Children in Pakistan continue to die in large numbers, mostly from preventable causes and at a much higher rate than in our neighbouring countries. According to an evaluation report of the Ministry of Planning and Development and Technical Resource Facility (TRF), 78 infants die out of every 1,000 live births before they reach their first birthday. A 2012 WHO Report, shows the same rate for Kenya, India and Bangladesh, which is respectively at 55, 48 and 38. Death rates for children dying before the age of five are also higher in Pakistan (87 per 1,000 live births) than in India (63) and Bangladesh (48). These numbers do not look so frightening until we translate them in actual numbers. For instance, of the almost 5.3 million births in Pakistan (mid-2006), nearly half a million died in that year, and almost another half a million children died under the age of five. Most of the deaths, roughly 100 children every hour, in Pakistan, were preventable. Although people are told that these children die a natural death, the fact is that the unpreventable deaths could not be more than 2-3 per thousand live births, as is the case in some developed countries, such as Germany, Finland and Czech Republic. Add to these deaths, people dying from other preventable causes such as communicable diseases, traffic accidents and chronic illnesses such as tuberculosis, diabetes, cardio-vascular and gastro-enteric diseases, etc the numbers become astronomical. For example, in one year, in the hospitals of Punjab, there were over two million children under the age of five treated and almost the same number of older persons, suffering from diarrhoea/dysentery, 1.3 million for dental caries, almost one million from traffic accidents, 831 thousand for suspected malaria, 522 thousand for suspected TB, almost 2 million for hepatitis, 267 thousand for typhoid fever and 47 thousand for STDs. These patients suffered from causes that were preventable, had they or their guardians, adequate knowledge and motivation to take proper action.Of course, many people die because they cannot access timely help; medical facilities are ill equipped, ill staffed and lack medicines. But they also die because of a lack of knowledge and awareness of how to prevent getting sick and what to do if they do fall ill. In addition, illiteracy and lack of information on health matters, for ages, have ingrained taboos and misperceptions about the causes of illnesses and treatment. Nutrition is another huge area where people have a lot to learn. But who should teach them? The burden of disease hurts individuals, their families and, ultimately, the society. Recent case of the epidemic of Dengue fever that caused hundreds of fatalities in Sindh and Punjab in 2011, showed beyond doubt that such a disaster can have even political ramifications. Some pandemics such as polio have international repercussions. Pakistan, unfortunately, cannot free itself from the onslaught of epidemics that keep coming like waves, one after the other. While we are still struggling to eradicate polio, outbreaks of measles have been reported. Then there are endemic communicable diseases that are afflicting millions, such as Hepatitis B and C, tuberculosis, HIV/AIDS, malaria, typhoid, and so on.The well known saying, “prevention is better than cure”, is oft repeated, but hardly practiced in Pakistan. Preventive healthcare has not been a priority of our governments. It is said that “cleanliness is next to Godliness” or “cleanliness is half of Iman” and still even basic health and hygiene practices such as sanitation, clean water supply, safe and hygienic disposal of wastewater and garbage, are tasks that communities leave to committees, municipalities and corporations that are ill equipped or simply unable to cope with them. Governments have consistently kept expenditures on health very low, lately, to about less than 0.8 percent of the GDP. The country of 180 million people cannot ignore for too long the fact that its public sector cannot cope with the enormous disease burden with the limited manpower, ill equipped and understaffed facilities, and expensive medicines. Politicians rely too much on people’s ignorance, fatalism and apathy. Healthcare in the private sector has the good, the bad and the ugly. There are private practitioners, private hospitals and clinics, qualified hakims, pharmacists, homeopaths and herbalists as well as spiritual healers, fake medicine men, and even untrained barbers and traditional midwives providing services at affordable to unaffordable costs. Since rules and regulations governing dispensing of drugs that are not enforced, self-treatment is common place. The drug industry has black sheep that sell ineffective and even harmful substances disguised as medicines.The near absence of accurate, relevant and understandable knowledge of the germ theory of disease, modes of transmission of communicable and infectious diseases, basic knowledge of balanced diet and nutrition, exercise, and necessity of proper sanitation and hygiene have created a knowledge vacuum in the society, which is inevitably being filled by quackery, outright exploitation of the population through misinformation, fake and unproven products and advice. Our school system has conveniently ignored adding health education in the curricula.Awareness is the first step towards maintenance of good health. Well aware persons can identify the benefits of a balanced and nutritious diet, and of exercise, and what precautions to take to ward of communicable diseases, and even the non-communicable chronic diseases. Only well informed and knowledgeable consumers can recognise the strengths and weaknesses of various health systems and providers, protect themselves from communicable diseases and fake healers, take preventive precautions, and seek proper care in timely fashion when they need it. A well aware population ultimately is an asset for the state. Because such population does not fall sick often, and does not become a burden on the state’s medical infrastructure. Even older people can stay healthy, avoid chronic non-communicable diseases, by simple practices and routines, on their own. Research has shown that by proper diet and exercise, even diseases like hypertension and diabetes, can be controlled.  The truth is that small investment in health promotion can go a long way in saving lives and mega billions in healthcare for the state. Unfortunately, in 65 years of Pakistan’s existence, we have neither well trained and well equipped health educators in the public sector, nor have we built institutions where men and women could seek appropriate and adequate professional training for health education at the master’s and doctoral levels. To quote Dr Sania Nishtar, Pakistan’s foremost advocate and authority on public health: “As opposed to prevention, health promotion has never been a priority area in public health in Pakistan.” Indeed, lack of awareness of prevention of disease is killing the people of Pakistan. Lack of scientific and evidence based knowledge on health matters that health education could provide, is adding to the disease burden in society and causing untold misery through preventable deaths and disability. This is another reason that Pakistan is failing to meet its health-related MDGs. There is no way that Pakistan can meet MDGs 4 and 5 that pertain to maternal and child health by 2015. According to WHO estimates, almost nine million Pakistanis have Hepatitis C virus that can lead to liver diseases, even cancer and death. If people are made aware of how Hepatitis C virus is transmitted, they can prevent its further spread. This is true for all infectious and communicable disease. Pakistan largely relies on the mass media and hearsay for medical information and advice. However, a cursory look at the talk shows on television leaves the audience with more questions than answers. Rarely, health experts use audio-visual aids to explain how diseases spread and develop in body. TV channels do not have production cells dedicated to health information. It is usually a low-cost production that fills a time slot, with no focus on the outcome, follow-up or impact. The print media’s role is no less ineffective. Some print publications are replete with advertisement of medicines and treatments for ailments that apparently have no simple or any type of cures. The NGOs role in health education appears to be limited and mostly limited to donor-funded issue-specific projects. The purpose of health education is to create awareness, change attitudes and behaviour positively towards health. In Pakistan, health education has rarely gone beyond the awareness stage and, even so, it is scant and limited to the extent delivered through the mass media. Most health education efforts are limited to either epidemic crisis situations or donor-funded projects. The scope of public health should not be limited to the communicable diseases, but extended to all preventable causes of deaths and disability, including deaths caused by traffic accidents, fires, food poisoning, electrocution, snake bites, rabies, and similar incidents, every year. Most, if not all, of these incidents can be prevented or largely minimised through strict enforcement of laws and regulations together with voluntary action of well informed individuals. 

The writer is a former UN health communication consultant.