Introduction
In community health planning and promotion, non-governmental organizations (NGO’s) develop national and international advocacy through inter-agency and local and global collaborations. This article compares local and global roles of an NGO in the United States and Central Europe, based on community assessment with Susan G. Komen for the Cure and health promotion in rural Hungary in 2009.
Comparing approaches in the U.S. and Hungary
In the United States, NGO’s use health promotion, needs assessment, and fund-raising events to increase support for programs and services. For community assessment of breast cancer services in North Texas, morbidity and mortality data were combined with interviews and focus groups with community leaders, service providers, breast health educators and navigators, screened patients and survivors. Findings were applied to prioritize programs: prevention outreach with diverse groups; collaboration with local health and social agencies; funding for screening and treatment for uninsured women (Susan G. Komen for the Cure, 2009).
In Hungary, the health care system provides care for all residents, with hospices for cancer patients. Public and non-profit health and social agencies collaborate with communities to promote rural health, service access, social integration and empowerment of disadvantaged groups. Social mobility, poverty and marginalization vary among urban and rural populations. Many Roma (“gypsies”) are unemployed, due to deindustrialization and low education (Szelenyi, 2006); many attend “special schools” for those with mental disabilities, behavioral problems, language or cultural differences. Few studies have compared their health with that of the national population, but life expectancy remains lower. Health promotion is advocated to improve poor health in Roma settlements (Kosa, et al, 2007).
The international Komen Foundation, Open Society Institute Roma Initiatives and American Jewish Joint Distribution Committee coordinate community health education and screenings with Red Cross, local health and social agencies. Every woman aged 45-65 is eligible for breast cancer screening once in two years; about one-third are screened, and men and younger women with family histories of cancer also receive services.
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| Event in Hungary Photo Sue G. Lurie, Ph.D. |
Of over 20 regional health events in 2009, three were observed during the author’s Fulbright lectureship (Semmelweis University, Budapest): Me’lyk’ut, a town in southeastern Ba’cs-Kiskun region; Nyiregyhaza, in northeastern Szabolcs region near Ukraine and Romania, a former military site with an anti-Roma history; and an eastern Roma town, Tizabo’, north of the city of Szolnok in Ja’sz-Nagykun region. In both of the latter areas, Roma families depend on social assistance.
The “Roma Minority Self Government” leader, a liaison between the municipality and his community, coordinated the first event with collaborating agencies and regional ministry of health medical director. Roma families from this and surrounding towns participated, followed by non-Roma. Families participated in games, received food (goulyash, bread, fruit) and entertainment. Nurses, staff and volunteers provided free screenings for breast cancer, blood pressure, glucose, allergies, COPD (lung capacity), strength, vision tests, and health education, including family planning and HIV/AIDS.
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| Health Screenings. Photo Sue G. Lurie, Ph.D. |
The second event followed one near the Slovakian border, where a “Pink Walk” had drawn some Roma participants. At the second site, Roma HumanNet and health agency staff and volunteers provided education and screenings; Austrian social work students observed this collaboration. Breast cancer screening was referred to a health care center, but Roma are marginalized to the town’s outskirts, and many women lack transportation.
The third event was initially planned with a nearby town. A large number of families received screenings and health education at this site, where children presented pictures of fruits and vegetables. Roma entertainment was preceded by a Roma national health expert’s presentation on the need for empowerment that was challenged as “not helping the Roma.” Such a response (possibly) reveals local priorities for direct services.
Comparing National and Global Advocacy by NGO’s
Community health promotion and planning by NGO’s in the United States are designed to increase local awareness and support for programs and services, with inter-agency collaboration. International non-governmental health planning that promotes empowerment for health equity is integrated through local and global collaborations. In this process, community priorities must be addressed.
References cited:
Kosa, Z., et al. A Comparative Health Survey of the Inhabitants of Roma Settlements in Hungary. American Journal of Public Health 2007:97:853-859.
Lada’nyi, J., Szele’nyi, I. Patterns of Exclusion: Constructing Gypsy Ethnicity and the Making of an Underclass in Transitional Societies of Europe. East European Monographs, Boulder, Colorado. Columbia University Press, New York. 2006.
Susan G. Komen for the Cure Tarrant County Affliate. Community Profile Report. 2009.
By Sue G. Lurie, PhD, Assistant Professor, Social and Behavioral Sciences, School of Public Health, UNT Health Sciences Center, Fort Worth, Texas.