Yamandú Pagliano plans to cross Praia do Cassino, the world’s longest beach, stretching 250 kilometers along Brazil’s southern coast from Uruguay, in his homemade wheeled wind buggy, to highlight the need to address global heating. Credit: Yamandú Pagliano
ROME, Mar 26 2024 (IPS) – Extreme sports are not just for young people. Climate activism isn’t either. Yamandù Pagliano is proof.
The 59-year-old father of two is gearing up for an epic feat. He plans to cross the longest beach on Earth, the Praia do Cassino, stretching from the border of Uruguay 250 kilometres up Brazil’s southern coastline, on his home-made wheeled wind buggy.
It’s a massive challenge both in physical and mental terms and one that brings multiple risks with it, including the danger of getting lost, crashing, or being swept out into the sea if the weather turns nasty.
But the Montevideo native has a special motive for taking it on.
Organizers want to highlight the “institutional indifference” to the climate crisis at all levels of government, promote sustainable transport and tourism, draw attention to the need for more cycle paths, especially in southern Italy, and make a loud appeal for peace around the world
Pagliano is a member of Parents for Future (PFF), a global network of citizens concerned about the climate crisis set up to support and echo the calls made by the young people of the Fridays for Future (FFF) movement.
When he takes on the Praia do Cassino challenge, he’ll be flying the Parents for Future flag on the mast of his wind buggy to highlight the need to address global heating.
“It’s going to be a PFF challenge,” Pagliano told IPS.
“My involvement in PFF started after my daughter joined FFF. Soon I was in Parents for Future Latin America (PFF LATAM) and then I helped to set up PFF Uruguay.
“I hope all the detailed stories of the crossing will help people become aware of the climate crisis, biodiversity loss and pollution. I’ll probably find dead animals and plastic garbage on the beach and face extreme weather events”.
Pagliano knows that the climate crisis is no longer a distant problem for future generations as people in Uruguay have been faced with the consequences first hand, as seen with last year’s severe drought that caused dramatic water shortages.
“In Uruguay the winters are not as cold as they used to be, and summers are a lot hotter,” he said.
“We have had big floods, with houses carried down the coast, and recently we had the biggest drought in our history, with almost no water coming out of the tap”.
Fittingly for an initiative that seeks to show the need for sustainability, Pagliano made his windcar out of reused material, welding together pipes he picked up from a scrap yard, while the sail is second-hand.
“There’ll be no phone signal in the middle section of the beach and I’ll be on my own for quite some time,” said Pagliano, who works in construction.
“I will be completely isolated. You have to be ready for every eventuality.
“Depending on the wind, it could take two or three days.
“It could take just one day with an early departure in good conditions, with the wind blowing in the perfect direction and at the perfect strength.
“It gets tiring physically after a while, but the adrenalin keeps you pumped up.
“It’s a good way to highlight the need to be sustainable.
“It’s a natural sport. There’s no contamination. No carbon footprint.
“I’ll do the crossing first and then go public if I’m successful, like Gagarin,” he quipped.
He is not the only parent harnessing renewable energy to draw attention to the need for climate action.
On the other side of the world, the Italian section of PFF is getting ready for the Running For Future, Cycling For Peace – a bike event which, fittingly for the land of the Giro d’Italia, is split into stages.
The ‘race’ starts in Rome’s Piazza del Popolo on May 10 and features 16 stages over nine days, roughly following the Via Francigena pilgrimage route southwards to end in Lecce on May 19.
Each stage will be used to focus on a specific aspect of the ecological crisis, such as air pollution, urban sprawl and the problems created by intensive livestock farming, while at the same time showing how they are all interconnected.
Among other things, organizers want to highlight the “institutional indifference” to the climate crisis at all levels of government, promote sustainable transport and tourism, draw attention to the need for more cycle paths, especially in southern Italy, and make a loud appeal for peace around the world.
The Italian section of Parents for Future gears up for “Running For Future, Cycling For Peace” — a multi-stage cycling event starting in Rome’s Piazza del Popolo on May 10th and ending in Lecce on May 19th, following the Via Francigena route. Credit: Paul Virgo
“We chose a cycling initiative because the bicycle has become a symbol of ecology,” said Maria Santarossa of Parents for Future Italia. “It is a clean means of transport, which enables you to stay fit and be in direct contact with nature.
“We chose a pilgrims’ path because we can consider it an emblem of the beauty of nature and it’s a way to remind ourselves that we must take care of beauty.
“We have involved many other movements, associations, committees, and networks because we want people to know that many of us have the same objectives regarding the very serious climate and environmental crisis that is present in everyone’s lives”.
It is free to take part in the event, although participants have to cover their own accommodation and food expenses.
It is the second such event. The first took place in 2021, going from Rome northwards along the Via Francigena to Milan for the PreCOP26 conference that was held there.
That was such a success that it inspired the Polish section of Parents for Future to stage a climate grand tour of its own.
Each national PFF group is autonomous and does its own thing, campaigning on the issues that are most appropriate given the local situation.
PFF Italia, for example, is currently engaged in a major campaign to convince consumers to switch to utility companies whose electricity comes only from renewable sources.
There is also an umbrella group, Parents for Future Global (PFFG), which, among other things, is campaigning to support the drive for a Fossil Fuel Non-Proliferation Treaty.
Hypertension is the most common risk factor for cardiovascular diseases (CVDs).1 Globally it affects about 40% of the population and causes approximately 7.6 million deaths every year.2 Despite the availability of effective interventions, including antihypertensive medication only 20% with hypertension have well-controlled blood pressure.3 In Nepal, high blood pressure was the leading cause of CVDs in 20174 where 20–30% of adult women and men have hypertension.5 The high proportion of untreated (89% of those aware) and uncontrolled (96% of those on treatment) hypertension in Nepal,5 jeopardizes the government’s commitment to reduce CVDs.6
Management of hypertension may require substantial efforts, including adherence to antihypertensive medications, monitoring of blood pressure, frequent follow-up with healthcare providers, weight reduction, physical activity, healthy diet, and avoidance of alcohol and tobacco use.7 Patients with chronic conditions like hypertension often need social and family support to optimally manage their ailment.8,9 Social support is a multidimensional concept often defined as activities and relationships that individuals receive and provide to each other within their social networks.10 A large and diverse social support network can boost self-esteem and provide better access to information and resources.11,12 Health-related interactions with friends and family promote healthy behaviors including adherence to treatment.13–16 Feeling connected with others and the awareness that support is available when needed are important for positive health outcomes.17–19 Positive social relationships help patients cope with illness associated stress promoting better prognosis.20 Social support may protect patients from complications by helping with health management,16 or by encouraging healthy behaviors.21 However, the evidence on the role of social support in the management of chronic conditions is inconclusive. Studies have shown a positive,22–26 null27,28 and an inverse association29 between social support and management of chronic conditions. The role of social support in the management of chronic conditions like hypertension has not been sufficiently explored in the Nepalese context. One study from Nepal reported a positive association between social support and self-care for hypertension.30 In this study, we explored how perceived social support influences medication adherence and control of high blood pressure. The results from this study could serve to inform targeted community-based interventions according to the level of social support received by hypertension patients for controlling hypertension.
Materials and Methods
Study Setting
The study was conducted in Budhanilkantha municipality, Kathmandu, Nepal. The municipality has nearly 150,000 inhabitants31 and has 11 public health facilities that provide primary health care and tertiary care is provided by the private and public hospitals nearby. Hypertension prevalence of the urban areas such as Budanilakantha (25.2%) is similar to the national average (24.5%).5
Study Design and Population
Cross-sectional data collected at baseline from 1252 hypertensive individuals enrolled in a cluster randomized trial (Registration no: NCT05292469). The detailed trial methods are published elsewhere.32 Trained enumerators identified participants seeking support from health workers and volunteers, screened for eligibility, and obtained written informed consent after explaining the trial objectives. Eighteen years and older individuals with established hypertension diagnosis (systolic BP ≥140 mmHg and/or diastolic BP ≥ 90 mmHg on at least two consecutive visits or using antihypertensive medication) and able to respond to the questions were recruited. Pregnant women were excluded.
Data Collection
Trained enumerators collected baseline data from 2 May 2022 through 7 November 2022 using an android operating system tablet installed with KOBO toolbox electronic data collection platform. The questionnaire was pretested. Participants were shown picture cards with examples of physical activity and commonly used utensils for drinking alcohol to ensure accurate measurements.5
Outcomes
Hypertension control
An “Omron” digital instrument was used to measure blood pressure three times in a resting position and the mean of the last two measurements was registered. Participants with systolic and diastolic blood pressure less than 140 and 90 mmHg were categorized as controlled hypertension others as uncontrolled hypertension.
Medication adherence
We administered an eight-item Morisky Medication Adherence Scale (MMAS-8) (Supplementary Table 1).33 The scale is widely used to measure medication adherence and is reported to have good reliability (α = 0.83) and validity with sensitivity of 93% and specificity of 53% for low adherence.34 The first seven questions have responses YES coded as 0 and NO coded as 1. The code of the fifth question was reversed and the responses to the eighth question were re-coded from 2 to 0.75, 3 to 0.5, 4 to 0.25, 5 to 0 during the analysis. Responses to all eight questions were added to get MMAS, and a score above 6 was considered good adherence and ≤6 poor adherence.35
Exposures
Modified multidimensional scale of perceived social support (MSPSS) was used to measure the adequacy of support participants received from family, friends, and significant others (Supplementary Table 2).36 Twelve questions with answers on a 5-point Likert scale (1 = strongly disagree; 5=strongly agree) were asked to the participants. Cronbach’s alpha has been estimated to be 0.92, 0.85, 0.85 and 0.86 for total and family, friends, and significant others subscales, respectively.36 The MSPSS was translated into Nepali by SB and was reviewed by the study clinician. During training, the wording of the questions was discussed with the enumerators from the study community. The enumerators pretested the questions, and any problems encountered in administering the questions were discussed and addressed before finalizing the tool. The internal consistency reliability for the MSPSS was found good with a Cronbach’s alpha of 0.91 for the overall score and 0.87, 0.91, and 0.84 for family, friend, and significant other subscales, respectively. The overall MSPSS ranged between 12 and 60, high scores indicate high perceived social support. The subscale scores were calculated by adding the responses for related questions. During analysis, scores were divided by the number of questions included in each scale resulting in scores ranging between 1 and 5. The scores were categorized as low (1.00–3.59), moderate (3.60–4.59), and high (4.60–5.00) support.
Covariates
The covariates included in the model were age (continuous), gender (female/male), ethnicity (Brahmin Chettri/Newars/Tamang, Sherpa, Rai, Gurung, Magar/Dalits), current marital status (unmarried/married), education (illiterate/primary/secondary/high school and above), and per capita annual income in US dollars (continuous). Other variables considered were occupation status (unemployed/paid employment), self-reported diabetes status (status not known/non-diabetic/diabetic), years since hypertension diagnosis, and prescribed antihypertensives (Yes/No). The diet quality questionnaire assessed 32 different food groups participants ate in the 24 hours preceding the survey.37 The global dietary recommendation score (ranging from 0 to 18, higher score means better diet quality) was calculated by subtracting foods recommended to limit from foods recommended as healthy and adding nine. It measures adherence to a healthy diet protective against non-communicable diseases.37 Fruits and vegetable scores ranged from 0 to 6, with scores of <3 indicate the likelihood of eating less than 400 grams of fruits and vegetables.37 Daily salt intake was asked and categorized as ≤10 grams, 11–15 grams, and >15 grams. A global physical activity questionnaire38 was used to calculate metabolic equivalents of task (METs) minutes per week categorizing <600 METs (inadequate) and ≥600 (adequate). Body mass index of <25 kg/m2 and ≥25 kg/m2 was categorized as normal weight and overweight, respectively.39 Standard drinks per week were calculated by asking current alcohol drinkers about drinking frequency and amount of different types of alcohol5 and categorizing into non-drinkers (≤1 standard drink per month), moderate drinkers (<3 standard drinks per week), and high drinkers (≥3 standard drinks per week). Tobacco use including both smoked and chewed was categorized as never, and ever users.
Statistical Analysis
Descriptive statistics were presented as frequencies and percentages for categorical variables and mean and standard deviation for continuous variables. Confounders included in the model were identified a priori by constructing a directed acyclic graph (DAG)40 to assess the association between MSPSS and controlled hypertension and adherence to antihypertensives. We fitted Poisson regression to assess the association between MSPSS and hypertension control. Prevalence ratios and corresponding 95% confidence intervals were estimated. Two models were fitted, unadjusted (model 1) and adjusted for age, gender, ethnicity, marital status, education, and income (model 2). Similar models were also fitted to assess the association between MSPSS and adherence to antihypertensives. Based on the DAGs, mediators such as dietary, lifestyle and clinical factors were not included in the model. All analyses were performed with Stata 18.41
Ethics
We have obtained ethical approval from Nepal Health Research Council (Protocol number: 682/2021) approved on 24 December 2021 and Regional Committee for Medical and Health Research Ethics, Norway (Reference number: 399479) approved on 22 February 2022. We have adhered to the declaration of Helsinki throughout the research process.
Results
The mean age of study participants was 57.5 years, and 60% were females. Table 1 shows the distribution of sociodemographic, lifestyle and clinical factors by categories of overall MSPSS. Participants with high social support were generally younger and more often males, married, belonged to Brahmin/Chettri ethnicity, were highly educated, had paid employment, had high per capita income, physically active, overweight, drink <3 standard drinks per week, current tobacco users, consumed daily <10 grams salt, had high global dietary requirement score, consumed less fruits and vegetables, were diabetic, were prescribed more than three antihypertensives, had shorter duration since diagnosis of hypertension and had poorly controlled blood pressure.
Table 1 Socioeconomic, Lifestyle, and Clinical Factors by Levels of Overall MSPSS
Out of the 1252 participants 914 (73%) reported receiving moderate to high overall MSPSS. Figure 1 shows that the high proportion of individuals with controlled hypertension and good adherence to antihypertensives were in moderate MSPSS category (58.7%) and high MSPSS category (74.3%), respectively. The distribution of MSPSS subscales by status of hypertension control and adherence to antihypertensives are shown in Supplementary Tables 3 and 4.
Figure 1 Proportion controlling hypertension and good adherence to antihypertensives in categories of overall MSPSS.
Overall, there was no significant association between social support and controlled hypertension (Table 2). However, individuals who received a moderate level of social support from friends exhibited 1.18 (95% CI, 1.04–1.33) times higher prevalence of controlled hypertension compared to those receiving low support.
Table 2 Association Between MSPSS and Controlled Hypertension
Further, Table 3 shows that there was no association between social support and prevalence of adherence to antihypertensives, and unadjusted and adjusted estimates were very similar.
Table 3 Association Between MSPSS and Adherence to Antihypertensives
Discussion
In this study, we explored how perceived social support received by hypertension patients affected adherence to antihypertensives and control of hypertension. Our analysis showed that 73% of participants received moderate to high social support. Despite anticipating a positive association between MSPSS and controlled hypertension, we found that participants in the high MSPSS category had the lowest proportion of hypertension control (51%) while the proportion of good adherence did not differ between MSPSS categories. There was no association between MSPSS and adherence to antihypertensives and controlled hypertension except for friend’s sub-scale where higher prevalence of controlled hypertension was observed in moderate social support compared to low.
Very few studies from Nepal have reported on the relationship between social support and hypertension control and adherence to antihypertensives. Our finding that hypertensive patients receive high social support is in line with previous studies from Ethiopia42 and Turkey,43 but not with studies from Nepal30 and Malaysia.44 Previous studies from high-income countries agree with our findings that social support is neither associated with hypertension control45,46 (Spain/Korea) nor with adherence to antihypertensives28 (USA). However, a positive association between social support with controlled hypertension has been reported by a study from Vietnam47 and with adherence to antihypertensives by studies from India,23 China48 and Turkey.43 The inconsistent findings could be due to discrepancies in how social support was measured. A few studies have used MSPSS30,43,49 to measure social support but their outcome measure was self-efficacy to hypertension rather than hypertension control while those with hypertension control as the outcome measured social support differently by measuring frequency of visits by friends and family,45 social support inventory,28 self-esteem and belongingness23 and availability of informational, emotional, practical support.27,46,48
The quality and type of social support received has a bearing on adherence to medication and hypertension control.13 Practical support received for household chores lowered the risk of uncontrolled hypertension in Vietnam,47 whereas financial support from friends was harmful to adherence to medication in China.48 Therefore, nuanced studies disentangling the mechanisms through which social support the process of hypertension management are needed.
The reason hypertensive patients received high social support in our study may be due to availability of family members rendered by large family size in our sample. Despite the high level of support received by participants, we did not observe a significant positive association between MSPSS and hypertension control and adherence to antihypertensives. This may be due to a tendency of parents not wanting to burden children with their health concerns.50 Also, nearly 33% of the participants were illiterate and their friends and family are likely similar. Even when support is available, a poorly educated social network may not be capable of imparting the informational support needed to adhere to treatment and thereby control hypertension.51
Another explanation to the discrepancy of our results with other studies might be differences in individual and cultural characteristics. A large proportion of unemployed individuals may have skewed our sample towards a higher level of social support. People value financial support and therefore financially dependent individuals may report receiving high support. Also, the threshold for expected support may vary between different societies, for example in a patriarchal society like Nepal, women as primary care takers in the family may have a lower threshold of social support, whereas elderly men who command more respect in society may have a higher threshold.
We found a numerically higher prevalence of controlled hypertension among those receiving moderate support from friends but not those receiving higher support. A possible explanation might be that those receiving higher support spend longer time with friends and are thereby more exposed to peer pressure for unhealthy behaviour which was indicated as a barrier for effective control of blood pressure in our formative study in the same population.52 Reverse causation can also not be ruled out, as those with poorly controlled blood pressure may be receiving higher support from friends.
Strengths and Limitations
Our study adds to the sparse literature examining this association using validated instruments such as MSPSS and MMAS-8. We recruited hypertension patients from the community (not hospital) ensuring a representative sample. Since the outcome of interest (controlled hypertension and good adherence to antihypertensives) was common (larger than 10%), we fitted a modified Poisson regression model which gives a better approximation of the risk than overestimated odds ratio.53 This study is not without limitations. The cross-sectional design may have masked the true association between social support and controlled hypertension, as it is possible that individuals with uncontrolled hypertension or with poor adherence were receiving more support. Given the numerous statistical tests we conducted, it is essential to interpret any significant findings with caution to mitigate the risk of drawing false-positive conclusions. The findings are based on data from one urban municipality, which might limit the generalizability of our findings to the general hypertensive population in Nepal. Social support as a construct would be better explored using a mixed-method approach as the MSPSS tool does not capture the type of social support received.49 The reliance on self-reported data on medication and social support may have resulted in recall bias skewing the data in the direction of social desirability leading to over-estimated adherence and social support.
Conclusion
This study shows that hypertensive patients in Nepal in general have good social support.
However, social support was not foremost for medication adherence and control of hypertension. Future interventions for example digital technologies that facilitate remote monitoring and communication with care providers54 should nurture the high level of social support received by the hypertension patients. However, contextual studies to delineate the mechanisms through which social support can augment adherence to treatment, healthy behaviour, routine monitoring, and follow-up for hypertension management are needed for social support to have precedence in future interventions for hypertension patients.
Abbreviations
CVDs, Cardiovascular diseases; DAG, Directed acyclic graph; METs, Metabolic equivalents of task; MMAS, Morisky medication adherence scale; MSPSS, Multidimensional scale of perceived social support.
Data Sharing Statement
Data cannot be shared publicly for ethical reasons but are available on reasonable request to Ms Sanju Bhattarai and Dr Abhijit Sen.
Acknowledgments
We would like to thank all the participants in the study. We would like to thank field researchers Ms Apsara Basnet, Ms Geeta Tripathi, Ms Pema Tamang, Ms Prasoon Pandey, Mr Kishore Adhikari, Ms Sarita Bhandari, Ms Supriya Kharel.
The MMAS-8 Scale, content, name, and trademarks are protected by US copyright and trademark laws. Permission for use of the scale and its coding is required. A license agreement is available from MMAR, LLC., www.moriskyscale.com.
Funding
This work was supported by Norwegian University of Science and Technology, Trondheim, Norway (Project number 981023100).
Disclosure
The authors declare that they have no competing interests in this work.
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Credit: Students in Nepal’s Chitlang. Both Nomads/Forus
NEW YORK, Mar 21 2024 (IPS) – At the half-way point of the 2030 Agenda, the Sustainable Development Goals (SDGs) “are in deep trouble.” The need to accelerate progress towards the Sustainable Development Goals has never been more urgent as only approximately 12% of targets are currently on track. “Planet” is equally at risk as “people”.
As civil society leader Mavalow Christelle Kalhoule, Forus Chair and President of SPONG, the Burkina Faso NGO network, puts it, “What unfolds in the Sahel and in so many other forgotten communities ripples across the globe, impacting us all even if we choose to look away. Implementing the Sustainable Development Goals is vital to unlock a different future.”
The new “Progressing National SDGs Implementation” report looks at how countries around the world are advancing in their efforts towards sustainable development. The 2023 edition of the report is particularly significant as it marks the midpoint towards the 2030 Agenda’s goals, and the “world is not delivering”.
The report, which has been published since 2017, looks at crucial aspects such as governance, civil society involvement and space, localization, the importance of policy coherence, and the principle of Leaving No One Behind.
To compile the analysis, the report combines official Voluntary National Reviews (VNRs) submitted by member states with spotlight and alternative assessments, which aim to offer a more complete picture of national progress, particularly with respect to the fundamental 2030 Agenda principle to leave no one behind.
The report highlights that while more countries are engaging in ‘whole of government’ planning to implement the SDGs, at the same time many of the same countries do not ensure a wider ‘whole of society’ approach that involves civil society partners in delivery of the 2030 Agenda.
The report calls for a renewed global commitment to the SDGs, with a focus on:
• Increased ambition: Countries need to adopt more ambitious plans to achieve the SDGs and ensure policy coherence. • Leaving no one behind: Data collection and policy focus must ensure that everyone benefits from SDG progress pacitularly by considering the extra challenges faced in reaching historically marginalized groups. • Stronger partnerships: Governments, civil society, and the private sector need to work together more effectively. • Improved monitoring: More robust data, national statistical and monitoring systems are needed to track progress and identify areas lagging behind.
Oli Henman from Action for Sustainable Development said: “We need to ensure that SDG reviews are genuinely inclusive of all parts of society and that national plans are backed up with real steps towards financing implementation at the community level. This to the only way that the world can get back on track to deliver the transformative change that was promised in 2015.”
Wangu Mwangi, a seasoned environmental journalist and expert in sustainable development, has authored the Progressing National SDG Implementation Report 2023, drawing on her extensive experience in sustainable development, land governance, natural resources management, climate change adaptation, and African development.
This report was coordinated by A4SD, in collaboration with ANND, BOND, Cooperation Canada, CPDE, Forus, IISD, Save The Children UK, and Sightsavers.
On International Women’s Day on Mar. 8, thousands of Chilean women of all ages took to Santiago’s central Alameda avenue to demonstrate peacefully for several hours and turn the Chilean capital into a stage for protest and demands for their rights. Some of them were women caregivers accompanied by dependent women. CREDIT: Orlando Milesi / IPS
SANTIAGO , Mar 20 2024 (IPS) – In Chile, as in the rest of Latin America, the task of caring for people with disabilities, the elderly and children falls to women who, as a result, do not have access to paid jobs or time for themselves.
Unpaid domestic and care work is crucial to the economies of the region, accounting for around 20 percent of gross domestic product (GDP).
Ana Güezmes, director of ECLAC’s Division for Gender Affairs, told IPS that “in most countries women work longer total hours, but with a lower proportion of paid hours.”
“This work, which is fundamental for sustaining life and social well-being, is disproportionately assigned to women. This situation impacts women’s autonomy, economic opportunities, labor and political participation and their access to leisure activities and rest,” Güezmes said at ECLAC headquarters in Santiago.
The situation is far from changing as it is replicated in young women who devote up to 20 percent of their time to unpaid work.
Paloma Olivares, president for Santiago of the women’s organization Yo Cuido, works in her office in the working-class municipality of Estación Central, in the northeast of the Chilean capital. CREDIT: Orlando Milesi / IPS
Women left on their own as caregivers
Paloma Olivares, 43, chairs the Yo Cuido Association in Santiago, Chile, which brings together 120 members, only two of them men.
“Women caregivers are denied the right to participate on equal terms in society because we are forced to choose between exercising our rights or doing caregiving work. And we cannot choose because it is a job we do for a loved one, for a family member.” — Paloma Olivares
“Women caregivers are denied the right to participate on equal terms in society because we are forced to choose between exercising our rights or doing caregiving work. And we cannot choose because it is a job we do for a loved one, for a family member,” she told IPS.
“We are left in a position of inequality, of absolute vulnerability because you have to devote your life to supporting someone else at the expense of your personal life,” she said.
Olivares stopped working to care for Pascale, her granddaughter, who was born with cerebral palsy and hydrocephalus.
Three days after her birth, a bacterium became lodged in her central nervous system. She was hospitalized for almost a year and became severely dependent.
At the time, she was given a seven percent chance of survival. Today she is eight years old, goes to school and lives an almost normal life thanks to the work of her caregivers.
She is now cared for by her mother Valentina, who had her at the age of 15. Paloma was able to return to paid work, but her daughter abandoned her studies to take care of Pascale.
“When you start being a caregiver, friendships end, because no one can keep up. Even the family drifts away. That’s why most caregiving families are single-parent, the woman is left alone to care because the man can’t keep up with the pace and the emotional and economic burden,” she said.
Olivares participated from Mar. 12 to 14 in a public hearing, digital and in person, on the right to care and its interrelation with other rights, in a collective request of several social organizations and the governments of Chile and other Latin American countries before the Inter-American Court of Human Rights (IACHR Court), based in San Jose, Costa Rica,
In the request for an opinion from the IACHR Court, “we asked the Court to take a stance on the right to care and how the rights of women in particular have been violated because there are no public policies in this regard. We want the Court to pronounce itself on the right to care and how the States should address it so that this right is guaranteed and so the rights of caregivers are no longer violated,” she explained.
It is expected that the Court’s pronouncement on the matter will come out in April and could establish minimum parameters regarding women caregivers for Chile and other Latin American countries.
Critical situation for women caregivers
Millaray Sáez, 59, told IPS by telephone from the southern Chilean city of Concepción that her son Mario Ignacio, 33, “is no longer the autonomous person he was. Since 2012 he has become a baby.”
She chairs the AML Bío Bío Corporación, an association of women in the Bío Bío region created in 2017 to address the question of female empowerment and today dedicated to the issue of caregivers.
“I have been a caregiver for 30 years for my son who has refractory epilepsy. He became prostrate in 2012 as a result of medical negligence,” said the international trade engineer who has become an expert in public policies on care with a gender perspective.
Sáez said “the situation of women caregivers is very bad, very precarious. There is a single cause, which is the work of caregiving, but the consequences are multidimensional…. from physical deterioration to the lack of legislation to protect against forms of violence, and ranging from the family to what society or the State adds.”
She also pointed to the economic consequences of dependent care.
She cited cases in which caregivers spend over 150 dollars a month on diapers alone for a person who needs them. And she pointed out that the government provides an economic aid stipend of just 33 dollars a month.
Teresa Valdés, head of the Gender and Equity Observatory of the Catholic University of Chile, praises the new registry of caregivers promoted by the Chilean government, but underlines the importance of municipal experiences and initiatives that promote homes and care centers to facilitate the lives of women caregivers. CREDIT: Orlando Milesi / IPS
The magnitude of the problem
It is a pending task to determine the number of women caregivers in Chile.
The government of leftist President Gabriel Boric created a system for caregivers to register and receive a credential that gives them access to public services.
“The credential is the gateway to the Chile Cuida System. With it we seek to make them visible in services and institutions and to reward them for their work by saving them waiting time in daily procedures,” the Minister of Women and Gender Equity, Antonia Orellana, explained to IPS.
So far, there are 85,817 people registered, of whom 74,650 are women, or 87 percent of the total, and 11,167 are men, according to data provided to IPS on Mar. 14 by the Undersecretariat of Social Services of the Ministry of Social Development and Family.
But Chile has 19.5 million inhabitants, and “17.6 percent of the adult population has some degree of disability and, therefore, requires the daily care and support of other people in the home,” the minister said.
That means 3.4 million Chileans depend on a caregiver.
According to Orellana, facing the care scenario projected by the aging of the population will require the collaboration of everyone to “create and sustain an economic and productive system that generates decent work and formal employment, leaving no one behind.”
Other urgent demands by women
Sociologist Teresa Valdés, head of the Gender and Equity Observatory, told IPS that there are many social problems facing Chilean women today, “especially those related to access to health care, social security, unequal pay and access to different goods and services.”
Valdés regretted that the term “women caregivers” is used to refer to the role that women play and the tasks that are culturally assigned to them as a priority.
“We are all caregivers, all women work double shifts. The time-use survey shows that we work an additional 41 hours per week of so-called unpaid reproductive care work,” she said.
According to Valdés, the main advance in this problem is to include it in the debate because these are policies that require a lot of resources and extensive development, since they have to do with the structure of the labor market.
“Part of the proposal should be how to ‘de-genderize’, how care becomes a task of shared responsibility and not only that women have more time to take on the care tasks,” she said.
“When we call women caregivers, we are referring to the group most affected by the conditions of sexual division of labor and family reproduction,” she added.
The expert proposes progressively identifying ways to support women caregivers in order to provide them with available time and take care of their mental health.
She praised the programs promoted by some municipalities to free up time for these women to enjoy leisure and self-care.
“We have to move towards a cultural conception that we are all dependent. Today I depend on you, tomorrow you depend on me. Care is a social task in which I take care of you today so that you can take care of me tomorrow. And that is something that has to start from the earliest childhood,” she argued.
MONTEVIDEO, Uruguay, Mar 19 2024 (IPS) – This year more than half the world’s population has the chance to go to the polls. That might make it look like the most democratic year ever, but the reality is more troubling. Too many of those elections won’t give people a real say and won’t offer any opportunity for change.
2024’s bumper election year comes as a record number of countries are sliding towards authoritarianism, and global advances in democratisation achieved over more than three decades have been all but wiped out. In 2023, no authoritarian state became a democracy, and while some countries made marginal improvements in the quality of their democracies – by improving civic space, making inroads on corruption or strengthening institutions – many more experienced often serious declines.
Nearly three quarters of humanity now live under authoritarian regimes. Defending democracy and holding political leaders to account is becoming harder as civic space is shutting down. The proportion of people living in countries with closed civic space, 30.6 per cent, is the highest in years.
The latest State of Civil Society Report, from global civil society alliance CIVICUS, shows how conflict is exacerbating this regressive trend. In war-torn Sudan, hopes for democracy, repeatedly denied since the 2019 overthrow of dictator Omar al-Bashir, receded further as elections were made impossible by the civil war between the military and militia that erupted last April. Russia’s sustained assault on Ukraine brought intensified repression of domestic dissent, and there were no surprises in the recent non-competitive vote that maintained Vladimir Putin’s grip on power.
The ineffectiveness of civilian governments in dealing with jihadist insurgencies has also been the justification used by military leaders to take or retain power in Central and West Africa. As a result, rule by junta is in danger of becoming normalised after decades in which it appeared on the verge of extinction. A ‘coup belt’ now stretches coast to coast across Africa. None of the states that fell victim to military rule in recent years have returned to civilian government, and two more – Gabon and Niger –joined their ranks last year.
Authoritarian regimes that experienced mass protest movements in recent years, including Iran, Nicaragua and Venezuela, have regained their footing and hardened their grip. In states long characterised by autocratic rule, many civil society activists, journalists and political dissidents have sought safety in exile to continue their work. But they often didn’t find it, with repressive states – China, Turkey, Tajikistan, Egypt and Russia are the worst five abusers –increasingly using transnational repression against them.
Many elections are held with no competition. Last year several non-democratic states of various kinds – including Cambodia, the Central African Republic, Cuba, Eswatini, Uzbekistan and Zimbabwe – held votes in which autocratic power was never in question. Voting was ceremonial, its purpose to add a veneer of legitimacy to domination.
Many more regimes that combine democratic and authoritarian traits have been home to recent elections with less predetermined results, where there was at least some chance of the ruling party being defeated. But incumbent advantage was reflected in the fact that change rarely materialised, as seen in Nigeria, Paraguay, Sierra Leone and Turkey. The outlier was Maldives, where voters have a history of rejecting sitting presidents.
Some hybrid regimes, notably El Salvador, experienced further democratic backsliding through the erosion of freedoms and institutional checks and balances – a road typically travelled by populist authoritarians who claim to speak in the name of the people and insist they need to concentrate power to deal with crises.
When voters do have a genuine say, in free and fair elections, they’re increasingly rejecting mainstream parties and politicians. In a time of economic uncertainty and insecurity, many express disappointment with what democracy is offering them. Anti-rights political entrepreneurs are successfully exploiting their anxieties by scapegoating migrants and attacking women’s and LGBTQI+ people’s rights. Right-wing populists using such tactics recently took control of Argentina, came first in elections in the Netherlands and Switzerland and entered government in Finland. Even where they don’t take office, far-right forces often succeed in shifting the political centre by forcing others to compete on their terms. They’re expected to make big gains in the European Parliament elections in June 2024.
Polarisation is on the rise, fuelled by disinformation, conspiracy theories and hate speech. These are made so much easier by AI-powered technologies that are spreading and evolving faster than they can be regulated. The first elections of 2024, including those in Bangladesh and Indonesia, offered cautionary tales of the unprecedented levels of manipulation that AI can enable. We’re likely to see a lot more of this in 2024.
But our research findings support our hope, because they show movement isn’t all in one direction. In Guatemala, a new party born from mass anti-corruption protests was the unlikely 2023 election winner, and people mobilised in numbers to defend the result in the face of powerful political and economic elites. Despite China’s concerted attempts to derail Taiwan’s election, including through cyberattacks, people vindicated their right to have a say in their own future. In Poland, a unity government pledging to restore civic freedoms came to power after eight years of right-wing nationalist rule, offering new potential for civil society to partner in retrieving democratic values and respecting human rights. In Mexico, which is among the many countries going to the polls in 2024, people mobilised in numbers against the threat posed by a democratically elected leader seeking to override checks and balances. Given the dangers it may entail, civil society is pushing for transnational regulation of AI.
Things would be much worse were it not for civil society, which continues to mobilise against restrictions on freedoms, counter divisive rhetoric and strive for the integrity of electoral processes. Throughout 2024, civil society will keep pushing for elections to take place in free and fair conditions, for people to have the information they need, for votes to be properly counted, for losers to accept defeat and for winners to govern in the common good.
‘Global Africa” is a term popularised by the late Kenyan scholar Ali Mazrui and used to refer to African diasporas of enslavement and colonialism, covering the Americas, the Caribbean, Europe and the Indian Ocean.
My recently publishedGlobal Africa: Profiles in Courage, Creativity and Cruelty (Jacana) consists of 100 essays, written over the past three post-apartheid decades. They cover historical and political figures, technocrats, activists, writers, public intellectuals, music and film artists and sporting figures.
The essays seek to capture the zeitgeist of the post-apartheid era, arguing that Africa’s liberation struggles were mirrored by similar anti-colonial battles in the Caribbean as well as the American civil rights movement.
The book examines three historical figures: Cecil Rhodes, Mahatma Gandhi and Woodrow Wilson.
Rhodes was the greatest symbol of imperialism during the late 19th century, plundering Africa’s riches by often brutal means while expanding British colonial territory.
Wilson was the US president from 1913 to 1921. His supposedly “liberal” foreign policy entailed imperial “gunboat diplomacy” in Latin America and the Caribbean.
Gandhi has been widely lauded for his role in the liberation of the colonial world. His many racist utterances during his 21 years in South Africa (1893-1914) have, however, recently tarnished his legacy in Africa and beyond.
The book also provides kaleidoscopic profiles of 18 African and eight Western political figures: Ghana’s Kwame Nkrumah and two of South Africa’s Nobel peace laureates, Albert Luthuli and Nelson Mandela, as well as Thabo Mbeki, were all actively involved in Africa’s liberation movement as Prophets of the Pan-African Pantheon.
Mbeki was the heir of Nkrumah, with both acting as philosopher-kings seeking to craft a visionary pan-African foreign policy. Zambia’s Kenneth Kaunda and Zimbabwe’s Robert Mugabe both contributed greatly to the liberation of southern Africa, but instituted autocratic rule and oversaw catastrophic economic policies. FW de Klerk ruled an undemocratic apartheid state, but embarked on peacemaking with fellow Nobel laureate, Mandela, to usher in democratic rule.
Nigeria’s Olusegun Obasanjo and Ghana’s Jerry Rawlings were autocratic military rulers before becoming elected civilians, though Rawlings remained more popular among his citizens.
South Africa’s Jacob Zuma – dogged by allegations of graft – had a similar cunning “native intelligence” to Obasanjo’s, while controversial Nobel peace laureate, Liberian president Ellen Johnson Sirleaf (who had funded Liberian warlord Charles Taylor during the country’s civil war in the 1990s), was a technocrat politician.
Ethiopia’s Meles Zenawi and Nobel peace laureate Abiy Ahmed both ruled as strong-fisted, intellectual freedom fighters. Zaire’s Western-backed Mobutu Sese Seko’s 31-year rule brought about the very chaos he had repeatedly argued that only he could prevent.
Uganda’s Idi Amin and Kenya’s Daniel arap Moi oversaw tyrannical regimes, mirrored by Rwanda’s Paul Kagame. Libya’s mercurial Muammar Gaddafi suffered from monarchical delusions of grandeur, while promoting a quixotic pan-Africanism.
US Democratic presidents – Bill Clinton and Kenyan-Kansan Nobel peace laureate Barack Obama – were both intelligent, charismatic but ultimately cynical leaders who, respectively, oversaw the forced withdrawal of UN peacekeepers from Rwanda at the height of the 1994 genocide, and the extended militarisation of Africa by the US military in the 2010s.
American president Donald Trump, British prime ministers Margaret Thatcher, Tony Blair and Boris Johnson, and French president Nicolas Sarkozy all expressed prejudiced thinking towards Africa. The legacies of two US secretaries of state – Colin Powell and Madeleine Albright – are also assessed.
The perspectives, personalities and performance of 14 global technocrats are then examined: Egypt’s Boutros Boutros-Ghali; Ghana’s Nobel peace laureate Kofi Annan; Nigeria’s Adebayo Adedeji, Ibrahim Gambari, Margaret Vogt, Ngozi Okonjo-Iweala and Eloho Otobo; Algeria’s Lakhdar Brahimi; Tanzania’s Augustine Mahiga; South Africa’s Nkosazana Dlamini Zuma, Naledi Pandor and Mamphela Ramphele; Argentina’s Raúl Prebisch; and France’s Jean Monnet.
I then turn to the legacies of seven activists from Global Africa: American civil rights stalwarts, Nobel peace laureate Martin Luther King Jr and John Lewis; Kenyan environmental campaigner Wangari Maathai and her Congolese fellow Nobel laureate, anti-sexual violence campaigner Denis Mukwege (who unsuccessfully ran for his country’s presidency last year); martyred Nigerian environmental activist Ken Saro-Wiwa; and two martyred South Africans, Ruth First and Solomon Mahlangu.
Two Europeans are highlighted who contributed to Africa’s political (Tor Sellström) and journalistic (Kaye Whiteman) struggles.
I then analyse the rich diversity of African literature, starting with the influence of 19th-century British writer Charles Dickens on the continent’s writers, before profiling Nigeria’s Chinua Achebe, Nobel laureate Wole Soyinka, Buchi Emecheta and John Pepper Clark, as well as America’s James Baldwin, Maya Angelou, Nobel laureate Toni Morrison and bell hooks.
Ten public intellectuals are then showcased who pioneered Africa’s Triple Heritage (Kenya’s Ali Mazrui); Post-Colonial Studies (Palestinian American Edward Said); Négritude Literary Criticism (Nigeria’s Abiola Irele); Post-Colonial African Literary Criticism (Kenya’s Chris Wanjala); the Political Economy of Rebel Movements in Africa (Malawian-Swede Thandika Mkandawire); the Politics of Rural Societies in Africa (Nigeria’s Raufu Mustapha); America’s Prison Industrial Complex (African-American Angela Davis); and the Struggles for Global Reparations (America’s Randall Robinson, Barbadian Hilary Beckles and Nigeria’s Ade Ajayi).
I examine the legacies of seven artistes: Iconoclastic, anti-establishment rebels, Nigeria’s Fela Aníkúlápó Kuti and Jamaica’s Bob Marley; American multiple Grammy-winning superstar Michael Jackson; Bahamian American Oscar-winning actor Sidney Poitier; Nigerian-British Oscar-nominated actress Cynthia Erivo; and Nigerian Grammy-winning Burna Boy and his songbird compatriot, Asa.
I conclude by assessing the legacies of 21 of the greatest sporting figures in history: Three-time African-American world boxing heavyweight champion and civil rights campaigner Muhammad Ali; Afro-Brazilian three-time World Cup winner Pelé; Mozambican-born European footballer of the year Eusébio; Argentinian World Cup-winning captain Diego Maradona; Africa’s only Ballon d’Or winner, Liberia’s George Weah; five African players of the year: Cameroon’s Samuel Eto’o, Ivorian Didier Drogba, Egypt’s Mohamed Salah, Senegal’s Sadio Mané and Gabon’s Pierre-Emerick Aubameyang; the all-conquering anti-apartheid West Indian cricket team of Viv Richards, Clive Lloyd, Michael Holding and Joel Garner; American quadruple Olympic gold medal sprinter Jesse Owens; rugby’s first global superstar, New Zealand’s Jonah Lomu; Spanish tennis phenomenon Rafael Nadal; Nigerian American two-time NBA (National Basketball Association) champion Hakeem Olajuwon; and my late businessman father and sports administrator Israel Adebajo.
With negative stereotyping and widespread Afrophobic views of the continent and its diaspora still so rife in the Western imagination and media, it is critical to counter these views through these giants of Global Africa. DM
