Paul Pholeros is a multi talented architect/artist/community organizer who lives in Australia.  I met him at a North-South conference on housing and homelessness and have followed his effective and surprisingly simple approach to this complex challenge.  He founded and directs Healthhabitat which improves the living environment of indigenous Australians thereby improving their health.   His work has impacted the lives of over 40,000 indigenous Australians in 180 locations by improving over 7,000 houses. Healthhabitat is now spreading overseas to New Zealand, Nepal and the USA.  Here is Paul's contribution to: What would you like to become more visible in 2011?   This is an addition to the original collection.  You can also Download Becoming Visible  -  the complete collection of 58 essays.

Starting simple
 
When asked the apparently simple question in the mid 1980ʼs – how to find ways to "stop people getting sick", who would have thought that 25 years later the answer (1) would still be evolving, have spread far and wide from its central Australian, indigenous focused, desert origins to most parts of Australia and a few other parts of the world. The simple principles (2) are still as relevant today.
 
Simple is a tricky concept. 
 
Simple can be easily confused with simplistic, the glib "one liner", a mindless advertising message or the short lifespan health promotion mantra. Simple is slow to make, has longevity and emerges, slowly. Simple allows expansion and change without losing direction by providing clear focus. Ideas are reviewed and recycled rather than being replaced by the latest fashion.
 
To make simple is hard work.
 
The earliest version of "the answer" to the question of finding ways to "stop people getting sick", took 6 months of detailed and considered work. It involved a skilled medical team digging through and sorting local, regional, national and international health data. It meant finding the direct connections between health issues, the environment where people lived and the people who lived there. 
 
Most importantly it meant distilling down complex information and learnings into nine apparently simple goals, the nine Healthy Living Practices, and giving these nine practices an order of priority. There is never enough time or money to achieve all goals and priority is important.
 
Simple involves connecting and refining detail 
 
If you take the first of the nine Healthy Living Practices, Washing People, then this detail quickly becomes apparent. 
 
⁃ Poor hygiene increases the transmission of diseases, including diarrhoeal
disease, respiratory disease, hepatitis and infections. 
⁃ The rates of these diseases in some Indigenous communities in Australia are as high as in many developing countries and are many times higher than for non-Indigenous children.
⁃ Diarrhoea and respiratory diseases, in particular, are the major causes of illness among Indigenous children and also play a major role in
malnutrition in the first three years of life. 
⁃ Skin infection is one of the most common problems of Indigenous children and causes chronic illness and discomfort. Recurrent or persistent skin infection is known to increase the risk of developing kidney disease and rheumatic fever. 
⁃ Trachoma and bacterial eye infections are known to be associated with poverty and poor living conditions. Studies have shown regular face washing can reduce the amount of eye infection.
⁃ Being able to wash hands after using the toilet can significantly reduce the transmission of hepatitis.
 

Healthy Living Practice 1: the ability to wash people particularly children Paul-washing The "health hardware required to support the first Healthy Living Practice: the ability to wash people, particularly children, includes a chain of essential, connected and functioning parts.

A water supply, water storage, pipes to distribute the water to people, a working hot water system with adequate hot water for a large family, a functional wet area with working hot and cold water taps, a shower, or a bath or a tub or a hand basin for washing children and working drainage to remove the waste water. Available soap, shampoo, clean towel and clean clothes will increase the health benefits of washing the child.
 
Simple makes action, complex makes words 
 
Having made connections between people, the living environment and health, the task of making change is not hampered by endless reports or repeatedly redefining the problems. Simple and immediate actions ensure people have access to the "hardware" that allows them to carry out the Healthy Living Practices. 
 
For the "Washing People example given above, work typically involves repairing or replacing hot water systems, shower/bathroom wall linings, taps, shower hoses, unblocking drains and making sure there is sufficient hot and cold water. The work is immediate, unsexy, unglamorous but essential and effective.
 
Simple gains local community support 
 
The drawings of each Healthy Living Practices communicate a simple message to local community members who become involved in the work. 70% of all the project teams are local people.
 
The greater the distance traveled from the local community the more likely you find politicians and bureaucrats embarrassed by the "ordinariness" of the work and the bluntness of the Healthy Living Practices.  It is just too simple for their housing or health policies, plans and strategies. The academies similarly find little joy in the simple direction of the Healthy Living Practices.
 
In stark contrast, local community members see the importance of a working shower, toilet or kitchen, they need no convincing about why the work is important. For those who see benefits from the work, itʼs simple.

footnotes

1
 Nganampa Health Council Inc., South Australian Health Commission and Aboriginal Health Organisation of South
Australia 1987, Report of Uwankara Palyanyku Kanyintjaku, An Environmental and Public Health Review within the
Anangu Pitjantjatjara Lands, Alice Springs.
2
 Pholeros, P, Rainow, S & Torzillo, P 1993, Housing for Health, Towards a Healthy Living Environment for Aboriginal
Australia, Healthabitat, Newport Beach.

NOTES:

Click to read my previous post on Paul's work: No Survey Without Service – Tips for Solution Based Advocacy.

You can download the complete collection of Becoming Visible responses here: Download Becoming Visible.  Or by clicking the Becoming Visible Category on the right hand side of your screen.

Please share and distribute to your friends and through your various networks, websites etc.  I think you will agree – these are too good to keep to ourselves.

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