Water Democracy vs. Globalization & Public-Public Partnerships

First off, watch this shocking video to learn more about the impact of the global water crisis:

Beyond Scarcity: Power, Poverty, and the Global Water Crisis

I just read an interesting article written by Dr. Vandana Shiva, author of the book Water Wars. The article exposes water theft (hydropiracy) by large corporations like Coca-Cola, water privatization by the World Bank (in an effort to shift from "social to commercial value"), and other scandals like rerouting rivers to maximize land use (consider the World Bank-supported River Linking Project in India). I never thought of water as a commodity subject to theft! But theft is indeed occurring, and it reminds me of a poignant point made by presenters in our last class who compared our current battle over oil to the possibility of a war over water rights & access. Facing the prospect of water scarcity makes the oil crisis seem laughable.

The article also discusses public-public partnerships (PUP's). Private multinational corporations like the Suez Group--which made over a billion dollars in profit last year--have unfortunately failed to deliver improvements in water access in countries worldwide (e.g Argentina, Bolivia & Tanzania). Public-private partnerships can apparently leave a country with less water and more debt than they had to begin with. The concept behind PUP's is simply to shut out the for-profit sector by forming partnerships that include public authorities, donor governments, international organizations, NGO's, trade unions, and communities/local actors.

As we talked about in class, water is a basic human right, and when that's the case, the onus falls on the public sector. Privatization can indeed help, but in the case of water, taking into account the private sector's failures and the extreme urgency of water needs in developing countries, should PUP's be considered instead?

Check out this article on PUP's worldwide to learn more about their current role and possibilities for the future: "Public Water For All"

Among currently employed, successful PUP's in national water distribution (taken from the above article, and originally described in the book Reclaiming Public Water):

-Public-collective partnership in Cochabamba (Bolivia): democratic control over the public utility SEMAPA (via citizens elected onto the company’s board) and a strong role for local water committees in distributing bulk water supplied by SEMAPA to the unconnected periurban areas.

- Community-utility partnership in Savelugu (Ghana): Ghana Water Company delivers bulk water to the community, who run the next stages of water delivery; planning, tariff setting, new connections, maintenance and billing.

- Public-Workers Partnerships in the province of Buenos Aires (Argentina): a worker’s cooperative manages the public water utility ABSA, consulting closely with public authorities and water users.

- Communitarian water delivery in Venezuela: local communities, the water utility and elected officials co-operate in communal water councils to identify needs and priorities for improvements, allocate available funds and develop joint work plans.

There are definitely barriers to implementing PUP's, but it seems like there is also strong evidence that they could be the answer to establishing water democracies.

Public health in Palestine

Watch the video "This Is Not Your War" on American nurse Lynn Gras' humanitarian trips to Gaza, Bethlehem, Ramallah and Hezbollah to work with local health care workers. The photo was taken from Palestine Children's Relief Fund.

It's becoming increasingly evident that the topic of global health has a lot to do with issues that don't fit neatly into the sphere of health as we know it. Lynn's video is a testament to that. As a pro-peace Muslim, it is interesting to see how, as the narrator puts it, Western Europe imported its religious strife and racism in the early 1900's to the otherwise neutral "Islamic world" that Muslims, Jews and Christians were cohabiting. Many people don't know that the Quran, the book of the Muslims, urges people of all scriptures to unite peacefully under monotheism. Instead, we're fighting world wars and oppressing each other (and the people behind it are actually portrayed as the most religious). And to make matters worse, vast inequalities mean that the rich always win.

When the political issues are so heavy, can we even talk about public health? This is one of the worst human rights issues in the last century. It seems like there is a lack of political will to do the right thing. And how do we define the right thing? I guess for one thing, it'd be to achieve an environment where kids grow up safe and healthy, in that order.

Micro-gardening...another creative food security option

Landlessness is becoming an increasingly common problem in some rural areas, as governments take over subsistence farmers' land for large-scale development projects. Micro-agriculture is another potential answer for food-insecure communities with limited capacity to grow their own foods. Oxfam is teaching these techniques to inhabitants of the Sahel region. It's not a widely disseminated tool yet, but I think it could have exciting potential, especially in developmentally hopeless situations (e.g. Sudanese refugee camps, perhaps).

It's not about what you know..

...it's about what you do with what you know. We are a highly privileged group of people. Obviously, we aren't completely homogenous, but as Dr. Shahi said the very fact that we're graduate students at USC says that we all have access to the same level of education at a specific kind of institution. It seems to me that historically, knowledge has always been revered--the recognition goes to the person who knows the most stuff. That's one of the reasons physicians command such respect (in some countries more than others). But nowadays, most of us have access to the internet, and there's not a tremendous difference between your knowing, say, all the letters of the Greek alphabet, and my looking them up in seconds using Google.

What our challenge will be is to figure out how to use all that information. Of course, we have to be knowledgeable; we can't use information without first being aware of its existence and content. But after that, the people who will do the most good, I think, are those that look for--or even just stumble on--the hidden ideas and solutions buried in all that data. Einstein's thought experiments and Muhammad Yunus' bottom-up approach, both brought to our attention by Dr. Shahi, are two great examples of people who changed the way we think by keeping their eyes and ears wide open to what others took for granted. Hopefully, we can learn from their approach and remember that the solutions are out there--we just have to tease them out and bring them to life.

Some of the world's greatest feats were accomplished by people not smart enough to know they were impossible. -Doug Larson

An Argument for CVD

So in class this week we talked about chronic diseases. I know what you're thinking: why should gung-ho global development champions care about something like cardiovascular disease, the curse of privileged rich men?

Well, because 17 million people worldwide are dying from it. Sure, when you combine worldwide deaths from AIDS, TB, malaria, malnutrition and diarrhea, you get a figure comparable to 17 million. But in terms of a cost-benefit analysis, a single, multi-faceted intervention (with cultural adaptations) could be developed that would address the elevated number of deaths from this one condition. The same can't be said for HIV/AIDS, TB, malaria and other diseases--to combat that group of diseases, a diverse group of interventions are required to create a positive effect. Disseminating antiretrovirals at a cheap price works great for AIDS, but drug therapies are not going to work for malnutrition. Preventing diarrhea requires better sewage systems and cleaner water--another unique strategy. These interventions are indeed necessary and deserve the attention they receive. BUT, we're also facing a pretty compelling global burden of CVD, and I think that because it's a global problem and is shared by a demonstrably heterogenous mix of nations, it's possible to find a solution that is a)beneficial to most, and b)fairly cost-effective (concentrating solely on CVD could help prevent 17 million deaths, whereas concentrating just on HIV/AIDS would help prevent only 3 million). An obvious counter-argument is that treating diseases like diarrhea, malaria and AIDS would be oh-so-easy with primary and secondary preventive measures, whereas changing people's behaviors is more difficult. But those "easy" solutions are still not being executed, and it's largely because the same old barriers of funding, human resources, infrastructure etc. get in the way. Human behavior can be difficult to influence, but it can't be that difficult--people with monetary incentives (ie, the private sector) do it extremely well.

The point is, chronic disease matters too, and not just to the rich. The countries with the most rapid increases in chronic disease prevalence are, in fact, developing nations (most notably in Asia). And because those countries don't have the resources for preventive measures like screening, drug therapies and surgical procedures, they're dying younger from their conditions than their counterparts in developed nations. Women are taking a hit, too. Tobacco, sedentary jobs, and shifting dietary patterns are some of the culprits. Dr. Shahi urged us to think about what needs to be done in global health after the MDG's are accomplished. If we do end up reaching those targets, it looks like tackling chronic disease will be high on the new list of long-unfinished business.

The behemoth of an article that inspired this post (a very good one from the Earth Institute at Columbia University) is "A Race Against Time."

Check out these excellent videos on the chronic disease epidemic in the U.S., too:

Face to Face With Chronic Disease (WHO video)
Reversing Diabetes With Raw Foods in 30 Days
Community Educators in Oregon Help Prevent Chronic Disease

Power to the People

Why do aid agencies assume they have to do it all? As we know from our readings on global health initiatives, local people and frontline providers of goods and services must be empowered to distribute any kind of development aid that gets dished out. It's the only way for that development to have any kind of lasting effect.

While researching for my paper I realized just how great a tool information technology would be for developing countries. Information is power. That Chinese baby I mentioned in my last blog? If her parents had the internet, they could have diagnosed her malnutrition themselves, before it was too late. And they would have, except for the fact that people like them, who have access to limited information and sub-par goods and services, don't even know that the internet exists. Many of these poorest of the poor don't even know that they are referred to, by some, as human rights violations.

The internet would be a wonderful tool for people in rural, developing areas to have. It would allow them to communicate suspected infectious disease outbreaks, request needed supplies to uphold quality of care, and put the power of information in the hands of those who have the greatest incentive to use it wisely and well. Access to information in areas where governing bodies are highly corrupted would also force centralized powers to be more transparent, more accountable, and more in-tune with the wants and needs of the people they're supposed to be serving.

At What Cost?

One of the assigned articles in our class on public health challenges in China recounts the story of Rongrong, a newborn baby whose parents were among villagers sold fake milk powder to feed their infants in 2004. At least 200 infants were severely malnourished as a result of consuming this cheap powder, and village doctors, who aren't rigorously trained or regulated, failed to recognize the signs of malnutrition. Instead, they called it the "big head disease"--a classic indication of malnutrition. Rongrong died in a city hospital. Her parents are responsible not only for the cost of her care prior to her death, but also for the illnesses her mother now suffers.

According to China Daily, rural people are most susceptible to counterfeit food products, where there is very little regulation. Companies wanting to turn a profit have apparently found their target population in China's most precarious citizens. Not only that, what kind of physicians fail to diagnose severe malnutrition?

The original article, published in The Economist, can be found here.

Learn more about the unexpected, adverse outcomes of globalization on the "have-nots": The UN Development Project's report on "Inequality & Development"

Making the case for capitalism: John Norberg video

Compounding the issue: Another video on politics, wealth, and health