Dear Neil and HIFA
The article and the photographs scream 'hazardous environment' and 'underdevelopment', with immense risks of waterborne, airborne, foodborne and other pathogens. Universal water and sanitation and adequate housing could reduce many of the risks to a level that no longer result in "90 percent of households in Kibera [using] antibiotics in the previous year" (if that figure is accurate). Improved diet and greater food sovreignty would also reduce risks and susceptibility.
The above would go a long way towards ensuring 'A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity'. Drugs are for sickness and disease. Depending on drugs, instead of providing people with the conditions they need to achieve WHO's definition of health, is precisely what gives rise to the scenarios depicted in the NY Times article.
Antimicrobial resistance is growing, at least in part, because 'health' is often viewed merely as 'the absence of disease or infirmity'. Overuse of drugs and pharmaceuticals contribute to resistance, not just in homes and health facilities, but also in agriculture and the broader environment; pesticides such as Dicamba and Glyphosate contribute to AMR.
My apologies if this sounds like soapbox oratory, but the NY Times article is about a lot more than antibiotics and AMR.
HIFA profile: Simon Collery is an Independent Consultant working in Tanzania and is currently director of The Toa Nafasi Project, training young women to provide special needs education to children in their first and second year at Tanzanian state schools. collery AT googlemail.com