Hesperian Health Guides
Chapter 3: Prevention of Disabilities
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Because this is a book on ‘rehabilitation’, it is mostly about children who are already disabled. However, preventing disabilities is also very important. For this reason, in most chapters on specific disabilities, we include suggestions for preventing them.
Notice that we place the discussion of prevention at the end of each chapter, not at the beginning. This is because people are usually not concerned about disability until someone they love becomes disabled. Then their first concern is to help that person. After we have helped a family to do something for their disabled child, we can interest them in ways to prevent disability in other members of the family and community.
We mention this because when health professionals design community programs, often they try to put prevention first—and find that people do not show much interest. However, when a group of parents comes together to help their disabled children, after their immediate needs are being met, they may work hard for disability prevention.
For a community program to be successful, start with what the people feel is important, and work from there.
To prevent disabilities, we must understand the causes. In most parts of the world, many causes of disability relate to poverty. For example:
- When mothers do not get enough healthy foods to eat during pregnancy, often their babies are born early or underweight. These babies are much more likely to have cerebral palsy, which is one of the most common severe disabilities. Also, some birth defects are related to poor nutrition during the first months of pregnancy.
- When babies and young children do not get enough to eat, they get infections more easily and more seriously. Diarrhea in a fat baby is usually a mild illness. But in a very thin, malnourished baby, diarrhea often leads to serious dehydration, high fever, and sometimes brain damage with seizures or cerebral palsy.
- Poor sanitation and crowded living conditions, together with poor food, make diseases such as tuberculosis—and the severe disabilities it causes—much more common.
- Exposure to toxic chemicals even before birth can cause different kinds of disabilities in children. More dangerous chemicals are used or disposed of in or near poor communities.
- Lack of basic health and rehabilitation services in poor communities makes disabilities more common and more severe. Often secondary disabilities develop that could be prevented with early care.
To prevent the disabilities that result from poverty, big changes are needed in our social order. There needs to be fairer distribution of land, resources, information, and power. Such changes will happen only when the poor find the courage to organize, to work together, and to demand their rights. Disabled persons and their families can become leaders in this process. Only through a more just society can we hope for a long-term, far-reaching answer to the prevention of disabilities caused by poverty.
Although the most complete prevention of disabilities related to poverty depends on social change, this will take time. However, more immediate actions at family, community, and national levels can help prevent some disabilities. For example,
- Polio, in most situations is prevented through vaccination. (However, effective vaccination depends on much more than good vaccine. See the box.)
In places where vaccination is not available or not fully effective, families and communities can help to lower the chance of paralysis from polio by breast feeding their children as long as possible.
- Brain damage and seizures can become less frequent if mothers and midwives take added precautions during pregnancy and childbirth, and if they vaccinate children against measles.
- Some birth defects and mental slowness can be prevented if mothers avoid most medicines during pregnancy, and spend the money they save on healthy foods.
- Spinal cord injury could be greatly reduced if fathers would spend on education and community safety what they now spend on alcohol and guns.
- Leprosy could mostly be prevented if people would stop fearing and rejecting persons with leprosy. By being more supportive and encouraging early home treatment, the community could help prevent the spread of leprosy, since persons being treated no longer spread it.
- Blindness in young children in some countries is caused by not eating enough foods with vitamin A. Again this relates to poverty. However, many people do not know that they can prevent this blindness by feeding their children dark green leafy vegetables, yellow fruits, or even certain weeds and wild fruit. Also, some kinds of deafness and mental slowness can be prevented by using iodized salt during pregnancy.
- Disability caused by poisons in food, water, air, or workplace. The recent, common, worldwide use of chemicals to kill insects and weeds has become a major health problem. Often villagers use these pesticides without any knowledge of their risks, or of the precautions they should take. As a result, many become paralyzed, blind, or disabled in other ways.
To prevent these problems, people need to learn about the dangers, not only to themselves and their children but to animals, birds, land, and to the whole ‘balance of nature’. Less dangerous ways to control pests give better results over time. Laws are also needed to prohibit the most dangerous products and to provide clear warnings.
- Poisonous foods in some areas are a major cause of disability. In parts of India, thousands of farm workers who are paid with a poisonous variety of lentils suffer paralysis from ‘lathyrism’. The poor know the danger but have nothing else to eat. Fair wages and less corruption are needed to correct this situation.
- Fluoride poisoning (fluorosis), mainly from drinking water, is a common cause of bone deformities (knock-knees) in parts of India and other places. Public health measures are needed to provide safe water.
- Dangerous work conditions, poisons in the air, and lack of basic safety measures result in many disabilities. These include burns, amputations, blindness, and back and head injuries. In some countries, the use of asbestos for roofs or walls in schools, work places, and homes causes disabling lung diseases. Strict public health measures and an informed, organized people are needed to bring improvements.
- Certain dangerous medicines, known to sometimes cause disabilities, are now prohibited in the countries that make them, but are still sold in other countries. For example, diarrhea medicines containing clioquinol caused thousands of cases of blindness and paralysis in Japan.
The high cost, overuse, and misuse of medicines in general adds greatly to the amount of poverty and disability in the world today. Better education of both doctors and people, and more effective international laws are needed to bring about more sensible supply and use of medicines.
Note: Although too much fluoride is harmful, some is necessary for healthy bones and teeth. In some areas fluoride needs to be removed from drinking water; in other areas it needs to be added.
The 4 biggest causes of ‘crippling’ in India, affecting over 2 million people, are reported to be polio, iodine deficiency, fluorosis, and lathyrism. Given the political will, all could be completely prevented!