They wanted to put up a gas station in the only green area in our community, but they weren't able to because we banded together to defend our right to see our children running around under the shade trees.
-Francisco Fortín, Chief, Bureau of Institutional Communications, Health Secretariat of Honduras

Last year there was no trash collection in our neighborhood, so we residents got together and hired a dump truck to remove the trash on a regular basis so we could keep our homes and yards clean.
-Marta Morazán, member of the janitorial staff in an office building in Tegucigalpa

As journalists we're finding more opportunities in the mass media to put health on the political agenda and to make health matters part of the daily concern of all Hondurans.
-Leonarda Andino, winner of the 1998 National Award for Journalism in Health

There is little we can do in life without health, but with it, everything is possible.
-Carlos Roberto Flores, President of the Republic of Honduras

Across the spectrum, people seem to regard health not only as a human right but as a social product-both a means paving the way to the common good and an end reflecting the achievement of sustainable human development.

In its mission statement, the Honduran Health Secretariat underscores its commitment "to guarantee access to comprehensive health care to all the population, ensuring quality, equity, and solidarity; and to play a leadership role in the health sector, developing the capacity to respond in a relevant, effective, and timely manner to the Honduran people's needs and aspirations in health, through technical, administrative, compassionate, and transparent processes that promote citizen participation, decentralization, and comanagement in health."

Despite this commitment, the Honduran public health system faces serious obstacles in fulfilling its mandate. According to 1998 government figures, of the nation's 6 million inhabitants, 81 percent live below the poverty line, and 55 percent live in rural areas with little or no access to clean drinking water and other basic health and sanitation services. The country's poor majority live in the daily shadow of sickness or death, with only a limited ability to prevent or control the so-called "diseases of antiquity" long vanquished in the developed world. At the same time, Honduras, like many other countries, faces "new" health problems, such as AIDS and violence, whose social origins require more complex approaches extending beyond strictly medical boundaries.

In conference rooms and on street corners, in homes, churches, and schools, the desire for a more equitable health situation echoes in daily conversations everywhere. Perhaps the most burning desire is to create a new map of Honduras-one where remote places lacking even the most basic primary health services no longer exist. Another is that health care respond in real time to real life situations, a desire echoed in the anguished words of Francisco Fortín: "The test results arrived two weeks after my mother had died; by then it was too late."

For some people, a visit to the hospital or clinic produces nothing out of the ordinary and can even turn out surprisingly well. Yet a closer look will likely reveal practices that seem unfair or discriminatory, according to Carolina Castillo, an administrative assistant for an international development project based in Tegucigalpa. "One night I accompanied a family member to an emergency room," she recalls. "Since there were doctors on duty there that we knew, they took us right away, while other people sat there waiting."

Jorán Martínez might have been one of them. Martínez, who works as a security guard in an office downtown, remembers having "gotten up at the crack of dawn for nothing." Not only did he have to miss work that day, he says, but he spent endless hours wondering if his name would ever be called. Laura Molina, a community social worker and child health consultant, sees a pervasive pattern. "People with better connections get better service," she says, pointing out one of the most blatant manifestations of health inequities-and why this situation must change.

What, then, would be the ideal? There really is little argument: support and respect for health posts, clinics, hospitals, and their health workers, who are valued by the communities they serve because they are able to help people with their problems. In other words, says Dr. Nora Maradiaga, an internist at the Choluteca Hospital and the National Thoracic Institute, "health care that truly optimizes resources; a system that assures that the essential medicines and equipment are on hand to enable us to treat adequately the conditions we're most likely to encounter; a system that doesn't leave us in the untenable position of having to say: 'we can't do this here,' or 'we don't have that here.' "

"You can't play games with health," says Ricardo Amaya, a journalist with Radio Reloj. "That's why the contribution of health workers is so important to society." Maradiaga agrees, pointing out that even the limitations imposed upon health professionals do not exempt them from their responsibility to serve the public and improve human welfare through interpersonal factors they can control.

"People want an environment where they feel at ease," says Molina. "In some cases, a pat on the back helps just as much as a medical prescription. People want somebody who will listen to them." Amaya agrees, saying that health care cannot be cold and impersonal. "The concerns of a young pregnant woman, an adolescent student, and a recently widowed older adult will be very different," he observes, "and health workers must understand this reality."

Of course, the other side of the coin-that those who greet us from the reception desk, and those who record our medical history, measure our blood pressure, and recommend a course of action are no more immune to unforeseen circumstances, family pressures, and nagging concerns than we are-is equally true. These factors shouldn't-but sometimes do-influence the performance of health personnel. We can make their job easier by meeting them halfway: recognizing they are only human, too, and showing courtesy and a willingness to cooperate.

Perhaps the health worker's most vital function is to help us understand why we become sick and how we can avoid illness. Therefore, a physician's stock-in-trade is not only the stethoscope and tongue depressor, but his or her ability to impart effective health promotion and protection strategies, as well. There is as much art as science in this role, since medical knowledge and the powers of persuasion hold equal sway. The health worker's job is completed only once the patient grasps the big picture.

"It's up to us to reinforce these basic messages of prevention on a collective scale," says Fortín, referring to the work of the Health Secretariat's communications office. Yet, sometimes, according to radio announcer Amaya, "public health campaigns aren't as successful as they could be because people think the message doesn't apply to them." Here is where journalists can change things, notes Leonarda Andino, who frequently reports on health. "We can convince people, so they will act," she says. Fortín agrees, emphasizing that while journalists do not decide the country's future, they hold tremendous sway over public opinion, and by orienting, informing, and educating people, can become a powerful catalyst for social change.

The energy to fuel any major social transformation-in this case, one in which a new culture of health can take root-must, of course, come from the highest levels of government. An unequivocal political commitment that places health as the cornerstone for socioeconomic development, coupled with strong leadership by the ministry of health, an enlightened national media, cooperation between the public and private sectors, and support from the international community, is the first step toward achieving the health we want.

These top-down activities, however, will succeed only to the extent that the general public embraces them with an understanding of what each person can contribute to the process. "We must change attitudes, beginning with our own," says José Armando Reaños, a taxi driver in Tegucigalpa. "There is a lot each of us can do."

Our willingness to take this process forward can be measured by how we respond to the everyday challenges and opportunities all around us. It is cleaning our yard without tossing the trash into the neighbor's; it is planting trees instead of burning them; it is remembering personal hygiene even when there is only half a pail of water. It is caring for our livestock but not living with the animals; it is playing ball with friends instead of looking for drugs; it is enabling our daughters to stay in school alongside their brothers. It is loving without limitations but safely; it is learning to preserve and respect what belongs to others as well as to us; it is choosing peace and compromise over conflict and intimidation. It is recognizing that change can and must begin with each of us, and that by joining together, the health we want can be within our reach.

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Rossany Auceda is a journalist and editor specializing in health promotion and protection, based in Tegucigalpa, Honduras, where she is participating in the U.S. Agency for International Development's Partnerships for Health Reform Project.