The need for global sustainable development

After a windy climb to Aguerzran, a small village nestled in the High Atlas Mountains, we reached the building where we were going to hold workshops. The small rectangular building, painted in pink and green faded by the sun, overlooked the lush valley. My colleague explained to the group, more than thirty women of different ages, the purpose of our visit: to organize both a cooperative construction workshop and a debate on women's health. While waiting for women to occupy primary school offices, I asked them why they thought health was important to them.

"Without health, we have nothing," proclaimed a woman. The conversation naturally continued, each woman having reiterated the same feeling.

In a few minutes, the mood in the room changed. A woman, a village matriarch, spoke in tears of the difficulties her community faces in accessing health care. Conscious of her heart condition, she was unable to leave the village to take action for her treatment. With only one ambulance in the municipality, he is physically and financially inaccessible. The nearest health center in Aguerzran is located in the souk of Imlil L'Aarba, a three-hour walk away. The workshop documents and diagrams originally provided to discuss nutrition, exercise and hygiene were important, but not sufficient.

The problem is not in the do's and don'ts of health. The problem lies in economic stability, education systems, the built environment and the community context; which are all social and structural determinants of health in Aguerzran.

Three months before our visit, the women participated in a workshop on empowerment organized by the High Atlas Foundation. The workshop aims to cultivate the visions that women have for themselves in different areas of personal development, including money, spirituality, emotions and the body. During our visit, the facilitators conducted follow-up interviews with women to monitor their progress in achieving their goals. Women expressed a more confident, active and self-aware feeling. Yet their perception of caring for their personal health and well-being was simply defined as "hard work".

Measured according to criteria such as healthy living, education and standard of living, Morocco ranks 123rd in the UN Human Development Index out of 189 countries. Although this indicator is widely used to badess the progress of the country, it may not take into account serious regional disparities and intersectoral inequalities. Nearly forty percent of the Moroccan population is rural and women make up half of the population. With the establishment of MoudawanaMoroccan Family Code and National Initiative for Human Development, Morocco has made progress in improving social and economic development. However, empowerment is not the only way of development; and the improvement of health is more than the result of development.

Health, empowerment and development have a symbiotic relationship. Significant progress in development should be comprehensive and include the reduction of health inequalities in order to achieve sustainable change. Morocco faces the double burden of communicable and growing diseases. A study published in 2015 in BMC Cancer revealed that Moroccan women living in rural areas are at higher risk of late diagnosis of bad cancer, the most common cancer among Moroccan women. Diseases such as tuberculosis are also often detected at an advanced stage in rural communities. According to the World Health Organization, noncommunicable diseases such as diabetes and cardiovascular disease account for nearly 75% of all deaths in Morocco. Associated with inaccessibility to clinical care and surveillance, rural communities are increasingly exposed to undetected chronic diseases. This epidemiological change is indicative of unresolved structural inequalities that exacerbate rates of noncommunicable diseases.

On a physical and figurative level, rural women face a double disadvantage. Weaker education systems in rural communities do not address health education, and weaker health systems can prevent women from continuing their education. In addition, the physical distance of health centers discourages and compromises safety. The women in Aguerzran said that lifting heavy objects and doing work caused intense pain. If left untreated, these pains can increase the risk of serious injury, interrupting their ability to work. Addressing the mutual relationship between these determinants will lead to better long-term health and equity outcomes for rural women and their communities.

In Aguerzran, Marrakech or elsewhere, the crucial role of women in their communities and their families is undeniable. The migration of rural men to cities has increased women's responsibilities for agriculture and domestic care, which has prevented a rural woman from taking care of her own health. As epicenters of their families, evidence suggests that there is a positive correlation between school achievement and children's overall well-being, education level, and the health of their mothers.

Encouraging women's overall empowerment not only encourages internal progress, but also paves the way for better generations and future communities. Empowering rural women through health helps to improve human capital, build capacity and achieve better long-term economic outcomes through participation in activities such as: cooperatives.

Talking to Aguerzran's women underscored the importance of including health in an empowering context. Since health seems to be really everything for these women, it should also be an integral part of the empowerment and development methodologies. Just as empowerment programs can inform women of their social rights, the right to health should also be achieved gradually through increased data, awareness and advocacy. Not prioritizing the well-being of the most vulnerable populations will prevent sustainable development from becoming a reality.

Fariha Mujeebuddin ([email protected]) is a student at the University of Virginia studying economics and global public health, and intern at the High Atlas Foundation.