciplina que ponga orden a las diferentes caras que tiene el hecho de que las acciones del hombre aumentan o disminuyen la salud individual y colectiva, y cmo la educacin conecta y genera cambios (Serrano Gonzlez, 1 997). Podemos establecer tres estrategias bsicas para la promocin de la salud que se apoyan, a su vez, en cinco reas de accin prioritarias, segn la Carta de Ottawa, y que exponemos a modo de tabla: Tabla 1 . Estrategias para la promocin de la salud y sus reas prioritarias
En 1 997, con la aprobacin de la Declaracin de Yakarta sobre la manera de guiar la promocin de la salud hacia el siglo XXI, se ratifica que estas estrategias y reas de accin son necesarias e imprescindibles para todos los pases. En este sentido, aaden que los enfoques globales para el desarrollo de la salud son los ms eficaces. Los que utilizan combinaciones de estas cinco estrategias son ms eficaces que los enfoques de una sola va (Glosario de Promocin de la Salud, 1 998: 11 ). Por tanto, la participacin se convierte en elemento clave y necesario para sostener los esfuerzos, convirtindose las personas en el centro de la accin. En este sentido, la Declaracin de Yakarta seala las cinco prioridades de cara a la promocin de la salud en el siglo XXI: Tabla 2. Las cinco prioridades de la Declaracin de Yakarta
Fuente: elaboracin propia, extrado de la Declaracin de Yakarta (1 997). Por tanto, el objetivo de la EpS es dar a la poblacin los medios necesarios para que adopte comportamientos ms favorables para su salud, aportndole los conocimientos necesarios, y se inserta as en el eje de adquisicin de aptitudes individuales. As, un aspecto fundamental para la continuidad de actividades de promocin de la salud, es que la comunidad sea consciente de los problemas, de sus propios problemas. Esta idea est muy relacionada con otro de nuestros focos de inters desde la investigacin e intervencin socioeducativa, como es la animacin sociocultural y el desarrollo comunitario.
3.
Participacin comunitaria y Animacin Sociocultural
Fuente: elaboracin propia (extrado de la Carta de Ottawa para la Promocin de la Salud, 1 986).
Al hablar de educacin y promocin de la salud ineludiblemente hacemos referencia a la participacin. Para que la EpS sea efectiva no basta slo con la transmisin de la informacin sino que es necesario tambin el fomento de la motivacin, de las habilidades personales y la autoestima. Estas cualidades resultan obligatorias para adoptar medidas destinadas a mejorar la salud. Por tanto, la EpS incluye no slo la informacin relativa a las condiciones sociales, econmicas y 62
N3
ambientales subyacentes que influyen en la salud, sino que tambin responde a los factores y comportamientos de riesgo, adems del uso de asistencia sanitaria. Estos conceptos han ido evolucionando y modificndose con los aos por lo que aspectos que promulgaba la Carta de Ottawa, y que abordamos anteriormente, como es la movilizacin social y la abogaca por la salud referidos a la educacin para la salud, en la actualidad estn incluidos en el concepto de promocin de la salud. La salud en general, y ms concretamente la EpS, se desarrolla en el mbito comunitario. Aunque pueda limitarse a un espacio ms concreto, ineludiblemente se relaciona o interrelaciona con el exterior. Segn Prez-Prez (201 3), Lehay defina la comunidad como el grupo de personas con ciertas caractersticas con intereses comunes y que viven dentro de una misma rea, dentro de una sociedad mayor. Con objeto de ir contextualizando este concepto de comunidad, nos basamos en San Martn y Pastor (1 984), cuando identifican los principales elementos a la hora de definir a la comunidad: - Los grupos de poblacin organizados e interrelacionados. - La coexistencia en una zona o regin geogrfica bien delimitada. - Cierto grado de integracin producido a travs de experiencias comunes y comportamientos sociales similares. - Cierto grado de comunidad funcional econmica. - Cierto grado de conciencia de unidad (tnica, cultural, social) local. - Cierto grado de unidad en la accin colectiva, particularmente en los grupos. - Existencia de instituciones sociales ms o menos desarrolladas entre las que cuentan como localmente importantes la educacin, salud, justicia, administracin local, etc. Asimismo, debemos identificar cuatro elementos fundamentales cuando hablamos de una comunidad, los cuales van a participar muy directamente en la accin comunitaria como son el territorio, la poblacin, demanda y recursos (Marchioni, 1 989 y Turabian, 1 992, citado por Prez-Prez, 201 3). Segn De Miguel (1 997), la comunidad es un sistema relacional e interactivo, formado por distintos grupos, que son: las instituciones polticas, los servicios
sociales, los centros educativos, los nios, los padres y madres, los centros de salud y los jvenes. Adems, subraya que en una correcta educacin para la salud deben intervenir todo y cada uno de los grupos de manera coordinada, ya que de lo contrario se conseguira una actuacin parcial y no globalizadora, que es lo que buscamos (De Miguel, 1 997: 267). De esta manera, cualquier trabajo comunitario consiste en buscar e incidir de manera relacional, coordinada, puntos de encuentro y trabajo en comn, tarea en la prctica nada fcil. Por ello, en el trabajo comunitario, uno de los objetivos es el cambio, al igual que ocurre con el desarrollo comunitario y la animacin sociocultural, que persiguen un cambio social, pero partiendo de las necesidades y participacin e implicacin de los propios destinatarios. En este marco de actuacin, consideramos importante introducir el enfoque de la animacin sociocultural (ASC) entendida como aquella metodologa participativa, basada en la pedagoga no directiva, que implica dinamismo y desarrollo social. Su principal funcin es la movilizacin social basada en el grupo y/o comunidad, con el fin ltimo de lograr un cambio o transformacin social. La ASC aspira a una visin poltica, a un modelo de sociedad donde pone los medios para caminar hacia su transformacin estructural y, simultneamente, desde un enfoque educativo, no busca lo anterior a travs del cambio tecnoeconmico o la toma de poder, sino a travs del perfeccionamiento de las personas y el cambio de sus mentalidades, valores, actitudes, en funcin de un determinado modelo de hombre. De esta manera, el Desarrollo Comunitario (DC) se centra en el lema de Paulo Freire nadie ensea a nadie, todos aprendemos de todos, mediados por el mundo. Segn Ander-Egg (1 987), no se trata de una accin sobre la comunidad, sino una accin de la comunidad donde la poblacin toma decisiones y asume las consecuencias. Supone una accin desde la comunidad, para la comunidad y con la comunidad. Por tanto, se trata de una metodologa de trabajo desde la base, que pretende desarrollar las potencialidades del individuo, grupo y comunidades con el objetivo de mejorar sus condiciones de existencia. En el caso del VIH/SIDA, en 2008 se public el informe Participacin del sector comunitario en VIH/SIDA de Amrica Latina y Caribe en el proceso de monitoreo y evaluacin en el logro de las metas de la Declaracin de compromiso en VIH/SIDA (LACASSO). En este informe, as como en la Declaracin de Compromiso 63
N3
en VIH/SIDA y las Respuestas Nacionales a la epidemia de Amrica Latina y Caribe el sector comunitario organizado en VIH/SIDA, las organizaciones de personas que viven con el VIH/SIDA y poblaciones en situacin de vulnerabilidad, han sido actores fundamentales en la prevencin, atencin, asistencia. Por otra parte, en dicho informe se recoge tambin la experiencia vivida en Bogot (Colombia), donde lderes comunitarios se autodefinen como comunidades afectadas directa o indirectamente por el VIH/SIDA, que se organizan en torno a necesidades y objetivos comunes ante la epidemia, con autonoma del gobierno, de las iglesias, del sector privado, de los partidos polticos, los sindicatos y las agencias de cooperacin en el marco de los derechos humanos sexuales y reproductivos (op.cit., p.4). Este informe avala en gran medida, junto a las mltiples experiencias que podemos encontrar en el mbito comunitario, la importancia de la participacin de los agentes implicados en la prevencin e intervencin socioeducativa, y ms concretamente, en el caso del VIH/SIDA. Algunas de las conclusiones del citado informe avalan que la respuesta comunitaria de Amrica Latina y el Caribe sigue su proceso de consolidacin y crecimiento. El desafo est en que los gobiernos y agencias internacionales acompaen sensiblemente este camino. Anteponiendo las necesidades de las comunidades, muchas veces interpretadas en iniciativas de las redes de ONGs y de PVVs, a las propias. Fomentando un dilogo directo, participativo y transparente (op.cit., p.6).
niveles de salud de la poblacin; de ah que propuestas estratgicas tales como la promocin de la salud o la atencin primaria de salud, dan un importante papel a la participacin comunitaria. Antes del uso del trmino participacin comunitaria surgi el de desarrollo comunitario en el tercer mundo, empleado por los britnicos para referirse al desarrollo de la educacin bsica y bienestar social en las Colonias (Morn Marchena, 1 998). Ya en 1 997, la OMS promulga el Plan Salud para todos en el ao 2000, estrategia que fij como principal meta lograr para todos los ciudadanos del mundo, un grado de salud que permita llevar una vida social y econmicamente productiva. Entre sus objetivos prioritarios, se encuentran: - La promocin de estilos de vida dirigidos a la salud. - La prevencin de enfermedades presentes. - Establecer servicios de salud. Por otra parte, la Carta de Ottawa marca las vas en las que deba basarse la promocin de la salud, donde destaca participacin de la comunidad, como reforzamiento de la accin comunitaria. Los ciudadanos, a nivel individual y colectivo, deben implicarse de forma real y efectiva en la promocin de la salud. Participacin que, adems, debe estar presente en todos los niveles, incluso en la toma de decisiones. En el caso del VIH/SIDA, uno de los aspectos claves para luchar contra esta epidemia es empoderar a la poblacin, y concretamente a las mujeres, a travs de la educacin sobre el SIDA. Algunos datos corroboran la importancia de esta implicacin y participacin ya que, por ejemplo, en 1 8 de los 49 pases de los cuales se poseen datos de tendencias, (por ejemplo: Camboya, Guyana, Namibia, Ruanda y Trinidad y Tobago) el conocimiento correcto e integral sobre VIH aument 1 0 puntos porcentuales o ms entre mujeres de 1 5 a 24 aos; ocurriendo lo mismo con hombres jvenes de 8 a 1 6 pases. Con objeto de hilvanar los conceptos desarrollados en el presente artculo, concluimos que la participacin comunitaria y educacin para la salud son estrategias metodolgicas en la promocin de la salud. Estas estrategias facilitan la difusin de mensajes culturalmente adaptados a las necesidades de los distintos colectivos, promoviendo comportamientos saludables que disminuyan la 64
4.
Conclusin
La similitud del desarrollo comunitario con la educacin y promocin de la salud es ms que evidente ya que el DC lleva implcitas la promocin y movilizacin de recursos humanos, a travs de un proceso educativo de toma de conciencia. Por tanto, la participacin popular es el elemento fundamental en los programas de desarrollo de la comunidad. Por ello cobra importancia la participacin comunitaria en educacin y promocin de la salud, adems que otorga valor aadido al implicarse los miembros de la comunidad, los propios destinatarios en su proceso de aprendizaje. La participacin es un instrumento que puede y debe contribuir a elevar los
N3
vulnerabilidad, aumenten la prevencin, analizando crticamente los factores sociales, econmicos y ambientales que influyen en la salud y desarrollen sus capacidades organizativas para conseguir cambios no slo en sus comunidades sino en las polticas que repercuten en la salud y bienestar (Mazarrasa, Blzquez, Martnez, Castillo y Llacer, 2006). En definitiva, se trata de una participacin permanente, activa, consciente y mayoritaria de la ciudadana para lograr un verdadero cambio o transformacin social.
- Ander-Egg, E. (1 987). Poltica cultural a nivel municipal. Buenos Aires: Humanitas. - Calvo Fernndez, J. R. et alt. (1 996): Educacin para la Salud. Conceptos y Mtodos, en Macas, B. E. y Arocha, J. L.: Salud Pblica y Educacin para la Salud. Las Palmas: ICEPSS, 371 -380. - De Miguel Martn, E. (1 997): Caractersticas de los proyectos de EpS ligados a la comunidad, en Serrano Gonzlez, M I. (Coord.): La educacin para la salud del siglo XXI: Comunicacin y salud. Madrid: Daz de Santos. - Hernando Sanz, M A. (2004): El entorno comunitario, en Perea Quesada, R. (2004): Educacin para la Salud. Reto de nuestro tiempo. Madrid: Daz de Santos. - Jesu, F. (Dir.) (1 994). Droits de lenfant et infection par le VIH. Pars: Institut de lenfance et de la famille. - Marquioni, M. (1 989): Planificacin social y organizacin de la comunidad. Madrid: Editorial Popular. - Mazarrasa, Blzquez, Martnez, Castillo y Llacer (2006): Promocin de la salud en poblacin inmigrante: participacin comunitaria y educacin entre iguales, en http://www.msc.es/ciudadanos/enfLesiones/enfTransmisibles/sida/prevencion/inmigra ntes/docs/capitulo6.pdf (consultado el 05 de marzo de 201 3). - Mdicos del Mundo (201 0): Educacin para la salud: gua prctica para los proyectos de salud, en http://www.redxlasalud.org/index.php/mod.documentos/mem.descargar/fichero.DOC401 %232E%23pdf (consultado el 1 7 de octubre de 201 2).
- Morn Marchena, J. A. (1 997): Educacin para la Salud en la Familia, la Escuela y el Trabajo, en Varios: La Cultura de la Salud en Espaa. Madrid: ADEPS, 78-86. - Morn Marchena, J. A. (1 998): Nuevas demandas de la sociedad actual: Educacin para la Salud y Educacin para el Consumo. Sevilla: GIPDA y Kronos. - Murga, M A. (2004): Salud y desarrollo humano sostenible: las competencias de la educacin, en Perea Quesada, R: Educacin para la Salud. Reto de nuestro tiempo. Madrid: Daz de Santos. - OMS (1 986): Carta de Ottawa para la Promocin de la Salud. Ottawa. - OMS (1 997): Declaracin de Yakarta, en http://www.promocion.salud.gob.mx/dgps/descargas1 /promocion/5_Declaracion_de_ Yakarta.pdf (consultado el 30 de septiembre de 201 2). - OMS (1 998): Glosario Prevencin de la Salud, en http://www.msssi.gob.es/profesionales/saludPublica/prevPromocion/docs/glosario.pdf (consultado el 30 de septiembre de 201 2). - PAHO (1 986): Carta de Otawa para la Promocin de la Salud, en http://webs.uvigo.es/mpsp/rev01 -1 /Ottawa-01 -1 .pdf (consultado el 25 de noviembre de 201 2). - Prez-Prez, I. (201 3): Educacin para el Desarrollo y Animacin Sociocultural: un enfoque desde la participacin comunitaria, en la Global Education Magazine, n 2, pp. 69-74, en la Web http://www.globaleducationmagazine.com/global-educationmagazine-2/ y en http://www.globaleducationmagazine.com/educacion-para-eldesarrollo-animacion-sociocultural-enfoque-desde-la-participacion-comunitaria/. (consultado el 07 de marzo de 201 3). - Sez Crdenas, S; Marqus Molas, F; Collel Brunet, R. (1 995): Educacin para la Salud. Lleida: Pags Editors. - Sanmartn, H; Pastor, V. (1 984): Salud comunitaria. Teora y prctica. Madrid: Daz de Santos. - Serrano Gonzlez, M I. (Coord.) (1 997): La educacin para la salud del siglo XXI: Comunicacin y salud. Madrid: Daz de Santos. - Turabian Fernndez, J. L. (1 992): Participacin comunitaria en la salud. Madrid: Daz de Santos. - UNAIDS (201 2): World AIDS Day Report. Switzerland: UNAIDS. 65
N3
Habilidades para la Vida: una Estrategia para Promover la Salud y el Bienestar Infantil y Adolescente
Resumen: La distribucin mundial de la carga de morbilidad pone de manifiesto que, en el
momento actual, los principales factores de riesgo responsables de las causas ms frecuentes de prdida de salud y muerte estn relacionados con los estilos de vida. Por otra parte, el estudio de los determinantes sociales de la salud muestra el papel relevante que las condiciones de vida representan con respecto a los estilos de vida y formas de comportamiento que subyacen al mapa actual de la morbimortalidad. Seala que, siendo los estilos de vida responsables de las principales formas de enfermedad y muerte en la actualidad, estn en buena medida condicionados por determinantes sociales de diverso tipo. Para fomentar con expectativas de xito la promocin de la salud, actuando sobre los estilos de vida poblacionales y los determinantes sociales que los condicionan, el modelo de educacin en habilidades para la vida se postula como una respuesta adecuada. La formacin en estas habilidades permite fomentar el empoderamiento personal y comunitario como va para afrontar los factores de riesgo que condicionan la salud y el bienestar. Con base en este modelo se han creado, implementado y evaluado actuaciones de diversa naturaleza que han mostrado resultados prometedores. Estas habilidades para la vida no pueden plantearse en clave de individualizacin de los riesgos sanitarios, sino que, por el contrario, incluyen posicionamientos crticos encaminados a deconstruir proactivamente los determinantes sociales que afectan negativamente a la salud pblica.
Life Skills: a Strategy to Promote Health and Well-Being among Children and Teenagers
Abstract: The worldwide distribution of the disease burden highlights the fact that the main
risk factors that most frequently cause poor health and deaths nowadays are related to lifestyles. Furthermore, the study of social determinants of health demonstrates the key role that living conditions play with regard to lifestyles and patterns of behaviour that underlie the present map of morbidity and mortality. It indicates that lifestyles are responsible for the main forms of illness and death at present, conditioned to a large extent by a wide range of social determinants. In order to promote health with expectations of success, and acting on the lifestyles of the population and the social determinants that affect them, the life skills educational model stands out as an ideal response. Training in these skills encourages empowerment on the personal and community levels as a way of dealing with the risk factors that affect health and wellbeing. A number of varied actions have been developed on this basis, and have shown promising results. These life skills should not be approached from the point of view of the individualisation of health risks; on the contrary, they include critical stances aimed at proactively deconstructing the social determinants that have a negative effect on public health.
Palabras clave: Promocin de la salud, determinantes sociales de la salud, estilos de

vida, empoderamiento, habilidades para la vida.
Keywords: Health promotion, social determinants of health, life styles, empowerment, life
skills.
Juan Carlos Melero.

Edex. Educacin para la salud y prevencin de las drogodependencias. e-mail: prevencion@edex.es
66
N3
La morbimortalidad en el siglo XXI
El concepto de carga de morbilidad es definido por la Organizacin Mundial de la Salud (201 2a) como la prdida de salud por todas las causas de enfermedad y defuncin, a nivel mundial. Segn los datos publicados por esta institucin en el Informe sobre la situacin mundial de las enfermedades no transmisibles 201 0 (Alwan, A. et al, 2011 ): Las enfermedades no transmisibles (ENT) son la principal causa de mortalidad en todo el mundo, pues se cobran ms vidas que todas las otras causas combinadas. En efecto, el mapa de la morbimortalidad dibujado por la OMS en su Estadsticas sanitarias mundiales 201 2 seala las enfermedades no transmisibles como un problema de salud de primer orden para el siglo XXI (OMS, 201 2b). As, seala que de los 57 millones de defunciones que ocurrieron en el mundo en 2008, el 63% se debieron a enfermedades no transmisibles. La previsin es que la cifra anual de defunciones por ENT alcance los 55 millones en 2030; en cambio, se pronostica que la debida a enfermedades infecciosas disminuir a lo largo de los prximos 20 aos. Las principales enfermedades no transmisibles son las siguientes: cncer, enfermedades cardiovasculares, diabetes y enfermedades respiratorias crnicas. Enfermedades vinculadas de manera muy estrecha con los estilos de vida de la poblacin. As, segn la OMS (201 2b), se calcula que los factores comportamentales, entre ellos el consumo de tabaco, el sedentarismo, la dieta malsana y el uso nocivo del alcohol, son responsables de alrededor del 80% de las coronariopatas y enfermedades cerebrovasculares. Ya en 2003 (Wilkinson, R., Marmo, M.) la OMS identificaba una batera de determinantes sociales ntimamente relacionados con las conductas y los estilos de vida humanos. En 2008, el Global Health Observatory (GHO) sealaba como principales factores de riesgo de las enfermedades no transmisibles los siguientes: Tabaquismo: el tabaquismo es reconocido internacionalmente como la principal causa prevenible de enfermedad y muerte prematura. Como sealaba la OMS en mayo de 201 2, la epidemia del tabaquismo mata cada ao a casi 6 millones de personas, entre ellas a 600.000 personas no fumadoras expuestas al tabaquismo pasivo (OMS, 201 2c). Uso nocivo de alcohol: segn la OMS, el consumo nocivo de bebidas alcohlicas causa 2,5 millones de muertes cada ao. Unos 320.000 jvenes de entre 1 5 y 29 aos de edad mueren por causas relacionadas con el consumo de alcohol
(2011 ) (una cifra que supone el 9% del total de muertes ocurridas en esa franja de edad. El uso nocivo de alcohol contribuye de forma importante a la carga mundial de morbilidad y ocupa el tercer lugar entre los principales factores de riesgo de muerte prematura y discapacidad a nivel mundial (OMS, 201 0). Dieta no saludable: la prctica de hbitos alimenticios inadecuados es identificada por la OMS en su Estrategia mundial sobre rgimen alimentario, actividad fsica y salud, adoptada en 2004, como un factor de riesgo de primer orden para el desarrollo de alteraciones como hipertensin, hiperglucemia, hiperlipidemia, sobrepeso, obesidad. La OMS (2004) considera que en general, 2,7 millones de muertes anuales son atribuibles a una ingesta insuficiente de frutas y verduras. Inactividad fsica: identificada por la OMS como un problema de salud pblica mundial: En sus propias palabras, las enfermedades no transmisibles asociadas a la inactividad fsica son el mayor problema de salud pblica en la mayora de los pases del mundo. Seala, as mismo, que la inactividad fsica es el cuarto factor de riesgo en lo que respecta a la mortalidad mundial (6% de las muertes registradas en todo el mundo), relacionada con enfermedades como la hipertensin, la cardiopata coronaria, los accidentes cerebrovasculares, la diabetes, el cncer de mama y de colon, entre otras. Sobrepeso y obesidad: estos trastornos han experimentado un considerable incremento en todos los rincones del planeta y en todas las etapas evolutivas, si bien resulta especialmente preocupante la obesidad infantil. De acuerdo con la OMS, La obesidad infantil es uno de los problemas de salud pblica ms graves del siglo XXI. La OMS estima que en 201 0 hubo un total de 42 millones de nios con sobrepeso en todo el mundo.
Los determinantes sociales de la salud

Las conductas y estilos de vida que aparecen como factores de riesgo de las principales causas actuales de morbimortalidad son, en una proporcin elevada, resultado de los llamados determinantes sociales de la salud. En palabras de la OMS, estos determinantes representan las circunstancias en que las personas nacen, crecen, viven, trabajan y envejecen, incluido el sistema de salud (OMS, 2008). Como respuesta al influjo de estos determinantes sobre la inequidad en el disfrute de la salud, la Comisin de Determinantes Sociales creada en 2005 por la OMS elabor en 2009 el informe Subsanar las desigualdades en una generacin. Alcanzar la equidad sanitaria actuando sobre los determinantes sociales de la salud. 67
N3
Dicho informe, que comienza con una frase que no deja lugar a dudas sobre la relevancia que sus autores confieren a la equidad en relacin con la salud (La justicia social es una cuestin de vida o muerte), recoge las siguientes recomendaciones de las que entresacamos algunos contenidos particularmente relevantes: Mejorar las condiciones de vida cotidianas:
-Emancipacin poltica, integracin y posibilidad de expresarse: La integracin, la representacin y el control son importantes para el desarrollo social, la salud y el bienestar. - Una gobernanza mundial eficaz: Un sistema de gobernanza mundial ( ) que convierta la equidad sanitaria en uno de los principales componentes de los programas de desarrollo y permita a todos ejercer su influencia en los procesos de decisin en pie de igualdad . Como dice la Comisin en este informe; Las polticas sociales y econmicas tienen efectos determinantes en las posibilidades de que un nio crezca y desarrolle todo su potencial, y tenga una vida prspera, o de que sta se malogre. En definitiva, tal y como seala la Comisin, Los determinantes estructurales y las condiciones de vida en su conjunto constituyen los determinantes sociales de la salud, que son la causa de la mayor parte de las desigualdades sanitarias entre los pases, y dentro de cada pas. Si la carga de morbilidad est en la actualidad fundamentalmente integrada por enfermedades no transmisibles. Si estas enfermedades son favorecidas en gran medida por los estilos de vida que la poblacin practica. Si estos estilos de vida son debidos, en una proporcin elevada, al influjo de diversos determinantes sociales que la investigacin ha puesto de manifiesto. Si, tal y como la OMS sostiene, esta cadena causal existe, parece evidente la necesidad de arbitrar un abanico amplio de medidas de diversa naturaleza que permitan desactivar tales riesgos para la salud individual y colectiva.
- Equidad desde el principio: Hay que enfocar los primeros aos de
vida de un modo ms integral ( ) ampliando el alcance de las intervenciones destinadas a la primera infancia para que incluyan el desarrollo socioemocional y lingstico-cognitivo. - Entornos salubres para una poblacin sana: El actual modelo de urbanizacin plantea importantes problemas medioambientales, en particular con respecto al cambio climtico, cuyo efecto es mayor en los pases de ingresos bajos y entre los grupos de poblacin vulnerables. - Prcticas justas en materia de empleo y trabajo digno: El estrs laboral est relacionado con el 50% de las cardiopatas coronarias. - Proteccin social a lo largo de la vida: Hay una correlacin entre la existencia de un sistema de proteccin social universal y generoso, y una poblacin ms sana. - Atencin de salud universal: Un sistema de atencin sanitaria accesible, bien concebido y bien gestionado contribuir considerablemente a la consecucin de los Objetivos de Desarrollo del Milenio. Luchar contra la distribucin desigual del poder, el dinero y los recursos:
- Financiacin equitativa: En todos los pases, con independencia de
La educacin en habilidades para la vida como parte de la respuesta

Como hemos visto, la OMS seala una diversidad de determinantes sociales de la salud que requieren un abanico amplio e integrado de respuestas. Una de estas respuestas, promovida por la propia OMS desde 1 993 y, del mismo modo, por otras agencias multilaterales (UNICEF, 2004), es la educacin en habilidades para la vida entre el conjunto de la poblacin, con especial incidencia en las primeras etapas evolutivas (en lnea con la propuesta de la Comisin de Determinantes Sociales de equidad desde el principio). Las habilidades para la vida han sido definidas, desarrolladas y categorizadas de mltiples formas, si bien, a efectos didcticos pueden organizarse en los siguientes tres bloques: 68
su nivel de desarrollo econmico, para tener una buena proteccin social y alcanzar la equidad sanitaria, es fundamental aumentar la financiacin pblica de las intervenciones ligadas a los determinantes sociales de la salud. - Responsabilidad del mercado: La salud no es un producto comercial. Se trata de un derecho y de un deber del sector pblico. Por ese motivo, los recursos destinados a la salud deben repartirse de forma equitativa y ser universales. - Equidad de gnero: Los prejuicios sexistas en el reparto del poder, los recursos y las prestaciones sociales, en las normas y los valores, y en la forma en que se estructuran las organizaciones y se administran los programas tienen efectos perjudiciales en la salud
N3
Habilidades cognitivas: Encajaran en esta categora aquellas destrezas psicosociales susceptibles de favorecer procesos cognitivos eficaces para permitir a las personas y a los grupos de los que forman afrontar los desafos de su entorno. Entre ellas cabe citar, a modo de ejemplo, el pensamiento crtico o la capacidad para tomar decisiones. Habilidades emocionales: En este eje se engloban las destrezas relacionadas con la conocida como inteligencia emocional (Goleman, 1 996), es decir, la capacidad de gobernar las emociones de manera respetuosa, entre las que cabe mencionar la empata o el manejo del estrs. Habilidades sociales: En esta tercera rea se integran aquellas destrezas cuyo manejo efectivo hace posible mantener interacciones sociales positivas, mutuamente gratificantes y de colaboracin. Entre ellas podemos sealar como ejemplo la asertividad o la competencia relacional. Se trata solo de una categorizacin formal, ya que en la prctica las diversas habilidades consideradas en este modelo estn plenamente integradas, siendo cada persona un universo cognitivo-emocional-social holstico, resultante de la combinacin singular de estas tres familias de habilidades. En su iniciativa Life Skills Education in Schools, la Organizacin Mundial de la Salud (WHO, 1 993) define las habilidades para la vida de este modo: aquellas aptitudes necesarias para tener un comportamiento adecuado y positivo, que nos permiten enfrentar eficazmente las exigencias y retos de la vida diaria. En definitiva, un conjunto de destrezas cuya posesin y manejo efectivos permitiran a las personas y, por ende, a los grupos y colectivos en los que se integran, afrontar los desafos vitales de un modo resiliente y desarrollar estilos de vida saludables susceptibles de reducir la proporcin de enfermedades no transmisibles en la carga mundial de morbilidad. Uno de los riesgos de un planteamiento inadecuado de este modelo es la tentacin de psicologizar los factores sociales y las situaciones de riesgo que se encuentran en la base de los estilos de vida relacionados con la salud. Un planteamiento errneo y claramente inefectivo en el sentido de que, como hemos visto, el impacto de los determinantes sociales en la salud personal y colectiva no puede reducirse a dimensiones personales, sino que, adems y en una medida fundamental, es debido, a condicionamientos de naturaleza social. En este sentido, el modelo de educacin en habilidades para la vida pone de manifiesto la necesidad de desarrollar en las personas una panoplia de destrezas
que las capaciten para socializarse de manera no problemtica en sus respectivos entornos, encontrando en s mismos y en la relacin con las dems personas estrategias susceptibles de favorecer la autonoma personal, el bienestar y la inclusin social. Es lo que conocemos como resiliencia (Munist, M. et al, 1 998), esa metafrica armadura personal con cuya vestimenta una persona puede desarrollar su vida con menores riesgos, revirtiendo procesos que, sin tales recursos psicosociales, podran amenazar la salud personal y colectiva. Por otra parte, el manejo efectivo de estas habilidades favorece en las personas actitudes proactivas hacia el cambio social positivo, en la medida en que, como hemos sealado, no se trata de habilidades que agotan sus posibilidades en la mismidad del sujeto, sino que, por el contrario, estn estrechamente relacionadas con la dimensin social constitutiva del ser humano. Son, por lo tanto, el ncleo del potencial relacional a partir del cual pueden conformarse redes y alianzas entre las personas para actuar sobre los determinantes sociales que subyacen al riesgo de prdida de la salud y cuya remocin favorecera la equidad en el disfrute de la salud y la cohesin social. Sobre la evidencia existente acerca del impacto positivo del desarrollo de estilos de vida saludables que incorporen como uno de sus componentes el manejo diestro de las habilidades para la vida, puede consultarse el documento Skills for Health publicado por la OMS (Clarke, 2003), as como el manual publicado en 1 999 por la Comisin Europea y la Unin Internacional de Promocin de la Salud y Educacin para la Salud (CE, UIPES, 1 999). Las diez habilidades para la vida promovidas desde 1 993 por la OMS son las siguientes: Habilidad 1 . Autoconocimiento: destreza para identificar y tomar conciencia de los rasgos que dibujan nuestra personalidad, la organizacin integrada de todas aquellas dimensiones psicosociales que nos caracterizan y nos hacen singulares. Habilidad 2. Empata: capacidad para ponerse en el lugar de las dems personas para, desde esa posicin, sintonizar con sus sentimientos y emociones. Habilidad 3. Comunicacin asertiva: habilidad para expresar opiniones, sentimientos, decisiones, etc., de manera apropiada al contexto en el que vive y a las personas con las que se entra en relacin. Habilidad 4. Relaciones interpersonales: competencia para interactuar de manera positiva con las dems personas, poniendo en accin en ese marco relacional todas aquellas otras habilidades sin cuyo manejo diestro el animal social 69
N3
que somos se vera limitado. Habilidad 5. Toma de decisiones: capacidad para construir racionalmente las decisiones cotidianas a partir del reconocimiento de las variables en juego, la identificacin de las opciones disponibles, la asuncin de las decisiones consideradas ms efectivas y la valoracin posterior de los resultados. Habilidad 6. Solucin de problemas y conflictos: destreza para afrontar de manera constructiva los conflictos inherentes a la vida humana, que afectan a las personas y las comunidades. Habilidad 7. Pensamiento creativo: destreza en la que se materializa uno de los procesos de pensamiento a disposicin de todas las personas para explorar respuestas innovadoras a cada momento y situacin vital. Habilidad 8. Pensamiento crtico: capacidad para cuestionar experiencias e informacin, sin asumir pasivamente criterios ajenos. Esta habilidad es uno de los principales motores del cambio personal y social. Habilidad 9. Manejo de emociones y sentimientos: destreza necesaria para reconocer y gestionar de manera positiva las emociones y sentimientos, tanto los propios como los de aquellas personas con las que entramos en relacin. Habilidad 1 0. Manejo de la tensin y el estrs: capacidad para reconocer las fuentes que subyacen a las tensiones y el estrs que afectan a nuestra vida cotidiana, y de actuar positivamente sobre ellas para erradicarlas o, cuando menos, compensar su impacto. En definitiva, cuando hablamos de habilidades para la vida hacemos referencia a un repertorio de destrezas psicosociales vinculadas tanto con el funcionamiento ntimo de cada persona como con su competencia relacional y su inclusin social. De la integracin equilibrada de estas habilidades cabe esperar resultados positivos para la capacidad de las personas, y los grupos de los que forman parte, de gestionar adecuadamente su vida, incidiendo positivamente sobre las influencias sociales que la condicionan.
aventura de la vida: (Flores, 201 2). Una iniciativa cuya primera edicin experimental se puso en marcha en 1 989 y cuyas principales seas de identidad son las siguientes: Naturaleza Se trata de un programa de Educacin para la Salud conformado por la integracin de dos ejes: - Eje temtico: centrado en los hbitos de salud sobre los que el programa se propone incidir: Alimentacin, Actividad y descanso, Alcohol, Tabaco, Medicamentos, Higiene y Seguridad. - Eje transversal: relativo a las habilidades para la vida sobre cuyo desarrollo pivota el programa. mbito de actuacin La escuela como comunidad educativa integrada por profesorado, alumnado y familias.
Poblacin destinataria
Escolares con edades comprendidas entre los 8 y los 1 2 aos. Objetivo Desarrollo en nias y nios de competencias adecuadas Fuente: Juan Carlos Melero para asumir de manera positiva y crtica el cuidado de su salud personal y pblica. Para ello, adems de compartir informacin relevante sobre los principales factores de riesgo, fomenta el desarrollo de las habilidades que estn en la base de la construccin de 70
A modo de ejemplo: La aventura de la vida

Basndonos en este modelo, la ONG espaola EDEX (http://www.edex.es) dinamiza desde los aos 90 del siglo XX diversos programas de promocin de la salud en el mbito escolar: programas genricos de educacin para la salud o programas ms especficos de prevencin de la obesidad infantil, de educacin afectivo-sexual o de prevencin de drogodependencias. Uno de estos programas de educacin para la salud es el denominado La
N3
estilos de vida saludables. Herramientas
experiencias, emociones, y dems elementos relacionados con cada uno de los temas que el programa aborda, para su tratamiento educativo. Cobertura Desde su creacin en 1 989 hasta la actualidad (curso escolar 201 2-201 3), el programa La aventura de la vida ha sido aplicado en Espaa y en los siguientes quince pases de Latinoamrica y El Caribe: Argentina, Bolivia, Colombia, Costa Rica, Cuba, Chile, Ecuador, El Salvador, Espaa, Guatemala, Mxico, Panam, Per, Repblica Dominicana y Uruguay. La dinamizacin del programa ha formado parte de diversos proyectos de cooperacin al desarrollo protagonizados en cada territorio por ONG locales, en colaboracin con sus gobiernos (locales, regionales o nacionales), y con el apoyo de diversas instituciones pblicas espaolas y europeas. Ms informacin Una descripcin ms detallada http://laaventuradelavida.net del programa puede encontrarse en:
Las herramientas educativas que el programa pone a disposicin de los diversos agentes implicados son las siguientes: - Para el alumnado: Un lbum de cromos para cada escolar de cada uno de los cuatro cursos de Educacin Bsica o Primaria a los que se dirige. Cada lbum integra un total de 36 cromos y otras tantas historias enlas que un grupo de nias y nios viven en primera persona diversas peripecias relacionadas con los temas abordados. - Para el profesorado: Cada docente comprometido con el desarrollo del programa en el aula dispone de una gua didctica. sta, adems de presentar la relevancia de la educacin para la salud, propone las pautas metodolgicas para la dinamizacin educativa del programa. Una metodologa activa y participativa, que reconoce el lugar central del alumnado en la construccin de contenidos significativos. En este sentido, La aventura de la vida no persigue adoctrinar al alumnado en torno a la salud, sino entrenarle en el desarrollo de competencias que le permitan adoptar las decisiones ms adecuadas desde el punto de vista del autocuidado y del cuidado de las dems personas y entornos con los que se relaciona. - Para las familias: La gua titulada 1 0 pasos para educar a sus hijas e hijos ante los riesgos del alcohol y otras drogas es la base del trabajo educativo realizado con las familias. Un trabajo que puede materializarse, en funcin de los diversos contextos en los que el programa se desarrolla, en la dinamizacin de Escuelas de Madres y Padres, el desarrollo de encuentros monogrficos en torno a alguno de los temas abordados por el programa, la distribucin masiva de la gua como material de lectura y debate en encuentros familiares de diverso tipo, etc. Dinmica educativa El profesorado, mediante el recurso a dinmicas pedaggicas de corte ldico y participativo, utiliza las herramientas didcticas del programa (las historias y los cromos mencionados) para propiciar la emergencia en el aula de experiencias significativas del alumnado como materia educativa. En este sentido, las historias propuestas no pretenden ser un relato cerrado que cada escolar deba interiorizar de manera acrtica. Antes bien, tiene como principal cometido evocar en nias y nios
Conclusiones
La distribucin de la carga de morbilidad entre pases y en el interior de cada pas no se debe al azar. Antes bien, subyacen a la misma estilos de vida que se encuentran estrechamente relacionados con las enfermedades ms prevalentes en la actualidad: las enfermedades no transmisibles. Estos estilos de vida se encuentran en buena medida condicionados por determinantes sociales de diversa naturaleza que la investigacin ha ido desentraando. Incidir sobre ellos para su modificacin, as como entrenar a las personas para compensar de manera resiliente su influjo, son actuaciones a desarrollar para la promocin de la salud individual y pblica. De los mltiples componentes que debe integrar una estrategia slida que se proponga tener impacto real sobre la salud, la educacin en habilidades para la vida propuesta por la OMS hace ahora dos dcadas, es un elemento con un elevado potencial. Habilidades para la vida que, lejos de psicologizar la salud pblica, contribuyen al desarrollo de personas socialmente competentes, susceptibles de acometer colaborativamente aquellas mejoras que la realidad requiere.
71
N3
Referencias bibliogrficas y webgrficas
- Alwan, A. (2011 ). Informe sobre la situacin mundial de las enfermedades no transmisibles. 201 0. Resumen de orientacin. Ginebra: OMS. - Clarke, D. et al (2003). Skills for Health. Skills-based health education including life skills: An important component of a Child-Friendly/Health-Promoting School. Information series on school health. Document No. 9. - Geneva: WHO. - Comisin Europea, Unin Internacional de Promocin de la Salud y Educacin para la Salud (1 999). La Evidencia de la Eficacia de la Promocin de la Salud. Configurando la Salud Pblica en una Nueva Europa. Parte Una y Parte Dos. Libro de Evidencia. Madrid: Rumagraf, S.A. - Flores Fernndez, F. (1 989-201 2). La aventura de la vida. Bilbao: EDEX. - GHO (2008). Noncommunicable diseases. WHO. Recuperado de http://www.who.int/gho/ncd/en/index.html - Goleman, D. (1 996). Inteligencia emocional. Madrid: Kairs. - Munist, M., Santos, H., Kotliarenco, M.A., Surez Ojeda, E.N., Infante, F., y Grotberg, E. (1 998). Manual de identificacin y promocin de la resiliencia en nios y adolescentes. Washington, DC: OPS. - OMS (2004). Estrategia mundial sobre rgimen alimentario, actividad fsica y salud. Recuperado de http://www.who.int/dietphysicalactivity/strategy/eb11 344/strategy_spanish_web.pdf - OMS (2008) Recuperado de http://www.who.int/social_determinants/es/ - OMS (2009). Subsanar las desigualdades en una generacin. Argentina: La Stampa, S.A. - OMS (201 0). Estrategia mundial para reducir el uso nocivo de alcohol. Italia: OMS. - OMS (2011 ). Alcohol. Recuperado de http://www.who.int/mediacentre/factsheets/fs349/es/index.html
- OMS (201 2a). 1 0 datos sobre la situacin sanitaria mundial. Recuperado de http://www.who.int/features/factfiles/global_burden/es/index.html - OMS (201 2b). Estadsticas sanitarias mundiales 201 2. Ginebra: OMS. - OMS (201 2c). 1 0 datos sobre la epidemia de tabaquismo y el control mundial del tabaco. Recuperado de http://www.who.int/features/factfiles/tobacco_epidemic/es/index.html - UNICEF (2004). Life Skills-Based Education for Drug Prevention: Training Manual. New York. Recuperado de http://www.unicef.org/spanish/lifeskills/files/DrugUsePreventionTrainingManual.pdf - WHO (1 993). Life Skills Education in Schools. Geneva: WHO. - Wilkinson, R., Marmo, M. (Eds.). (2003). Social determinants of health: The solid facts. Second edition. Denmark: WHO.
72
N3
Medioambiente y Ciudadana: Educacin para la Participacin como Base de 1 una Educacin Ciudadana Planetaria
Resumen: Ciudadana y medio ambiente se plantean como dos de los grandes
retos a abordar en el siglo XXI en el mbito de la educacin. Esta investigacin pretende aportar resultados acerca de la relevancia que los programas de participacin ciudadana tienen en el alumnado en orden a fomentar las competencias relacionadas con la ciudadana activa. Proponemos un marco terico conjunto de la educacin ambiental y la educacin para la ciudadana asumiendo una perspectiva de educacin ciudadana planetaria o educacin global. La investigacin se desarrolla sobre varios casos de programas de educacin para la participacin ciudadana (Ecoescuela, Parlamento joven, Seguro que te mueves) en Andaluca y utiliza una metodologa cualitativa de triangulacin de datos con cuestionarios, entrevistas y grupos de discusin, utilizndose el software Atlas.ti para el tratamiento de los datos. Pretendemos as identificar las potencialidades y limitaciones de dichos programas, que han ido surgiendo de la necesidad de dar respuesta a valores considerados como deseables para la ciudadana del siglo XXI. Entre los resultados obtenidos destacamos la potencialidad de estos programas educativos para formar ciudadanos comprometidos con los problemas sociales y ambientales desde una perspectiva de ciudadana planetaria.
Environment and Citizenship: Education for the Participation as a Base for a Global Citizenship Education
Abstract: Citizenship and environment are presented as two of the big challenges
to be faced in the 21 st century in the area of education. This research aims to provide results about the relevance that citizen participation programs have on students in order to foster the skills related to active citizenship. A theoretical framework of environmental education and education for citizenship is set assuming a perspective of planetary or glob al citizenship education. The research is based on several cases of
education programs for citizen participation (Eco-Shool, Parlamento Joven, Seguro que te mueves) in Andalusia and uses a qualitative methodology of triangulation data through questionnaires, interviews and focus groups, using the software Atlas.ti for the data processing. We intend to identify the potentials and limitations of these programs, which have arisen from the need to provide responses to what are considered desirable values for 21 st century citizenship. Among the results we highlight the potential of these educational programs to educate citizens involved in social and environmental problems from the perspective of global citizenship.
Palabras Claves: Participacin ciudadana, ciudadana planetaria, educacin,

estudio de casos, conocimiento escolar.
Key words: Citizenship Participation, Planetary Citizenship, Education, Case Study,

School Knowledge.
Olga Moreno Fernndez

Doctoranda en Educacin. Universidad Pablo de Olavide e-mail: olgamariamoreno@gmail.com
Francisco F. Garca Prez

Profesor Titular del Departamento de Didactica de las Ciencias Experimentales y Sociales. Universidad de Sevilla e-mail: ffgarcia@us.es
73
N3
Planteamiento de la investigacin
En este artculo presentamos el planteamiento y los resultados de una investigacin que constituye la tesis doctoral Educacin ambiental y educacin para la ciudadana desde una perspectiva ciudadana planetaria. Estudio de experiencias educativas en Andaluca. El inters por conectar problemas ambientales y sociales surge de la realizacin de un trabajo de investigacin previo, en el que se profundiz sobre las concepciones que el alumnado de cuarto y quinto de educacin primaria (en una muestra de Sevilla) tena acerca de la contaminacin y sobre cmo este conocimiento cotidiano era relevante de cara a la construccin de un aprendizaje significativo. A partir de los resultados obtenidos consideramos necesario trabajar sobre el hecho de que el alumnado no slo contemplara ciertos problemas desde una perspectiva ambiental, sino que incorporara planteamientos ciudadanos que le hicieran partcipe de la problemtica socioambiental con una mirada ms integradora. Tras el anlisis de estas cuestiones se decidi adoptar un enfoque donde educacin ambiental, educacin ciudadana y participacin confluyeran, de forma que favorecieran la inclusin de una perspectiva de ciudadana planetaria en el contexto escolar, abogando as por una nueva forma ms comprometida y compleja de entender la ciudadana, asumiendo, tal y como sealan Garca Prez y De Alba (201 2, p. 304), que la participacin ciudadana es la dimensin central de la educacin para la ciudadana y ello exige la vinculacin de los procesos educativos a la prctica real, a la accin, al compromiso con la solucin de los problemas de nuestra sociedad, en aquellos campos en los que los alumnos y alumnas tengan posibilidades de intervenir. El propsito que surge con este nuevo proyecto de investigacin es, pues, el de realizar un estudio cualitativo de los programas escolares que abordan temas ambientales y temas ciudadanos en el mbito geogrfico de la Comunidad Autnoma de Andaluca, en Espaa. A travs del anlisis de dichos programas se pretende demostrar que ambos ejes o temas transversales (educacin ambiental y educacin para la ciudadana), presentes en el currculo escolar, se pueden relacionar dando lugar a una educacin ciudadana planetaria. Una ciudadana planetaria o ciudadana global, universal, mundial, cosmopolita, responsable, activa, crtica, intercultural, diferenciada, paritaria, democrtica y social, ambiental, que bebe, entre otras fuentes, de las races de la denominada quinta generacin de la educacin para el desarrollo.
Aunque el trmino ms utilizado sea ciudadana global, como escribe Gadotti et al. (2003, p.1 00), estara mucho ms ligado al reciente proceso de globalizacin provocado por los avances tecnolgicos; en cuanto a la planetariedad, contina siendo un deseo, un sueo que viene de mucho ms lejos; por lo que hemos decidido hacer uso de la denominacin ciudadana planetaria2 . Son muchos, de hecho, los trminos que se refieren a la ciudadana planetaria, no menos que los matices conceptuales que pueden encontrarse segn unos u otros autores, pudindose afirmar que existen diversos enfoques para la ciudadana planetaria y que situamos el de esta investigacin en una opcin de cambio, orientada a la transformacin social y a la mejora del entorno a partir de la participacin ciudadana. Ciudadana planetaria es un trmino enmarcado como se ha esbozado antes- dentro de la educacin para el desarrollo, por lo que suele contextualizarse ligado al trabajo que se realiza desde las organizaciones no gubernamentales (ONGs). Pero si nos trasladamos al contexto escolar, la ciudadana planetaria termina desvanecindose, pese a que en la legislacin educativa, en muchos casos, se hace mencin explcita a la necesidad de incorporar una perspectiva de ciudadana global en las aulas. As, en las recomendaciones realizadas por el Consejo de Europa y en la Red Eurydice en el informe Citizenship Education in Europa, publicado en 201 2, se aprecia la inclusin de la ciudadana planetaria en algunos de los contextos escolares de los pases europeos. Para el caso de Escocia, por ejemplo, se lee: Other important areas of school activity may also be included in school evaluation. For example, in the United Kingdom (Scotland), the guide for inspections also includes aspects related to international education, global citizenship and sustainability issues (Eurydice, 201 2, p. 79). O incluso referencias a proyectos donde ONGs y centros escolares unen sus esfuerzos, como es el caso de Espaa: In Spain, since 2009, the Vicente Ferrer National Award for Education for Development selects 15 school projects from all educational levels each year. The winning projects should raise awareness, develop critical thinking and encourage the active participation of students in the pursuit of global citizenship, solidarity, eradication of poverty and sustainable development (Eurydice, 201 2, p. 67). Tambin la legislacin educativa espaola en su Ley Orgnica 2/2006, de 74
N3
Educacin (LOE), al referirse a la educacin para la ciudadana, explicita que su finalidad consiste en ofrecer a todos los estudiante un espacio de reflexin, anlisis y estudio acerca de las caractersticas fundamentales y el funcionamiento de un rgimen democrtico, de los principios y derechos establecidos en la Constitucin espaola y en los tratados y las declaraciones universales de los derechos humanos, as como de los valores comunes que constituyen el sustrato de la ciudadana democrtica en un contexto global (p. 1 71 63). Por lo dems, pensadores como Edgar Morin (y la propia UNESCO) han destacado como principio bsico la importancia de educar para afrontar los problemas de nuestro mundo y saber responder a la imprevisibilidad que caracteriza las dinmicas sociales y ambientales. Un enfoque que constituye la opcin central del Proyecto IRES 3 (Garca Daz, 1 998; Garca Daz y Garca Prez, 2000; Garca Prez, 2000, 2011 ). Desde las aportaciones que el proyecto IRES ha realizado a la educacin y en relacin a este trabajo de investigacin, nos parece conveniente destacar la atencin prioritaria que le ha dedicado a los problemas ambientales y a los problemas sociales como problemticas fundamentales (e ineludibles) de nuestro mundo, representando estos problemas socio-ambientales como una estrategia para integrar, significar y contextualizar el conocimiento cotidiano y cientfico en el proceso de construccin del conocimiento escolar, facilitando, de esta manera, la comprensin y anlisis crtico de los problemas sociales de nuestro mundo (Gonzlez Puentes, 2011 , p. 25). En consecuencia, consideramos indispensable en la enseanza el uso de un modelo didctico que favorezca la interaccin del alumnado con el profesorado y con el entorno en que se desenvuelven, para que la prctica educativa genere un aprendizaje significativo produciendo cambios relevantes en los esquemas de aprendizaje de los discentes y en la forma de entender el mundo que les rodea. La finalidad de esta investigacin es, en definitiva, aportar nuevas informaciones e ideas acerca de la importancia que tienen estos programas para fomentar en nuestro alumnado la participacin y hacer de ellos ciudadanos competentes. Por otra parte, pretendemos demostrar cmo la educacin ambiental y la educacin ciudadana estn ntimamente relacionadas, de forma que, conociendo esta relacin, los profesores y profesoras puedan abordar, de forma consciente, ambos temas desde un punto de vista complejo, favoreciendo la reflexin, tanto propia como del los alumnos y alumnas, sobre la problemtica actual a la que nos
enfrentamos y propiciando la actuacin ciudadana comprometida.
Metodologa
Dentro de un marco legislativo donde se favorece la ciudadana planetaria en los escenarios educativos, como hemos mencionado anteriormente, esta investigacin realiza un estudio cualitativo de algunos de los programas escolares (no especficamente curriculares) que abordan cuestiones ambientales y/o ciudadanas en Andaluca, partiendo del supuesto de que en dichos programas se fomenta al menos uno de los dos tipos de temticas, ya sea la educacin ambiental o la educacin ciudadana, pero que en ambos casos se relacionan entre s recprocamente, aunque ello no se explicite. Nos preguntamos entonces si esta relacin entre las dimensiones ambiental y cvica termina confluyendo en aspectos relacionados con la perspectiva, ms integradora, de ciudadana planetaria, mediante cuestiones como: Se considera el alumnado parte de una comunidad mundial? Considera el profesorado que es viable abordar la ciudadana planetaria desde el contexto escolar? Cmo abordan la dinmica de trabajo de estos programas los monitores y coordinadores de los ayuntamientos?... A estas y a otras cuestiones intentamos ir dando respuestas, centrndonos en el rol que el alumnado adopta hacia estos programas educativos y en el papel que ocupan los docentes y los monitores y dinamizadores. Somos conscientes de que los resultados derivados de lo recogido y analizado no puede generalizarse a todo el espectro de programas educativos existentes, no slo por la diversidad de los contextos geogrficos en los que se encuentran, sino tambin por las seas de identidad propias de cada Comunidad, as como por los diversos niveles de complejidad que se pueden identificar dentro de cada programa educativo, independientemente de que stos sean de nivel local, estatal o internacional. Estamos seguros, en todo caso, de que esta investigacin puede aportar informaciones, ideas y nuevas perspectivas sobre la importancia que estos programas tienen en nuestros centros escolares para fomentar una ciudadana activa, responsable, comprometida y participativa. Asimismo, los resultados de la investigacin contribuyen a acercar la educacin ambiental y la educacin ciudadana, de forma que, conociendo esta relacin, los agentes implicados puedan abordar ambas temticas desde un punto de vista complejo que les haga reflexionar sobre las problemticas actuales a las que nos enfrentamos, abriendo as una va a las propuestas de formacin del profesorado. Es esta una temtica relevante que se aborda ms especficamente en 75
N3
el proyecto de I+D+i Estrategias de formacin del profesorado para educar en la participacin ciudadana (EDU2011 -2321 3), al que se vincula este trabajo de investigacin, en el cual se realiza una aproximacin a distintos escenarios educativos a nivel internacional, centrndose en la formacin (inicial y en ejercicio) del profesorado para educar en la participacin ciudadana. En este marco nos hemos planteado los objetivos generales de la investigacin, tales como: proponer un marco conceptual de la educacin ambiental, la educacin para la ciudadana y la perspectiva conjunta de ambas bajo la denominada educacin ciudadana planetaria; conocer el contexto socio-educativo en el que situamos nuestra investigacin (programas educativos Ecoescuela, Parlamento Joven y Seguro que te mueves); analizar en qu medida estn presentes las dimensiones de educacin ambiental, educacin para la ciudadana, participacin y ciudadana planetaria en las concepciones del alumnado, del profesorado, de los monitores y agentes de dinamizacin juvenil, y en los recursos publicados por las diferentes instituciones oficiales que ofertan los programas. Es, sobre todo, el ltimo objetivo citado el que se desarrolla mediante el trabajo emprico. Ms concretamente, nos planteamos varios objetivos especficos: detectar las concepciones de la muestra seleccionada con respecto a los temas de estudio que nos ocupan; comprobar si existen relaciones entre los programas educativos de carcter ms ambiental y los programas con un enfoque ms centrado en la educacin ciudadana; verificar si la educacin ambiental est presente en los programas educativos Parlamento Joven y Seguro que te mueves; igualmente, si la educacin para la ciudadana est presente en el programa Ecoescuela; evaluar si estos programas educativos favorecen la formacin de una ciudadana comprometida; as como detectar cules son las posibilidades y limitaciones que se dan en los programas educativos a estudio. Aplicamos, en la investigacin, una metodologa cualitativa de triangulacin de datos, mediante cuestionarios, entrevistas y grupos de discusin, utilizndose el software Atlas.ti para el tratamiento de los datos.
participacin ciudadana, indirectamente, favorecen una mayor comprensin medioambiental del entorno. El proceso de investigacin no slo nos ha permitido conocer ms detenidamente estos programas educativos, sino tambin a comprender cmo se abordan en ellos las cuestiones relacionadas con la educacin ambiental y con la educacin para la ciudadana. Y ello ha sido posible a travs de la profundizacin en la idea de educacin para la participacin, buscando indicadores que hicieran referencia a la idea de ciudadana planetaria y analizando la influencia que pueden tener los programas citados en la integracin de dicha idea educativa en los centros escolares. Nos ratificamos as en la idea de que una perspectiva de educacin para la ciudadana planetaria es deseable, y posible, para el desarrollo de la ciudadana del siglo XXI. Esta perspectiva planetaria, como sealan Gutirrez y Prado, nos obliga a crear nuevas relaciones e interacciones; nuevas formas de solidaridad para proteger toda la vida sobre la Tierra y nuevas responsabilidades ticas (1 995, p. 1 34). Una educacin ciudadana planetaria proporciona una visin de polis mundial desde la escuela, la comunidad, los Estados donde todos los seres humanos, independientemente del lugar del mundo donde se encuentren, se sientan parte de un mismo pueblo. Su finalidad es, pues, en ltimo trmino, favorecer la participacin activa y responsable en las decisiones que afectan a nuestro planeta. Para que este cambio sea posible, en las escuelas es necesario que los docentes estn preparados para incorporar esta perspectiva planetaria tanto al anlisis de los problemas como a su intervencin educativa. Y es aqu donde pueden incidir los resultados de nuestro estudio, porque, sin duda, la educacin para una ciudadana planetaria es una alternativa posible para promover una educacin transformadora y una escuela abierta al mundo, una ciudadana ms acorde a las nuevas realidades y retos del siglo XXI, formando ciudadanos y ciudadanas cosmopolitas que: - demuestran inters en conocer y reflexionar crticamente sobre los problemas mundiales y sobre cmo interactan en nuestras vidas y en la de los otros; - estn arraigados en lo local, se sitan en el mundo a travs de formas de identidad complejas, mltiples, plurales, que se entremezclan las unas con las otras; 76
Resultados y conclusiones
A travs los datos recogidos mostramos cmo los programas educativos que estn relacionados con contenidos medioambientales favorecen, a su vez, la participacin del alumnado en sus vidas cotidianas y en la comunidad donde viven. Asimismo, que los programas educativos que estn relacionados con de
N3
- muestran, por consiguiente, respeto a la diversidad e indignacin frente a la injusticia y la exclusin (consciencia de complejidad humana y conciencia cosmopolita, planetaria); - participan y se comprometen activamente en la vida ciudadana en sus diferentes niveles (desde los ms locales a los ms globales) con el fin de lograr un mundo ms justo e inclusivo (consciencia democrtica y tica planetaria); - son conscientes de sus derechos y obligaciones y se responsabilizan de sus acciones como ciudadanos del planeta (identidad y consciencia terrenal); - son personas responsables, crticas, que no slo exigen sus derechos y cumplen con sus obligaciones, sino que, adems, tambin lucha por un mundo mejor para todos (cfr. De Paz, 2007, pp. 52-53). Una ciudadana planetaria que establece una forma de entender las relaciones con los otros, entendiendo por otros todo aquello que est fuera de uno mismo. Es una sinergia entre el yo y el mundo, donde cada accin local conlleva inexorablemente una reaccin global, y donde el ser humano tiene su mayor responsabilidad.
- De Paz, D. (2011 ). Escuelas y educacin para la ciudadana global. Barcelona: Intermon Oxfam. - Eurydice (201 2). Citizenship Education in Europa. Bruselas: Education, Audiovisual and Culture Executive Agency. - Gadotti, M. et al. (2003). Perspectivas actuales de la educacin. Mxico: Siglo XXI. - Garca Daz, J. E. (1 998). Hacia una teora alternativa sobre los contenidos escolares. Sevilla: Dada. - Garca Daz, J. E. y Garca Prez, F. F. (2000). Aprender Investigando. Una propuesta metodolgica basada en la investigacin. Sevilla: Dada Editora. - Garca Prez, F. F. (2000). Un modelo didctico alternativo para transformar la educacin: el Modelo de Investigacin en la Escuela. Scripta Nova, Revista Electrnica de Geografa y Ciencias Sociales, vol. IV, n 64 (1 5 de mayo de 2000). En: http://www.ub.es/geocrit/sn64.htm (consultado el 1 5 de enero de 201 3). - Garca Prez, F. F. (2011 ). Geografa, problemas sociales y conocimiento escolar. Anekumene. Revista virtual. Geografa, cultura y educacin, vol. 1 , n 2, p. 6-21 . En: http://www.anekumene.com/index.php/revista/article/view/24/23 (consultado el 21 de enero de 201 3). - Garca Prez, F. F. y De Alba, N. (201 2). La educacin para la participacin ciudadana entre dos polos: el simulacro escolar y el compromiso social. En De Alba, N.; Prez Garca, F. F. y Santisteban, A. (Coord.). Educar para la participacin ciudadana en la enseanza de las Ciencias Sociales, Vol. 1 , pp. 297-306. [Publicacin accesible en: http://dialnet.unirioja.es/servlet/libro?codigo=500467]. - Gonzlez Puentes, J. F. (2011 ). El medio urbano como mbito de conocimiento escolar. Anlisis y propuestas a partir de un estudio de concepciones de alumnado de Bogot. Tesis doctoral. Universidad de Sevilla, Facultad de Ciencias de la Educacin. Departamento de Didctica de las Ciencias Experimentales y Sociales. [Accesible en: https://www.educacion.gob.es/teseo/mostrarRef.do?ref=923496]. - Grupo Investigacin en la Escuela (1 991 ). Proyecto curricular Investigacin y Renovacin Escolar (IRES). Sevilla: Dada Editora. - Gutirrez, F. y Prado, C. (1 995). Ecopedagoga: Ciudadana planetaria. Costa Rica: Editorial Heredia.
- Ley Orgnica 2/2006, de 3 de mayo, de Educacin. BOE n 1 06 de 4 de mayo de 2006. En: http://www.boe.es/boe/dias/2006/05/04/pdfs/A1 71 58-1 7207.pdf (consultado el 21 de enero de 201 3).
Notas 1 . Este trabajo es parte de la tesis doctoral Educacin ambiental y educacin para
la ciudadana desde una perspectiva planetaria. Anlisis de experiencias educativas en Andaluca, dirigida por el Prof. Dr. D. Francisco F. Garca Prez y resultado parcial de la fase primera de desarrollo del Proyecto I+D+i, con referencia EDU2011 2321 3, financiado por el Ministerio de Educacin y Ciencia y por Fondos FEDER, denominado Estrategias de formacin del profesorado para educar en la participacin ciudadana, con plazo de ejecucin de 01 /01 /201 2 al 31 /1 2/201 4.
2. En efecto, utilizamos el trmino planetaria, con preferencia al de global, entre
otras razones, para evitar la ambigedad con que en ocasiones se entiende global (significando tanto general como del globo terrqueo) y enfatizar, as, de forma inequvoca, la escala mundial en la que se manifiestan los problemas y desde la que se debera plantear la educacin para afrontarlos.
3. El Proyecto IRES (Investigacin y Renovacin Escolar) surge en 1 991 a partir del
grupo de investigacin DIE (Didctica e Investigacin Escolar) fundado en la escuela de Magisterio de la Universidad de Sevilla, constituyndose actualmente como una red de docentes de todos los niveles educativos (www.redires.net) que afrontan su actividad profesional a partir de un modelo de enseanza-aprendizaje basado en el modelo didctico de investigacin en la escuela.
77
N3
Medios Abiertos de Amrica Latina: Apuntes sobre la Aplicacin de los Indicadores Meditico-Culturales
Resumen: La actual situacin mundial imprime mayor celeridad, si cabe, a la evaluacin
de los sistemas mediticos en el mundo. El proceso de globalizacin, la concentracin de medios, las plataformas multimedia o la falta de libertad de expresin y de acceso de informacin en algunos entornos mediticos, influenciadas negativamente por la actual crisis financiera, apuntan a la importancia de mtodos de medicin fiables para recuperar uno de los baluartes de la opinin pblica: los medios de comunicacin libres (Daz Nosty, 201 2). Como afirma Dnis de Moraes (2011 , p.47): en las luchas por la hegemona, la centralidad de los medios de comunicacin se vuelve decisiva, ya que producir y difundir informacin e ideas que contribuyen a la formacin del consenso en torno a algunas concepciones de vida 1 . Desde la publicacin de los Indicadores de Desarrollo Meditico de la Organizacin de las Naciones Unidas para la Educacin, la Ciencia y la Cultura (UNESCO) en 2008, esta organizacin internacional ha puesto en marcha una estrategia de aplicacin de dichos instrumentos de medicin en todo el mundo, prestando especial atencin a la situacin latinoamericana. En su conjunto, los indicadores nacen con el objetivo de proporcionar un mapa completo de la ecologa meditica que es necesario construir a fin de velar por la libertad de expresin, el pluralismo y la diversidad de los medios de comunicacin. En 2011 , Ecuador fue el primer pas latinoamericano que analiz su entorno meditico a travs de estos mecanismos y, actualmente, est terminando el proceso en Brasil, que dar como resultado la publicacin en breve de los resultados. Sin embargo, otros pases como Bolivia, Venezuela o Uruguay han mostrado su inters en el cotejo de sus medios de comunicacin a travs de dichas herramientas y estn realizando sus investigaciones en este momento. El presente artculo pretende adentrarse en el mundo de la aplicacin de los Indicadores de Desarrollo Meditico en Latinoamrica con el objetivo de descifrar los cdigos de diseo e interpretacin de dichas herramientas desde una lectura panormica y, al mismo tiempo, profunda sobre el presente de dicha regin.
Open Media of Latin America: Notes on the Implementation of Media-Cultural Indicators

Abstract: The current global situation calls for more celerity, if at all possible, in the
evaluation of media systems throughout the world. The globalization process, the concentration of the media, multimedia platforms or the lack of freedom of expression and access of information in some media environmentsnegatively influenced by the current financial crisisshows the importance of efficient measure methods in order to recuperate one of the mainstays of public opinion: the media (Daz Nosty, 201 2). According to Dnis de Moraes (2011 , p.47): in the fight for hegemonic control, the centrality of the media becomes a decisive factor given that it serves to produce and disseminate information and ideas that contribute to the formation of the consensus around some conceptions of life. Since the publication of the Indicators for Development in Media Publication by the United Nations Educational, Scientific and Cultural Organization (UNESCO) in 2008, this international organization has launched a world-wide application strategy for the aforementioned media instruments, with special attention to the Latin-American situation. In general, the indicators are created with the objective of mapping the entirety of the media ecology, which is necessary to promote freedom of expression, pluralism, and diversity in the mass media. In 2011 , Ecuador was the first Latin-American country to analyze its media environments by means of this mechanism and, currently, this process is being finished in Brazil, which will result in the publication of the findings shortly. However, other countries such as Bolivia, Venezuela, or Uruguay have also shown interest in the analysis of their respective mass media though such methods, and currently each nation is conducting research. This article will delve into the application of Media Development Indicators in Latin America in order to decipher the design and interpretation codes of these said toolsthrough a panoramic readingand, at the same time, probe the current situations of this region.
Keywords: Communication, Media-Cultural Indicators, Latin America, UNESCO
Palabras clave: Comunicacin, Indicadores meditico-culturales, Amrica Latina,

UNESCO
Ruth De Frutos Garca

Investigadora FPU. Departamento de Periodismo. Universidad de Mlaga. e-mail: ruth.defrutos@uma.es
78
N3
En el nuevo panorama que se dibuja en Latinoamrica, envuelto por los vientos de cambio que soplan desde el Sur, paulatinamente estn encontrando cabida banderas desplegadas en luchas sociales
(Osvaldo Len, 2013, p. 7)
Introduccin
El clsico Las venas abiertas de Amrica Latina (1 971 ) del escritor uruguayo Eduardo Galeano ya haca referencia a los contrastes de una regin con fuertes identidades y tradiciones culturales que estaban claramente amenazadas por las desigualdades propias del engranaje mundial del modelo econmico vigente. Recientemente, el propio Galeano haca referencia en una entrevista a un peridico espaol ya desaparecido al proceso de renacimiento latinoamericano (201 0), lo que tambin se reproduce en los medios de comunicacin de dicha regin. Dados los inmensos y acumulativos desequilibrios econmicos y sociales que caracterizan el mundo en general y Amrica Latina en particular, la problemtica del desarrollo meditico contina ocupando la atencin acadmica y gubernamental aunque, a diferencia de las ltimas dcadas, con una preocupacin principalmente centrada en los problemas de la medicin e intervencin pblica. Cuando se estudia y teoriza sobre este rea en constante cambio se debe tener en cuenta el desafo al que un mundo unido por la comunicacin de masa puede enfrentarse si no utiliza los medios de una forma adecuada, responsable y necesaria. Ya en 2004, el informe del Programa de las Naciones Unidas para el Desarrollo acerca de la democracia latinoamericana hizo explcita la potencialidad de los medios masivos para actuar como una amenaza contra el funcionamiento del orden democrtico. Los medios tienen la capacidad de generar agenda, de predisponer a la opinin pblica a favor o en contra de diferentes iniciativas y de erosionar la imagen de figuras pblicas mediante la manipulacin de denuncias (PNUD, 2004, p.1 56), seal ese informe al referirse a la capacidad meditica para limitar la autonoma y el poder de las instituciones polticas (Torrico, 2009, p.2) Los medios de comunicacin son, actualmente, parmetros que son utilizados para analizar el desarrollo de un pas, un pueblo o una comunidad. Sin embargo, an desde esta perspectiva, resulta inevitable interrogarse acerca de la validez y confianza no slo de los instrumentos de medicin utilizados sino tambin de la pertinencia y eficiencia de la propia perspectiva terica que los sustenta (Nosty,
1 999; de Frutos, 2011 ). Numerosas han sido las iniciativas que han intentado analizar y comparar las diferentes situaciones en las que se encuentran los entornos meditico-culturales latinoamericanos a lo largo de los ltimos aos. Entre los principios de dichas iniciativas cabe destacar, por ejemplo, los postulados del Coletivo Brasil de Comunicao Social - Intervozes 2, creado en 2002 y ligado a la Campaa por los Derechos de la Comunicacin en la Sociedad de la Informacin 3 (CRIS, segn sus siglas en ingls) en Brasil, en el Manual para la Evaluacin de los Derechos a la Comunicacin, publicado como resultado del Proyecto de Gobernanza Global de la campaa CRIS.
El derecho a la comunicacin requiere que se creen, de facto, las condiciones necesarias para un ciclo positivo de comunicacin, que incluye un proceso no slo de bsqueda, recepcin y transmisin de informaciones, sino tambin de escucha, comprensin, aprendizaje, creacin y respuesta () (Brasil, Intervozes: 201 0, p.23)
Dicha organizacin elabor en 201 0 Contribuies para a construo de Indicadores do Direito Comunicao, que tena como objetivo fomentar el debate sobre la construccin de referencias cuantitativas y cualitativas de medicin del derecho de comunicacin en Brasil entre investigadores, organizaciones y movimientos del sector de la comunicacin (Intervozes, 201 0, p.11 ). El proyecto, que comenz en 2004, cuando la entidad trabajaba en una relatora brasilea del Global Governance Project, fue creado para construir bases tericas y herramientas prcticas sobre el derecho a la comunicacin y fue ejecutado en cinco pases, dos de ellos latinoamericanos: Colombia y Brasil. La publicacin de Intervozes Contribuies para a construo de Indicadores do Direito Comunicao estaba dividida en cuatro partes: en los tres primeros captulos se justificaba el desarrollo de indicadores en este mbito, objetivos y metodologa utilizados en la investigacin; en los siguientes apartados se defina la temtica de los indicadores del derecho a la comunicacin y en los dos ltimos captulos se exponan dichos indicadores. Los indicadores del derecho a la comunicacin continuaron desarrollndose hasta 2007, coincidiendo con la noticia de la creacin de instrumentos de medicin de esta materia por parte de Unesco, organizacin que ya estaba trabajando sobre indicadores a nivel internacional.
79
N3
Qu es un indicador?
El abordaje de la problemtica de los indicadores meditico-culturales requiere plantear la pregunta previa: qu significa exactamente indicador? Como expone el socilogo Paul Tolila4, los indicadores son herramientas que apuntan a la concertacin de acciones positivas que mejoran la realidad, abriendo la posibilidad de establecer un dilogo sobre las estrategias a usar. (201 0, p.4) Por indicador, Unesco entiende un factor, o una variable, cuantitativo o cualitativo, medido en el tiempo, que brinda una base simple y fiable para evaluar los logros, los cambios o el desempeo de los medios de comunicacin de un pas. Tomando como referencia dicha definicin, los indicadores mediticoculturales se convierten en herramientas indispensables para la gestin, el pilotaje estratgico, la anticipacin y la evaluacin de acciones. (Tolila, 201 0, p.1 3) Sin embargo, advierte que la idea de un indicador nico, satisfactorio y pertinente para todo el mundo se confronta con el menor sentido comn y con la simple reflexin racional. (dem, p.1 5) La proliferacin de iniciativas de construccin de indicadores, ya sea desde organizaciones internacionales como Naciones Unidas o Unesco, diferentes administraciones pblicas u organizaciones no gubernamentales, plantea la necesidad de comprender la distinta naturaleza de los corpus de estos instrumentos de medicin de la realidad. (Carrasco, 1 999) As, el significado de un indicador no es meramente contextual, sino que depende de la posicin de quin lo interpreta. En este sentido, es importante contextualizar correctamente los comportamientos o fenmenos sociales que se pueden denominar indicadores ya que puede que algunos de ellos no sean representativos de todas las lgicas sino de aquellas dominantes. (de Moraes, 2011 ; Vidal-Beneyto, 2006) La posibilidad del desarrollo de un indicador est condicionada por algunos aspectos: La existencia de un sistema de informacin suficiente y fiable. Una definicin clara de las reglas de construccin de un indicador. La relacin explcita de un indicador con un objetivo claro de trabajo y la formacin de actores en el manejo de los indicadores y su sensibilizacin en la problemtica general de la importancia de la informacin. La capacidad de asegurar el seguimiento del indicador y de su mtodo de construccin en el tiempo, ya que slo esta va en el tiempo hace del indicador una herramienta verdaderamente til. (Tolila, 201 0, p.1 9)
En el caso especfico de la comunicacin, los estudios al uso no ofrecen, segn el catedrtico de Periodismo Bernardo Daz Nosty, una perspectiva integradora, es decir, un anlisis sistemtico del espacio meditico en su conjunto, por lo que, desde esa visin fragmentaria de partida, es difcil evaluar el papel que, en cada pas, juega cada uno de los medios, el tiempo de uso social, la credibilidad e influencia que alcanzan y su incidencia en la sedimentacin de valores cvicos y culturales. (Daz Nosty, 2005)
Indicadores de Desarrollo Meditico de Unesco

El acta de constitucin de Unesco5, firmada el 4 de noviembre de 1 946, tras la reunin de las 44 naciones que pertenecan a Naciones Unidas fue un punto de inflexin para la definicin y el estudio de la cultura a nivel mundial. Sin embargo, habr que esperar hasta la dcada de los 60 del siglo XX para que se relacione el concepto de cultura con instrumentos de medicin, es decir, con indicadores sociales. El salto desde los indicadores sociales a los estrictamente culturales se produjo mucho despus, principalmente debido a la falta de inters gubernamental y a las dificultades metodolgicas de los indicadores culturales. Para acelerar dicho proceso, UNESCO organiz la reunin de Helsinki, en 1 972, donde por primera vez se debati sobre la importancia de las estadsticas y los indicadores en el campo de la cultura. Ocho aos despus la International Conference on Comunication congreg en la ciudad mexicana de Acapulco a diversos expertos que debatieron en la sesin Los indicadores culturales y el futuro de las sociedades desarrolladas varias lneas de investigacin sobre estadsticas culturales. En 1 982, la Academia de la Ciencia Austriaca realiz una reunin bajo el nombre Los indicadores culturales para el estudio comparativo de la cultura. Fruto de todas estas reuniones, en 1 986 se gener el proyecto de UNESCO Framework for Cultural Statistics (FCS). Fue especficamente en 2006, durante la 25 del Consejo Intergubernamental del Programa Internacional para el Desarrollo de la Comunicacin (PIDC), en la que se puso en marcha el proyecto de lo que se convirti dos aos despus en la publicacin del informe Indicadores de. Desarrollo Meditico: Marco para evaluar el desarrollo de los medios de comunicacin social. Segn los promotores de los Indicadores de Desarrollo Meditico (IDM), stos proporcionan una herramienta neutra y objetiva para analizar en un pas todos los aspectos de la ecologa meditica y as diagnosticar, de una manera rigurosa y lejos de polmicas, el estado de la comunicacin en un determinado contexto nacional. Sin embargo, han de 80
N3
aplicarse teniendo en cuenta el contexto social, poltico, profesional y econmico de cada pas. Desde esa fecha, dichos instrumentos de medicin han sido reconocidos por el PNUD, el Banco Mundial o el Consejo de Europa6 . Los indicadores abordan los entornos mediticos desde el compromiso con la gobernabilidad y el desarrollo democrtico de los pases, estructurndose en cinco categoras: Un sistema regulador conducente a la libertad de expresin, el pluralismo y la diversidad de los medios de comunicacin social. Pluralidad y diversidad de los medios de comunicacin social, igualdad de condiciones econmicas y transparencia en la propiedad. Los medios como plataforma para el discurso democrtico. Capacitacin profesional e instituciones de apoyo a la libertad de expresin, el pluralismo y la diversidad. La capacidad infraestructural suficiente para apoyar a medios independientes y pluralistas. Actualmente, los IDM se estn aplicando en diversas regiones del mundo, con el objetivo de realizar evaluaciones detalladas sobre los diferentes entornos mediticos (ver Tabla 1 ). Tabla 1 . Estado de la aplicacin de los IDM en el mundo
Aplicacin de los IDM en Amrica Latina

Si bien numerosas organizaciones internacionales, tanto pblicas como privadas, estn llevando a cabo indicadores de todo tipo para evaluar distintas partes del entorno meditico (transparencia, la libertad de expresin o el gnero, por citar slo algunos ejemplos), la primera experiencia de aplicacin de un corpus de indicadores que intente abarcar todos los mbitos del espectro de un entorno meditico en Amrica Latina germina en el trabajo del Centro Internacional de Estudios Superiores de Comunicacin para Amrica Latina (CIESPAL). La labor del CIESPAL es de particular inters al disear la metodologa de aplicacin de los IDM en Ecuador, as como realizar la primera versin del estudio y organizar los talleres de consulta que se desarrollaron en Quito. Dicho trabajo fue el germen del informe Anlisis del Desarrollo Meditico en Ecuador 2011 : Basado en la aplicacin de los Indicadores de Desarrollo Meditico de la UNESCO, publicado por la Oficina de Quito de UNESCO. Este documento supone la primera aplicacin prctica de los Indicadores de Desarrollo Meditico planteados por UNESCO en 2008 y que pretenden ser herramientas diagnsticas antes que mandamientos conceptualizados con el propsito de ayudar con los programas de desarrollo meditico antes que imponer alguna condicionalidad. (Unesco, 2008, p. 5) Como se subraya en el informe, durante el proceso de aplicacin de dichos indicadores desde 2009 a 2011 , Ecuador vivi un debate sobre diferentes aspectos relacionados con la comunicacin debido a la elaboracin del proyecto de Ley de Comunicacin por parte de la Asamblea Nacional7. Las buenas relaciones de Unesco con diversas instituciones acadmicas y no gubernamentales en Brasil8 dieron lugar a una colaboracin desde 2009 entre la propia organizacin internacional en el pas lusfono, el Laboratrio de Polticas de Comunicao de la Universidad de Brasilia (LaPCom), Intervozes y el Ncleo de Estudos Transdisciplinares de Comunicao e Conscincia da UFRJ (Netccon.UFRJ). De hecho, esta colaboracin fue relevante ya que, por primera vez, la Unesco cede la aplicacin de los IDM a tres instituciones colaboradoras: dos universidades privadas y una organizacin sin nimo de lucro en defensa de la democratizacin de la comunicacin. El seminario A Construo de Indicadores do Direito Comunicao no Brasil9, llevado a cabo en noviembre de 2009 en el auditorio de la Facultad de Comunicacin de la Universidad de Brasilia, fue el punto de partida de la aplicacin de los IDM en el entorno meditico brasileo. 81
* En los lugares marcados con un asterisco (*) el estudio no se ha realizado por UNESCO sino por Media Foundation for West frica y DANIDA en Benn y de Doha Centre for Media Freedom en Qatar. Fuente: UNESCO (201 3). Media Development Indicators Information Note. 57 encuentro de la oficina PIDC, 201 3.
N3
Para los integrantes del grupo de expertos elegidos para la aplicacin de los IDM en el entorno meditico brasileo la construccin de los indicadores no deba ser solamente un resultado sino, sobre todo, una gran experiencia destinada al proceso de construccin del dilogo que permitiese la superacin del dficit de comunicacin y democracia1 0, segn expres el representante del Netccom.URJ, Evandro Ouriques en dicho seminario. Una de las controversias que se plasmaron en el encuentro fue la importancia de la definicin de indicadores. En este sentido se posicion el coordinador de Relaciones Acadmicas de la Agncia de Notcias dos Direitos da Infncia (Andi), Fbio Senne: cmo medir los parmetros? Cmo pueden tener sentido dichos indicadores para nosotros?11 As, Senne sugiri que dichos indicadores deben ser formulados de forma simple, poniendo como ejemplo las tres dimensiones del ndice de Desarrollo Humano: riqueza, educacin y esperanza media de vida. Entre los documentos que sirvieron para realizar dicha aplicacin destacaron los propios de Unesco (2008) que, como ya se ha explicado, sugeran cinco categoras de indicadores para analizar el desarrollo meditico de un pas y, en segundo lugar, el informe Contribuies para a construo de indicadores do direito comunicao (201 0), elaborado por Intervozes con el apoyo de la Fundacin Ford y que organiza los indicadores teniendo en cuenta factores como la libertad de expresin, el pluralismo de los medios de comunicacin, etc. y del que ya se ha hablado previamente. Bolivia1 2 es otro de los pases que ya ha realizado la aplicacin de los IDM en su territorio. Fue durante el ao pasado, aunque an no ha sido posible publicar los resultados, segn afirma la coordinadora de Proyectos y Asistente de Programas del Sector de Comunicacin e Informacin de la Oficina multipas para Bolivia, Colombia, Ecuador y Venezuela de Unesco, Martha Baquero. En este caso, el proyecto fue suscrito entre la Consejera Regional de Comunicacin de UNESCO para los Pases Andinos y el Observatorio Nacional de Medios (ONADEM) de la Fundacin UNIR y cont con el aporte del consultor uruguayo Gustavo Gmez. La primera reunin del grupo consultivo, formado por 1 7 participantes1 3 representantes de gremios periodsticos de los medios privados, pblicos y comunitarios, as como representantes del gobierno y de la sociedad civil, fue realizada el 1 5 de agosto de 2011 en La Paz. Las investigaciones sobre el diagnstico del entorno meditico boliviano se programaron durante un ao de trabajo y fueron debatidas en la segunda reunin del grupo consultivo, que tuvo lugar entre el 25 de mayo y el 5 de junio de 201 21 4.
En Uruguay1 5 se ha organizado un grupo de universidades interesadas en realizar un estudio nacional de desarrollo meditico con los indicadores de Unesco y algunas adaptaciones. La propia Oficina Regional de la UNESCO en Montevideo est participando en ese grupo de investigacin. El pasado 1 4 de septiembre de 201 2, la directora general de la Unesco, Irina Bokova, visit durante tres das el pas uruguayo y, durante dicho periodo, el secretario de la Presidencia uruguayo, Alberto Breccia, expres que los conceptos manifestados por Bokova coincidan con la postura del Gobierno en sobre el derecho a la comunicacin, ejemplificndolo precisamente con el informe sobre IDM (Unesco, 2008). La ltima aplicacin de los Indicadores de Desarrollo Meditico de UNESCO en Latinoamrica comenz el 2 de febrero de 201 2 en Venezuela1 6, lamentablemente el ejercicio no pudo ser completado por la compleja situacin poltica del pas, segn Baquero. Segn la pgina web de Unesco el grupo estudi la metodologa a emplear en la aplicacin de los Indicadores de Desarrollo Meditico en Venezuela e hizo sugerencias y recomendaciones para garantizar su aplicacin rigurosa, lo cual refleja la pluralidad de perspectivas en este pas, a travs de la consultacin de fuentes fidedignas que tambin reflejen de manera cabal el estado de desarrollo de las cinco reas en cuestin: sistema regulador, pluralidad y diversidad meditica, aportes a un discurso democrtico y construccin de capacidades e infraestructuras (Unesco, 201 2, online). Sin embargo, el proyecto fue cancelado a solicitud de la institucin que coordinaba la investigacin, Medianlisis. Tras la primera y nica reunin del grupo consultativo formado por representantes del sector venezolano de la comunicacin: medios privados y comunitarios, universidades e instituciones acadmicas, funcionarios del gobierno, ONG en pro de la libertad de expresin, gremios profesionales, organizaciones de la sociedad civil y dems partes interesadas, comenz la evaluacin inconclusa del entorno meditico venezolano. La directora ejecutiva de Medianlisis, Elsa Cecilia Pia, explica que situaciones externas y ajenas a nuestra voluntad nos impidieron concluirlo. Sin embargo, aprendimos mucho de la experiencia. Actualmente trabajamos en un proyecto al que denominamos "Ranking de Medios Socialmente Responsables", el cual toma en cuenta varios aspectos de los IDM.
Apuntes finales
Ecuador, Brasil, Bolivia, Uruguay y Venezuela han sido los primeros pases latinoamericanos en analizar sus respectivos entornos mediticos a travs de los Indicadores de Desarrollo Meditico de Unesco. Segn la organizacin internacional, el objetivo de dichos anlisis es crear un instrumento que servir como referencia 82
N3
para la planificacin de proyectos y polticas pblicas, asimismo podr contribuir a mejorar los esfuerzos de las organizaciones y donantes internacionales permitiendo una mejor identificacin de las necesidades del sector meditico y facilitando la medicin del impacto de sus intervenciones en este campo (Unesco, 2011 , online). Sin embargo, el proceso de diagnstico de los diversos entornos mediticos latinoamericanos es an incipiente y debe ser programado con el nico propsito de realizar series temporales y estudios comparados puesto que, sin dicha finalidad, cualquier tipo de indicador meditico-cultural pierde su razn de ser. Notas 1 . Nas batalhas pela hegemona, a centralidade dos meios de comunicao tornase decisiva, visto que eles elaboram e disseminam informaes e ideias que concorrem para a formao do consenso em torno de determinadas concepes de vida (de Moraes, 201 3, p. 7) (traduccin propia) 2. El Colectivo Intervozes es conocido internacionalmente al estar asociado a la bandera histrica del derecho a la comunicacin, que tiene su origen en las discusiones realizadas por Unesco en las dcadas de los 60 y 70 del siglo pasado sobre el Nuevo Orden Mundial de la Informacin y la Comunicacin y sobre la necesidad de polticas nacionales de comunicacin. (Csar Ramos, 2007, p. 46) 3. Esta campaa fue la fase preparatoria de la Cumbre Mundial sobre la Sociedad de la Informacin (CMSI) y tuvo como objetivo promover un enfoque de derechos como alternativa a la visin tecnolgica. (Len, 201 3, p. 23) 4. Socilogo, filsofo e investigador, cuando escribi el artculo al que se hace referencia era inspector general del Ministerio de Cultura y Comunicacin de Francia. 5. El objetivo de UNESCO es el de contribuir a la paz y al bienestar social, promoviendo la colaboracin entre las naciones a travs de la educacin, la ciencia y la cultura, con el fin de asegurar el respeto universal de la justicia, la ley, los derechos humanos y las libertades fundamentales para todos, sin distincin de raza, sexo, lengua o religin que la carta de Naciones Unidas reconoce a todos los pueblos. 6. Para consultar la Resolucin 1 636 del Consejo de Europa (2008). Indicators for media in a democracy: http://assembly.coe.int/main.asp?Link=/documents/adoptedtext/ta08/eres1 636.htm. 7. En Ecuador, la Constitucin aprobada el 28 de septiembre de 2008 contempla el reconocimiento de la comunicacin como un derecho humano fundamental pero la Ley de Comunicacin que desarrolla los principios constitucionales califica a los
grandes medios empresariales como ley mordaza. (Len, 201 3, 1 5) Para ms informacin consultar Comisin Especializada Ocasional de Comunicacin de la Asamblea Nacional de Ecuador. (201 0, 1 de julio) 8. En Brasil el debate por la democratizacin de la comunicacin se fomenta desde diversos sectores de la sociedad, como se represent en 2009 en la Conferencia Nacional de Comunicacin (Confecom), que concluy con la aprobacin de 665 propuestas. 9. El encuentro cont con la presencia de especialistas, profesores, representantes del gobierno, de instituciones y alumnos entre los que destacaron el coordinador del rea de Comunicacin e Informacin de Unesco en Brasil, Guilherme Canela; Sayonara Leal, del LaPCom-UnB; Csar Bolao, de la Asociacin Latinoamericana de Investigadores de la Comunicacin (LaPCom/ALAIC); Evandro Ouriques, del Netccon.UFRJ y Bia Barbosa y Joo Brant, del Colectivo Intervozes. 1 0. Traduccin propia de la declaracin de Evandro Ouriques: Considero que a construo de indicadores seja, no somente a obteno de um resultado, mas, sobretudo, uma grande experincia focada no processo da construo do dilogo e que permita a superao do dficit de comunicao e democracia, disse o representante do Netccon.UFRJ, Evandro Ouriques, recogida por Unesco Brasil, consultada el 28 de diciembre de 201 2, http://www.unesco.org/new/pt/brasilia/aboutthis-office/singleview/news/seminar_to_discuss_the_right_to_communication_indicators_in_brazil/. 11 . Traduccin propia de la declaracin de Fbio Senne recogida por Unesco: Como medir os parmetros? Como os indicadores podem fazer sentido para ns?, consultada el 28 de diciembre de 201 2, http://www.unesco.org/new/pt/brasilia/aboutthis-office/singleview/news/seminar_to_discuss_the_right_to_communication_indicators_in_brazil/. 1 2. La constitucin boliviana reconoce la comunicacin como un derecho humano y el 8 de agosto de 2011 se promulg la Ley General de Telecomunicacin. Tecnologas de Informacin y Comunicacin, que, entre otras disposiciones, estableci la distribucin del espectro radioelctrico en los siguientes trminos: 1 . Estado, hasta el treinta y tres por ciento. 2. Comercial, hasta el treinta y tres por ciento. 3. Social comunitario, hasta el diecisiete por ciento. 4. Pueblos indgenas originario campesino, y las comunidades interculturales y afrobolivianas, hasta el diecisiete por ciento. 1 3. A la mencionada reunin asistieron representantes de la Asociacin Boliviana de Radiodifusoras (ASBORA), Asociacin Nacional de la Prensa de Bolivia (ANPB), Confederacin Sindical de Trabajadores de la Prensa de Bolivia (CSTPB), Educacin Radiofnica de Bolivia (ERBOL), Servicio de Capacitacin en Radio y Televisin para el Desarrollo (SECRAD) de la Universidad Catlica Boliviana San Pablo, Red TIC 83
N3
Bolivia, Asociacin Boliviana de Investigadores de la Comunicacin (ABOIC), Comisin Nacional Boliviana de Cooperacin con la Unesco, Ministerio de Comunicacin, Programa de Apoyo a la Democracia Municipal (PADEM), Asociacin de Periodistas de La Paz (APLP), Asociacin Mundial de Radios Comunitarias (AMARC), Consejo Nacional de tica Periodstica (CNEP), Tribunal Nacional de tica Periodstica, Asociacin Boliviana de Carreras de Comunicacin Social (ABOCCS), Red Minera de Radio y Televisin, Agencia Nacional de Noticias por los Derechos de la Infancia (ANNI). 1 4. A dicha reunin asistieron Fidel lvarez de la Red TICs Bolivia, Jos Luis Aguirre del SECRAS-UCB La Paz, Mara Eugenia Verstegui del Consejo Nacional de tica Periodstica (CNP), Ral Novillo de la Asociacin Boliviana de Radiodifusoras (ASBORA), Juan Len de la Asociacin Nacional de la Prensa (ANP), Juvi Molina de la Asociacin Boliviana de Carreras de Comunicacin Social (ABOCCS), Mario Maldonado impulsor del Tribunal Nacional de tica Periodstica (TNP), Jos Luis Espaa del Programa de Desarrollo Municipal (PADEM), Claudio Rossel del Ministerio de Comunicacin, Ramiro Echaz de la Confederacin Sindical de Trabajadores de la Prensa de Bolivia, Augusto Pea de ERBOL y Reyna Mojica de la Asociacin de Periodistas de La Paz. 1 5. Las normas del Servicio de Radiodifusin Comunitaria en Uruguay son reconocidas por Osvaldo Len (201 3, 1 4) como medidas democratizadoras, a travs de la sancin de la Ley 1 8232 de diciembre de 2007, por la que se establecen las emisoras comunitarias al menos un tercio de las frecuencias disponibles en todas las bandas de radio y televisin analgicas y digitales. 1 6. En diciembre de 2005 se sancion la Ley de Responsabilidad Social de la Radio y la Televisin (conocida como Ley Resorte) y otras polticas en las que se fomentan los medios pblicos y comunitarios.
- Brasil, Intervozes (201 0). Contribuies para a contruo de indicadores do direito comunicao. San Paulo. Intervozes. - Carrasco, S. (1 999). Indicadores Culturales: Una Reflexin. Consultado el 1 8 de agosto de 2009. Consultado el 7 de enero de 201 3 en: http://www.uv.es/~carrascs/PDF/indicadoresCult.pdf. - Comisin Especializada Ocasional de Comunicacin de la Asamblea Nacional de Ecuador. (201 0, 1 de julio). Informe de mayora para segundo debate del Proyecto de Ley Orgnica de Comunicacin. Consultado el 9 de marzo de 201 3 en: http://documentacion.asambleanacional.gov.ec/alfresco/d/d/workspace/SpacesStore/
dbad6446-e0b1 -4456-966a1 f4d89479963/Ley%20Org%C3%A1 nica%20de%20Comunicaci%C3%B3n. - De Frutos R. (2011 ). Indicadores de libertad de expresin: un sistema eficaz. III Congreso Internacional Latina de Comunicacin Social, III CILCS, Universidad de La Laguna, diciembre, 2011 . ISBN: 978-84-939337-6-0. - De Moraes, D. (2011 ). Voces Abertas da Amrica Latina. Estado, polticas pblicas e democratizao da comunicao. Rio de Janeiro. Mauad X y Faperi. - Daz Nosty, B. (2005). El dficit meditico. Donde Espaa no converge con Europa. Barcelona. Editorial Bosch. - Daz Nosty, B. (2006). Repensar la comunicacin. La huella es el mensaje. Tendencias, pp. 1 5-43. Consultado el 08 de enero de 201 3 en: http://www.infoamerica.org/TENDENCIAS/tendencias/tendencias06/pdfs/02.pdf. - Edouard, F. (2011 ). Anlisis del Desarrollo Meditico en Ecuador - 2011 . Quito. UNESCO. - Galeano, E. (2003). Las venas abiertas de Amrica Latina. Barcelona. Siglo XXI de Espaa. 1 edicin: 1 972. - Galeano, E. (Entrevista de Ana Delicado). Amrica Latina est exorcizando la cultura de la impotencia: Escritor e intelectual uruguayo. Elogia un redescubrimiento latinoamericano que busca recuperar la dignidad y la diversidad. Pblico. Madrid, 3 de enero 201 0. - PNUD (2004). La democracia en Amrica Latina. Hacia una democracia de ciudadanas y ciudadanos. Buenos Aires. Alfaguara, S.A. - Tolila, P. (201 0). Qu es un indicador ? Problemtica general, historia, usos y lmites. En Consejo Nacional para la Cultura y las Artes de Mxico (CONALCULTA). Seminario construccin de indicadores de desarrollo cultural comunitaria. Ciudad de Mxico. Consultado el 27 de diciembre de 201 2 : http://issuu.com/flyoscar/docs/libro. - Torrico, E. (2009). La observacin meditica como insumo para polticas de comunicacin intercultural. Seminario Periodismo, tica y democracia. Quito, 20-22 de octubre de 2009. Consultado el 2 de febrero de 201 3 en : http://es.scribd.com/doc/26685844/Ponencia-CIESPAL-Erick-Torrico. - UNESCO (2008). Indicadores de Desarrollo Meditico: Marco para evaluar el desarrollo de los medios de comunicacin social. Paris: Unesco. - UNESCO (201 3). Media Development Indicators Information Note. 57 encuentro de la oficina PIDC, 201 3. - Vidal-Beneyto, J. (Ed.). (2006). Derechos humanos y diversidad cultural. Globalizacin de las culturas y derechos humanos. Barcelona. Icaria Editorial.
84
Transversal Studies
Daniel Lpez
Section 3
N3
Research Papers. Section 3. Transversal Studies
Importancia del Psiclogo en Pacientes Infectados con VIH/SIDA. Estudio del Caso de Dajabn, Repblica Dominicana.
Resumen: El VIH/SIDA es una de las enfermedades ms difciles de tratar, y actualmente
est considerada una de las ms delicadas a la hora de establecer un tratamiento. El objetivo general de esta investigacin es destacar la importancia que tiene un psiclogo a la hora de tratar personas afectadas por VIH/SIDA. Este estudio se realiza en Dajabn, en la zona fronteriza de Repblica Dominicana y Hait.
Importance of Psychologist in Patients Infected with HIV/AIDS. Case Study Dajabn, Dominican Republic.
Abstract: HIV/AIDS is one of the most difficult diseases to treat, and is currently
considered one of the most delicate when treatment instituted. The main objective of this research is to highlight the importance of a psychologist when treating people affected by HIV/AIDS. This study is conducted in Dajabn, on the border of the Dominican Republic and Haiti.
Palabras clave: SIDA, VIH, Psiclogo, Dajabn, Repblica Dominicana
Keywords: AIDS, HIV, Psychologist, Dajabon, Dominican Republic
Francisco Orgaz Agera

Docente e Investigador en Universidad Tecnolgica de Santiago, UTESA (Repblica Dominicana). Doctorando en Turismo en Universidad de Sevilla (Espaa) e-mail: franorgaz@hotmail.com / web: www.twitter.com/franorgaz
Eugenia Cruz
Estudiante de Licenciatura en Psicologa en Universidad Tecnolgica de Santiago, UTESA (Repblica Dominicana) e-mail: eugenia_cruz_1 2@hotmail.com
86
N3
I ntroduccin
El virus de la inmunodeficiencia humana (VIH) es una enfermedad zoontica, causante de la enfermedad del SIDA. En este caso, se dice que alguien padece de SIDA cuando su organismo no es capaz de ofrecer una respuesta inmune adecuada contra las infecciones, debido a la inmunodeficiencia provocada por el VIH. Es una de las enfermedades ms difciles de tratar, y hoy en da est considerada una de las ms delicadas a la hora de establecer un tratamiento, por diversos factores, pero donde destacan los psicolgicos y sociales, y que provocan nmeros efectos negativos que incluso pueden llevar a la muerte. El objetivo general de esta investigacin es destacar la importancia que tiene un psiclogo a la hora de tratar personas afectadas por VIH/SIDA en Dajabn. Los objetivos especficos son: Destacar la importancia de la asistencia psicolgica para las personas infectadas; determinar el nmero de personas que estn infectadas y que acuden a tratamiento en Dajabn; identificar los principales problemas psicolgicos y sociales que tiene un paciente; determinar de cules recursos dispone el hospital de Dajabn para tratar a los pacientes; e identificar el tipo de atencin que reciben los pacientes infectados en el hospital de Dajabn. El origen de esta investigacin est en el trabajo de campo desarrollado en el hospital de Dajabn por parte de uno de los autores de esta investigacin, y su posterior presentacin en el monogrfico para optar al ttulo de Licenciado en Psicologa de la Universidad Tecnolgica de Santiago (UTESA) en el recinto Dajabn. Las partes que componen esta investigacin son: Revisin de la literatura, descripcin del rea de estudio, metodologa, resultados, conclusiones y bibliografa.
Por el contrario si se ha investigado sobre otro tipo de problemticas relacionadas con la salud en esta provincia: Asma bronquial (Rowland et al., 1 998), de hbito tabquico (Olivero et al., 2002) o de la problemtica de los mosquitos (Mekuria et al., 1 990). En este sentido queremos contribuir al conocimiento del VIH/SIDA en la provincia de Dajabn, as como dijimos anteriormente en los objetivos, establecer tambin la importancia que tiene un psiclogo a la hora de tratar esta enfermedad en infectados por VIH/SIDA, en concreto en los pacientes que acuden a tratamiento al hospital de esta provincia: Hospital Ramn Matas Mella.
rea de estudio
El rea de estudio de esta investigacin es la provincia de Dajabn. La provincia de Dajabn forma parte de la regin Cibao Noroeste y tiene una superficie total de 1 .009 km. Limita al norte con Montecristi, al este con Santiago Rodrguez, al sur con Elas Pia y al oeste con la Repblica de Hait. La mitad sur de la provincia est ocupada por la Cordillera Central. El principal ro es el Dajabn o Masacre, que sirve como lnea fronteriza desde la ciudad de Dajabn hasta su desembocadura. Este ro nace en territorio dominicano y se convierte en fronterizo algunos kilmetros antes de desembocar en la Baha de Manzanillo. La provincia de Dajabon est constituida por cinco municipios: Dajabn, Loma de Cabrera, Partido, Restauracin y El Pino, y cuatro distritos municipales: Capotillo, Caongo, Santiago de la Cruz y Manuel Bueno. Segn el Informe Final del Programa Art-Gold del PNUD de 2009, el 46% del territorio de la provincia est dedicado a la agricultura, el 27% son bosques (entre bosque confero abierto, bosque seco y nublado), el 1 9% matorrales y el 7% pastos. Mientras que el 7.1 6% del territorio de la provincia corresponde a reas protegidas, cuyo peso equivale solo al 0.71 % nacional y al 1 .7% de territorio boscoso. En lo referente a la economa de Dajabn, como en todas las provincias fronterizas del pas, existe poco desarrollo econmico en general. La actividad principal hace referencia al mercado fronterizo. del municipio de Dajabn. El sector financiero general (bancos, cooperativas, prestamistas, remesas y casas de cambio) se ven beneficiados ampliamente por la existencia del comercio de este mercado binacional. Tambin podemos destacar la agricultura, donde predominan los cultivos de arroz, y la ganadera. Existen tambin empresas extranjeras que explotan 87
Revisin de la literatura
Muchos han sido los investigadores y acadmicos que han intentado aportar algo a la sociedad referente al VIH/SIDA (Berer y Ray, 1 993; Bays, 1 995; Castilla y De La Fuente, 2007; Gatell et al., 201 0). Pero hasta ahora no se han encontrado nada referente al estudio de esta problemtica en Dajabn, ciudad objeto de estudio en este trabajo.
N3
recursos mineros y desarrollan proyectos tursticos y agroindustriales en la zona fronteriza. Por otro lado, la provincia de Dajabn cuenta con un hospital provincial, en el cual se desarrollar la metodologa referente al trabajo de campo de esta investigacin. Este hospital se encuentra en el municipio de Dajabn. El hospital cuenta con diversas reas y zonas: rea de tuberculosis (TB); rea de VIH/SIDA; rea de planificacin familiar; zona de aislamiento; unidad de adolescencia; zonas de emergencia; rea de odontologa; rea administrativa; sala de seguro SENASA; zona de cocina; farmacia; laboratorio; cafetera; y parqueo. En este hospital existen diferentes salas para atender a los pacientes: Sala de parto; sala de pre y posparto; sala de ciruga; sala de emergencia; sala de ingreso; sala de nios; sala de espera; y baos. Por ltimo, debemos resaltar que el Ministerio de Salud Pblica de Repblica Dominicana ha estado trabajando en los ltimos aos en la mejora de las instalaciones del Hospital Ramn Matas Mella de Dajabn con el objetivo de garantizar una mejor calidad e higiene a favor de los usuarios, enfatizando en el logro de la calidad y humanizacin de los servicios. En este sentido, la Organizacin Panamericana de la Salud (OPS) seleccion en 2011 este hospital como el ms limpio de la frontera dominico-haitiana.
El universo de esta investigacin est compuesto por 51 2 pacientes infectados con VIH/SIDA, de los cuales se tom una muestra al azar de 38 pacientes voluntarios, tras la realizacin de una frmula. Hemos utilizado un nivel de confianza del 80% para un error de la muestra del 1 0%, debido a que no todos los pacientes estaban interesados en participar y la investigacin se haca difcil a un error de la muestra menor. Hay que tener en cuenta que no todos los pacientes se sienten cmodos hablando de esta enfermedad y buscan hablar lo menos posible de ellos con terceras personas. Las encuestas se han desarrollado durante la ltima semana de febrero de 201 3, aprovechando una actividad dirigida a los pacientes infectados con VIH/SIDA en el Hospital Ramn Matas Mella de Dajabn.
Tabla 1 . Ficha metodolgica.
Metodologa
En esta investigacin utiliza fuentes secundarias para la revisin de la literatura y la explicacin del rea de estudio, y fuentes primarias, en concreto trabajo de campo, para desarrollar las encuestas que darn respuesta a los objetivos de esta investigacin. En este sentido, podemos definir la encuesta como una investigacin realizada sobre una muestra de sujetos representativa de un colectivo ms amplio, que se ejecuta en el contexto de la vida cotidiana, utilizando procedimientos estandarizados de interrogacin, con el fin de obtener mediciones cuantitativas de una gran variedad de caractersticas objetivas y subjetivas de la poblacin (Garca Ferrando et al., 1 993). La encuesta que se utiliza en este trabajo est formada por 1 0 preguntas, que nos ayudaran a responder los objetivos que se propuso con esta investigacin .
Fuente: Elaboracin propia Resultados de la Investigacin

El 58% de los encuestados expres que padece la enfermedad del VIH/SIDA desde hace ms de 1 5 aos. El 1 3% afirma que tiene esta enfermedad desde hace 6-1 0 aos y el mismo porcentaje asegura que la padecen desde hace 11 -1 5 aos. El 1 6% restante aseguran que poseen el VIH/SIDA desde hace 5 o menos aos. En cuanto al tipo de asistencia psicolgica, el 79% de los encuestados afirman que reciben evaluaciones psicomtricas, que incluye tanto la terapia individual como la familiar. Por su parte, un 1 6% recibe solamente terapia individual y un 5% solo terapia familiar. Por otro lado, el 61 % de los encuestados afirman que todas las personas de 88
N3
su entorno conocen su enfermedad frente a un 26% que dicen que solamente algunos la conocen. Existen un 1 3% que sealan que ninguno de sus amigos y familiares conocen que padecen el VIH/SIDA. El 42% de los encuestados son rechazados por las personas que les rodean frente a un 34% que son aceptados. Existen un 24% que afirman que le es indiferente el trato de las personas que le rodean. En cuanto a la importancia del psiclogo, el 1 00% de los encuestados afirma que es importante la labor de este profesional a la hora de tratar la enfermedad del VIH/SIDA en pacientes infectados por este virus. Un 37% de los encuestados afirma que el VIH/SIDA produce estados depresivos con ideas de suicidio. Justo detrs, con un 26% aparece el problema del aislamiento. Un 1 3% afirma que esta enfermedad provoca ruptura de las relaciones socio-laborales y familiares. Un 5% y un 3% afirman que produce un alto nivel de estrs y ansiedad acumulado, y un aumento de la violencia familiar, respectivamente. Por ltimo, un 1 6% de los encuestados afirman que el VIH/SIDA genera todos los problemas citados anteriormente. El 66% de los encuestados afirman que el deterioro de la autoestima es una de las caractersticas de una persona con VIH/SIDA. Un 1 0% responden que la negacin y un 8% la apata. Por ltimo, el 1 6% dicen que todas las anteriores son caractersticas de una persona enferma con este virus, es decir, que tanto el deterioro de la autoestima, la negacin y la apata se conforman como algo presente en personas infectadas por este virus. Un 76% de los encuestados tiene constancia de que el hospital de Dajabn dispone de un departamento de psicologa. Un 1 6% y un 8% afirman que ofrece educacin permanente sobre salud sexual y que tiene normas de seguridad e higiene, respectivamente, pero desconocen el departamento psicolgico que apoya a personas con VIH/SIDA. El 58% de los encuestados afirman que reciben del personal que atienden a los afectados de VIH/SIDA en el hospital de Dajabn una atencin personalizada, frente al 39% que dicen que la atencin recibida es integral. Por ltimo aparece un 3% que indican que existe un distanciamiento entre personal y paciente. Por ltimo, un 45% de los encuestados afirman que el paciente debe
apegarse al tratamiento. Un 1 3% dicen que los pacientes deben tener una actitud comprometida y responsable. Tambin, existe un 42% que indican que el paciente, adems de tener una actitud comprometida y apegarse al tratamiento, debe recibir apoyo moral.
Conclusiones
Las conclusiones que ofrece este trabajo son claras en la mayora de los casos. En primer lugar observamos como la mayora de pacientes tiene el VIH/SIDA desde hace ms de 1 5 aos. Esto nos deja entrever que el VIH/SIDA en Dajabn no es algo nuevo, si no que lleva tiempo, y hay muchas personas que lo padecen desde hace muchos aos. Por otro lado, ms de la mitad de los infectados han mostrado su enfermedad a todas las personas de su cercana, y no tienen miedo a mostrarla. Aunque existe un alto nmero de pacientes (42%) que se sienten rechazados por las personas que les rodean y conocen su enfermedad. La totalidad de los pacientes que han participado en esta investigacin afirman que es importante la labor de un psiclogo a la hora de intervenir en la enfermedad del VIH/SIDA en los pacientes infectados por este virus. As se confirma al psiclogo como un elemento fundamental e importante a la hora de tratar personas afectadas por el VIH/SIDA que acuden al hospital Ramn Matas Mella del municipio de Dajabn. En este sentido, resolvemos el principal objetivo de esta investigacin, y mostramos que los pacientes creen necesaria su intervencin para tratar su enfermedad. El psiclogo es importante para tratar los estados depresivos con ideas de suicidio, el aislamiento y el deterioro de la autoestima, que son los tres elementos que provoca el VIH/SIDA en los pacientes infectados en la provincia de Dajabn. Por su parte, el hospital de Dajabn dispone de un departamento de psicologa, que se ocupa a travs de sus psiclogos, de organizar talleres sobre salud sexual y reproductiva. Tambin, este departamento, ha establecido unas normas de seguridad e higiene para todos los pacientes infectados de VIH/SIDA. Lo que refleja la investigacin es que no todos los pacientes conocen que existe este departamento o que los psiclogos que imparten los talleres pertenecen al mismo. En este sentido, es fundamental la promocin de este departamento y la puesta en marcha de un Plan de Actividades que le otorgue ms fuerza y reconocimiento a este departamento en la ciudad de Dajabn. 89
N3
La mayora de los pacientes reciben del personal que atienden a los afectados de VIH/SIDA en el hospital de Dajabn una atencin personalizada. Para un elevado grupo (45%), el tratamiento es muy importante para tratar la enfermedad, aunque muchos pacientes (42%) creen que se debe tener una actitud comprometida y recibir apoyo moral. Por ltimo, y segn los objetivos de esta investigacin, comprobamos que el Hospital Ramn Matas Mella de Dajabn recibe actualmente 51 2 personas infectadas por VIH/SIDA, y que dispone de numerosas salas y departamentos para poder ofrecer un buen servicio a todos estos pacientes que luchan da a da por mejorar su enfermedad. Como conclusin final, observamos que el psiclogo es importante a la hora de tratar personas infectadas con VIH/SIDA. El trabajo de estos profesionales es fundamental no solo en esta provincia, si no en todos los dems consultorios del pas y otros pases, para tratar a personas que quedan traumatizadas al enterarse que padecen esta enfermedad, y ms an durante la etapa de tratamiento de los pacientes, que es cuando ms problemas psicolgicos pueden aparecer en los infectados.
- Mekuria, Y.; Tidwell, M.A.; Williams D.C., & Mandeville, J.D., (1 990): Bionomic studies of the Anopheles mosquitoes from Dajabon, Dominican Republic. En: Journal of the American Mosquito Control Association, Vol. 6, pp. 651 -657. - Olivero, N.; Garca, A.; Soto, G.; Reyes, W. & Reyes E., (2002): Frecuencia y descripcin del hbito tabquico entre escolares del municipio de Dajabn. En: ADOERBIOOOI, Vol.63, N 3, pp. 282-284. - Rowland Cruz, C. M.; Soto, N.; Comas U. O. A. & Galarza, L., (1 993): Incidencia de asma bronquial en la clnica rural Manano Cestero de la Provincia Dajabn. En: ADOERBIO 001 , Vol. 59, N. 3, pp. 1 97-1 99.
BIBLIOGRAFIA
- Bayes R., (1 995): SIDA y psicologa. Barcelona: Martnez Roca. - Berer, M., & Ray S., (1 993): Women and HIV/AIDS: An international resource book. London: Pandora Press. - Castilla J. & De La Fuente, L. (2000): Evolucin del nmero de personas infectadas por el virus de la inmunodeficiencia humana y de los casos de sida en Espaa: 1 9801 988. Med Clin: Barcelona. - Garca Ferrando, M.; Ibez J. & Alvira F., (1 996): El anlisis de la realidad social. Mtodos y tcnicas de investigacin. Madrid: Alianza Universidad Textos. - Gatell J. M.; Zulaica, D.; Del Romero, J. & Robledo T., (201 0): Cmo promover y facilitar el diagnstico precoz de la infeccin por el VIH-1 . Enf Emerg.
90
N3
Prevenir o Educar? Una Aproximacin a la 1 Gestin de Placeres y Riesgos

Resumen: La educacin en materia de drogas no debe basar sus planteamientos en la
abstencin o la prevencin como nicas respuestas ante la relacin con las drogas, ni en los aspectos negativos como nica manera de definirlas. Parece evidente que tras muchos aos de trabajo en este sentido, el consumo de drogas sigue prevaleciendo e incluso aumente en determinados contextos. Cuando existen colectivos o personas que voluntariamente deciden consumir drogas, e incluso las incorporen a su estilo de vida, el discurso prevencionista se vaca de sentido y carece de utilidad, perdiendo los que mantienen estas posiciones toda la legitimidad ante aquellos usuarios que no presentan consumos problemticos. Es en este punto en el que se deben reforzar las pautas y valores que posibiliten una adecuada formacin e informacin sobre el tema, tanto entre los usuarios como entre los profesionales de la salud y lo social, reforzando acciones como las que desarrollan colectivos como Energy Control, extendindolas ms all de los espacios de ocio e incorporndolas a estrategias educativas especficas.
To Prevent or to Educate? A Close-up on the Pleasures and Risks Management

Abstract: Drug education should not be based on its abstention or prevention as the only
way to relate to drugs, nor on the negative aspects of drugs to define it. It seems evident that after many years of work on this subject, drug use still prevails and keeps increasing in particular contexts. When a group of people or a single person decides to consume any drug, or even incorporate it to their lifestyle, the preventive speech becomes pointless and useless, losing all their legitimacy in front of the consumers who dont have problems with drug abuse. Is in this point in which we should reinvent and strengthen the standards and values we have created to educate and inform about this subject, given it to consumers and/or healthcare professionals, reinforcing groups such as Energy Control, taking them from only being in social gatherings to be part of educational strategies
Key words: drugs, prevention, consume, trance, risks reduction, pleasure and risks
management.
Palabras claves: drogas, , prevencin, consumo, trance, reduccin de riesgos, gestin

de placeres y riegos.
Jos Ignacio Bozano Herrero

Doctorando en Antropologa Social y Cultural, Facultad de Geografa e Historia, Universidad de Sevilla. e-mail: josbozher@gmail.com
91
N3
Introduccin
Resulta dificultoso establecer una definicin de lo que es droga en un sentido general, y este es ya un punto de partida conflictivo que complica la gestin de las diferentes situaciones que se relacionan con ella. Para ser capaces de entender la polisemia existente en este trmino hemos de atender al contexto en el que se inserta, esto es, en funcin de quin lo defina encontraremos multitud de acepciones diferentes, e incluso algunas que coinciden en sus trminos pero que les separan matices insalvables que hacen de esta una cuestin de gran complejidad en el que las posturas, definidas a base de intereses, se encuentran enfrentadas. En este sentido, es fundamental que seamos capaces de aceptar la existencia de percepciones positivas sobre las drogas y relaciones no problemticas con estas, esto es, de personas que valorizan su uso como algo deseable, algo que les reporta experiencias efectivas, y cuyo consumo no implica deficiencias en sus relaciones sociales ni en su vida cotidiana. Es en este punto en el que debemos plantearnos la poca eficacia de la generalizacin de los discursos y las estrategias abstinenciales, pues en el momento en el que existe gente que decide consumir drogas ya poca utilidad mantienen los alegatos en favor del "NO", con lo que el peso de las acciones deben centrar esfuerzos en ofrecer formacin e informacin sobre las diferentes sustancias, en definitiva, en educar en ciertas pautas y valores para tratar de prevenir problemas y ofrecer a las personas las herramientas necesarias para poder gestionar sus consumos de una manera autnoma y responsable. El presente artculo surge a partir de un trabajo de investigacin que pretende analizar las disonancias existentes entre los discursos y prcticas en materia de drogas que sostienen las distintas administraciones y entidades afines a estos posicionamientos, y las que sostienen aquellos individuos o colectivos que realizan uso de estas sustancias. Ante la imposibilidad de ponderar todas y cada una de las diferentes posiciones, nuestro inters etnogrfico se centra en un movimiento cultural concreto que defiende el uso de las drogas y las utiliza como mecanismos vlidos de experimentacin y autoconocimiento, el cual tomaremos como ejemplo paradigmtico en cuanto a lo que a consumo de drogas se refiere aunque es extensivo a muchos otros contextos diferentes en los que prevalece un consumo de drogas recreativo. Nos estamos refiriendo al movimiento relacionado con la msica trance 2, que viene desarrollndose en Andaluca desde principios del 2000, y que tiene en las raves 3 su mayor expresin cultural y su principal espacio de interaccin y construccin de identidad grupal. As, el hecho de conocer y reconocer la existencia de estas diferentes actitudes debe servirnos para desarrollar estrategias educativas adaptadas a las diferentes situaciones que se dan en cuanto al uso de
este tipo de sustancias. No debemos limitarnos a lo superficial y concluir que la nica accin adecuada es la encaminada a separar los factores de riesgo de la poblacin, lo que resulta la base de las acciones prevencionistas tal y como expone Roman (2008), pues estaramos condenando al ostracismo y por ende a situaciones de vulnerabilidad, a aquellos individuos que deciden conscientemente consumir drogas, dejndolos desprotegidos, negndoles su derecho a informarse adecuadamente de todos aquellos aspectos que sean relevantes a la hora de relacionarse con estas, y sin los cuales la problemtica asociada sera, en definitiva, mucho mayor. Del mismo modo, se acredita un grave desconocimiento por parte de muchos profesionales de la salud y lo social sobre el panorama actual de las drogas, que muchas veces extrapolan los estereotipos extendidos desde el discursos hegemnico a su labor profesional.
Fundamentacin terica
Por droga (psicoactiva o no) seguimos entendiendo lo que hace milenios pensaban Hipcrates y Galeno, padres de la medicina cientfica: una sustancia que en vez de "ser vencida" por el cuerpo (y asimilada como simple nutricin) es capaz de vencerle, provocando (en dosis ridculamente pequeas si se comparan con las de otros alimentos) grandes cambios orgnicos, anmicos o de ambos tipos (Escohotado, 1 996: 9). Si atendemos pues a esta definicin podramos englobar sustancias categorizadas de una manera tan dispar como el tabaco, el alcohol, la morfina, la aspirina, la anfetamina, el xtasis, etc. Como vemos, la nica caracterstica que comparten es la presentada en la definicin de Escohotado (Ibid.), pero entonces, a qu se debe la pluralidad de significados que se les otorga cuando nos referimos a cada una de ellas en particular? Esta pregunta nos hace volver sobre la variable cultural, es decir, sobre el significado que estas sustancias tengan en grupos determinados.
La definicin de droga, por lo tanto, es algo que depende del contexto social y cultural en el que se inserta, y es que como expone Furst (1 980), existe una interrelacin entre naturaleza y cultura en el uso de sustancias psicoactivas en los distintos grupos humanos. Su definicin es de carcter arbitrario y variar, no ya slo en funcin del uso y significado que cada pueblo pueda otorgarle, sino que en el seno de sociedades como la nuestra encontramos posiciones tan alejadas como irreconciliables. Y es que en general, el debate sobre las drogas est atravesado por la dialctica del bien y del mal, de lo permitido y de lo prohibido, de lo legal y lo ilegal, y es que en nuestra sociedad la posibilidad de establecer los atributos negativos o positivos de estas sustancias dependen directamente del poder 92
N3
hegemnico, que a travs de instituciones oficiales, organismos afines y medios de comunicacin promueven eso que Escohotado (1 996) define como farmacracia, esto es, el monopolio sobre este tipo de sustancias an cuando son deseadas por otros. Esta idea se relaciona con el Modelo Mdico Hegemnico (MMH), que Menndez (1 998) define como un poder que regula y controla la salud pblica, entendida esta desde parmetros establecidos por este mismo poder, que deja de pertenecer a los individuos para convertirse en una forma de control. Por lo tanto, las administraciones desde su posicin privilegiada promueven una posicin con respecto a las drogas, sobre la que dirigen todos sus esfuerzos: la abstencin. En Espaa, la administracin central pone en juego a travs del PNSD 4 las polticas y herramientas para gestionar la cuestin de las drogas, siempre bajo los preceptos marcados a nivel europeo, y tambin en los niveles autonmico y local. Lo nico que se contempla es la cuestin problemtica, que existe, pero se obvian otro tipo de dimensiones, como la cultural, e incluso otro tipo de formas de afrontar la cuestin, lo que quizs supondra una mejor estrategia para minimizar los conflictos relacionados con el uso de drogas. Por otro lado, tambin se evitara la apricin de nuevos problemas, pues en el seno de los discursos y prcticas abstencionistas se producen una serie de efectos perversos, tal como los enunciara Boudon (1 980), esto es, las administraciones al querer erradicar el problema de la droga sin atender a la voluntad de los actores, consigue el resultado opuesto, generando una problemtica asociada a las drogas que va desde la persecucin y criminalizacin de los usuarios 5, pasando por la desproteccin de la salud de los consumidores, la desatencin de sus requerimientos y derechos, hasta la aparicin y consolidacin de mafias que controlan el mercado de estas sustancias. La sociedad civil, representada a travs del tejido asociativo, acepta mayoritariamente esta idea de las drogas como elemento de conflicto y contaminacin simblica, por lo que las actuaciones de estas asociaciones subvencionadas por las distintas administraciones pblicas van dirigidas casi exclusivamente a tratar aspectos tales como la rehabilitacin, la asistencia, la prevencin. Aunque es cierto que en el plano administrativo surgen algunas contradicciones en cuanto a la perspectiva que institucionalmente se ofrece de las drogas y el trabajo de algunas asociaciones que, en sus planteamientos ms bsicos, difieren del anlisis de la situacin que se realiza desde los poderes pblicos, desechando el mensaje emanado desde estas instancias, a saber: la abstencin total. Tomaremos aqu como ejemplo paradigmtico el programa de reduccin de riesgos Energy Control de la ONG Asociacin Bienestar y Desarrollo (ABD), con mbito de actuacin estatal y con delegaciones de dicho proyecto en las
Comunidades Autnomas de Catalua, Madrid, Islas Baleares y Andaluca. Este proyecto lleva a cabo diferentes actuaciones e investigaciones en materia de drogas en contextos recreativos, por lo que supone un elemento de referencia en la investigacin en este mbito, debido a que su forma de trabajar los sita como espectadores privilegiados del panorma de las drogas. El programa estrella que llevan a cabo desde esta asociacin, por el que es conocida y reconocida, es el del anlisis de sustancias 6. El inters principal expresado desde esta asociacin no es exclusivamnete el analizar las sustancias, sino el poder establecer un feed-back con las personas que se acerquen a hacer uso del servicio, para de esta manera ofrecerles pautas relacionadas con la reduccin del riesgo. Este es un concepto que viene contemplado en las estrategias de la administracin, aunque en cierta medida supone un giro de ciertos planteamientos, pues la cuestin es que se admite que existe un consumo y se trata de establecer cierto tipo de control sobre l, conscientes de que las acciones desarrolladas hasta ahora no han conseguido nada de lo que pretendan, tal como explica Vanthournhout (2001 ). Del mismo modo, se pretende dotar a los usuarios de las herramientas necesarias para un consumo "seguro", tanto a nivel orgnico como legislativo. Los enfoques basados en la reduccin de riegos pretenden acabar con la manera de contemplar las drogas desde una perspectiva excesivamente peyorativa, no obstante, el paradigma de la reduccin de riesgos contina manteniendo una visin negativa del consumo, pues lleva implcito una definicin de las mismas desde su componente problemtica, esto es, desde los riegos asociados. Por lo tanto, al hacer uso de este concepto en cierto modo estamos recayendo en esa visin abstinencial de la que venimos hablando segn la cual lo mejor es no consumir ningn tipo de sustancia, ya que esta es la nica forma segura de evitar sus posibles riesgos. Pero si queremos realizar un acercamiento adecuado a la pluralidad de situaciones en relacin a las drogas, no podemos obviar que hay personas que deciden usarlas y no piensan, o al menos no exclusivamente, en los posibles daos que de ello devengan, sino que tambin est presente, quizs en mayor medida, la bsqueda del placer, por lo que quizs un concepto ms adecuado que el de la reduccin de riesgos sera el de la gestin de placeres y riesgos7. (Hidalgo, 2003) Este tipo de estrategias como las desarrolladas por Energy Control, resultan muy efectivas porque actan con las personas que deciden usar estas sustancias, evitando juzgar los motivos que aducen. Un ejemplo lo consituye el movimiento andaluz del trance, que ha supuesto nuestra unidad de observacin principal. El embrin de este movimiento surge a finales de los 60 en el estado de Goa, en la 93
N3
India. Papadimitropoulos (2009) explica que a finales de esa dcada, y con la prdida de fuerza del movimiento hippie, muchos de sus integrantes se refugiaron en este lugar dando origen al movimiento, generando un renacer de su tica bajo una forma completamente novedosa. En Andaluca el movimiento aparece a finales de los 90 y se consolida a lo largo de la dcada del 2000, cuando empiezan a surgir colectivos 8 coincidentes con algunas de las capitales de provinicia. Estos colectivos se renen varias veces al ao, siempre dentro de los periodos intersticiales de la vida institucional, no superando normalmente el centenar de asistentes y cambiando la localizacin de las fiestas en cada ocasin. En sus encuentros las drogas estn muy presentes, se convierten en un elemento indispensable para la accin que se desarrolla, por lo que de nada servira lanzar mensajes previniendo del consumo de estas sustancias, de hecho ello implicara una no comprensin de la accin y supondra perder la oportunidad de ofrecer una adecuada educacin en lo que a salud se refiere, lo que explicara gran parte del fracaso de este tipo de estrategias.
tcnica ms provechosa para la Antropologa permite: realizar una primera toma de contacto sobre el tema, localizar aspectos a investigar que a priori no hayan sido considerados y entrar en contacto con los informantes, de cara a ver si alguno puede, en la aplicacin posterior de una tcnica cualitativa, ofrecer ms informacin. Se han realizado cuatro entrevistas semiestructuradas, a un integrante de los colectivos andaluces de trance, a participantes del movimiento y usuarios de drogas, y a un voluntario de la asociacin Energy Control. Por otro lado se realiz 1 grupo de discusin mixto con usuarios de drogas y participantes del movimiento andaluz de trance. No obstante, la fuente principal de obtencin de informacin la ha constituido la observacin participante tanto en el espacio ciberntico, como en el espacio de la "fiesta", y en este contexto a su vez desde una doble posicin, la de participante en la rave y la de voluntario en el stand de Energy Control. La realizacin de la observacin permite tomar contacto con la realidad y observar lo que all ocurre, a travs de lo que cuentan pero tambin de lo que se ve.
Diseo y metodologa
En el desarrollo de la investigacin han resultado de vital importancia las ideas de dos autores que reflexionan sobre la necesidad de atender a distintos espacios a la hora de acercarnos a la realidad analizada. En primer lugar la etnografa multisituada enunciada por George Marcus (1 995), segn la cual determinados objetos de estudios no pueden ser explicados etnogrficamente atendiendo a un nico contexto, se trata de desarrollar una etnografa que se desplace entre los distintos espacios que involucran a nuestro objeto de estudio para conocer la circulacin de significados y relaciones. En segundo lugar, la ciberetnografa explicada por ngel Ruiz Torres (2008), que se configura como una forma de afrontar muchas de las investigaciones de las realidades culturales actuales principalmente en las llamadas sociedades occidentales, aunque no nicamente en este contexto. Esto es as debido a la relevancia de internet y la creciente dependencia de su uso, que permite conectar en tiempo real individuos que comparten patrones culturales y se encuentran distantes geogrficamente hablando. Es por ello que a lo largo del proceso etnogrfico se tienen en cuenta bsicamente tanto los datos recogidos en distintas raves, como aquellos generados en el contexto de internet, y aquellos extrados a partir de la interaccin con los usuarios de drogas a travs del stand de Energy Control. Las tcnicas que se han utilizado son las siguientes. En primer lugar, y pese a que nuestra orientacin es fundamentalmente cualitativa, hemos credo conveniente realizar un cuestionario, combinando distintos tipos de preguntas. Aunque no sea la
Resultados
Es innegable la existencia de diferentes percepciones, muchas muy positivas, en cuanto al uso de drogas. As aspectos como el placer, la alteracin de conciencia, la exploracin, la experimentacin y el autoconocimiento, se convierten en motivos vlidos esgrimidos para consumir drogas. Loli, una chica sevillana asidua a raves de trance lo explica as: Las drogas son muy importantes, claro. Sin las drogas no estaramos all fijo. Yo cuando pienso en una rave, no es que piense en drogarme, t sabes, pero si pienso en las drogas, bueno en la sensacin que me dan, sabes lo qu te digo? Cuando se que voy a ir a una rave, pienso en como me siento all con la msica y con el M (MDMA). Para m, eso es lo mejor, lo ms especial, sabes? Poder ir a un sitio y sentirte libre de verdad, es una cosa mgica que slo pasa all." Es frecuente que en espacios de ocio aparezcan sustancias tales como el alcohol, el tabaco, el cannabis, las anfetaminas, el xtasis, la cocana, la ketamina, el LSD o la psilocibina de los llamados hongos mgicos, y menos frecuente otras como el DMT, GHB o 2CB, sin contar aquellas sustancias de nueva sntesis (conocidas como Research chemicals o novel psychoactive subtances) y que estn encontrando un hueco en estos contextos ya sea como adulterantes o como "drogas en s", tales como la metoxetamina, la ethcatinona o la mefedrona. Las personas que consumen drogas en estos contextos se preocupan por su 94
N3
salud, mantienen en la mayora de los casos vidas socialmente normalizadas, con obligaciones laborales o educativas, responsabilidades familiares, etc. Se sienten desprotegidos en muchos aspectos y temerosos de mensajes con un claro marcado carcter paternalista, as es frecuente que en el stand de Energy Control una de las preguntas ms habituales sea: Informacin sobre drogas? Qu me vais a decir que no me drogue? Se ha comprobado que muchos de los profesionales que se relacionan con estos contextos carecen de la formacin adecuada, por ejemplo es habitual que en las ambulancias contratadas por los promotores de festivales de msica electrnica desconozcan las sustancias que estn presentes en ese tipo de eventos, con lo que a priori no estn completamente preparados para afrontar determinadas situaciones. Adems existen numerosos estereotipos por parte de estos profesionales con respecto a las personas que consumen drogas, lo que resulta preocupante cuando se constata que estos estn presentes en la relacin de estos profesionales con los usuarios
Conclusiones
El fracaso producido, y constatado, por la utilizacin exclusiva de las acciones orientadas por la visin abstinencial en todos los niveles de gestin en materia de drogas a partir de situaciones como la aparicin de un mercado negro al que deben acudir los usuarios, la adulteracin de las drogas y los problemas para la salud que esto provoca, el estigma con el que cargan los usuarios en determinados contextos, la aparicin y extensin de sustancias desconocidas y poco controladas como las NPD (novel psychoactive subtances), los problemas asociados a la falta de informacin especfica sobre sustancias determinadas, etc., deben servirnos como acicate para implementar otras muchas medidas que, aunque desarrollados en menor medida, se han mostrado tremendamente eficaces tales como el anlisis de sustancias que permite generar alertas ante sustancias desconocidas o potencialmente dainas que circulan por los espacios de ocio, los puntos de anlisis de alcoholemia en este tipo de espacios para evitar la conduccin tras haber ingerido alcohol, las recomendaciones para evitar la transmisin de las enfermedades infecciosas, la informacin sobre la naturaleza de las sustancias, sus efectos y contraindicaciones, etc. As la extensin del modelo que promueven programas como el de Energy Control debe llegar a muchos ms mbitos. Entre estos es necesario poder llevar la informacin ofrecida en los contextos de ocio a todos los espacios posibles en los
que se de consumo de drogas, principalmente a usuarios, de manera que seamos capaces de empoderar a estas personas para afrontar su relacin con las drogas sin perjuicios innecesarios. Del mismo modo, es vital que los profesionales de la salud y lo social se involucren en el reconocimiento de la realidad actual de las drogas y se formen adecuadamente para saber hacer frente a una realidad tan cambiante como es la del panorama de las drogas, que gracias a las modernas herramientas tecnolgicas se caracteriza por una profunda y continua metamorfosis para la que debemos estar preparados, y ante lo que debemos aportar al grueso de la sociedad las herramientas necesarias para una correcta gestin, pues lo contrario atentara contra el derecho de los individuos a estar informados, gestionar su cuerpo y su salud, y decidir libremente. En este sentido sera interesante tambin valorar la posibilidad de extender estas acciones formativas y educativas a mbitos como el de la familia, donde los padres, como primer elemento en la socializacin de las personas, pueden y deben formarse e informarse para contar con mayores herramientas para gestionar posibles consumos en sus hijos, evitando crear situaciones de desorientacin donde los progenitores se vean incapaces de actuar, o lo hagan de una manera que implique un distanciamiento de la unidad familiar y por lo tanto un empeoramiento de las relaciones que se desarrollan en su seno. Una de las consecuencias ms importantes que encuentran las acciones preventivas en materia de drogas, uno ms de estos efectos perversos a los que hacamos referencia, lo constituye el hecho de la prdida de legitimidad de las instituciones antes los usuarios de drogas. Cuando el discurso sostenido no deja lugar a ms opciones que el NO, y los efectos derivados de la relacin con las drogas no son negativos, esto es, no impiden que la persona contine con su vida de manera absolutamente normal, aquellos entes que se mostraron adalides de tal mensaje pierden toda la influencia que pudieran poseer, mostrndose completamente ineficaces debido a que los usuarios pierden todo inters en campaas y otro tipo de acciones. Por el contrario, estas personas acogen con gran inters y agradecimiento el trabajo de asociaciones como Energy Control, a quien reconocen como un interlocutor vlido lo que supone una oportunidad nada despreciable de acceder a estos usuarios y promover pautas adecuadas en su relacin con las drogas.
95
N3
NOTAS
- BOUDON, R. (1 980) Efectos perversos y orden social. Mxico: Premia - ESCOHOTADO ESPINOSA, A. (1 996) Historia Elemental de las drogas. Barcelona: Anagrama - DOUGLAS, M. (1 973) Pureza y peligro. Un anlisis de los conceptos de contaminacin y tab. Madrid: Siglo XXI - FERNNDEZ CALDERN, F. ET AL. (201 2) Efectos asociados al policonsumo en fiestas rave, en Salud y Drogas vol. 1 2, n 1 , pp. 37-59 - FURST, P.. (1 980) Alucingenos y cultura. Madrid: Fondo de Cultura Econmica de Espaa - GOFFMAN, E. (2006) Estigma: La identidad deteriorada. Buenos Aires: Amorrortu - HIDALGO DOWNING, E. (2003) I Choose: Droguin. Interzona Revista de Cultura y Drogas, N 3. - MARCUS, G. (1 995) Ethnography in/of the World System: The Emergence of MultiSited Ethnography, en Annual Review of Anthropology, vol. 24, pp. 95-11 7 -MENNDEZ SPINA , E.L. (1 998) Salud pblica: sector estatal, ciencia aplicada o ideologa de lo posible. En, La crisis de la salud pblica: Reflexiones para el debate. N 540. Washington DC: Organizacin Panamericana de la Salud. pp. 1 03 - 1 22. - PAPADIMITROPOULOS, P. (2009) Psychedelic Trance: ritual, belief and transcendental experience in modern raves, en Durham Anthropology Journal vol.1 6(2), pp. 67-74 - RESTREPO RAMREZ, L.C. (2004) La fruta prohibida. La droga como espejo de la cultura. Madrid: Ediciones Libertarias - ROMAN ALFONSO, O. (2008) Polticas de drogas: prevencin, participacin y reduccin del dao, en Salud Colectiva, pp. 301 -31 8, Septiembre - Diciembre. Buenos Aires - ROVIRA GUARDIOLA, J., E HIDALGO DOWNING, E. (2003). Gestin del placer y del riesgo: o cmo ensear a disfrutar la noche y no morir en el intento. VIII Jornadas sobre Prevencin de Drogodependencias de Alcorcn. - RUIZ TORRES, . (2008) Ciberetnografa: Comunidad y territorio en el entorno virtual, en Ardevl Piera, E., Estalella Fernndez, A. y Domnguez Figaredo, D.(Coords). La mediacin tecnolgica en la prctica etnogrfica. Espaa: Ankulegi Antropologia Elkartea - VANTHOURNHOUT, A. (2001 ) La rduction des risques l'usage des drogues de synthse : prvention ou promotion de la sant ?, en Psychotropes, Vol. 7, pp. 1 271 69.
1 . Este artculo aborda algunas de las cuestiones paralelas investigadas con motivo
del TFM del Mster en Antropologa de la universidad de Sevilla. El ttulo del trabajo es "Andaluca en trance: usos neotradicionales de entegenos en el contexto performativo de la rave", defendido en Septiembre 201 2 y dirigido por el Prof. Dr. David Lagunas Arias. 2. El trance o psytrance, es una msica electrnica caracterizada por ritmos hipnticos y complejas melodas creadas con sintetizadores, con un ritmo medio de entre 1 40 a 1 50 beats por minuto. 3. Las raves son encuentros de personas en espacios perifricos de las ciudades o en lugares naturales, que se renen en torno a un determinado tipo de msica electrnica para bailar, interaccionar y construir una experiencia colectiva. Su duracin vara entre pocas horas y varios das, y sus caractersticas difieren en funcin del tipo de msica que se "pinche". Para Fernndez Caldern et al. (201 2) diferentes estudios han demostrado que el consumo de drogas en raves es superior al que se encuentra en otros contextos recreativos, de ah nuestro inters en este contexto particular. 4. Plan nacional sobre drogas 5. Douglas (1 973) y Goffman (2006) se refieren a la gente polucionante y al estigma, respectivamente. Ambos conceptos refieren a etiquetas negativas que se establecen para todos aquellos que de alguna manera sobrepasan la norma, estos atributos descalificadores se imponen a aquellos individuos que se mantienen al margen de lo establecido por el poder hegemnico y por ello son considerados nocivos. 6. Puede ser der tres tipos: a travs del envo de una muestra de la sustancia a analizar por correo ordinario, en los locales de las distintas delegaciones (Madrid y Barcelona) y en los lugares de ocio, donde Energy Control monta su punto de informacin y asesoramiento. 7. Para Claudio Vidal Gin, director de EC Andaluca, el concepto de gestin del placer permite solventar las atribuciones negativas que el concepto de reduccin de riesgos ofrece del consumo de drogas. 8. En Sevilla los colectivos Psylocibe, Red Dust y M.I.G.T.U.O; en Mlaga Skizodelic Mind; en Granada y Crdoba Fullmoongui ; y en Huelva al colectivo Transition
96
N3
A.B.S. Azioni di Bassa Soglia. Lesperienza della Citt di Firenze.

Abstract: Allinterno del quadro teorico relativo alla marginalit ed alla riduzione del danno
la Regione Toscana promuove nella citt di Firenze un nuovo progetto di lavoro di strada che opera nel contesto territoriale della stazione centrale. Il progetto ABS si propone di contattare il pi ampio numero di persone e gruppi marginali, italiani e stranieri, coinvolti nelluso di sostanze legali e illegali e di implementare una lavoro di rete tra i vari soggetti del territorio. Ad una prima fase di mappatura seguita una fase di contatto diretto con lutenza, attraverso le metodologie tipiche degli interventi di lavoro di strada e riduzione del danno. La presenza stabile degli operatori di strada allinterno del contesto della stazione di Santa Maria Novella consente una visione ampia e focalizzata rispetto al fenomeno delle marginalit in citt, permettendo da un lato di osservare aspetti specifici quali le caratteristiche del target, i rapporti con i servizi/associazioni della rete e luso di sostanze e dallaltro di intervenire con azioni personalizzate e condivise con le persone e svolgere un lavoro di attivazione della rete. Una lettura psicosociale del fenomeno permette di andare oltre la connotazione esclusivamente legata al deficit e attivare interventi di promozione del senso di efficacia personale mirati a favorire un atteggiamento positivo verso il cambiamento.
ABS (Azioni di Bassa Soglia) Low-threshold Programs. The Experience of the City of Firenze.
Abstract: Among the literature concerning marginality and harm reduction, Toscana
Region is promoting in Firenze a new project of street work, which is operating on the Central station area. The purpose of the ABS project is contacting as many marginal people as possible (and also groups of this kind of people), italian or foreign as well, which are using legal or illegal drugs, and also enforcing a network between the various subjects who are operating in the same territory. The first step of this project was a mapping, followed by a stage of straight contact with users, operated throught the typical methodologies of street work and harm reduction. The street workers are constantly present among the area of Santa Maria Novella station, and this fact gives a wide and focused vision on the phenomenon of marginality in our city, allowing us not only to observe specific aspects (as characteristics of the target, relationship with services/associations and drug use), but also to act in a specific way to a specific person (a way shared with people, too) and to activate the already mentioned net. Reading this phenomenon by a psycho-social point of view lets us go beyond the idea of deficit, and activates measures of self efficacy promotion to help a positive attitude towars the possibility of change.
Parole chiave: Marginalit, Riduzione del danno, Consumo di Sostanze, Azioni di Bassa
Soglia, Empowerment, Firenze.
Keywords: Marginality; Harm Reduction; Drug Use; Low-threshold Programs;

Empowerment; Firenze.
Eleonora Moscardi
Associazione Insieme Onlus e-mail: ele.moscardi@gmail.com
Valentina Menzella
Cooperativa Sociale CAT e-mail: vmenzella@yahoo.com
Mara Marchitelli
Associazione Insieme onlus e-mail: m_stella82@hotmail.com
97
N3
Introduzione
Il diffondersi di situazioni di marginalit ha storicamente accompagnato lo sviluppo delle citt e delle metropoli e la necessit di pensare interventi specifici rivolti allarea delle marginalit estreme sempre pi evidente allinterno dei contesti urbani, particolarmente in questa fase storica. Infatti, da un lato si evidenzia sempre pi la dimensione della citt disabitata con i centri storici che divengono vetrine per il turismo e sempre meno luogo di vita, di socializzazione e di integrazione tra cittadini; dallaltro, la citt disabitata diventa luogo di riferimento per gruppi marginali e in grave difficolt che utilizzano gli spazi per costruirsi aree di sopravvivenza, mobili e precarie, invischiate spesso in attivit illegali. La situazione appare complessa e richiede interventi capaci di prendersi cura del contesto attraverso una politica di accoglienza e riconoscimento dei diritti/bisogni delle persone che ci vivono (Barnao 2004; 2007). Con il termine marginalit sintendono gruppi eterogenei per origini e caratteristiche culturali, per bisogni specifici e per le problematiche che creano nel contesto urbano. Gruppi costituiti prevalentemente dalla popolazione dei senza dimora in cui si intrecciano difficolt economiche, espulsione dal mercato del lavoro e fragilit personali. Lestendersi di fenomeni quali tossicodipendenza, alcoldipendenza, problematiche psichiatriche, immigrazione clandestina (la L. 1 5 luglio 2009, n. 94, introduce lo stato di clandestinit come reato), ha ulteriormente aggravato la situazione complessiva, con il rischio di portare a contrapposizioni laceranti fra gli stessi cosiddetti marginali. un soggetto marginale (sia esso un gruppo o un individuo) chi distante dal centro del sistema sociale cui appartiene (occupa cio una posizione periferica) ed prossimo ai confini che separano tale sistema dall'ambiente esterno (o da altri sistemi). La marginalit sociale, dunque, si colloca lungo l'asse integrazione/esclusione e pu essere considerata come una delle posizioni intermedie di una scala che vede ai suoi estremi le due figure opposte dell'integrato e dell'escluso. Tuttavia alla figura del marginale viene generalmente attribuita una qualit specifica, derivante dal fatto paradossale di appartenere di diritto a una certa categoria e al tempo stesso essere escluso sia dalle decisioni e dal godimento delle risorse, sia dalle garanzie assicurate alla maggioranza degli altri appartenenti al sistema (Gallino, 1 993). Proprio questa posizione 'liminale' ha contribuito alla formazione di rappresentazioni sociali della marginalit che ne hanno enfatizzato di volta in volta i potenziali di devianza (in quanto area sottratta al controllo sociale), di innovazione sociale, di opposizione all'ordine costituito (Park, 1 928). Le teorie sulla
marginalit sociale, infatti, si sono affiancate e susseguite nel corso della storia, modificando i propri assiomi in relazione ai cambiamenti delle societ di riferimento e, quindi, dei suoi marginali. Nelle societ tardo-capitalistiche, in particolare, emergono nuove forme di marginalit sociale, i cui tratti tipici sono i seguenti: la marginalit sembra essere meno facilmente localizzabile nelle aree periferiche (Barbano, 1 982, p. 28); assistiamo oggi a una "trasformazione in senso adattivo-funzionale della marginalit sociale" (Paci, 1 981 ); infine, nelle societ contemporanee, si vede ampliarsi progressivamente l'area della "vulnerabilit sociale" (Castel, 1 991 ). Ci che caratterizza l'uomo marginale , quindi, l'esperienza della non appartenenza, dell'impossibilit permanente dell'integrazione e la necessit di sviluppare relazioni con gli altri sempre e solo di tipo adattivo (Ranci, 1 996). Queste nuove fenomenologie richiedono, per essere comprese appieno, una nuova concettualizzazione della marginalit, che sottolinei maggiormente il carattere mobile e processuale delle sue manifestazioni pi recenti. In unottica di centralit della persona, di inclusione e di attenzione alla tutela della salute la Regione Toscana ha ritenuto di finanziare su vari territori una serie di progetti volti ad intraprendere azioni che portino al raggiungimento di tutte quelle persone escluse dalla rete consueta dei servizi. In linea con i concetti di bassa soglia e di riduzione del danno, si ritenuto strategico lavvio nella citt di Firenze di un nuovo progetto di lavoro di strada (realizzato dallAssociazione Insieme onlus e dalla Cooperativa Sociale CAT), finalizzato alla promozione e facilitazione dellaccesso ai servizi sociali e sanitari e allattivazione delle risorse della comunit locale sui temi della salute, dellaccoglienza e della sicurezza. Gli interventi di riduzione del danno, nati come trattamenti sostitutivi con oppiacei e come programmi di scambio siringhe (Berridge, 1 993; Marlatt, 1 998), hanno gradualmente esteso il loro campo di azione fino alla presa in carico delle esigenze sociali e sanitarie dei tossicodipendenti problematici, in particolare quelli pi esclusi (EMDCCA, 2009). Questi interventi si collocano, dunque, in un approccio di sanit pubblica che legge luso delle droghe illecite non come un fenomeno causato da fattori individuali (psicologici o morali) ma come un fenomeno che causa problemi sociali e minaccia la salute pubblica (Drucker, 1 995). Secondo questottica, infatti, i danni della droga non stanno solo (o non stanno tanto) nelle caratteristiche chimiche delle droghe, quanto nella scelta di criminalizzare il consumo, che spinge alla stigmatizzazione e allemarginazione sociale dei consumatori, mentre produce un 98
N3
fiorente mercato illegale. Lobiettivo, quindi, dellintervento pubblico si ritiene debba concentrarsi sulle conseguenze del consumo pi che sulle cause e debba consistere nella gestione del fenomeno dei consumi, piuttosto che nelleliminazione della droga (Cohen, 1 999; Zuffa, 2006). Ci si traduce nella pratica in politiche sociosanitarie di sostegno e promozione di culture e modelli di uso pi sicuro, a partire dalla riconosciuta capacit degli individui di gestire e controllare i consumi, passando a modelli duso pi moderati e/o riducendo i rischi connessi. Il modello di promozione della salute, adottato dalla riduzione del danno, ha, infatti, il vantaggio di essere assolutamente flessibile, rispetto a quello di prevenzione/cura della patologia, e quindi si caratterizza per una maggiore dinamicit e possibilit dinnovazione dei programmi, rivolti sia ai consumatori pi problematici che non riescono a beneficiare dei trattamenti disponibili, sia a quelli meno problematici che periodicamente attraversano periodi di uso pi rischioso e intensivo. Gli interventi di riduzione del danno sono strettamente collegati al concetto di bassa soglia, ossia servizi facilmente accessibili che si sforzano di rispondere alle domande/bisogni dellutenza. Secondo una ricerca sulla bassa soglia e sullaccesso al sistema dei servizi (Camposeragna, 2009), in Italia risultano 1 57 servizi, suddivisi in sei tipologie: servizi di accoglienza diurni (drop in); servizi di accoglienza notturna; servizi di accoglienza su 24 ore; unit di strada per tossicodipendenti; unit di strada nei contesti del loisir; interventi altri. Le prime quattro tipologie agiscono nellambito della riduzione del danno sociale, oltre che sanitario, essendo rivolte a persone dipendenti in condizioni di marginalit; la quinta tipologia agisce nellambito della riduzione dei rischi, rivolgendosi ai consumatori e/o ai consumatori problematici e lultima tipologia raggruppa interventi quali i servizi di pronta accoglienza residenziale che hanno progressivamente abbassato la soglia fino ad offrire momenti di tregua della vita di strada (Zuffa, 2011 ). Allinterno di questo quadro di riferimento si inserisce il progetto A.B.S. (Azioni Bassa Soglia) che prende avvio nellanno 2009, ed il cui contesto territoriale di riferimento quello della Stazione Centrale della citt di Firenze e delle aree immediatamente limitrofe. Nello specifico si tratta di zone contraddistinte da una forte presenza di gruppi di marginali, eterogenei per etnia, et e caratteristiche socioculturali, che si trovano spesso in situazioni fortemente problematiche. A seguito dellesperienza sviluppata e dei risultati raggiunti nel primo anno di attivit (Morandi et al., 201 0), la successiva edizione del progetto, iniziata nellaprile 201 2 e tuttora in corso, si propone di proseguire e consolidare la sperimentazione di azioni e servizi che promuovano una logica di prossimit verso la persona, intesa sia
come costruzione di una relazione, sia come strategia di riduzione del danno. Di attivare interventi che siano in grado di promuovere una diversa cultura della sicurezza, che non si esaurisca nel solo ordine pubblico, ma che sia sviluppo di progetti personalizzati e coinvolgimento attivo delle persone, e quindi azione di controllo sociale positiva. Ed infine, di promuovere strategie che consentano di riconoscere la strada come luogo privilegiato di osservazione dei mutamenti in atto.
Obiettivi
Obiettivo generale: implementazione dei servizi di prossimit e bassa soglia che operano per le marginalit e le dipendenze nellarea fiorentina e loro raccordo con la rete dei servizi sociosanitari del territorio. Il progetto si articola in due sotto-obiettivi specifici Unit di Strada A.B.S. Il nome ABS Azioni di Bassa Soglia nasce come indicazione riconoscibile e immediata del progetto, in rappresentanza dellattivit svolta. Il logo del progetto, raffigurante un uomo che cammina con uno zaino in spalla e una mano tesa, il simbolo della metodologia di strada applicata dall'quipe. La finalit principale quella di contattare il pi ampio numero di persone e gruppi marginali, italiani e stranieri, coinvolti nelluso di sostanze legali e illegali, al fine di realizzare interventi di prevenzione e riduzione del danno, favorire azioni volte alla cura di s, fornire strumenti di tutela della salute, ridurre alcune condizioni di rischio correlate ai comportamenti e avviare il contatto e la presa in carico da parte dei servizi socio-sanitari del territorio. Si intendono inoltre attivare azioni educative finalizzate alla promozione dellautonomia individuale che favoriscano laccesso alla rete di supporto formale e informale. Azioni di collegamento Il progetto si propone come strumento di implementazione di una rete di collegamento tra i diversi interventi di bassa soglia e riduzione del danno presenti sul territorio; come strumento capace di favorire un intervento di rete tra i servizi istituzionali e quelli del privato sociale (Servizi per le Dipendenze, Ufficio Inclusione Sociale del Comune Firenze, Reparti Ospedalieri, Servizi di Salute Mentale, Servizi Sociali Territoriali, Sportelli di Consulenza Legale, Centri Accoglienza, Dormitori, 99
N3
Mense, Associazioni di Volontariato, Ferrovie dello Stato, Forze dellOrdine e Polizia Ferroviaria); come strumento di informazione e aggiornamento su tematiche relative alla marginalit, al lavoro con le minoranze, alle emergenze relative al consumo di sostanze ed ai trend relativi alle situazioni di tossicodipendenza in strada.
Metodologia
La prima fase ha previsto una rilevazione del contesto territoriale attraverso losservazione della presenza del fenomeno, sia allinterno della stazione che nelle zone circostanti. Inoltre, secondo unottica ecologica, stata svolta una rilevazione del contesto sociale di riferimento, contattando direttamente gli attori sociali presenti (associazioni di volontariato che operano in stazione, esercizi commerciali e pubblici) e individuando possibili luoghi di riparo meno visibili. Nella fase successiva ha preso avvio il contatto con lutenza attraverso le metodologie tipiche degli interventi di lavoro di strada e riduzione del danno, quindi con azioni di maggiore vicinanza, strumento che favorisce la possibilit di entrare in relazione, riconoscendo i bisogni che la persona avverte come prioritari, per intraprendere un percorso condiviso e personalizzato. Lquipe si avvalsa di strumenti operativi quali lascolto attivo, la relazione, la mediazione sociale e la mediazione culturale. Lintervento degli operatori ha avuto come finalit lattivazione di percorsi volti al miglioramento delle condizioni di vita delle persone presenti in strada, fornendo strumenti e conoscenze e, parallelamente, lavorando al rafforzamento della consapevolezza di s e delle proprie competenze, con unazione di potenziamento dellempowerment individuale. Trasversalmente agli interventi con lutenza diretta si sono effettuati incontri con i diversi nodi della rete, si preso parte ai diversi tavoli attivi nella citt ed stato portato avanti un lavoro di connessione dei vari soggetti coinvolti a vario titolo negli interventi con la popolazione target.
Nei primi otto mesi della seconda edizione (maggio-dicembre 201 2) sono state coinvolte 1 32 persone, la cui maggioranza di genere maschile (72%), dato che rispecchia la composizione della popolazione di strada, ma che vede un aumento della presenza femminile, spesso caratterizzata da situazioni di forte rischio. Per quanto riguarda le fasce d'et, la maggior parte delle persone si situa tra i 26 e i 55 anni (l86%). Appare rilevante anche un 1 0% di persone di et superiore ai 56 anni, dato anche questo in aumento rispetto alla precedente edizione, che pare rispecchiare nuove forme di marginalit, anche tardiva, legate ad un aggravarsi delle gi precarie condizioni socio-economiche di alcuni. Rispetto alla nazionalit, la percentuale pi alta quella degli italiani (51 %); a seguire risulta piuttosto rilevante la percentuale dell'utenza proveniente dall'area del Maghreb. Inoltre, in aumento la presenza di cittadini Comunitari, provenienti principalmente da Ungheria, Polonia e Romania (22%). DallEuropa non Comunitaria arrivano cittadini provenienti principalmente da Albania, Bosnia, Croazia, Kosovo, Moldavia (1 4%). In linea generale possibile affermare come sussistano due macro-tipologie di utenza: un primo gruppo, numericamente ridotto ma pi problematico per quanto riguarda la dipendenza da sostanze e la salute personale, che vive la stazione quotidianamente sia durante il giorno che nelle ore notturne; e un secondo gruppo, pi numeroso ma meno visibile perch pi mobile, che utilizza la stazione soltanto in ore notturne e in occasione delle distribuzioni di pranzi o cene ad opera delle associazioni. Di questultimo gruppo fanno parte anche coloro che potrebbero essere definiti nuovi poveri, la cui marginalit dovuta spesso a unestrema precariet economica o abitativa. Nel complesso delle persone contattate lo stare in gruppo appare rilevante, in quanto permette loro di far fronte ad alcuni bisogni primari tra cui il reperimento di beni materiali, lo scambio di informazioni ma anche il bisogno di sicurezza, soprattutto per le donne o per coloro che sono sulla strada da meno tempo. Il 28% non ha alcun documento didentificazione valido, il 23% possiede un documento italiano, il 5% ha un regolare permesso di soggiorno e il 3% il passaporto del paese d'origine. Per quanto riguarda i documenti sanitari si riscontra tra gli stranieri un 1 4% in possesso del documento Stranieri Temporaneamente Presenti (STP), mentre tra gli italiani solo il 1 0% possiede la Tessera Sanitaria, ed quindi regolarmente iscritto al Sistema Sanitario Nazionale. Il possesso dei documenti determina la possibilit di accesso a molti servizi, pertanto, soprattutto nel caso di stranieri senza permesso di soggiorno, stato ritenuto prioritario procedere allottenimento del certificato STP. Non sempre stato possibile ottenere informazioni 1 00
Alcuni risultati
Caratteristiche del target
Nella prima edizione del progetto sono state contattate 1 45 persone (83% maschi), di et media circa 40 anni, di cui il 54% stranieri (soprattutto provenienti dai paesi dellEst Europa e Nord Africa).
N3
approfondite sui documenti (1 7%) poich si tratta di uninformazione delicata e talvolta causa di sospetto e diffidenza. Per quanto riguarda gli italiani si evidenzia come il 50% del target sia composto da fiorentini, di nascita e/o per residenza. Nel complesso il 60% delle persone contattate non possiede una residenza, quindi priva della possibilit di accedere a tutta larea della presa in carico sociale. Il 76% delle persone contattate vive e dorme sulla strada o in situazioni molto precarie (chi si trova temporaneamente ospite in casa di amici, chi alloggia in case abbandonate o in baracche, camper, macchine, vagoni treno, ecc.), mentre solo il 21 % che dorme in un alloggio proprio o in una struttura di accoglienza. Rispetto al lavoro, elemento caratterizzante del fenomeno di esclusione sociale, si nota come quasi nessuno abbia un lavoro stabile: il 94% del target infatti si divide equamente tra chi ha perso il lavoro (disoccupati 45%) e chi non lo ha mai avuto (inoccupati 49%), il restante 6% riguarda chi ha un contratto lavorativo anche di tipo saltuario.
sociale estrema mostrano un rifiuto netto della possibilit di usufruire dei servizi istituzionali, probabilmente dovuto anche al timore di perdere relazioni significative e parte dellidentit di senza dimora acquisita nel tempo. Le informazioni sui rapporti con le associazioni di volontariato mostrano come si costruiscano relazioni con quelle realt che offrono una risposta immediata a bisogni primari (cibo, vestiti, ecc.). Per quanto riguarda infine laccesso ai centri diurni del territorio, intesi come spazio di tregua e punto di partenza per percorsi di miglioramento delle condizioni socio-sanitarie, solo il 25% che frequenta o ha frequentato in maniera stabile tali strutture. Questo dato fa emergere la necessit di diffondere nella popolazione target le informazioni riguardanti la presenza, laccesso e il funzionamento di tali servizi.
Uso di sostanze
Le sostanze stupefacenti legali e illegali sono consumate in misura simile da parte ditaliani e stranieri, anche se rispetto agli utenti nordafricani necessario fare qualche distinzione. Per molti marocchini la condizione di marginalit legata a questi ultimi anni di crisi economica, che ha determinato la mancanza di lavoro e quindi, per molti, la perdita di unabitazione stabile. La percezione del temporaneo fallimento del progetto migratorio sembra essere spesso legata a un consumo di alcool piuttosto problematico. Per quanto riguarda, invece, gli utenti tunisini, la cui et media risulta pi bassa, si caratterizzano per unabitudine maggiore al consumo e al piccolo spaccio di cocaina ed eroina, delle quali, nel tempo, sono diventati, per la gran parte, consumatori problematici o tossicodipendenti. Negli ultimi anni la rotta balcanica degli stupefacenti ha perso improvvisamente molto peso, lasciando la maggior parte dei piccoli pusher (generalmente tunisini) senza approvvigionamento (da parte di grossisti solitamente albanesi). Da quel momento molti pusher tunisini hanno perso quella forza economica che li diversificava dagli altri e che si rifletteva, ad esempio, nel poter fare a meno di entrare in contatto con quelle realt volte, tra laltro, allerogazione di servizi primari (docce, distribuzione alimenti, vestiario, ecc.). L'improvviso venire meno dello "scudo" denaro ha reso molte di queste persone maggiormente consapevoli delle problematicit della loro condizione di vita, facendo maturare in alcuni il desiderio di rientro in patria, visto come modalit di ricostruzione del s e di una nuova prospettiva di vita. 1 01
Rapporto con i servizi/associazioni

Il rapporto con i servizi rappresenta uno degli elementi centrali da cui partire per la strutturazione di interventi di tipo personalizzato. Dalla rilevazione dei dati effettuata emerge che solo il 41 % dellutenza contattata si riferisce ad uno dei servizi presenti sul territorio (37% servizio per le tossicodipendenze; 3% ufficio inclusione sociale del comune di Firenze; 1 % servizi sociali territoriali e 1 % servizi di salute mentale), il restante 59% rappresenta quel sommerso cui maggiormente il progetto chiamato a riferirsi. I contatti con i servizi, quando esistano, risultano essere spesso frammentati e, talvolta, conflittuali; molte persone preferiscono utilizzare servizi di emergenza come il pronto soccorso: nei momenti di emergenza pi critici (crisi acute da etilismo, ad esempio), gli utenti affermano di riferirsi autonomamente al pronto soccorso dellospedale di Santa Maria Nuova (il pi vicino alla zona della stazione) per interventi tampone. La difficolt maggiore, riportata nel rapporto con le strutture pubbliche notturne e diurne, riguarda limpossibilit di accedervi poich privi dei documenti necessari, mentre rispetto ai servizi sanitari, riguarda la percezione di stigma e pregiudizio che talvolta viene percepita nel rapporto con gli operatori di questi servizi. inoltre necessario sottolineare come spesso coloro che vivono in condizione di marginalit
N3
Le ultime persone arrivate, in prevalenza dalla Tunisia, a seguito dei fatti del 2011 , sono generalmente molto giovani e inizialmente non implicate nel consumo di sostanze. Molti di essi decidono comunque di avviare un certo rapporto con le sostanze diventandone venditori, attratti dal potere di acquisto che lo spaccio consente, ma comunque consapevoli dei rischi cui vanno incontro. Questa nuova generazione, contrariamente alla vecchia, spende tutto in beni di consumo e non invia alcun denaro al paese di origine e si differenzia anche per le peculiarit dei bisogni e dei progetti di vita. I vecchi immigrati, che prima gestivano il mercato dellhashish, appaiono adesso provati dalla precariet e dalla vita di strada, e diventano cos soggetti pi deboli e con meno potere contrattuale nella propria comunit di appartenenza, anche perch users (con stili di consumo distinto: iniettivo, inalatorio o fumato). Per quanto riguarda le sostanze consumate dalle persone contattate, lalcool risulta essere la sostanza pi diffusa (60%), sia per il numero di utenti, italiani e stranieri, sia per lo stile di consumo quotidiano e manifesto. Rispetto al consumo problematico di alcool occorre qui operare una breve digressione teorica relativa allapproccio teorico di riferimento ed alle relative modalit di intervento del progetto che differisce da quello a cui si riferiscono la maggior parte dei servizi sociosanitari del territorio. La gran parte dei servizi fiorentini che si rivolgono ai consumatori di alcool si riferiscono, su un piano teorico, al modello disease: la persona dipendente una persona malata e laddiction vista come entit discontinua, o si addict o non lo si . Reputando la malattia della dipendenza come irreversibile, lunica cura possibile rimane il trattamento e lunico obiettivo lastinenza. A questo tipo di approccio il progetto contrappone quello dellharm reduction, che sviluppa i propri principi allinterno della prospettiva psicologica dellapprendimento sociale. La salute intesa come stato complessivo di benessere della persona nellambiente, dando quindi rilevanza non solo alle variabile biologiche, ma anche quelle psicologiche e sociali. Il consumo di sostanze viene quindi letto come unabitudine appresa ed il comportamento additivo concepito come un continuum e non come entit discontinua. Nello specifico lalcolismo ritenuto un disturbo a genesi multifattoriale (bio-psico-sociale) associato allassunzione protratta (episodica o cronica) di bevande alcoliche, con presenza o meno di dipendenza, capace di provocare una sofferenza multidimensionale che si manifesta in maniera
diversa da individuo a individuo (SIA - Societ Italiana di Alcologia). La ricerca sul campo, e le osservazioni dirette sui consumatori nei setting naturali confermano una visione dellalcoldipendenza come fenomeno multifattoriale, in cui, oltre a fattori organici, entrano in gioco fattori psicologici (legati allazione euforizzante e ansiolitica dellalcol), fattori socio-culturali (usanze e abitudini, modelli culturali e di comportamento accettati nelle comunit, situazioni sociali e familiari) e fattori personali (il tentativo a quietare ansia, angoscia, paura, senso di solitudine, tristezza, insicurezza, delusione, rabbia senza riuscirvi e nuovi problemi da risolvere come conseguenza del bere). Lattenzione dellunit di strada, quindi, sia sul piano di intervento, sia su quello della ricerca, si sposta dalla persona alle relazioni interagenti nellambiente o ecosistema di riferimento. Lalcool rappresenta inoltre, per il 1 8% degli utenti contattati, la base stessa del policonsumo, che lo vede associato al consumo di eroina, cocaina e psicofarmaci. A questo proposito necessario sottolineare come il policonsumo rappresenti un dato sempre pi concreto in termini sia quantitativi che qualitativi: lapproccio e il rapporto con luso di sostanze, infatti, cambiato nel corso degli anni, ed cresciuta la diffusione e laccessibilit a diversi tipi di sostanze, non pi delimitate a contesti specifici, ma trasversali ad essi. Questo fa s che si scelga la sostanza pi adeguata (o il mix di sostanze) a seconda degli effetti che si vogliono ricevere e del setting in cui ci si trova in un dato momento. infine necessaria una riflessione riguardo all'abuso di farmaci senza prescrizione medica e, pi nel dettaglio, rispetto al misuse di metadone e psicofarmaci, che stato possibile osservare grazie alla presenza nelle piazze di consumo. importante fermarsi ad osservare e riflettere sul misuse farmacologico, quindi di sostanze legali prescritte dai servizi sanitari, per gli alti rischi connessi a questa pratica, sia a breve termine (overdose da metadone, uso iniettivo di specialit destinate a un'assunzione orale), sia a lungo termine (dipendenze iatrogene). Questa osservazione permette inoltre riflessioni sullinterazione del fenomeno con i servizi sanitari (ad esempio in termini di soglie di accesso), per capire se siano ipotizzabili cambiamenti nell'organizzazione o nelle modalit di accoglienza del servizio, e rappresenta unoccasione di approfondimento dei cambiamenti che si stanno verificando tra la popolazione consumatrice di sostanze, in termini di stili di consumo ma anche di etnografia. 1 02
N3
Lesistenza di un mercato grigio di metadone e di farmaci fatto oramai noto, la novit rappresentata dallampliamento di questo mercato e dal superamento delle frontiere, con un trasferimento in paesi in cui molto fiorente e quindi lucroso. Gli stili di "spaccio" attuali riguardano prevalentemente metadone, subutex e rivotril: si pu ipotizzare che la sempre peggiore qualit delle sostanze illegali di strada da un lato, e la facile reperibilit e sicurezza dei farmaci dallaltro, possa influire sullaumento del ricorso a questi ultimi e, quindi, sul proliferare del mercato grigio. Per quanto riguarda target e modalit di assunzione del metadone di strada si potuto riscontrare un utilizzo prevalente tra persone giovani, alcuni dei quali utenti dei servizi per le tossicodipendenze che si caratterizzano per una bassa compliance al trattamento. Luso prevalentemente per via endovenosa e alcuni giovani e giovanissimi italiani sostengono di essersi avvicinati all'uso iniettivo con il metadone concentrato e non con l'eroina, perch la considerano una sostanza pi "sicura". I rischi vanno dal rapido aumento dellassuefazione agli oppiacei, dal rischio di infezione sia se iniettato endovena che se iniettato fuori vena, fino al rischio di overdose.
necessita, inevitabilmente, della capacit delloperatore di creare una parentesi che privilegi latto dellascolto e della comprensione allazione, permettendo alla persona di rivolgersi alloperatore anche solo per cercare uno spazio socialmente vitale. Un intervento che d la possibilit di esprimere socialmente se stessi, cosicch loperatore possa restituire, al contesto istituzionalizzato dei servizi, linterezza dellesperienza di vita della persona, il suo mondo di riferimento, i significati che sottendono alle sue scelte. Gli interventi brevi risultano efficaci con persone che consumano in maniera rischiosa e dannosa, collocandosi in uno spazio intermedio tra prevenzione primaria e trattamenti pi intensivi, con lobiettivo di dare alla persona strumenti per cambiare le attitudini basilari e affrontare una variet di problemi sottostanti. Gli elementi essenziali di questo tipo di counselling si possono riassumere in quattro passaggi: informare sui livelli di rischio; adattare lintervento allo stadio del cambiamento in cui si trova la persona (dalla refrattarietprecontemplazione, allazione-mantenimento); offrire informazioni su come raggiungere i livelli di consumo a basso rischio; prevedere delle strategie di mantenimento, aiutando la persona a identificare i segnali e le situazioni di ricaduta.
Attivazione della rete

Agire consapevoli di trovarsi allinterno di un sistema uno dei presupposti su cui si poggia lintervento, nella convinzione che solo attraverso la conoscenza, la condivisione e la sinergia nella programmazione e nellimplementazione degli interventi, si possa migliorarne lefficacia. Il target ha determinato, fin da subito, la necessit di un raccordo con i servizi per le tossicodipendenze, per la condivisione di bisogni, percorsi e interventi da concordare con le persone, ed agendo come strumento di connessione tra la persona ed il servizio nel favorire laggancio, o il riaggancio quando il rapporto si sia per vari motivi interrotto. Oltre che con i servizi per le tossicodipendenze, risulta ovviamente indispensabile lo stretto rapporto con il drop in presente sul territorio (centro diurno Porte Aperte Aldo Tanas) e con le altre Unit di Strada, nellottica di una sempre maggiore sinergia e condivisione di strumenti e modelli di intervento tra servizi di bassa soglia e riduzione del danno. Si sono poi costruiti rapporti con il Pronto Soccorso e con alcuni reparti ospedalieri, prevalentemente Tossicologia e Malattie Infettive, e di particolare rilievo lo scambio con il Centro Medico Niccol Stenone, servizio della Caritas Diocesana di 1 03
Interventi effettuati
Nei primi otto mesi del progetto sono stati realizzati 693 contatti (sono conteggiate tutte le volte che gli operatori hanno incontrato e si sono relazionati con i 1 32 utenti). I bisogni che emergono maggiormente riguardano il tema della salute e della cura di s (26%) e quello del rapporto/accesso ai servizi (1 7%), temi legati sia alle condizioni di vita in strada, quindi di estrema marginalit, che a problemi di dipendenza (8%). Lambito della marginalit e dellinclusione sociale (che ricopre complessivamente il 21 % dei bisogni espressi) investe argomenti specifici quali soluzioni abitative (11 %), ricerca del lavoro (8%), problemi legali (2%). Si sottolinea come, nella costruzione della relazione, le persone sentano il bisogno di raccontare la propria storia personale, elemento che favorisce un rapporto di fiducia che, nel tempo consente lemersione dei bisogni specifici, ai quali gli operatori possono rispondere con azioni di orientamento, di mediazione e di affiancamento nellaccesso ai servizi del territorio (49%). necessario infine porre l'attenzione sullattivit di counselling (51 %), che
N3
Firenze, che si rivolge a persone che versano in condizioni di forte marginalit e che necessitano di visite mediche gratuite e qualificate. Date le caratteristiche di forte marginalit del target a cui lintervento si rivolge, risultata prioritaria la partecipazione alle attivit del Tavolo dellInclusione Sociale, tavolo di coordinamento che nasce come momento di incontro e raccordo tra gli attori che nel territorio fiorentino si occupano a vario titolo di inclusione sociale e come osservatorio preciso e puntuale per il monitoraggio delle marginalit e dei fenomeni ad essa legati, al fine di offrire risposte univoche ai bisogni riscontrati attraverso una sinergica co-progettazione delle attivit territoriali. Bisogni, quelli con cui il progetto si dovuto confrontare, che sono in gran parte attinenti allarea sociale, ed in prevalenza connessi alla mancanza di un alloggio. Problematica alla quale si cercato di dare risposta attraverso il lavoro di rete con i dormitori del territorio, per tutti coloro che possiedono i requisiti per accedervi, e con la partecipazione attiva al Progetto di Accoglienza Invernale, che prende avvio nel mese di novembre, e che risulta unimportante risorsa aggiuntiva in fatto di accoglienza notturna, dal momento che garantisce laccoglienza anche agli stranieri privi del Permesso di Soggiorno con problematiche sanitarie rilevanti. Il tentativo di dare risposte sempre pi sinergiche ha determinato lo stretto raccordo con i servizi sociali territoriali, con lufficio Inclusione Sociale del Comune di Firenze, oltre che con la Caritas Diocesana di Firenze e con tutte le associazioni di volontariato che operano nel contesto territoriale della stazione di Santa Maria Novella e che rappresentano unimportante risorsa per lattivazione tempestiva degli interventi. Cercare di rispondere ai bisogni espressi, ha inoltre determinato la relazione con gli sportelli di consulenza legale gratuita del territorio, a cui le persone con problemi giuridico/legali, vengono inviate. Sono stati infine strutturati degli incontri periodici con Ferrovie dello Stato e con le Forze dellOrdine, in particolare con la Polizia Ferroviaria, al fine di condividere le criticit della stazione e presentare gli interventi effettuati.
rispetto al fenomeno delle marginalit in citt. Parallelamente questo sguardo consente anche di rilevare come la Stazione nel suo complesso sia non soltanto una struttura fisicamente presente nella citt, ma anche una dimensione sociale nella quale si rispecchiano i cambiamenti della comunit. Ad oggi la Stazione si configura sempre pi come un luogo di arrivi, soste e partenze, come piazza cittadina nella quale si intrecciano dinamiche economiche e relazionali. chiaro quindi che in questa prospettiva si debba mantenere una costante attenzione e sensibilit verso tutte quelle forme di marginalit che la abitano. In tal senso il ruolo di mediazione svolto dagli operatori rende possibile costruire un dialogo tra soggetti molto distanti tra loro e, potenzialmente. ridurre i fenomeni di stigma ed esclusione. Il progetto ha consentito di avviare alcune azioni centrate sui bisogni individuali, finalizzate ad avviare un percorso di miglioramento delle condizioni di vita attraverso la promozione dellautonomia individuale, tramite lacquisizione di competenze e conoscenze utili ad accedere alla rete di supporto formale e informale presente. Latteggiamento non giudicante e una rilettura condivisa dei bisogni espressi, ha permesso di far emergere come, nella formulazione degli interventi rivolti a questa fascia di popolazione, sia necessaria una fase in cui alla persona viene fornita lopportunit di pensare a s in modo diverso o di possibilizzazione, secondo unottica di empowerment. La condizione di marginale ha infatti implicazioni non soltanto di carattere socioeconomico ma anche rispetto alla costruzione di unidentit derivante dallappartenenza a questa categoria. In altri termini potremmo definire la marginalit, prima ancora che un problema sociale, un luogo psicologico determinato dallattribuire a s norme, valori, e comportamenti che appaiono funzionali a costituire unidentit personale e sociale adatta al contesto di vita. In conclusione, possibile affermare come una lettura psicosociale del fenomeno permetta di andare oltre la connotazione esclusivamente legata ai deficit che la condizione di marginalit comporta. Un aspetto fondamentale risiede nella definizione di obiettivi condivisi con la persona e programmati sulla base di un progetto costituito da obiettivi intermedi, in grado di essere facilmente raggiungibili e colti come successi nel proprio percorso di vita. Pur considerando il lavoro e lalloggio come gli obiettivi principali, appare quindi indispensabile la promozione di un senso di efficacia personale mirato a favorire un atteggiamento positivo verso il cambiamento.
Conclusioni
La presenza stabile degli operatori allinterno del contesto della Stazione centrale di Firenze risulta favorire una visione ampia e al contempo focalizzata
1 04
N3
Riferimenti bibliografici
- Barbano F. (1 982). Le frontiere della citt. Casi di marginalit e servizi sociali. Franco Angeli. Milano. - Barnao C. (2004). Sopravvivere in strada. Elementi di sociologia della persona senza dimora. Franco Angeli. Milano. - Barnao C. (2007). L'osservazione partecipante per la comprensione dei fenomeni di marginalit sociale. Salute e Societ, 2007/2, pp. 65-86. Franco Angeli, Milano. - Berridge V. (1 993). Harm minimization an public health: a histotical perspective. Heather N., Wodak A., Nadelmann E., OHare P. (eds.). Psychoactive drugs and harm reduction: from faith to science. Whurr Publishers. London. - Bourgois P. (2005). Cercando rispetto. Drug economy e cultura di strada. Derive & Approdi. Roma. - Camposeragna A. (a cura di) (2009). Report della ricerca azione su servizi a bassa soglia e accesso al sistema dei servizi. Provincia di Milano, marzo (paper). - Castel R. (1 991 ). De l'indigence l'exclusion, la dsaffiliation. Prcarit du travail et vulnrabilit relation nelle. Donzelot J. (a cura di). Face l'exclusion. Le modle franais. Espirit. Paris, pp. 1 37-1 68. - Cipolla C. (a cura di) (1 978). Marginalit e devianza. Ipotesi e prospettive nella formazione delloperatore sociale. Ptron Editore. Bologna. - Cohen P. (1 999). Shifting the main purposes of drug control: from suppression to regulation of use. Reduction of risks as the new focus for drug policy. The International Journal of Drug Policy. 1 0, pp. 223-234. - EMDCCA (2009). Rapporto annuale sullo stato del problema droga in Europa. Lisbona, novembre. - Ferrarotti F. (a cura di) (1 978). Mercato del lavoro, marginalit sociale e struttura di classe in Italia. Franco Angeli. Milano.
- Gallino L. (1 993). Marginalit. Dizionario di sociologia. Tea/Utet. Torino, pp. 405406. - Marlatt A. (eds.) (1 998). Harm reduction. Pragmatic strategies for managing high risk behaviors. The Guilford Press. New York-London. - Morandi A., Stagnitta M., Bertoletti S. (201 0). Interventi di bassa soglia con persone senza fissa dimora a Firenze. Psicologia di Comunit. Giornale della Societ Italiana di Psicologia di Comunit. Anno XIII, numero 21 , pp.1 2-1 3. - Paci M. (1 981 ). La struttura sociale italiana. Il Mulino. Bologna. - Park R.E. (1 928). Human migration and the marginal man. American journal of sociology. XXXIII, 6, pp. 881 -893. - Ranci C. (1 996). Marginalit sociale. Enciclopedia delle Scienze Sociali. Treccani. Roma. - Zuffa G. (2006). La normalizzazione del consumo di droghe. Spunti per nuovi indirizzi di politiche pubbliche. Animazione Sociale. XXXVI, 204 (seconda serie), pp. 20-29. - Zuffa G. (2011 ). Droghe, riduzione del danno e bassa soglia. Bertoletti. S., Meringolo P., Stagnitta M., Zuffa G. (a cura di). Terre di confine. Soggetti, modelli, esperienze dei servizi di bassa soglia. Unicopli. Milano, pp. 55-71 .
1 05
N3
Reflections on the HIV Program in India
Introduction
It has crossed thirty years since the official global reports of HIV and two and a half decades in the Country. Approximately 1 72,000 people died of AIDS related causes in 2009 in India (NACO, No year). Rate of new HIV infections has fallen by more than 25% between 2001 and 2009 in 33 countries (Harvard School of Public Health, December 1 2, 2011 ) and by 50% in India (NACO, No year) providing evidence that prevention has been effective. Expanding access to treatment has contributed to a 1 9% decline in deaths among people living with HIV between 2004 and 2009 (Harvard School of Public Health, December 1 2, 2011 ). From the early days of the epidemic, it was clear that HIV and AIDS was much more than addressing a disease. Social conditions had profound effect on risks and vulnerability and hence responding to HIV and AIDS would require to responding the underlying issues such as poverty, illiteracy, hunger, and marginalisation. Health and development of the affected communities was closely related to social attitudes, legal and justice frameworks. It required a multi-dimensional and multi-sectoral response where countries played an active role. India has stood up to these in an arena where poverty and marginalisation is high. This paper will provide for reflections from the Indian sub-continent; this will be useful for professionals worldwide to replicate and learn from in their fight against the virus or in other health problems. It is story of hope and commitment by the State and communities who joined hands to halt of the spread. Indian response to HIV/AIDS It is estimated that 2.27 million individuals are infected with HIV in the country. The epidemic is concentrated in high-risk populations, such as sex workers, men who have sex with men, transgender, injecting drug users, and clients of sex workers. Unprotected sex (87.1 % heterosexual and 1 .5% homosexual) is the major route of HIV transmission. This is followed by transmission from Parent to Child (5.4%) and use of infected blood and blood products (1 .1 %). Injecting Drug Use accounts for 1 .7% of HIV infections nationally, this is predominant seen in the North Eastern states. What is a cause of concern is that the infection is spreading form high prevalence to low prevalence areas (NACO, No year). The Indian government put in place the National AIDS committee in 1 987 within a year after the first HIV case was identified. This was evolved as the National AIDS Control program in the year 1 992. The response of the government has 1 06
Abstract: The Indian HIV program has put in place a public health program that has gone
beyond the traditional health care and has moved towards developing an enabling environment from a multi-dimensional perspective. This article attempts to capture these experiences and the lessons it has provided during the process of implementing the program. The program has been able to make an impact due to the multi-pronged approach which included clinical services along with partnership with communities, policy changes and program management system. The learnings can be useful for addressing health problems what have been difficult to deal due to social circumstances that communities face such as being on the margins, hidden and difficulty to penetrate.
Key words: HIV/AIDS program, India, Enabling environment
Anita Rego
Independent Consultant Social Development e-mail: anitarego@yahoo.com
N3
evolved over the years through the National AIDS Control program, NACP. NACP-1 (1 992-1 999), launched in 1 992, was later extended from 1 997 to 1 999. NACO set on itself to develop a national public health programme in HIV/AIDS prevention and control and set up State AIDS Control Societies as the instrument to support the initiative. In the second cycle NACP II, operational from 1 999 to 2007, attempted to reduce the spread of HIV infection primarily through strengthening testing services and behaviour change, a shift from the predominant mass awareness program for prevention to a targeted intervention approach focussed on risk populations. In the third cycle, NACP-III (2007-201 2) the program sought to halt and reverse the epidemic by providing an integrated package of services for prevention, care, support and treatment. Saturating the coverage of high risk groups through targeted intervention and expanding prevention messages to general population to prevent new infection, the program also put in place systems for providing care, support and treatment to people living with HIV/AIDS. The Country is currently in the fourth five year cycle of programming for HIV (NACP IV). The draft strategy for the National AIDS Control Program (NACP) phase-IV for 1 2th Five Year Plan that has been presented to the Planning Commission aims to curb the cases of new infections by 80% in the country.
Option B+ on a pilot basis in some high prevalence states. Community care centres were established. The involvement of peer counsellors and the establishment of positive networks reduced stigma. The peer outreach workers and counsellors across the country that mobilised continued treatment among positive communities. Systematised tracking mechanisms ensured that those who were loss to follow up or had dropped out were counselled to come back to the folds of treatment.
Partnering with high risk groups for prevention

The common package of services under the targeted intervention includes behaviour change communication; access to condoms, STI services and HIV treatment, care and support; provision of enabling environment through drop in centres and community mobilisation. With a focus on prioritisation and saturating coverage of high risk group, the NACP III channelized prevention resources on interventions for female sex workers and men who have sex and for the bridge and vulnerable groups largely through mainstreaming strategy. Female sex workers are estimated to be 830,000 - 1 ,250,000 (NACO, No year) in the country. Female sex work is deeply rooted in inequalities that are evidenced as illiteracy, poverty, disadvantaged situation and familial responsibilities. Sex workers face violence within the family as well as from the sex trade. Collectivisation of sex workers into local level networks led to sex workers forming district, state and national level collations advocating for their rights leading to the recent judgement for extending State responsibility towards promoting social equity for sex workers. Focused approach to reach various categories such as bar girls and younger girls is not yet robust. Greater involvement of sex workers in policy making bodies has been weak if not absent. Strategy to reach to regular partners and clients has been through the sex worker rather than direct, making condom use and reduction of violence a kneejerk response. Lubricants are not made available thus undermining the existence of anal sex among sex workers. It is estimated that 2,350,000 MSM live in the country and of them 235,000 are male sex workers (NACO, No year). Infection among men who have sex with men has not shown a downward trend. The coverage of men who have sex with men was dismal during the NACP II days. In NACP III, concerted efforts were made which resulted in a reach of 2,74,000 through 1 55 exclusive and 200 composite. This is a seven-fold increase from NACP-II and is expected to increase through the MSM CBOs and efforts on community systems strengthening. Surveillance sites for MSM 1 07
Testing, treatment, care and support

The National program set up testing and counselling centres across the country at the peripheral and referral institutions of the government. Testing is carried free of cost and mechanisms have been put in place to ensure that the report could be received on the same day. Counsellors provide pre and post test counselling services. The introduction and upscale of ART centres and link centres across the country within a public system model since 2004 ensures free access to ART services thus making services equitable and resulted in decline in the number of deaths. The corridor for services approach promoted easy access. The national program has rolled out the ART program across the country. As some individuals developed resistant to first line ART drugs, through consistent advocacy by civil society organisations and the PLHIV networks, second line ARTs centres were introduced. The PMTCT (prevention of parent to child transmission) rates currently at 5.4% (UNICEF, 201 0) are now set to change with the recent introduction of the WHO Triple ARV prophylaxis. This revised guideline promotes single, universal regimen both to treat HIV infected pregnant women and to prevent MTCT of HIV termed
N3
have also been increased. Lubricants have been incorporated into the national program and the country has recently launched the male version of female condom for MSM. The national strategy for MSM was recently revisited to incorporate mental health, family support, violence reduction, extension services to partners and reach to communities over the internet for those do not prefer to seek services at the DICs. Men who have sex with men face stigma in the form of homophobia. In 2009, the Delhi High Court decriminalized consensual sex between adult men acknowledging that Section 377 of the Indian Penal Code obstructed effective HIV prevention (Godwin, 201 0). Involvement of the LGBTI organisation and networks are seen in the formulation of national policy and guidelines related to HIV. Initially, the transgender were clubbed with the MSM intervention, but with concerted advocacy by the community and an appreciation of the specific problems they face, the national program is formalising a program incorporating specific needs through standalone or composite MTH interventions. In the State of Tamil Nadu, the State Government has established the Tamil Nadu Aravanigal (Transgender) Welfare Board (TGWB) to address the social protection needs of hijra by linking them to social welfare programmes with the aim of reducing vulnerability to HIV and AIDS (Godwin, 201 0). Advocacy is on to develop similar models of social protection programmes for hijra in the other parts of the Country. It is noteworthy to mention that the efforts have resulted in the inclusion of the third gender as an option in the voter card, recognition of transgender as a category requiring special attention in the national plan document and opening of free legal aid services and expanding welfare services. It is estimated that 96,000 -1 89,000 male; and 1 0,000 - 33,000 female Intravenous drug users (IDUs) (NACO, No year) are living in the country. Intravenous drug use was thought to be prevalent only in the North East, however, during the NACP III phase, it was realised that smaller numbers were found in the other peripheral parts of the country. Special attention is being paid to female IDUs to deal with multiple issues such as sex work and violence. Composite and exclusive interventions through needle exchange were set up in select pockets across the country for regular and irregular users. Oral substitution programs using buprenorphine was established in the North East. What needs attention is that intravenous drug users have several needs and the program has not been able to provide for a continuum of care that is required. Migrant population and transport workers form an important bridge population
for the transmission of HIV. The 2.3 million long distance truckers in India have an estimated HIV prevalence of 3-7% and 1 -7% percent have at least one STI (NACO, No year). The transport worker intervention moved from an exclusive NGO led intervention to involvement of transport sector through the National Networking of Truckers TIs (NNTI) for managing the interventions. The migrant intervention has also seen changes in the program strategy from a predominantly halt point strategy to a corridors approach which incorporates source transit -destination points as part of interventions. Generating an enabling environment through the support of labour department, industry and social welfare required coordination, advocacy and efforts. Reaching to families of truckers and migrant workers has not got adequate attention.
Enhancing service uptake by PLHIV

The national program mobilised PLHIV into district level networks and national network of people living with HIV and AIDS. The networks formed an important lifeline for several PLHIV and the advocacy helped bring about recognition of the rights of PLHIVs and greater involvement of people living with AIDS. The program supported them to establish drop in centres across the country (201 as of 2011 ) and they provided psychosocial support and linkages to services. In addition women living with HIV and AIDS established specific drop in centres for women in six states (as of 2011 ). The national program established community care centres to provide for care and support services. The peer counsellors supported the national program to follow on left out and drop out, bringing several PLHIV into the folds of continued treatment. When PLHIV and their families faced stigma and discrimination, the networks independently or in collaboration with other stakeholders worked towards reducing rights violations, some of them being reintegrating affected children back to schools or reinstating people back to work place or providing legal access for accessing their property rights. PLHIVs have been also been helped to access social welfare and social protection measures; such efforts have greatly improved their lives.
Gender
The impact of HIV and AIDS goes beyond health; there are several social and economic consequences. In India, women account for around 2 million of the approximately 5.2 million estimated cases of people living with HIV in 2005, constituting 39 percent of all HIV infections (Sundar & Sundar, 2006). Among ever1 08
N3
married women aged 1 549, only 55 per cent of had heard about AIDS. More than 90 percent of women acquired HIV infection from their husbands or their sexual partners; not due to their own sexual behaviour, but because they are partners of men who belong to the high risk group (HRG). The wider implication of this situation is that in almost six percent of cases in 2008, the route of transmission of infection was from mother to child. Anal transmission routes may be practiced by women, however receives limited attention. Interventions for women are primarily through the parent to child transmission (PPTCT) program. Antenatal woman learn on their status during routine pregnancy related testing. Women who are not in the reproductive cycle may not seek reproductive health services and hence are greatly disadvantaged. Gender inequality and unequal power relations between and among women and men continue to be major drivers of HIV transmission. These are not only associated with the spread of HIV but also experience as a consequence to testing positive. The women who at risk and are affected face targeted violence. Women experience multiple risks such as access to information and services which are often located in their disempowered status. Women hold lower status which is reflected in early marriage, trafficking, sex-work, migration, lack of education, gender discrimination and malnutrition. The study carried out by NCEAR, UNDP and NACO established that women face greater consequences of HIV/AIDS at the household level. Rural women are at risk primarily as their husbands migrate to cities for work that increases their risk. The link worker program was an initiative that primarily reached out to women in rural area and served as is the main source of information but this program is downsized to reach only in specific pockets. On the other hand, members of the Panchayat Raj Institutions, women of self help groups, auxiliary nurse midwives, Registered Medical Practioners and Private practioners are brought into the folds of HIV program and encouraged to facilitate testing and access to medical and other welfare services. An integrated approach to integrate SRH and HIV may help in expanding services to women, which may improve access to services and reduce the stigma and discrimination attached to HIV.
Integrated Child Development Services Kishori Balika program reach to the youth. It is estimated that there were 1 60,000 children and adolescents living with HIV in Asia in 2009. In 2007, the Indian government rolled out the Policy framework for children and AIDS (NACO; UNICEF;MWCD, 2007) for desirable actions within a life cycle approach. Some states have developed specific plans for linkages with social sector programmes for accessing social support for infected through outreach and transportation subsidy to facilitate ART uptake and follow up and for accessing nutritional, educational, recreational and skill development support. Our work in building synergy for children affected by HIV and AIDS in the district of Koppal involved linking parents of children who are tested at the Integrated testing and counselling centre and children on paediatric ART to the District child protection services and thereby providing linkages for a comprehensive child care program that includes scholarship, education services and residential care if necessary. The program in a pilot stage has potential to be scaled across the country.
Mainstreaming
The involvement and coordination from the various sections of society was crucial for a sustained response to the underlying issues of HIV and AIDS. Government has actively involved the industries. Nineteen government social protection schemes have been amended and 41 directives by the State Council on AIDS have enabled social protection of the marginalized groups. Several private sector industries and industrial confederation in the country have initiated HIV interventions for employees. Programs have been conducted for various categories of the uniformed services and for training institutes for the police. HIV program is positioned to be integrated with the national health program as part of NACP IV and efforts are on to strengthen it.
Creation of an enabling environment

Creation of an enabling environment is considered as an important element in containing the epidemic in the National AIDS Program. Involvement of communities through collectives of sex workers, men who have sex with men and people living with HIV and AIDS brought the affected communities who are socio-politically on the margins to the centre stage of epidemic control. PLHIV and core communities have been involved in training programmes, advocacy workshops and outreach activities 1 09
Addressing the Needs of the Vulnerable and Specific Children and adolescents
Children and adolescent have not received the needed attention except for the Adolescence Education Programme (AEP); the program aims at provide correct information to youth in the age group of 1 5-29 years. The red ribbon clubs and the
N3
as resource persons/ positive speakers. The drop in centres made functional through the CBOs and CSO have provided psychosocial support, counselling and referral services and linkages to welfare schemes to core populations and PLHIV. Positioning HIV programs as rights based where the affected communities have a right to live a life of dignity and without stigma and discrimination created an environment that supported communities to seek help with confidence. When communities did face issues, the District and State AIDS Committees facilitated the process of redressal of grievances and getting justice. Legal aid was provided by civil society organisation working on legal issues which led to reforms. Insurance program for HIV has been piloted in some states. Several national programs such as Right to Education Act, the National Rural Employment Guarantee Scheme and the Anna Antodaya Scheme had tweaked their criteria to make it HIV sensitive. Linkages were made with shelter homes and care homes under Ministry of Women and Child Development or the Ministry of Social Justice & Empowerment to open them to women and children living with HIV. Free legal aid has been expanded in some states for legal suits related to property and insurance claims faced by people living with HIV and AIDS. Decriminalisation of same sex behaviour was made possible by the repeal of Section 377.
Resourcing for program delivery

Financing the response largely depended on the global assistance that came through the World Bank, DFID and BMGF to name a few. The global recession resulting in advocacy for greater engagement by the Government to take responsibility through domestic expenditure for furthering gain made in containing the epidemic. The Government of India has on principal agreed to fund the NACP IV; the commitment is yet to be formalised.
Focus on saturated coverage

From the NACP III, the focus was on saturating coverage. Districts were mapped to classify them based on the epidemic presentation. Gaps in programs were identified and necessary prioritisation was set to ensure coverage. Peer based approaches and community managed interventions were put in place. Micro-tools for easy tracking and sharpening interventions brought communities to the folds of essential actions for prevention and care.
Community as partners and community led intervention

The partnership with core communities and PLHA networks created an enabling environment which brought hidden communities to the centre stage and helped in addressing issues of stigma, discrimination, legal and ethical concerns. Communities became advocates for prevention and services. People Living with HIV and core communities represented their concerns and actively engaged in decision making forums and committees.
What made success a possibility

The Indian story of implementation is globally acknowledged as a story of success; there are several lessons to be learnt especially when the country is battling with large base of people living with the virus and rampant poverty.
Responding to HIV within a national public health programme

The National AIDS Control program establishes the program base forming Societies within the Government structure and later district AIDS Prevention Control units as mechanisms to work with the district administration. Program planning from NACP III has followed a bottom up approach which ensures local needs and prioritisation and fund allocation flow in tandem. The program was incrementally decentralised through the institutional structures. Visionary leadership at the national, state and district level have played a major role in ensuring relevance, effectiveness and efficiency in the program.
Partnership with international, national and local organisations

Organisations were encouraged to work in partnership with the Government and institutional mechanisms to facilitate multi-partner engagement was made possible through technical resource groups, consultative forums, intervention partnerships and research support. The three ones strategy aligned strategy, program and information management across partners.
11 0
N3
Evidence based programming
determinant of vulnerability. People who are living with HIV and AIDS have higher rates of non communicable diseases as well as opportunistic infections. With the ARTs, people are living longer and hence likely to develop both HIV and non HIV related health conditions. More and more people are getting resistant to drugs that treat infections like tuberculosis. Despite the sufficient information and evidence flowing in, the response has been lukewarm and insufficient. The dynamics of the spread of infection is fluid and responds to the changes in the larger environment. Patterns of core group behaviour is constantly evolving and changing. Government programs are mostly static and often complex to have cycles that gear to the local contexts. A delayed response can make infection spread. The momentum built as of now will need to be maintained to ensure that the spread of the epidemic is reversed. New challenges such as the penetration of drug abuse across the country, home based sex work, and so on need to be deliberated and planned processes need to be considered within the program.
Placing the HIV services within the system and periodic research studies such as behavioural sentinel studies and health sentinel studies helped the government to generate needed information to inform actions. These researches have been carried out by independent organisations and widely disseminated to bring in alternate opinions and actions.
Galvanizing political will and momentum

Strong advocacy was put in place to galvanise support from the political arena. Media was engaged to bring out the right messages and focus on pertinent areas. This led to parliamentarians getting engaged in HIV discussions and provides support for synergetic actions within the plan process. Both media and political leaders were taken on cross visits and forums were created to encourage for exchanges and learning. Media helped in message penetration and building facilitative environment.
Good management practices

Programs were followed across the country using a standard operating procedures and systems that brought about uniformity across programs. The nationwide Strategic Information Management System was synchronised and development partners shared data with the national program. Quality in human resources was assured through setting in minimum qualifications, appraisal systems and selection processes. Supply chain mechanisms were put in place so that stock out was minimised.
Conclusion
HIV program has been provided solutions on how public health program reaching to the margins of society should be evolved and built. Often within a health program, there is very little space provided for responding to the underlying structural issues that are barriers to access to services. The HIV program in India has made some concrete steps to move infection control beyond the traditional approaches. This required leadership from the national program which is inclusive to newer ideas emerging from experiences, research and from community needs. Translating such actions in a program base and provide directions and standard for practice to make it operational helps in taking the step forward. Tracking programs to see the process as well as the results and building and responding to feedback loops ensured quality in program. The Indian program for HIV has been successful and is working towards making change possible. The momentum needs to be sustained to ensure that we truly are able to reverse the epidemic.
Way forward
The India program is here to stay; it needs to continue to be dynamic and vibrant to improve access to services through intensifying and consolidating quality programs through innovative and long-lasting mechanism. From the perspective of AIDS-specific funding, these shifts have been made possible through the synergising with the health program. The health program would have to learn a lot from the HIV program to continue momentum. It means moving away from the current political sphere where medical fraternity dominance to inviting sociological and anthropological perspectives to inform programs. This signals an opportunity to critically evaluate lessons learnt from the three decades of response and re-visit the fundamental ideological position and approaches that addresses the structural
References
- Godwin, J. (201 0). http://asiapacific.undp.org/practices/hivaids/documents/874_UNDP_ExecutiveSummary.pdf. Retrieved March 20, 201 3, from www.asia-pacific.undp.org. 111
N3
- Harvard School of Public Health. (December 1 2, 2011 ). Proceeding of the symposium AIDS @ 30. . Engaging to End the Epidemic. Harvard: Harvard School of Public Health. - NACO. (No year). http://www.nacoonline.org/upload/IEC%20Division/Parliamentarian%20Forum%2045%20july%202011 /NACO%20Monograp%20NACP.pdf. Retrieved March 20, 201 3, from www.nacoonline.org. - NACO. (No year). http://www.nacoonline.org/upload/IEC%20Division/Parliamentarian%20Forum%2045%20july%202011 /NACO%20Monograp%20NACP.pdf. Retrieved March 20, 201 3, from www.nacoonline.org. - NACO; UNICEF;MWCD. (2007, July 31 ). http://ww.nacoonline.org/.../Policy_Framework_for_Children_with_AIDS. Retrieved March 20, 201 3, from www.nacoonline.org. - Sundar, B. K., & Sundar, R. (2006). http://www.undp.org/content/dam/india/docs/gender.pdf. Retrieved March 20, 201 3, from www.undp.org. - UNICEF. (201 0). http://www.unicef.org/aids/files/IndiaFactsheet_PMTCTFactsheet_201 0.pdf. Retrieved March 20, 201 3, from www.unicef.org.
11 2
N3
Acesso a gua: Desenvolvimento Humano, Sade e Educao

Resumo: A gua um recurso bsico vida e pr-requisito para o
desenvolvimento humano. As razes da crise global de acesso gua no esto na falta absoluta de fornecimento fsico, mas associadas pobreza, desigualdade sociopoltica e econmica e polticas deficientes de gesto da gua. Esta situao condena uma considervel parte da humanidade a vidas de vulnerabilidade e insegurana. Neste texto, so apresentados aspectos da crise global relacionados disponibilidade e acesso gua, desenvolvimento humano, gnero, sade e educao.
Access to Water: HumanDevelopment, Health and Education

Abstract: Water is a basic resource for life and a prerequisite for human
development. The roots of the global crisis of access to water aren't in the absence of physical supply, but associated with the poverty, sociopolitical and economic inequality, and water management policies inefficient. This condemns a considerable part of mankind to live in the vulnerability and insecurity. In this text, are presented aspects of the global crisis related to the availability and access to water, human development, gender, health and education.
Palavras-chave: Pegada Hdrica; Educao Global; Crise Global da gua;

Conservao da Natureza; Pobreza.
Key words: Water Footprint, Global Education, Global Water Crisis, Nature
Conservation; Poverty;
Valdir Lamim-Guedes
Universidade Federal de Ouro Preto, Instituto de Cincias Exatas e Biolgicas, Departamento de Biodiversidade, Evoluo e Meio Ambiente. Programa de Ps-Graduao em Ecologia de Biomas Tropicais e-mail: dirguedes@yahoo.com.br / website: www.naraiz.wordpress.com/
11 3
N3
A crise global da gua condena uma considervel parte da humanidade a vidas de pobreza, vulnerabilidade e insegurana (Pnud, 2006).
Disponibilidade de gua
A gua um recurso natural essencial como componente de seres vivos, meio de vida de vrias espcies vegetais e animais, elemento representativo de valores sociais e culturais e, inclusive, fator de produo de bens de consumo e produtos agrcolas. A gua doce do planeta, que pode estar disponvel para o uso do homem, de cerca de 0,3% do total (Bassoi, 2005). Em termos globais, as fontes de gua so abundantes. No entanto, so mal distribudas na superfcie da Terra. Mesmo no Brasil, que possui a maior disponibilidade hdrica do planeta, com cerca de 1 3,8% do deflvio mdio global (5.744km/ano), essa situao no diferente, visto que 68,5% dos recursos hdricos esto localizados na regio norte do pas (regio da Floresta Amaznica), onde habitam 7% da populao brasileira (Bassoi, 2005). A crise global da gua no reside na falta absoluta de fornecimento fsico, mas se prendem pobreza, desigualdade sociopoltica e econmica, bem como a polticas de gesto da gua deficientes, que aumentam a escassez (Pnud, 2006). Portanto, o acesso gua no determinado apenas por sua distribuio, por exemplo, em reas ridas, mas tambm depende de como se d a distribuio de outros bens (por exemplo, terra ou animais) ou de alteraes peridicas na produtividade das terras (Moran, 201 0). A Pegada Hdrica (PH) o volume total de gua doce, em metros cbicos, que utilizado para produzir os bens e servios consumidos por indivduos, indstrias ou pases, sendo tambm um indicador do consumo de gua doce. O entendimento da PH de uma nao altamente relevante para o desenvolvimento de polticas nacionais mais adequadas, esclarecendo diferenas no acesso gua. A PH mdia anual per capita global de 1 .243m3, a dos norte-americanos de 2.482m3, enquanto que a dos brasileiros de 1 .381 m3. Cerca de 38% da PH global refere-se a trs pases: China, ndia e Estados Unidos (Hoekstra e Mekonnen, 201 2). At 2030, preve-se que quase metade da populao global ter problema de abastecimento e a demanda por gua vai superar a oferta em mais de 40% (Jnior, 201 3). A maior utilizao de gua ocorre na produo agrcola, sendo que um volume significativo de gua consumido e poludo tambm nos setores industrial e domstico. A PH permite que as iniciativas pblicas e privadas, assim como a populao 11 4
Introduo
O Dia Mundial da Sade celebrado em 7 de Abril, aniversrio da Organizao Mundial de Sade (OMS). Apesar de ser uma data com um tema a cada ano e que, em 201 3, destaca a hipertenso arterial, focaremos, neste texto, um aspecto bsico para a obteno da sade: a gua. A responsabilidade sobre a gua destacada no artigo 1 . da Declarao Universal dos Direitos da gua, promulgada pela ONU em 1 992: A gua faz parte do patrimnio do planeta. Cada continente, cada povo, cada nao, cada regio, cada cidade, cada cidado plenamente responsvel aos olhos de todos (Onu, 1 992). De todos os nossos recursos naturais, a gua tornou-se o mais precioso. A maior parte da superfcie da Terra coberta por mares que a envolvem; no entanto, em meio a toda esta fartura, ainda queremos mais. Por um estranho paradoxo, a maior parte da abundante gua da Terra no pode ser utilizada para a agricultura, indstria ou para o consumo humano em virtude da elevada quantidade de sais marinhos; dessa forma, a maioria da populao mundial passa ou ameaada por uma escassez crtica. Em uma era em que o ser humano esqueceu suas origens e est cego at mesmo para suas necessidades mais bsicas de sobrevivncia, a gua, assim como outros recursos, tornou-se uma vtima da indiferena humana. (Carson, 201 0). Apenas em julho de 201 0, a Assembleia Geral da Organizao das Naes Unidas (ONU) aprovou uma resoluo, afirmando que o acesso gua e ao saneamento um direito humano essencial ao pleno desfrute da vida e de todos os direitos humanos (Worship, 201 0). A importncia da cooperao para o manejo de recursos hdricos limitados em um mundo em que a demanda est em rpido crescimento no pode ser subestimada: 1 45 pases compartilham uma grande bacia hidrogrfica com pelo menos mais uma nao. A Assembleia Geral das Naes Unidas proclamou 201 3 como o Ano Internacional de Cooperao pela gua (Unesco, 201 3).
N3
em geral, entendam o quanto de gua necessria para a fabricao de produtos ao longo de toda a cadeia produtiva, ou seja, como indicador de sustentabilidade, a pegada hdrica capaz de monitorar o impacto humano sobre o meio ambiente. Desta forma, os segmentos da sociedade podem quantificar a sua contribuio para os conflitos de uso da gua e degradao ambiental nas bacias hidrogrficas em todo o mundo (Lamim-Guedes, 201 3). A crise do acesso gua ressalta a grande importncia da preservao da quantidade e da qualidade dos recursos hdricos disponveis no planeta - em especial das guas superficiais - que a cada dia se tornam relativamente mais escassos em funo do acelerado crescimento populacional, da m utilizao dos recursos naturais pelo homem e da poluio (Brasil, 2006a). A disponibilidade de gua diretamente relacionada proteo da natureza e consequente manuteno dos servios ambientais de produo e purificao da gua.
Diante desse cenrio de escassez e desastres naturais, uma importante estratgia para se garantir recursos hdricos com qualidade e em quantidade suficiente proteger as reas naturais por meio do estabelecimento de unidades de conservao. Atualmente, da gua disponvel para uso humano no Brasil, 9% captada dentro dessas unidades e 26% captada em fontes a jusante s reas protegidas. Outra ao fundamental incentivar a proteo de mananciais em propriedades particulares, que pode ser feito por meio de mecanismos de pagamento por servios ambientais, premiando financeiramente proprietrios particulares que mantm as reas naturais em suas terras e que adotam prticas conservacionistas de uso do solo (Nunes, 201 3). A mensagem geral de que a preservao da vegetao, o uso e a ocupao adequados do solo nas bacias contribuintes influenciam diretamente na preservao da qualidade das guas dos mananciais. A necessidade de aes urgentes para conter a degradao dos recursos hdricos no exclusividade brasileira. No Timor-Leste, o acesso gua uma das grandes questes que retardam o desenvolvimento humano. Se as queimadas continuarem, daqui a 1 0 ou 1 5 anos no vamos mais ter gua no Timor por causa da perda de matas. Este cenrio apresentado pelo ambientalista timorense Demtrio Amaral de Carvalho em entrevista jornalista brasileira Rosely Forganes (2002). Alm do acesso gua, o pas ainda sofre com a seca em grande parte do ano, devido ao ciclo das mones que faz com que haja uma temporada chuvosa com muitas enchentes - e um extenso perodo seco. As questes envolvendo a gua vo alm do acesso, incluindo sade e tambm o lanamento de esgoto nos corpos dgua que, por outro lado, so recursos produtivos. Em Dli, capital do Timor-Leste, por exemplo, pequenos canais de drenagem do esgoto so utilizados para o cultivo da hortalia Kankung ou Kankun (Ipomoea aquatica Forsskal, Convolvulaceae). O consumo desta hortalia proporciona o risco de contaminao por microrganismos patognicos e ovos de vermes intestinais, derivados de excrementos humanos e de animais, colocando em risco a sade das pessoas. Por outro lado, esta hortalia de significativa importncia na base alimentar dos timorenses em geral, sendo rica em protenas e outros nutrientes e fonte de renda para muitas famlias (Freitas, 2011 ). Alm disto, ela pode ser utilizada para a reduo da poluio por nutrientes em guas eutrficas e dessalinizao (Hu et al., 2008). 11 5
gua e a conservao da natureza

O artigo 3. da Declarao Universal dos Direitos da gua lembra que os mecanismos naturais de transformao da gua bruta em gua potvel so lentos, frgeis e muito limitados. Assim sendo, a gua deve ser manipulada com racionalidade, precauo e parcimnia (Onu, 1 992). A qualidade da gua um atributo dinmico no tempo e no espao e bastante susceptvel s aes antrpicas (Brasil, 2006a). O desmatamento e o reflorestamento afetam o processo hidrolgico de tal forma que podem influenciar diretamente na disponibilidade de gua (Oel e Hoekstra, 201 2). Em terras sob cobertura florestal, o sistema radicular, serrapilheira e vegetao adensada das matas conseguem, juntos, reter em mdia 70% do volume das precipitaes, regularizando a vazo dos rios, contribuindo para a melhoria na qualidade da gua (Silva et al., 2011 ). O desmatamento causa um efeito direto que pode ameaar a quantidade e a qualidade de gua disponvel (Padua et al., 2011 ). Neste sentido, aes de conservao das matas ciliares e da vegetao em reas de recarga hdrica do lenol fretico so muito importantes para a manuteno do fornecimento de gua pelo ambiente. Ainda que o total da gua que participa do ciclo hidrolgico no se altere, por se tratar de um ciclo fechado, pode-se modificar a sua distribuio e a sua qualidade nos principais ambientes que retm a gua, ainda que transitoriamente (atmosfera, oceanos e continentes).
N3
Os prs e contras envolvendo o cultivo da kankun no esgoto mostra a complexidade em torno da produo de alimentos para consumo humano, a falta de reas cultivveis e pobreza. Como prprio das questes envolvendo gua, a proteo natureza tem consequncias diretas na qualidade de vida e na sade das pessoas, j que a gua a via de transmisso de muitas doenas.
A gua a fotografia do clima. A violncia da atmosfera e dos oceanos muda radicalmente o regime de chuvas, ventos, rios, oceanos, desertos, florestas, geleiras, animais e o habitat dos seres humanos, ou seja, a carncia, excesso ou variabilidade errtica das guas vem das mudanas climticas. Quem olha um v o outro. Quem cuida de um cuida tambm do outro (Silva et al., 201 2). Economicamente, alm de permitir a produo agropecuria, a gua, como geradora de energia eltrica, a fonte de energia renovvel mais importante e mais amplamente usada, representando 1 9% do total de energia produzida no mundo. No caso do Brasil, a principalmente fonte de energia. O rpido crescimento da populao mundial, a grande expanso urbanstica, a industrializao, a agricultura e a pecuria intensiva, a produo de energia eltrica, o aumento desenfreado do consumo fizeram com que quantidades crescentes de gua passassem a ser exigidas. Esses processos, especialmente vorazes nos ltimos 60 anos, acrescidos de um ciclo ininterrupto de poluio (para cada mil litros de gua utilizados outros 1 0 mil so poludos), tornaram a gua o recurso natural mais estratgico de qualquer pas do mundo (Senra, Friedrich e Duailibi, 2011 ). De modo geral, a questo envolvendo a gua uma parte de uma problemtica que pode ser resumida na frase de Rajendra Pachauri, Presidente do Painel Intergovernamental sobre Mudanas Climticas (IPCC) e Prmio Nobel da Paz 2008: Sociedades no se sustentam onde o meio ambiente sucumbe (Senra, Friedrich e Duailibi, 2011 ). As dimenses da crise de acesso gua tambm envolvem questes de gnero. Para as mulheres, a falta de acesso gua e ao saneamento traduz-se na perda de oportunidades educacionais e de possibilidades decorrentes desta. As jovens e as mulheres arcam com uma percentagem desigual dos custos suportados pelo agregado familiar, por exemplo, em muitos pases o tempo perdido a ir buscar gua uma das razes para o enorme fosso entre gneros verificado no nvel da frequncia escolar. As disparidades existentes a nvel educacional, relacionadas com a falta de acesso a gua e saneamento, acarretam impactos que se arrastam por toda uma vida e que se transmitem de gerao em gerao (Pnud, 2006).
gua e o desenvolvimento humano

Para manter a sade e dignidade, necessrio o acesso gua potvel, assim como para a manuteno dos sistemas produtivos e ecolgicos, os quais fornecem meios de subsistncia. Em comemorao ao Dia Mundial da gua (22 de maro), o Secretrio-Geral da ONU, Ban Ki-moon, afirmou que o acesso gua a chave para um desenvolvimento sustentvel (Jnior, 201 3).
Figura: Colheita de
kankun (Ipomoea aqutica), no crrego prximo ao Parlamento Nacional e do Palcio do Governo timorenses. Foto: Thiago Allis.
A existncia de gua potvel e de saneamento bsico pode promover o desenvolvimento humano, no sendo somente um direito fundamental, mas um importante indicador do progresso dos povos. Tambm constitui a base de outros direitos humanos, sendo condio bsica para que se atinjam metas de desenvolvimento humano mais exigentes (Pnud, 2006). Como o caso do 7. Objetivo do Milnio (ODM) que refere-se a promover o desenvolvimento sustentvel, reduzir a perda de diversidade biolgica e reduzir pela metade, at 201 5, a proporo da populao sem acesso a gua potvel e sanitrio bsico (Objetivos do Milnio, 201 3). A relao entre gua e desenvolvimento humano vai alm do acesso gua. Alm da sade, aspecto bsico que ser discutido a seguir, outro ponto importante so as mudanas climticas. Vrios estudos apontam para o aumento de desastres naturais secas e inundaes. Atualmente, 1 5% de todas as mortes relacionadas a desastres naturais so por causa de enchentes (Plurale em revista, 201 3).
11 6
N3
gua e sade
As estatsticas impressionam: h mais de um bilho de pessoas a quem se nega o direito a gua potvel e 2,6 bilhes de pessoas sem acesso a um saneamento adequado. Cerca de 1 ,8 milhes de crianas morrem em decorrncia de diarreia e outras doenas provocadas por gua contaminada e por ms condies de saneamento (Pnud, 2006). Isto representa uma mdia de 5 mil mortes dirias de crianas por causa de doenas que poderiam ser evitadas, todas relacionadas qualidade ou acesso gua ou saneamento bsico (Plurale em revista, 201 3).
seja largamente conhecida nos meios cientficos, estas doenas assumem, atualmente, propores inaceitveis, demonstrando a dissociao entre a academia e a qualidade de vida das populaes. A gua, o saneamento e higiene tm importante impacto tanto na sade quanto na doena e dependem de todas as reas que direta ou indiretamente possam interferir no equilbrio ou desequilbrio ambiental (Dockhorn, 2004). A relao entre gua e sade deve-se ao fato da gua poder veicular um elevado nmero de agentes infecciosos, cuja transmisso pode se dar por diferentes vias. importante destacar que tanto a qualidade da gua quanto a sua quantidade e regularidade de fornecimento so fatores determinantes para o acometimento de doenas no homem. Conforme mostram os mecanismos de transmisso descritos, a insuficiente quantidade de gua pode resultar em (i) deficincias na higiene; (ii) acondicionamento da gua em vasilhames, podendo tornar-se vulnerveis deteriorao da qualidade e ambiente para procriao de vetores e (iii) procura por fontes alternativas de abastecimento, que constituem potenciais riscos sade pelo contato das pessoas com tais fontes (risco para esquistossomose, por exemplo) ou pelo uso de guas de baixa qualidade microbiolgica (risco de adoecer pela ingesto) (Brasil, 2006b). Dois dos principais problemas emergentes de qualidade da gua para consumo humano guardam relao direta com o uso e a ocupao do solo na bacia de captao: a transmisso de protozooses (ex.: giardase e criptosporidiose) e o desenvolvimento de cianobactrias (Brasil, 2006a). Alm destas, a dengue, transmitida pelo mosquito Aedes aegypti L. (Culicidae), que tem a gua como ambiente para o desenvolvimento de suas larvas, um caso srio de sade pblica em toda a regio tropical e subtropical do mundo. As ms condies de sade, associadas falta de gua e de saneamento pem em perigo a produtividade e o crescimento econmico, reforando as profundas situaes de desigualdade que caracterizam os atuais padres de globalizao e apanhando os agregados familiares vulnerveis em ciclos de pobreza (Pnud, 2006). Solues simples, rpidas e baratas tambm vm sendo desenvolvidas para minimizar os problemas da contaminao da gua. Para alm dos benefcios diretos de diminuio de doenas de veiculao hdrica, essas tecnologias representam ganho ambiental e reduo de custos para as famlias, uma vez que no demandam combustvel para ferver a gua. Algumas destas tcnicas, chamadas tecnologias sociais, podem ser obtidas no livro gua e mudanas climticas: tecnologias sociais e ao comunitria (Silva et al., 201 2). 11 7
Figura: Mulher e menina transportando A meta de reduo pela metade do mercadorias e gua. Ilha de Ataro, Timornmero de pessoas sem acesso a gua Leste. Foto: V. Lamim-Guedes. potvel foi atingida em 201 0. Segundo Ban Ki-moon, "alcanamos uma meta importante, mas no podemos ficar-nos por aqui" (Lusa, 201 2). Em 201 0, 89% da populao mundial (6,1 bilhes de pessoas) usam fontes melhoradas de gua potvel, como abastecimento canalizado e poos protegidos. Contudo, a meta para saneamento bsico no ser alcanada at 201 5. Apenas 63% da populao mundial tem acesso a saneamento melhorado, ou seja, a existncia de uma instalao que separa higienicamente os excrementos humanos. Estima-se que poder ser 67% at 201 5, muito abaixo dos 75% almejados pelos ODM (Lusa, 201 2).
Os nmeros no mostram os rostos humanos dos milhes de pessoas a quem negada a oportunidade de realizar o seu potencial. A crise de acesso gua, assim como a fome, no foco de destaque na mdia internacional, nem de grandes programas internacionais, assim como nacionais. uma crise suportada pelos pobres e tolerada, seno negligenciada, por que detm poder poltico ou financeiro para a resoluo dos problemas de acesso gua e saneamento bsico. Com a crescente urbanizao, aumento da densidade populacional e maior impacto ambiental, as doenas infecciosas relacionadas gua so hoje a maior causa de morbi-mortalidade em todo o mundo (Who, 1 994). Embora sua preveno
N3
"Melhor gua, saneamento e higiene so cruciais para promover a sade humana e o desenvolvimento", afirmou a diretora-geral da OMS, Margaret Chan, ao salientar que, apesar dos "progressos animadores, quase dez por cento de todas as doenas continuam ligadas fraca qualidade da gua, do saneamento e da higiene" (Lusa, 201 2).
futuras (Onu, 1 992). A perspectiva de emprstimo das geraes futuras exige uma gesto atual dos recursos naturais adequada. A unio destes dois aspectos a base da definio de desenvolvimento sustentvel, ou seja, o desenvolvimento que satisfaz as necessidades atuais sem comprometer a capacidade das geraes futuras para satisfazerem as suas prprias necessidades (Cmmd, 1 991 ). Aes educativas envolvendo a gua podem usar a Pegada Hdrica, ferramenta interessante para uso didtico por ser uma medida do consumo de gua. Um aspecto interesse seu uso em atividades de educao ambiental, j que est enraizado no reconhecimento de que os impactos humanos nos sistemas de gua doce podem estar ligados ao nosso consumo, e que questes como a escassez de gua e a poluio podem ser melhor compreendidas e tratadas, considerando a produo e cadeias de suprimento como um todo (Lamim-Guedes, 201 3). Para Arjen Hoekstra, criador do conceito de PH, apesar dos governos terem papel fundamental na elaborao de leis que tornem em obrigao a gesto eficiente da gua, a populao e as empresas tambm devem se envolver completamente. As companhias precisam entender como utilizar os recursos hdricos da melhor forma e devolv-los limpos para a natureza. J os consumidores devem se preocupar com a origem dos produtos que consomem e com os procedimentos adotados na produo (WWF Brasil, 2011 ).
Educao e o consumo de gua

Dois pontos cruciais para a compreenso da importncia da educao como meio para facilitar o acesso das pessoas gua so: a) a escassez que se encontra no corao da crise mundial da gua tem as suas razes no poder, na pobreza e na desigualdade, no na disponibilidade fsica; b) quando as pessoas tm negado o seu acesso gua potvel no lar ou quando no tm acesso gua enquanto recurso produtivo, as suas escolhas e liberdades so limitadas pela doena, pobreza e vulnerabilidade. Dos temas mais presentes no debate sobre a questo ambiental, nenhum discurso parece ter o mesmo potencial mobilizador do que aquele sobre a gua. Talvez por ser o elemento fundamental, presente em todas as formas vivas, ou por representar com clareza as ideias de transparncia e fluxo de ciclos, a gua smbolo da prpria vida em diversos contextos culturais e religiosos (Menezes, 2008), assim como, os problemas com escassez, desastres naturais e transmisso de doenas. Neste contexto, essencial reconhecer o papel poltico da educao, como fez o pedagogo brasileiro Paulo Freire (1 921 -1 997) em sua obra, sobretudo ao apresentar uma concepo libertadora da educao (Freire, 2002). Assim, a gua deve ser um tema convergente entre as aes educativas, englobando assuntos relacionados s suas dimenses ambientais, scias, polticas e econmicas. Neste ponto, alguns movimentos, como a Educao Global, tm buscado a aproximao da temtica ambiental, envolvendo a sustentabilidade com as questes relacionadas aos direitos humanos, como gnero, desafios do milnio e participao cidad (Educar para Vivir, 201 3) e uma forma de trabalhar a questo da gua de forma holstica. Segundo a Declarao Universal dos Direitos da gua, no artigo 5, a gua no somente uma herana dos nossos predecessores; ela , sobretudo, um emprstimo aos nossos sucessores. Sua proteo constitui uma necessidade vital, assim como uma obrigao moral do homem para com as geraes presentes e
Consideraes finais
Uma frase do Relatrio do Desenvolvimento Humano (Pnud, 2006) resume bem o desafio em torno do acesso gua, sade, educao:
A gua d vida a tudo, incluindo o Desenvolvimento e liberdade humanos.
Referncias
AGNCIA LUSA. (201 2). Alcanado Objetivo de Desenvolvimento do Milnio para gua potvel. Disponvel em www.ionline.pt/mundo/alcancado-objectivodesenvolvimento-milenio-agua-potavel BASSOI, L. J. (2005). Poluio das guas. In: PHILIPPI JR., A.; PELICIONI, M. C. F. Educao Ambiental e sustentabilidade (p. 1 75-1 93). Barueri: Manole, 2005. BRASIL. (2006a.). Boas prticas no abastecimento de gua: procedimentos para a minimizao de riscos sade. Braslia: Ministrio da Sade. 11 8
N3
CARSON, R. (201 0). Primavera Silenciosa. So Paulo: Gaia.
BRASIL. (2006b). Vigilncia e controle da qualidade da gua para consumo humano. Braslia: Ministrio da Sade. CMMD (COMISSO MUNDIAL SOBRE O MEIO AMBIENTE DESENVOLVIMENTO). (1 991 ). Nosso futuro comum. Rio de Janeiro: FGV. E
Management, v.11 , p.9942- 9949. ONU. (1 992). Declarao Universal dos Direitos da gua. Disponvel em http://www.jardimdeflores.com.br/ECOLOGIA/A27direitosdaagua.htm PADUA, S. M.; PADUA, C.; DITT, E.; ALMEIDA, T. (2011 ). Do Cdigo Florestal gua da torneira. Folha de So Paulo. Disponvel em http://www.ipe.org.br/ipe/docodigo-florestal-a-agua-da-torneira PLURALE EM REVISTA. (201 3). Especial gua. Ano 6, n. 34. Maro/abril 201 3. Disponvel em http://www.plurale.com.br PNUD. (2006). Relatrio do Desenvolvimento Humano 2006. Nova York: PNUD. SENRA, J. B.; FRIEDRICH, N. M.; DUAILIBI, M. (2011 ). Ciranda das guas. Braslia: MMA. SILVA, J.A.A.; NOBRE, A.D.; MANZATTO, C.V.; JOLY, C.A.; RODRIGUES, R.R.; SKORUPA, L.A.; NOBRE, C.A.; AHRENS, S.; MAY, P.H.; S, T.D.A.; CUNHA, M.C.; RECH FILHO, E.L. (2011 ). O Cdigo Florestal e a Cincia: contribuies para o debate. So Paulo: SBPC e ABC. SILVA, M. N.; GONTIJO, A. B.; LAMIM-GUEDES, V.; SANTOS, M. E. G. (201 2). gua e mudanas climticas: tecnologias sociais e ao comunitria. Belo Horizonte: CEDEFES / Fundao Banco do Brasil. Disponvel em http://www.sinquisp.org.br/pdfs/Livro%20Agua%20e%20Mudancas%20Climaticas%2 06fev1 2.pdf UNESCO. (201 3). Ano Internacional de Cooperao pela gua. Disponvel em http://www.unesco.org/new/pt/brasilia/201 3-international-year-of-water-cooperation/ WHO. (1 994). Water Sanitation www.who.int/water_sanitation_healt/en/ and Health. Disponvel em
DOCKHORN, M. S. M. (2004). gua, Sade Humana e o Ambiente. Vidya, vol. 41 , pp. 1 59-1 64. EDUCAR PARA VIVIR. (201 3). Disponvel em http://www.educarparavivir.com/ FORGANES, R. (2002). Queimado queimado, mas agora nosso! Timor: das cinzas liberdade. So Paulo: Labortexto editorial. FREIRE, P. (2002). Pedagogia da autonomia. 23. ed. Rio de Janeiro: Paz e Terra. FREITAS, R. S. (2011 ). Educao Ambiental em Timor-Leste: desafios e possibilidades. In: SANTOS, M. A. Experincias de professores brasileiros em TimorLeste: cooperao internacional e educao timorense (p. 300-321 ). Florianpolis: Ed. da UDESC. HOEKSTRA, A. Y.; MEKONNEN, M. M. (201 2). The water footprint of humanity. PNAS, vol. 1 09, n. 9, pp. 3232-3237. HU, M. H.; AO, Y. S.; YANG, X. E.; LI, T. Q. (2008). Treating eutrophic water for nutrient reduction using an aquatic macrophyte (Ipomoea aquatica Forsskal) in a deep flow technique system. Agricultural Water Management, vol. 95, pp. 607-61 5. LAMIM-GUEDES, V. (201 3). A pegada hdrica: conceito e uso em atividades de educao ambiental. Educao Ambiental em Ao, vol. 43. Disponvel em http://www.revistaea.org/artigo.php?idartigo=1 41 2&class=41 MENEZES, P. D. R. (2008). A oportunidade da gua. In: HISSA, C. E. V. (Org.). Saberes ambientais: desafios para o conhecimento disciplinar (pp. 1 25-1 40). Belo Horizonte: Editora UFMG. MORAN, E. F. (201 0). Adaptabilidade Humana: uma introduo antropologia Ecolgica. 2 ed. So Paulo: EDUSP, Editora SENAC. NUNES, M. (201 3). gua e Biodiversidade: compromisso com a vida. Plurale em Revista. Ano 6, n. 34. Maro/abril 201 3. Disponvel em http://www.plurale.com.br OBJETIVOS DO MILNIO. (201 3). Qualidade de vida e respeito ao meio ambiente. Disponvel em http://www.objetivosdomilenio.org.br/meioambiente/ OEL, P. R. VAN; HOEKSTRA, A. Y. (201 2). Towards quantification of the water footprint of paper: A first estimate of its consumptive component. Water Resource
WORSHIP, P. (201 0). Assembleia da ONU declara direito gua, mas com polmica. Folha de So Paulo. Disponvel em http://www1 .folha.uol.com.br/ambiente/774471 assembleia-daonu-declara-direito-a-agua-mas-com-polemica.shtml WWFBRASIL. (2011 ). Pegada Hdrica incentiva o uso responsvel da gua. Disponvel em http://www.wwf.org.br/?27822/Pegada-Hdrica-incentiva-o-usoresponsvel-da-gua
11 9
Letters to the Editor

How to Submit a Letter to the Editor?
Letters to the editor should be no longer than 1 000 words, must refer to an article that has appeared within the last editions or about current educational news, and must include the writer's name and email. We regret we cannot return or acknowledge unpublished letters. Writers of those letters selected for publication will be notified within a week. Letters may be shortened for space requirements. Send a letter to the editor by e-mailing:
globaleducationmagazine@gmail.com
N3
the very place of genocide, worlds heritage city of Dubrovnik, historical cites of Jajce and Mostar, known with beautiful Neretva River and the New Old Bridge, built after the war from the stones of a historical one appearing again from the ashes. Peace and Conflict Studies Program is Bosnia and Herzegovina is a special chance for study abroad, in a new group and environment, across the borders of continents, states and universities, groups and cultures. More of that, it is a unique opportunity to gain the knowledge and insights in the matter of conflict and peace at the place where the history and legacies of war, as well as efforts to build the state and sustainable peace, could be seen, touched and discussed with the witnesses and participants, giving to each lesson an additional dimension of living history. Also, this is the opportunity to meet the people, cultural heritage and beautiful nature of the country placed in the heart of Europe, and enjoy education!
New Peace and Conflict Studies Program, American University in Bosnia and Herzegovina
Cvijeta Novakovic
Peacebuilding and Conflict Transformation Specialist e-mail: cvijeta.201 2@gmail.com
and a synagogue almost literary touching each other, placed in the same little square. Despite divisions and horrible of war and over thousand days of the siege of the city, coexistence between people of different ethnic, religious and national backgrounds survived, and Sarajevo kept its multicultural life, visible on streets, schools and every place. Sarajevo was the Winter Olympic city in 1 984; and will confirm its hospitality again to the Youth Winter Olympic Games in 201 7. The Peace and Conflict Studies Program will be held from 2 June to 3 August, in facilities of the American University placed in an attractive and modern building at the heart of the city. Courses: Balkan history, Statebuilding and Peacebuilding, Security of Balkans, and Genocide, War Crimes and Transitional Justice with be given by local and international lecturers and enriched by number of meetings with governmental, local and international authorities and institutions with significant roles in the process of peacebuilding and building the state. (for more information about the Peace and Conflict Studies Program please, visit www.aubih.edu.ba/en/studyabroad) The Program also offers organized accommodation and number of study travels through the region that gives opportunity to meet the history and reality of Bosnia and Herzegovina, learn about wars and coexistence, its cultural richness and beauty, including visits to Srebrenica,
Dear friends,
modern science, partnerships and close cooperation with USA, local and Warmest greetings from the ancient city of international institutions, including Sarajevo, Bosnia and Herzegovina, and European Centre for Security Studies congratulations for the Global Magazine George C. Marshall, State University of 3! New York, George Mason University, etc. I am very happy to share with you news about the Peace and Conflict Studies Program that will be initiated in summer 201 3 by the American University in Bosnia and Herzegovina. The Program is part of the Study Abroad Program, giving opportunity to students from USA and around the world opportunity to learn, exchange, and enrich themselves by new knowledge and experiences, people and culture. The Program welcomes graduate and undergraduate students, as well as practitioners taking it for training, giving possibility for credit transfer and internships in respectable international and local institutions. Peace and Conflict Studies Program is set in Sarajevo, the capital of Bosnia and Herzegovina - the country which, with other countries of former Yugoslavia, at the end of twentieth century experienced one of the hardest wars in newer history of Europe. This is the country in which history of war and peacebuilding could be seen and touched, and touch the students with its authentic and power, as well as natural beauty and cultural richness. Rebuilding from the war, Bosnia and Herzegovina is in a steady progress to European Union and NATO membership.
Sarajevo is a beautiful historical city nested between five mountains, known by The American University in Bosnia and its cultural and religious diversities the Herzegovina is present since 2005 with place in which Islam, Judaism and departments in Tuzla, Sarajevo, Mostar Christianity are present in centuries, and and Banjaluka, several programs in towers of different churches, mosques
1 21
N3
Khair A. Barham
Palestinian youth and social justice email: khair.barham@gmail.com
1 22
N3
Open Enterprise Space in Brazil New Mindset Entrepreneurship

By Mikele Ferraro and Giovanni Cerrone
Co-creating and Social Business need strength and skills, we all will learn the power of Love as technology using it like a tool to enrich our potential and make some concrete transfortmation around our communities... Love is for strong people not for the weak ones! With us you will be much more strong than before... We must think liquid...
OES Brazil
experience and the spiritual andintangible component of living. OES Brazil is a new Mindset Edu Space based on Brazil btw Morro de Sao Paulo and Salvador de Bahia collaborating with the Federal University of Brazil, local Entrepreneurs and an international Join venture made up from Mikele Ferraro, the OES Director. https://www.facebook.com/OpenEnterpri seSpace Javier Collado, Julia Navarro, Guilliermo Cereceda co-founders at OES Brazil.
1 23
Traditional schools train people to achieve specific goals, to integrate into an existing professional environment. It is based on individual excellence and competitiveness. The school/space of the future must prepare people to create their own professional horizon in a world that is rapidly changing and making many of the traditional teachings obsolete. This new education is based on collaborative thinking as opposed to individualistic competitiveness, it will encourage creativity and personal spiritual fulfillment as opposed to only
material and professional achievements. It is a holistic approach to education not a traditional subject based curriculum. It focuses on relational information and practical experimentation not traditional theoretical knowledge. The school of the future needs to develop a new human being because the important question we ask is: who do we want to be? what kind of humanity do we want to prepare? As we answer these questions, we understand the need for a balanced approach between work and nonwork, between the material
N3
PIG PRODUCTION & MARKETING UGANDA LIMITED
Africa (3.4 kg/person per year). The majority of pigs are yields may not exceed 65%. kept by women in smallholder households, as part of the Pork is most nutritious with high fat and low water large informal sub sector, with limited access to content and has got better energy value than that of technology information and services. other meats. It is rich in vitamins like thiamine, Niacin MATUGGA TOWN - BOMBO ROAD and riboflavin. So this practice also fights Malnutrition. P.O.BOX 441 KAMPLALA UGANDA According to recent FAO statistics, pork is second Pig manure is widely used as fertilizer for Tel: +256 41 4 694 465 only to beef in terms of meat production in Uganda (see agriculture farms and fishponds. www.pigfarmers.co.ug Table Below) since imports and exports of meat products Pigs store fat rapidly for which there is an E-mail: admin@pigfarmers.co.ug, are negligible; this ranking also reflects the relative increasing demand from poultry feed, soap, paints and sales@pigfarmers.co.ug importance currently of pork in terms of meat other chemical industries. consumption. Company Strategies to help rural poor pig Mission Statement: To ensure effective and efficient Meat Production in Uganda farmers: production distribution and marketing of Pork/live pigs at affordable prices in East Africa. Through our program (Fighting Rural Household Poverty through Piggery), we support poor households Vision Statement: To provide top quality Pork for with training in production (breeding stock selection, healthy living of people all over the world and fighting Why Pigs? housing and veterinary services, feeding and waste rural household poverty through piggery in Uganda. Pigs have a number of advantages that suit rural management, pigs). This is done with support from our citizens making it one of the best way to run to in order developmental partners (Planet Changer USA, ABOUT PPM LTD to solve the issue of poverty. Mwanamke Afrika France, Mission Africa UK, The pig has highest feed conversion efficiency i.e. individual well-wishers from within and outside the Pig production and marketing Uganda limited is a company registered in the republic of Uganda. The they produce more live weight gain from a given weight country and recent Africa Rural Connect USA). company deals in production and marketing of pork and of feed than any other class of meat producing animals We also construct, manage and operate pig live pigs. We work closely with rural farmers helping except broilers. The pig can utilize wide variety of feed stuffs viz. multiplication and demonstration farms. These are used them produce and availing market for their produce. Together with development partners, PPM also fights Grains, forages, damaged feeds and garbage and as training grounds for farmers. They also provide rural household poverty through its project Fighting convert them into valuable nutritious meat. Feeding of piglets that are given to rural households to start their damaged grains, garbage and other home wastes own piggeries. Rural Household Poverty through Piggery (FRHPP). reduce the stress of buying food stuffs hence spending less or no money on food. Research in breeding, housing, marketing PRODUCTION They are prolific with shorter generation interval. A Feeding etc. sow can be bred as early as 8-9 months of age and can Background farrow twice in a year. They produce 6-1 2 piglets in each PPM aims at increasing the production of pigs through rural households; we empower them to produce Over the past two decades pig production has farrowing. Pig farming requires small investment on as they fight poverty. become an increasingly important activity in Uganda. In the last 30 years the pig population has increased from buildings and equipments. Pigs are known for their meat yield, which in 0.1 9 to 2.3 million, and there are more than 1 million households raising pigs. In 2011 , Uganda had the terms of dressing percentage ranges from 65-80 in highest per capita consumption of pork in sub-Saharan comparison to other livestock species whose dressing 1 24
N3
Growth and Market Opportunities in Uganda Problems as Result of Poor Pig Markets in Kamuli Selection of farmer group beneficiaries of the Pig industry: District. project, support to farmers; structures, training, seeds,
1 . Farmers cannot adopt better pig management The following Table shows the top five sub-Saharan methods that are highly profitable. African countries according to size of pig population. 2. Pig farming remains a backyard activity hence preventing its development in the district. Of these, Uganda has high consumption per 3. Farmers have no ability to acquire good breeds. capita, and appears to be experiencing the most rapid 4. Piggery is not taken as a job; people practice it as a growth in production. supplement to their incomes. 5. Pigs are now related to the spread of giggers, Kamuli Rapidly increasing production and consumption of Chief Accounting Officer had a suggestion to burn pig pork within the country, driven not only by population production in the district. growth, but also by a combination of rising incomes and changing preferences associated with urbanization and PPM Extension of Marketing services to changing production systems Kamuli District.
pigs, feeds, monitoring and follow up, monitoring of sharing out of proceeds, vaccination and drugs. All development activities will be executed through PPM's developmental project Fighting Rural Household Poverty Through Piggery. We have planned two sub counties for the initial work; Namwendwa and Bugulubya sub counties. The first priority will be given to Namwendwa because it has the highest pig population in the district.
Marketing
Our contacts and source of information for PPM initial work in Kamuli will be the district Veterinary officer, sub county veterinary officers, village leaders, NGOs (VEDCO) and existing farmer group leaders. We have already linked up with these people.
Growing demand for processed products as street In the year 201 3 the month of March, PPM Limited food and for supermarkets, and emergence of formal- plans to extend its marketing sevices to Kamuli district as sector enterprises (e.g. Fresh Cuts, Quality Cuts, My part of its strategies to develop pig production in poor Choice) must give capable farmers and NGOs a reason districts of Uganda. to start investing in pig farming as an income generation activity and tool to fighting poverty. Prices for pigs from farmers will rise from 2,000 Uganda shillings to 5,000 Uganda shilling. PPM also plans to give back 20% of its profit per year for a period of 5 years to Kamuli farmers to help develop the sector in the district.
Consultative meetings with Farmers in Isingo A and B with ILRI
Pig weight will be determined by live weight estimation because there is no standard measure for live pigs in Uganda. NB; The International Livestock Research institute is working on availing measures for live pig weight determination. PPM hopes to implement the measure as soon as it is available. The estimation The money will help PPM organize farmers into will be done fairly with no intentions of cheating farmers producer organizations, technical support to develop and by under estimating their pigs. disseminate improved breeds and farming systems for pig production and management. To equip farmers with PPM will use hired transport to transport pigs from knowledge and skills in disease prevention and control kamuli to Kampala. Part of the pork will be sold to PPM practices, feeding, proper management practices for pigs customers including fresh cut and the rest sold to and also improved pig farm products and waste Wambizzi Cooperative Abattoir. utilization for example extending the biogas technology Christopher Mulindwa/ PPM Ltd Production's Manager/P.O.Box 441 K'la to Kamuli farmers.
PPM Development Approach and Methods Development; Mobilization, sensitization, and

organization of communities into farmer groups.
chrismulindwa@pigfarmers.co.ug/+256 773 422 445/Skype: chrismulindwa Alex Kyeyune/PPM Ltd Finance & Marketing Manager/P.O.Box 441 K'la Uganda/alex@pigfarmers.co.ug/+256 784 542 889/Skype: alinkyeyune
1 25
N3
Water Resource
Bussiness I nnovation Research Development
Georges Radjou
Consultant chez International Conference Consulting On hazard Management
Some guidelines from CODATA outcomes Thanks to Horst Kremers http://www.codata.org/ recalling us theignored world of disaster reduction in a world versed into to technologies 1 -Sacred values: the indigenous people know better how to conserve the water
http://www.culturalsurvival.org/australia?gclid=CPmlx--H97UCFeXLtAode3gAEQ
2-Narrative stories: help to redue cost of risks: in Tsunami Dec, 26, 2004 the world
is awaken by a huge noise of the giant mega wave-Best one is dust bowl https://www.google.fr/searchq=dust+bowl&hl=fr&tbm=isch&tbo=u&source=univ&sa=X &ei=KxA_UaKtKsbBPLzugZgI&sqi=2&ved=0CEMQsAQ&biw=996&bih=599
acquistion, treament andinformation transmittted should not leave beside people, http://www.practicalmanagement.com/Organization-Development/OrganizationWater scarcity: Asia is the contient most at risk because it is where all humanity fundamentals.html resides. Already over a billion people lack of clean water (1 .2 billion people with no drinking water)- In the future expect 2/3 of the planet to be without water (4-5 billions): 4-Emerging country needs for GIS platform is paramount Myself , I used Google map for searching a road map in a foreign country or estimating a number of Pakash Pa tells more http://www.authorstream.com/Presentation/prakashpcombattants I would send in a war- Google map just work perfectly well, when 300635-water-india-pollution-ppt-scarcuty-related-indian-website-science-technologycountries allow the coverage. http://maps.google.fr/ powerpoint/
3-Nexus for changes with the Geo information System (GIF), which is mainly data
and information on megal risk: global, terrorism, If clean water has always existed, less and less water is available 5-Advertisement outerspace diseases...(Good point on these Mega risks,1 000 people passed close to due to pollutions (Hazards : Physical, chemical and biological). In the past, the Russia) http://www.reuters.com/article/201 3/02/1 5/us-russiameteorite-idUSBRE91 E05Z201 3021 5
best way to clean water was to leave the natural environment to selfrecycleits own water flows. http://www.forbes.com/sites/amywestervelt/201 2/09/26/three-ways-tosolvethe-water-crisis-now/ increase role - Take for example policies to legalize cannabis and its impacts Today, due to population growth, water uses -think making a Jean trouser uss 1 0,000 http://www.opensocietyfoundations.org/about/programs/globaldrug-policy-program liters of water-a full watertruck - This water is frozen. It cannot be used. Unless we pay the price to clean (which is becoming less likely today). It costs to clean water 7-Role of Twitter in disaster: during a risk event, map records showed a densification of the tweets in thehazard zones https://twitter.com/DisasterForms twice as much as the first glass of water. http://www.yorkshirewater.com/yourwaterservices/water-meters/water-meter-calculator.aspx
6-Perception of disasters: it is cutural and also, invidual motivation played an
I want to present you the Corporate Sustainable Officer (Analogy with

Chief Financial Officer CFO- and Chief Executitive Officer- CEO)- To be found in Green businesses. http://weinrebgroup.com/wpcontent/uploads/2011 /09/CSO-Back-Story-by-WeinrebGroup.pdf
1 26
Global Education Magazine invites all readers to disseminate the contents of the journal.
globaleducationmagazine@gmail.com
The authors accepted the terms to publish this magazine. Now, everyone can reproduce, adapt or distribute (in a free and non-commercial way) any article to aware the world-society about the Millenium Development Goals.

Global Education Magazine: World Health Day (April 7th 2013)

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Global Education Magazine: World Health Day (April 7th 2013)

Uploaded by

Copyright:

Available Formats

Daniel Lpez

UBUNTU Cosmic Energy: The Ethical Basis For Future Worldists

Javier Collado Ruano

La Energa Csmica UBUNTU: La Base tica De Los Futuros Mundlogos

Namaste! El objetivo principal de Global Education Magazine es

Javier Collado Ruano

17. UNHCR's work on HIV in the Americas.

Articles with are available for blinds!

15. Proyectos de la UNESCO para comienzos de ao.

Disseminate GEM to raise awareness!

Dr. Ala Alwan

In the Name of God, the Compassionate, the Merciful

Who Regional Director for the Eastern Mediterranean

on the occasion of WORLD HEALTH DAY 7 April 201 3

Dr. Ala Alwan

Who Regional Director for the Eastern Mediterranean

Special World Health Day

Health in United Nations: Millennium Development Goals

-Millennium Development Goal 1 : eradicate extreme poverty and hunger.

-Millennium Development Goal 6: combat HIV/AIDS, malaria and other diseases. As

-Millennium Development Goal 7: ensure environmental sustainability. Target 7C: By

Special World Health Day

-Millennium Development Goal 8: develop a global partnership for development.

Special World Health Day

"La verdad sigue estando oculta en el Sahara Occidental"

El Oasis de la Memoria. Entrevista con Aminatou Haidar.

El Oasis de la Memoria. Entrevista con Aminatou Haidar.

SHARE YOUR REFLECTIONS IN THE NEXT EDITION

WORLD REFUGEE DAY

Proyectos de la UNESCO para Comienzos del Ao

UNHCR's Work on HIV in the Americas

Rosalina Cermeo Vargas

What is the Role of the Pharmacist in the Health Care System?

Critical Pedagogy Against Capitalist Schooling:

Towards a Socialist Alternative

Picture by Laura Herrera

Salud para la Educacin

Jose Mara Barroso Tristn

Millenium Development Goals Global Education Transversal Studies

Rabbi DVorah Rose.

Education: an essential component in guaranteeing the right to health?

Cristina Sirur y Mariana Ruiz de Lobera. Emanuela Bezerra Gueiros.

Itahisa Prez-Prez y Juan Agustn Morn Marchena. Juan Carlos Melero.

Francisco F. Garca Prez y Olga Moreno Fernandez. Ruth De Frutos Garca.

Francisco Orgaz Agera y Eugenia Cruz. Jos Ignacio Bozano Herrero.

Eleonora Moscardi, Mara Marchitelli e Valentina Menzella. Anita Rego.

Millennium Development Goals

The goal of the world is economic efficiency?

Research Papers. Section 1 . Millennium Develpoment Goals.

Keywords: Millennium Development Goals, HIV/AIDS, Human Development,

Palabras clave: Objetivos de Desarrollo del Milenio, VIH/SIDA, Desarrollo

Research Papers. Section 1 . Millennium Develpoment Goals.

Research Papers. Section 1 . Millennium Develpoment Goals.

El Informe de Desarrollo Humano: el caso de Nicaragua

Research Papers. Section 1 . Millennium Develpoment Goals.

Research Papers. Section 1 . Millennium Develpoment Goals.

Tabla 3. Datos desiguales de Pases de Amrica Latina

Fuente: elaboracin propia, extrados los datos del PNUD.

Research Papers. Section 1 . Millennium Develpoment Goals.

Segn el Informe de ODM (201 2: 4):

Research Papers. Section 1 . Millennium Develpoment Goals.

Research Papers. Section 1 . Millennium Develpoment Goals.

Rabbi Dvorah Rose

Research Papers. Section 1 . Millennium Develpoment Goals.