Editor in Chief: Moh. Reza Huwaida Friday, January 17th, 2020

Low Health Literacy: A Silent Issue in Afghanistan


Low Health Literacy: A Silent Issue  in Afghanistan

In Afghanistan, when we talk about health concept it refers to somebody who has no physical disease or disability but based on scientific definition, health has a wider meaning which seems as a forgotten issue in the country. According to WHO, health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, and political belief, economic or social condition. Socially, the health of all people is fundamental to the attainment of peace and security and is dependent on the fullest co-operation of individuals and States. So, unequal development in promotion of health and control of diseases, especially communicable disease is a common danger. Therefore, governments have a responsibility for the health of their peoples which can be fulfilled only by the provision of adequate health and social measures.
Given the abovementioned points, we have several problems about health concept in the context of Afghanistan. Firstly, there is no clear definition about health among people; secondly, the public health literacy is extremely low; thirdly, we do not consider the mental illness as a serious issue and so people normally hide it or feel shy to go to psychiatrist while everyone can easily talk about his/her physical health. As a result, we may have millions of mentally sick people causing social problem or transit communicable diseases while there are no public measures to tackle the issue. This article aims to raise some more information about the third issue.
According to WHO, mental health is “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”. Based on this, mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make choices. Mental health is important at every stage of life, from childhood and adolescence through adulthood.
On the contrary, the mental illness is called mental health disorders that affect our mood, thinking and behavior. Examples of mental illness include depression, anxiety disorders, schizophrenia, eating disorders and addictive behaviors. Many people have mental health concerns from time to time. But a mental health concern becomes a mental illness when ongoing signs and symptoms cause frequent stress and affect our ability to function. A mental illness can make someone miserable and can cause problems in daily life, such as at school or work or in relationships. According to experts, the symptoms can be managed with a combination of medications and talk therapy.
Comparing the two definitions, it seems that all components proposed in the mental health definition is important but not mandatory aspects of mental health; as a matter of fact, they may contribute to a varying degree to the state of equilibrium, so that fully developed functions may offset impairment in another aspect of mental functioning. For instance, a very empathetic person, highly interested in mutual sharing, may compensate for a moderate degree of cognitive impairment, and still find a satisfactory equilibrium and pursue her/his life goals.
The basic cognitive and social skills are regarded as an important component of mental health in the light of their impact on all aspects of everyday life. Cognitive skills include the ability to pay attention, remember and organize information, solve problems, and make decisions; social skills involve the ability to use one’s own repertoire of verbal/non-verbal abilities to communicate and interact with others. All these abilities are interdependent and allow people to function in their environment. Reference to the “basic” level of these abilities is meant to clarify that mild degrees of impairment are compatible with mental health, while moderate to severe degrees of impairment, especially if not balanced by other aspects, may require support by other members of the society and a number of social incentives, such as facilitated job opportunities, financial benefits or ad hoc training programs.
Emotional regulation, i.e. the ability to recognize, express and modulate one’s own emotions, is also regarded as an important component of mental health. It has been proposed as a mediator of stress adjustment, and a link between inappropriate or ineffective emotional regulation and depression has been found in clinical and neuroimaging studies. A variety of modulated emotional response options, that can be flexibly employed, contribute to an individual’s mental health, and alexithymia (i.e., an inability to identify and express one’s own emotions) is a risk factor for mental and physical disorders. Empathy, i.e., the ability to experience and understand what others feel without confusion between oneself and others, enables individuals to communicate and interact in effective ways and to predict actions, intentions, and feelings of others . The absence of empathy is not only a risk factor for violence and a feature of antisocial personality disorder, but also impairs social interactions at all levels.
Flexibility and ability to cope with adverse events are also deemed important to mental health maintenance. Flexibility refers to the ability to revise a course of action in the face of unpredicted difficulties or obstacles, change one’s own ideas in the light of new evidence, and adapt to changes that different life epochs or contingent situations may require. Lack of flexibility may result in great distress for a person undergoing sudden and/or important life changes, and is an important aspect of several psychiatric disorders, such as obsessive personality or delusional disorder.
In general, the basic ability to function in social roles and to participate in meaningful social interactions is an important aspect of mental health and particularly contributes to resilience against distress; however, social exclusion and stigmatization often impair social participation, so any definition of mental health alluding to this aspect has to avoid “blaming the victim” and to carefully analyze social patterns of stigmatization, discrimination and exclusion that impair participation.

Mohammad Zahir Akbari is the permanent writer of the Daily Outlook Afghanistan. He can be reached at mohammadzahirakbari@gmail.com

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