From a NYT article today, this is Bush's explanation for why he vetoed a SCHIP expansion bill supported even by his own Republican contingency:
“It is estimated that if this program were to become law, one out of every three persons that would subscribe to the new expanded Schip would leave private insurance,” the president said. “The policies of the government ought to be to help poor children and to focus on poor children, and the policies of the government ought to be to help people find private insurance, not federal coverage. And that’s where the philosophical divide comes in.”
Well, he got that last part right. It is definitely a philosophical divide. Between him, and sane people. Because that's what insanity is: when things don't make sense and they aren't getting better, but we keep on ignoring intelligent stimuli because we're...not sane.
Wednesday, October 3, 2007
Monday, September 3, 2007
Stop Trying To 'Save' Africa
By Uzodinma Iweala
The Washington Post
Sunday, July 15, 2007; B07
Last fall, shortly after I returned from Nigeria, I was accosted by a
perky blond college student whose blue eyes seemed to match the
"African" beads around her wrists.
"Save Darfur!" she shouted from behind a table covered with pamphlets
urging students to TAKE ACTION NOW! STOP GENOCIDE IN DARFUR!
My aversion to college kids jumping onto fashionable social causes
nearly caused me to walk on, but her next shout stopped me.
"Don't you want to help us save Africa?" she yelled.
It seems that these days, wracked by guilt at the humanitarian crisis
it has created in the Middle East, the West has turned to Africa for
redemption. Idealistic college students, celebrities such as Bob
Geldof and politicians such as Tony Blair have all made bringing light
to the dark continent their mission. They fly in for internships and
fact-finding missions or to pick out children to adopt in much the
same way my friends and I in New York take the subway to the pound to
adopt stray dogs.
This is the West's new image of itself: a sexy, politically active
generation whose preferred means of spreading the word are magazine
spreads with celebrities pictured in the foreground, forlorn Africans
in the back. Never mind that the stars sent to bring succor to the
natives often are, willingly, as emaciated as those they want to help.
Perhaps most interesting is the language used to describe the Africa
being saved. For example, the Keep a Child Alive/" I am African" ad
campaign features portraits of primarily white, Western celebrities
with painted "tribal markings" on their faces above "I AM AFRICAN" in
bold letters. Below, smaller print says, "help us stop the dying."
Such campaigns, however well intentioned, promote the stereotype of
Africa as a black hole of disease and death. News reports constantly
focus on the continent's corrupt leaders, warlords, "tribal"
conflicts, child laborers, and women disfigured by abuse and genital
mutilation. These descriptions run under headlines like "Can Bono Save
Africa?" or "Will Brangelina Save Africa?" The relationship between
the West and Africa is no longer based on openly racist beliefs, but
such articles are reminiscent of reports from the heyday of European
colonialism, when missionaries were sent to Africa to introduce us to
education, Jesus Christ and "civilization."
There is no African, myself included, who does not appreciate the
help of the wider world, but we do question whether aid is genuine or
given in the spirit of affirming one's cultural superiority. My mood
is dampened every time I attend a benefit whose host runs through a
litany of African disasters before presenting a (usually) wealthy,
white person, who often proceeds to list the things he or she has done
for the poor, starving Africans. Every time a well-meaning college
student speaks of villagers dancing because they were so grateful for
her help, I cringe. Every time a Hollywood director shoots a film
about Africa that features a Western protagonist, I shake my head --
because Africans, real people though we may be, are used as props in
the West's fantasy of itself. And not only do such depictions tend to
ignore the West's prominent role in creating many of the unfortunate
situations on the continent, they also ignore the incredible work
Africans have done and continue to do to fix those problems.
Why do the media frequently refer to African countries as having been
"granted independence from their colonial masters," as opposed to
having fought and shed blood for their freedom? Why do Angelina Jolie
and Bono receive overwhelming attention for their work in Africa while
Nwankwo Kanu or Dikembe Mutombo, Africans both, are hardly ever
mentioned? How is it that a former mid-level U.S. diplomat receives
more attention for his cowboy antics in Sudan than do the numerous
African Union countries that have sent food and troops and spent
countless hours trying to negotiate a settlement among all parties in
that crisis?
Two years ago I worked in a camp for internally displaced people in
Nigeria, survivors of an uprising that killed about 1,000 people and
displaced 200,000. True to form, the Western media reported on the
violence but not on the humanitarian work the state and local
governments -- without much international help -- did for the
survivors. Social workers spent their time and in many cases their own
salaries to care for their compatriots. These are the people saving
Africa, and others like them across the continent get no credit for
their work.
Last month the Group of Eight industrialized nations and a host of
celebrities met in Germany to discuss, among other things, how to save
Africa. Before the next such summit, I hope people will realize Africa
doesn't want to be saved. Africa wants the world to acknowledge that
through fair partnerships with other members of the global community,
we ourselves are capable of unprecedented growth.
Uzodinma Iweala is the author of "Beasts of No Nation," a novel about
child soldiers.
The Washington Post
Sunday, July 15, 2007; B07
Last fall, shortly after I returned from Nigeria, I was accosted by a
perky blond college student whose blue eyes seemed to match the
"African" beads around her wrists.
"Save Darfur!" she shouted from behind a table covered with pamphlets
urging students to TAKE ACTION NOW! STOP GENOCIDE IN DARFUR!
My aversion to college kids jumping onto fashionable social causes
nearly caused me to walk on, but her next shout stopped me.
"Don't you want to help us save Africa?" she yelled.
It seems that these days, wracked by guilt at the humanitarian crisis
it has created in the Middle East, the West has turned to Africa for
redemption. Idealistic college students, celebrities such as Bob
Geldof and politicians such as Tony Blair have all made bringing light
to the dark continent their mission. They fly in for internships and
fact-finding missions or to pick out children to adopt in much the
same way my friends and I in New York take the subway to the pound to
adopt stray dogs.
This is the West's new image of itself: a sexy, politically active
generation whose preferred means of spreading the word are magazine
spreads with celebrities pictured in the foreground, forlorn Africans
in the back. Never mind that the stars sent to bring succor to the
natives often are, willingly, as emaciated as those they want to help.
Perhaps most interesting is the language used to describe the Africa
being saved. For example, the Keep a Child Alive/" I am African" ad
campaign features portraits of primarily white, Western celebrities
with painted "tribal markings" on their faces above "I AM AFRICAN" in
bold letters. Below, smaller print says, "help us stop the dying."
Such campaigns, however well intentioned, promote the stereotype of
Africa as a black hole of disease and death. News reports constantly
focus on the continent's corrupt leaders, warlords, "tribal"
conflicts, child laborers, and women disfigured by abuse and genital
mutilation. These descriptions run under headlines like "Can Bono Save
Africa?" or "Will Brangelina Save Africa?" The relationship between
the West and Africa is no longer based on openly racist beliefs, but
such articles are reminiscent of reports from the heyday of European
colonialism, when missionaries were sent to Africa to introduce us to
education, Jesus Christ and "civilization."
There is no African, myself included, who does not appreciate the
help of the wider world, but we do question whether aid is genuine or
given in the spirit of affirming one's cultural superiority. My mood
is dampened every time I attend a benefit whose host runs through a
litany of African disasters before presenting a (usually) wealthy,
white person, who often proceeds to list the things he or she has done
for the poor, starving Africans. Every time a well-meaning college
student speaks of villagers dancing because they were so grateful for
her help, I cringe. Every time a Hollywood director shoots a film
about Africa that features a Western protagonist, I shake my head --
because Africans, real people though we may be, are used as props in
the West's fantasy of itself. And not only do such depictions tend to
ignore the West's prominent role in creating many of the unfortunate
situations on the continent, they also ignore the incredible work
Africans have done and continue to do to fix those problems.
Why do the media frequently refer to African countries as having been
"granted independence from their colonial masters," as opposed to
having fought and shed blood for their freedom? Why do Angelina Jolie
and Bono receive overwhelming attention for their work in Africa while
Nwankwo Kanu or Dikembe Mutombo, Africans both, are hardly ever
mentioned? How is it that a former mid-level U.S. diplomat receives
more attention for his cowboy antics in Sudan than do the numerous
African Union countries that have sent food and troops and spent
countless hours trying to negotiate a settlement among all parties in
that crisis?
Two years ago I worked in a camp for internally displaced people in
Nigeria, survivors of an uprising that killed about 1,000 people and
displaced 200,000. True to form, the Western media reported on the
violence but not on the humanitarian work the state and local
governments -- without much international help -- did for the
survivors. Social workers spent their time and in many cases their own
salaries to care for their compatriots. These are the people saving
Africa, and others like them across the continent get no credit for
their work.
Last month the Group of Eight industrialized nations and a host of
celebrities met in Germany to discuss, among other things, how to save
Africa. Before the next such summit, I hope people will realize Africa
doesn't want to be saved. Africa wants the world to acknowledge that
through fair partnerships with other members of the global community,
we ourselves are capable of unprecedented growth.
Uzodinma Iweala is the author of "Beasts of No Nation," a novel about
child soldiers.
Friday, June 29, 2007
A Global Health Celebrity in the Family
I've been updating mostly on my other blog since I'm in India this summer, but this piece of news really belongs here. My cousin, Kavitha Narra (who I still remember in diapers), just returned from a visit to Germany for 2007's G8 summit. As you all know, the G8 summit is an annual meeting of the 8 most powerful countries in the world. They have instituted a (new?) feature of the G8 called the J8, wherein young representatives from each G8 country apply (via the United Nations) to participate in the history-making conference. Among other activities, J8 leaders sit with presidents from these 8 superpowers and discuss global issues like health care, the environment, peace and conflict, and other relevant topics.
Kavitha was not only a part of J8, she was the US team leader. She handpicked teammates and teachers, all from The Harker School in Saratoga, CA, to form the J8 team that represented the US this year. She spoke to world leaders along with her teammates, urging them to set small, measurable, achievable goals and calling out politicians who make empty promises just to borrow goodwill. Makes sense, no? She's fifteen.
Now, Kavitha's in Hyderabad, India, learning about female empowerment through business enterprise with ALEAP. She's visiting a lot of sites with her friend and J8 teammate, Rachel.
As you know, political and social apathy among the younger generation has been a definite concern in the past few decades. Some say that US youth haven't been motivated to contribute actively to better their country since the 1960s. I think that creating the J8, and encouraging motivated teenagers like Kavitha, not only shows that youth are starting to play a more active role; it also indicates how important it is for the future of global public welfare to engage these bright young voices.
Wednesday, June 20, 2007
All about Ayush
This week has been all about Ayush, the alternative system of medicine in India. As I’ve already mentioned, it’s much more widely accepted by the general public than its equivalent in the U.S., and it’s even recognized by the official government of India. Because of its cultural, historical, social and health care importance, I’m glad we got the chance to learn about it.
Ayush stands for Ayurveda, Yoga and naturopathy, Unani, Siddha, and Homeopathy. We didn’t go into much detail about unani, siddha and homeopathic cures; most of our time was spent learning about ayurveda, yoga and naturopathy. But these are all drugless therapies, so some version of hot/cold manipulation, physiotherapy, and herbal treatment is probably incorporated into each one of these. Meditation and breathing exercises also have healing properties in this system.
The basic principles of Ayush are that the body has five great elements: earth, water, air, ether (space), and fire. Health is defined as the harmonious vibrations of all the elements and forces composing the human entity.
The body is said to heal itself if it is given proper scope, or nourishment. We are what we eat. An acute disease is considered to be the healing and cleansing effort of nature, while a chronic disease is the suppression of an acute disease with drugs. There is also something called the unity of disease, which is the accumulation of foreign matter or toxins inside our system. Unity of cure is defined as the elimination of accumulated toxins from the body.
Interestingly, bacteria and germs are considered secondary causes of disease, which I agree with…they are not primary causes. This is an important distinction. Sanitation, improper diet, and other causes that will be discussed below are delineated as causes of disease.
The stomach is the origin of disease, and so it is to be treated first. 99% of diseases, according to our lecturer, Dr. Nair, start in the stomach.
And the last tenet is that the cause of all diseases is one, and their treatment is also one. Dr. Nair did not specify what that one cause was, but I think it’s meant to get patients thinking holistically instead of treating each specific ailment as it comes.
On to the causes of disease. Diseases are defined as violations of nature’s laws. This seems to mean that humans cause disease by going against nature. The causes are: a) ignorance; b) indulgence; c) indifference (high ego). Dr. Nair forgot one that I think is vitally important, and that is d) poverty. It is interesting that she did not include that. Poverty is lack of access to nutritious food, clean water, etc…before many people get the chance to be ignorant, indulgent or indifferent, they are simply poor.
Obviously, modern medicine could have a field day with some of these descriptions, but the traditional system in India is simply a theory. On its side are centuries of experience, so it can’t be easily dismissed.
There are many treatments that Ayush offers for various ailments. They are best for chronic conditions such as arthritis, obesity, diabetes, asthma, migraines, sinusitis, and depression. They do massage therapy, hydrotherapy, mud treatments, nutritional counseling (and fasting), chromotherapy (color therapy), yoga, acupressure, magnetotheraphy, electrotherapy, aromatherapy and acupuncture (the last two are widely practiced but are not officially Ayush, because they aren’t traditional Indian healing methods).
A few words on ayurveda (this is basic info that can be gotten anywhere): ayurveda is literally the science of life. Veda is science, and ayur means life. There are three main aims to it: 1) the prevention of disease by adopting a healthy lifestyle; 2) the cure of ailments through treatments, medicine and surgery (yes, surgery!); and 3) rejuvenation. The two major works of literature composing ayurvedic thought are the Charaka Samhita and the Sushruta Samhita. The first is a book on general medicine, and the second is on surgery. These were written by ancient physicians as early as the 7th century, though ayurveda was undoubtedly practiced even earlier. Ayurvedic medicine has a large scope; it was shocking to hear that it includes surgery. It also has branches in ophthalmology, ENT (ear, nose and throat), pediatrics, botany, and more. I’m fascinated to learn more about it.
Another highlight of our week at Bapu was the dance lesson we got yesterday. It was just Linda and I who wanted an Odissi lesson, but in the end, several others came to watch the guruji teach us the history, culture and movements of Odissi dance. I was deemed (by myself first, and more definitively by Dr. Nair) to have both the interest and physique, but not the talent and grace, for traditional dance. I hope it’s not true, but I suspect this ordinance holds true for other types of dance, too. I guess I should stick to athletics.
Oh yes, and there has been a change in travel plans! Tomorrow is our last day of CFHI fun…we are traveling to the village of Mewat, which I’m really looking forward to. If you remember, we postponed this trip a few weeks due to Gujjar uprisings. After tomorrow, Emma goes home and Sejal and I are planning a trip to Dehradun, a hill station in the Himalayas. Then we are (theoretically, God willing) off to Mumbai, where we will stash our bags at an Aunty’s house and go on to explore Goa. Let’s see how it all works out though, God only knows!
Ayush stands for Ayurveda, Yoga and naturopathy, Unani, Siddha, and Homeopathy. We didn’t go into much detail about unani, siddha and homeopathic cures; most of our time was spent learning about ayurveda, yoga and naturopathy. But these are all drugless therapies, so some version of hot/cold manipulation, physiotherapy, and herbal treatment is probably incorporated into each one of these. Meditation and breathing exercises also have healing properties in this system.
The basic principles of Ayush are that the body has five great elements: earth, water, air, ether (space), and fire. Health is defined as the harmonious vibrations of all the elements and forces composing the human entity.
The body is said to heal itself if it is given proper scope, or nourishment. We are what we eat. An acute disease is considered to be the healing and cleansing effort of nature, while a chronic disease is the suppression of an acute disease with drugs. There is also something called the unity of disease, which is the accumulation of foreign matter or toxins inside our system. Unity of cure is defined as the elimination of accumulated toxins from the body.
Interestingly, bacteria and germs are considered secondary causes of disease, which I agree with…they are not primary causes. This is an important distinction. Sanitation, improper diet, and other causes that will be discussed below are delineated as causes of disease.
The stomach is the origin of disease, and so it is to be treated first. 99% of diseases, according to our lecturer, Dr. Nair, start in the stomach.
And the last tenet is that the cause of all diseases is one, and their treatment is also one. Dr. Nair did not specify what that one cause was, but I think it’s meant to get patients thinking holistically instead of treating each specific ailment as it comes.
On to the causes of disease. Diseases are defined as violations of nature’s laws. This seems to mean that humans cause disease by going against nature. The causes are: a) ignorance; b) indulgence; c) indifference (high ego). Dr. Nair forgot one that I think is vitally important, and that is d) poverty. It is interesting that she did not include that. Poverty is lack of access to nutritious food, clean water, etc…before many people get the chance to be ignorant, indulgent or indifferent, they are simply poor.
Obviously, modern medicine could have a field day with some of these descriptions, but the traditional system in India is simply a theory. On its side are centuries of experience, so it can’t be easily dismissed.
There are many treatments that Ayush offers for various ailments. They are best for chronic conditions such as arthritis, obesity, diabetes, asthma, migraines, sinusitis, and depression. They do massage therapy, hydrotherapy, mud treatments, nutritional counseling (and fasting), chromotherapy (color therapy), yoga, acupressure, magnetotheraphy, electrotherapy, aromatherapy and acupuncture (the last two are widely practiced but are not officially Ayush, because they aren’t traditional Indian healing methods).
A few words on ayurveda (this is basic info that can be gotten anywhere): ayurveda is literally the science of life. Veda is science, and ayur means life. There are three main aims to it: 1) the prevention of disease by adopting a healthy lifestyle; 2) the cure of ailments through treatments, medicine and surgery (yes, surgery!); and 3) rejuvenation. The two major works of literature composing ayurvedic thought are the Charaka Samhita and the Sushruta Samhita. The first is a book on general medicine, and the second is on surgery. These were written by ancient physicians as early as the 7th century, though ayurveda was undoubtedly practiced even earlier. Ayurvedic medicine has a large scope; it was shocking to hear that it includes surgery. It also has branches in ophthalmology, ENT (ear, nose and throat), pediatrics, botany, and more. I’m fascinated to learn more about it.
Another highlight of our week at Bapu was the dance lesson we got yesterday. It was just Linda and I who wanted an Odissi lesson, but in the end, several others came to watch the guruji teach us the history, culture and movements of Odissi dance. I was deemed (by myself first, and more definitively by Dr. Nair) to have both the interest and physique, but not the talent and grace, for traditional dance. I hope it’s not true, but I suspect this ordinance holds true for other types of dance, too. I guess I should stick to athletics.
Oh yes, and there has been a change in travel plans! Tomorrow is our last day of CFHI fun…we are traveling to the village of Mewat, which I’m really looking forward to. If you remember, we postponed this trip a few weeks due to Gujjar uprisings. After tomorrow, Emma goes home and Sejal and I are planning a trip to Dehradun, a hill station in the Himalayas. Then we are (theoretically, God willing) off to Mumbai, where we will stash our bags at an Aunty’s house and go on to explore Goa. Let’s see how it all works out though, God only knows!
Until Mid-July....
...check out my Delhi blog, because that's where I'll be! I've been in Delhi for a month, but now it's time to pick up and travel around India some more. Mini-trips to the Himalayas, Bollywood and Goa are in the works (of course, God willing!). I came to India through an NGO called CFHI, to learn about HIV and public health challenges in this country of one billion people. Check it out!
Monday, May 21, 2007
Learning from the Acumen Fund: A strategic plan for international aid
I recently read an article on the Acumen Fund in the Stanford Business magazine, which I'm fond of. It was an appropriate piece to include in the publication, considering that the founder of Acumen, CEO Jacqueline Novogratz, is a graduate of the business school.
What struck me about her strategy is how simple it is. Basically, Acumen collects money from philanthropists and corporate investors, identifies businesses in developing countries that need assistance, gives loans to those business owners, and provides managerial assistance to ensure that improvements are made and that profits are eventually turned.
Loans, coupled with the business acumen provided by lenders, force small business owners to ferret out destructive elements like underperforming and pilfering. When a third party is scrutinizing all aspects of production (remember, they are now major stakeholders in the proposition), business owners become more efficient and more accountable. These are two crucial qualities sorely lacking in small businesses in developing countries.
How can this strategy be appropriated for use in the public health sector? For developing countries struggling to set up infrastructure, loans must come not only with instructions for use, but with built-in guidance and accountability. One of the keys to Jacqueline's success with business owners is that she constantly asks her customers what they think of Acumen's services. If they are unhappy, the company isn't doing its job. Likewise, if international lenders don't work with developing countries to find sustainable plans to use much-needed funds, little will be gained. Remember, we live in a world where 25,000 people die of hunger every day for reasons that have less to do with lack of resources than poor governance.
Acumen is an interesting example of market-driven solutions for human development. As it says on its website, the Fund aims to "provid[e] a product or a service that can be sold directly to out target market or to a small-scale entrepreneur, not only to government or donors who may be out of touch with the demands of low income consumers or their willingness to pay for what they value."
So there you have it. An example of the private sector not only being at the epicenter of global public health, but showing mistrust for other major stakeholders--governments and NGOs. To quote my sister, a current Stanford GSB student, "The quickest way to solve a problem is through business." Those of us in the field of public health and medicine will do well to heed those words.
What struck me about her strategy is how simple it is. Basically, Acumen collects money from philanthropists and corporate investors, identifies businesses in developing countries that need assistance, gives loans to those business owners, and provides managerial assistance to ensure that improvements are made and that profits are eventually turned.
Loans, coupled with the business acumen provided by lenders, force small business owners to ferret out destructive elements like underperforming and pilfering. When a third party is scrutinizing all aspects of production (remember, they are now major stakeholders in the proposition), business owners become more efficient and more accountable. These are two crucial qualities sorely lacking in small businesses in developing countries.
How can this strategy be appropriated for use in the public health sector? For developing countries struggling to set up infrastructure, loans must come not only with instructions for use, but with built-in guidance and accountability. One of the keys to Jacqueline's success with business owners is that she constantly asks her customers what they think of Acumen's services. If they are unhappy, the company isn't doing its job. Likewise, if international lenders don't work with developing countries to find sustainable plans to use much-needed funds, little will be gained. Remember, we live in a world where 25,000 people die of hunger every day for reasons that have less to do with lack of resources than poor governance.
Acumen is an interesting example of market-driven solutions for human development. As it says on its website, the Fund aims to "provid[e] a product or a service that can be sold directly to out target market or to a small-scale entrepreneur, not only to government or donors who may be out of touch with the demands of low income consumers or their willingness to pay for what they value."
So there you have it. An example of the private sector not only being at the epicenter of global public health, but showing mistrust for other major stakeholders--governments and NGOs. To quote my sister, a current Stanford GSB student, "The quickest way to solve a problem is through business." Those of us in the field of public health and medicine will do well to heed those words.
Monday, May 14, 2007
The other side of the coin
This is the story of another homeless man I interviewed on Skid Row, Pablo. The post's title refers to my previous entry and immigration issues as considered by the major stakeholders--the people. Obviously, this is anything but a homogenous stakeholder group.
Just like Severiano, I met Pablo at the Downtown Drop-in Center in L.A. He was sitting on a boulder at the Center, looking peacefully the street where a prostitute, a policeman, and a man in a wheelchair were gathered. He is staying temporarily at the nearby L.A. Mission, which he describes as “a living hell.” “The slop they give you isn’t sufficient to survive,” he says. “The guards search you three or four times a day. At Salvation Army, they kick you out after a few days, or start charging you ten bucks a night.”
Pablo was born in 1944 in Puerto Rico. He moved to New York in 1948 with his parents and three sisters, and attended primary school there.
“I’ve been working since I was eight years old,” he says. “I started selling fruits and vegetables on the street when I was ten or eleven.”
Pablo remembers Los Angeles thirty years ago, when he first came from the east coast to work in agriculture.
“L.A. was a lot better back then,” he claims. “There were a lot more job opportunities. Nowadays, there’s no work.”
When asked why he thinks there are fewer and fewer jobs in L.A., Pablo—like many politicians in the country—cites the increasing influx of immigrants.
“They’re willing to work for less,” he says. “If I go in asking for a living wage, employers don’t care because they know they can get the job done for less by an immigrant. They’ll find someone else who’ll sacrifice what they need to get money.”
According to Pablo, this is not a new phenomenon. “I was a union cook at a military academy, and after the [Vietnam] war, they told me, ‘We can get it done cheaper.’ They terminated a lot of Americans to bring the Vietnamese in. They brought them to [Fort] Indiantown Gap for cheap labor.”
Pablo also worked in the oil industry, delivering oil to Panama in the late 1980s when citizens went on strike against then-President Noriega. “The U.S. has a lot to do with the pollution of oceans,” he notes. He also worked in Boston, Texas, Washington and Tennessee, doing everything from coffee roasting to waste management. He likes the adventure of travel and the camaraderie that grows from working with fellow men. “You don’t have to look behind your back,” he reflects. “The guy next to you is your father, your brother, your mother. You don’t have time to argue.”
How long has Pablo been homeless? “I’ve been here three weeks,” he tells me. “I’m getting old, I need the sunny weather.” He then goes on to explain his battle to get financial support from the government. “I won it in court,” he claims. “They owe me disability. I can’t work no more after my bypass. I’ve worked all my life. But the government would rather die than give you any money. They never answer the phone and when you go in to see them, they treat you like garbage.”
I ask about Pablo’s plans for the future. “I’m just waiting for my social security to come in,” he says. “821 dollars.” Considering how often he moves around, I wonder how the check will make it to him. “Oh, I have direct deposit.” Once he gets his check, he’ll rent a room for $280 at a nearby hotel.
Pablo isn’t worried about drugs deals and other criminal activity on Skid Row—despite acknowledging rampant drug use, he seems to think it’s pretty safe. “But the government could take care of this if they wanted to. [The police] lock up 30 or 40 people every day for drugs. Nowhere in the world is [the culture of homelessness] as bad as it is here in L.A.”
A tale of two countries
I met Severiano O. at the Downtown Drop-in Center on Skid Row during L.A.’s Big Sunday 2007 event. He’s 26 years old, tan, tired and unkempt—they offer showers at the Drop-in Center, but from his appearance, that doesn’t seem to be a priority for him right now.
He is quick to tell me that the reason he is currently homeless is because of a restraining order placed against him by his girlfriend, with whom he was sharing an apartment in downtown L.A.
Growing up in the town of Colima near Guadalajara, Mexico, Severiano had four brothers and four sisters. It was a big brood, and when asked about family dynamics, he doesn’t hesitate to tell me that his family life was unproblematic.
“We didn’t have too many issues. My parents are still together,” he says.
Like so many Mexicans, Severiano came to the U.S. for job opportunities, and has had no trouble finding work in his chosen profession—construction. His friend, also in the construction business, helped pay his way from Mexico and even gave him a place to live and found him his first job. Severiano likes construction work; his only complaint is that employers are often unwilling to pay his going rate of $250 per day.
He tells me that has worked in various cities in Southern California, and even traveled to the city of Pasco in Washington state to build houses. However, in Pasco, the construction job fell through and he ended up working in the field, picking apples. When winter came, there was no more work, so in 2001 he came back to L.A.
After a one-month stint at an L.A. construction company, Severiano began “esquiñando,” literally, “cornering,” an activity many Californians are particularly familiar with. He would sit on the corner of a Home Depot, waiting for people to pick him up for a day’s work. Once, he found a “patron” who gave him steady work for eight months. He doesn’t mention why the job ended; he just tells me he went back to sitting on the corner.
I ask him if he has ever had trouble finding work. “No, I can find work easily. I can make an entire house from start to finish. They don’t want to pay $250, they’d rather pay $80 or $150.” Has he ever had a problem with wage arrears? “Sometimes they don’t want to pay what they promised,” he concedes. “They’re not happy with my work, or they just want to pay less.”
Like many homeless young men living on Skid Row, Severiano has both a drug problem and a police record. He was deported twice in 2006, after being incarcerated on separate occasions for domestic violence and driving under the influence. He was dumped at the border town of Tijuana only to return soon afterward.
“It’s very hard not to fall into drugs here,” he says, alluding to the rampant dealing of drugs that mark Skid Row’s decrepit atmosphere. Is he clean now? “Now, yes.”
Unlike many other immigrants, however, Severiano has family members in the area. As close as San Pedro, his cousin has a home, a job, and a growing family. A brother lives in Las Vegas, and a sister lives nearby in Los Angeles. Why doesn’t he stay there while he gets back on his feet? “I feel like a burden when I’m there. I want to make it on my own. What I get in my life, I want to earn with my own two hands.”
On the other hand, Severiano notices fundamental cultural differences in the way Mexicans and Americans live. “I’m not used to living alone. I’ve never been alone,” he tells me. Unconcerned with his familial relationships, Severiano just wants to make things right with his girlfriend. “I’ve let her down many times. But everything happens in its own time. With tranquility, calmness.”
And finally, I ask about the issue of documentation. How does Severiano feel about the politics surrounding migrant labor? His answer is apolitical—rather, it is simple, humane and reflective. “Leave that topic alone. There are many people who are good and honest, yet they don’t have their papers. There’s a lot of racism.”
“This country is ours too,” he declares. “Our own government is very corrupt. All are. There are mafia, trafficking of drugs, and many things.”
But the challenges for an illegal immigrant like Severiano are profound. “You can’t even say anything, or protect yourself,” he says. “You have no voice. You are boxed in. Some people rob, and do other things. I don’t.”
Above all, Severiano believes in humanity, self-improvement and fate. “All of us have problems. That guy has his, and I have mine. It’s just that I have some unruliness in me. I want to get rid of that. One has to resign oneself to life’s losses and gains. You don’t know your destiny.”
~As told to Farah K.
He is quick to tell me that the reason he is currently homeless is because of a restraining order placed against him by his girlfriend, with whom he was sharing an apartment in downtown L.A.
Growing up in the town of Colima near Guadalajara, Mexico, Severiano had four brothers and four sisters. It was a big brood, and when asked about family dynamics, he doesn’t hesitate to tell me that his family life was unproblematic.
“We didn’t have too many issues. My parents are still together,” he says.
Like so many Mexicans, Severiano came to the U.S. for job opportunities, and has had no trouble finding work in his chosen profession—construction. His friend, also in the construction business, helped pay his way from Mexico and even gave him a place to live and found him his first job. Severiano likes construction work; his only complaint is that employers are often unwilling to pay his going rate of $250 per day.
He tells me that has worked in various cities in Southern California, and even traveled to the city of Pasco in Washington state to build houses. However, in Pasco, the construction job fell through and he ended up working in the field, picking apples. When winter came, there was no more work, so in 2001 he came back to L.A.
After a one-month stint at an L.A. construction company, Severiano began “esquiñando,” literally, “cornering,” an activity many Californians are particularly familiar with. He would sit on the corner of a Home Depot, waiting for people to pick him up for a day’s work. Once, he found a “patron” who gave him steady work for eight months. He doesn’t mention why the job ended; he just tells me he went back to sitting on the corner.
I ask him if he has ever had trouble finding work. “No, I can find work easily. I can make an entire house from start to finish. They don’t want to pay $250, they’d rather pay $80 or $150.” Has he ever had a problem with wage arrears? “Sometimes they don’t want to pay what they promised,” he concedes. “They’re not happy with my work, or they just want to pay less.”
Like many homeless young men living on Skid Row, Severiano has both a drug problem and a police record. He was deported twice in 2006, after being incarcerated on separate occasions for domestic violence and driving under the influence. He was dumped at the border town of Tijuana only to return soon afterward.
“It’s very hard not to fall into drugs here,” he says, alluding to the rampant dealing of drugs that mark Skid Row’s decrepit atmosphere. Is he clean now? “Now, yes.”
Unlike many other immigrants, however, Severiano has family members in the area. As close as San Pedro, his cousin has a home, a job, and a growing family. A brother lives in Las Vegas, and a sister lives nearby in Los Angeles. Why doesn’t he stay there while he gets back on his feet? “I feel like a burden when I’m there. I want to make it on my own. What I get in my life, I want to earn with my own two hands.”
On the other hand, Severiano notices fundamental cultural differences in the way Mexicans and Americans live. “I’m not used to living alone. I’ve never been alone,” he tells me. Unconcerned with his familial relationships, Severiano just wants to make things right with his girlfriend. “I’ve let her down many times. But everything happens in its own time. With tranquility, calmness.”
And finally, I ask about the issue of documentation. How does Severiano feel about the politics surrounding migrant labor? His answer is apolitical—rather, it is simple, humane and reflective. “Leave that topic alone. There are many people who are good and honest, yet they don’t have their papers. There’s a lot of racism.”
“This country is ours too,” he declares. “Our own government is very corrupt. All are. There are mafia, trafficking of drugs, and many things.”
But the challenges for an illegal immigrant like Severiano are profound. “You can’t even say anything, or protect yourself,” he says. “You have no voice. You are boxed in. Some people rob, and do other things. I don’t.”
Above all, Severiano believes in humanity, self-improvement and fate. “All of us have problems. That guy has his, and I have mine. It’s just that I have some unruliness in me. I want to get rid of that. One has to resign oneself to life’s losses and gains. You don’t know your destiny.”
~As told to Farah K.
Monday, May 7, 2007
Conditional welfare: Is provisional aid really a threat to democracy?
In our very last class meeting, Dr Shahi urged us to think about the future of public health. Future directions have been a part of all our discussions in the past few months, but some interesting ideas come out of dedicating an entire class period to the topic.
We’ve talked about PPPs, SMART cards, diffusion of innovation, and community mobilization.
This post is dedicated to another acronym, CCTs: conditional cash transfers. CCTs refer to a government-based program whereby stipends are issued to poor families. It’s not the dole, though—in return for these stipends, families must pledge to immunize and school their kids, and comply with other basic measures designed to stem the vicious cycle of poverty.
Countries like Peru and Brazil (Bolsa Familia) have piloted CCT programs with great success. New York is unveiling a similar scheme, but as a recent NPR segment indicated, the idea has met with some opposition from critics concerned that CCTs are a form of coercion.
My take? I can understand why those suspicious of socialism oppose the idea of CCTs. There are lots of reasons why the program could go horribly wrong. It could be an ethics nightmare. What if no one wants to comply? Does the government deny those families their stipends, leaving them in poverty and without the freedom to choose what is best for their kids?
Peruvian officials deny these concerns, claiming that families are rarely dropped from CCTs, whether they end up complying with the stipulations or not.
But I think the critics are missing the point. There is such a thing as too much democracy. Are we, as a country, really wealthy enough all around to entirely shun socialist ideals? Or is there still a real need for these kinds of programs? As a collective society, I don’t think we’re as modern as we think we are. There’s a lot of room for improvement, and if designed and implemented with public health goals at the forefront, CCTs could really encourage people to access better opportunities for their kids. If we want to see some real changes in the inequalities we keep referring to, we need to get off our democratic high horses and experiment with a little of what appears to be working in other countries—whether you want to call it socialism or common sense.
Read more about CCTs in New York here. And then check out the Peruvian approach. Catch NPR’s coverage of both here.
We’ve talked about PPPs, SMART cards, diffusion of innovation, and community mobilization.
This post is dedicated to another acronym, CCTs: conditional cash transfers. CCTs refer to a government-based program whereby stipends are issued to poor families. It’s not the dole, though—in return for these stipends, families must pledge to immunize and school their kids, and comply with other basic measures designed to stem the vicious cycle of poverty.
Countries like Peru and Brazil (Bolsa Familia) have piloted CCT programs with great success. New York is unveiling a similar scheme, but as a recent NPR segment indicated, the idea has met with some opposition from critics concerned that CCTs are a form of coercion.
My take? I can understand why those suspicious of socialism oppose the idea of CCTs. There are lots of reasons why the program could go horribly wrong. It could be an ethics nightmare. What if no one wants to comply? Does the government deny those families their stipends, leaving them in poverty and without the freedom to choose what is best for their kids?
Peruvian officials deny these concerns, claiming that families are rarely dropped from CCTs, whether they end up complying with the stipulations or not.
But I think the critics are missing the point. There is such a thing as too much democracy. Are we, as a country, really wealthy enough all around to entirely shun socialist ideals? Or is there still a real need for these kinds of programs? As a collective society, I don’t think we’re as modern as we think we are. There’s a lot of room for improvement, and if designed and implemented with public health goals at the forefront, CCTs could really encourage people to access better opportunities for their kids. If we want to see some real changes in the inequalities we keep referring to, we need to get off our democratic high horses and experiment with a little of what appears to be working in other countries—whether you want to call it socialism or common sense.
Read more about CCTs in New York here. And then check out the Peruvian approach. Catch NPR’s coverage of both here.
Tuesday, May 1, 2007
STOP THE RAIDS AND DEPORTATIONS!!!
Today is the National May 1st Movement for Worker and Immigrant Rights. Visit the Mayday Movement Blogspot to find out more about events going on around California, Arizona, Nevada, Tijuana among other places.
The movement calls for a "Great American Boycott": NO economic activity, NO shopping, NO work and NO school for immigrants and their children, to show "what a day without immigrants in the economy signifies."
This can be considered a fight for human rights, but it is also more personal than that. It's a fight to keep families together. Children born in the U.S. are marching for the security of having their parents by their side. Immigrant parents are fighting for the right to raise their kids in peace in a country with which they've built a mutually beneficial relationship. Below is a photo from today's New York Times article of a father and a son whose mother was deported to Honduras two weeks ago in the early hours of the morning.
It's not easy to know exactly what to do, but what not to do--such as sudden deportation and raids--should be easy for public officials to figure out by now. For my thoughts on 21st century global immigration and to read other papers discussing various global health issues, check out our collection of essays on Emerging Trends in Global Health.
Thursday, April 26, 2007
Mobilizing communities: How far would you go?
First, check out this video about Treatment Action Campaign (TAC), South Africa's HIV movement led by HIV-positive citizens to demand ARV's and accountability from their government and transnational pharmaceutical companies.
It is so moving to see these people fighting for their rights. It reminds me of the quote by Margaret Mead that was brought to our attention by Dr. Shahi in class last week:
Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it's the only thing that ever has.
I believe that mobilizing communities is going to make the biggest difference in our reaching the Millenium Development goals. After all, excluding select groups from centralized processes is the very reason there is so much "unfinished business" in human development. Then we went and made it worse by telling them exactly what they need to do to make it better. Now, we seem to have finally come to the realization that involving (and hopefully, empowering) disenfranchised communities is the only way to truly make a difference.
The above picture, from the TAC website, is another dramatic example of community mobilization efforts. We can get lost discussing the merits of PPPs, cost-benefit analyses, global data systems and stakeholder summits. There are other ways to get things done.
What lessons can future health professionals take from this? It goes back to the title of this post: How far would you go? How far would we be willing to go to fight for ARVs, for polio eradication, for universal health care? Would we be willing to dance on a stage to rile people up against the injustice of a black infant mortality twice as high as that of whites? Would that be too unprofessional, too personal, too close to home?
After watching the TAC video, I really don't think so.
It is so moving to see these people fighting for their rights. It reminds me of the quote by Margaret Mead that was brought to our attention by Dr. Shahi in class last week:
Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it's the only thing that ever has.
I believe that mobilizing communities is going to make the biggest difference in our reaching the Millenium Development goals. After all, excluding select groups from centralized processes is the very reason there is so much "unfinished business" in human development. Then we went and made it worse by telling them exactly what they need to do to make it better. Now, we seem to have finally come to the realization that involving (and hopefully, empowering) disenfranchised communities is the only way to truly make a difference.
The above picture, from the TAC website, is another dramatic example of community mobilization efforts. We can get lost discussing the merits of PPPs, cost-benefit analyses, global data systems and stakeholder summits. There are other ways to get things done.
What lessons can future health professionals take from this? It goes back to the title of this post: How far would you go? How far would we be willing to go to fight for ARVs, for polio eradication, for universal health care? Would we be willing to dance on a stage to rile people up against the injustice of a black infant mortality twice as high as that of whites? Would that be too unprofessional, too personal, too close to home?
After watching the TAC video, I really don't think so.
Thursday, April 19, 2007
Ethics & Global Public Health
M.Lakshman, AP Photo / healthystartokawalton.org
Last week we discussed the role of ethics in emerging trends in global public health. Dr. Shahi asked an important question: Are we really confronting a new era in ethics, or are the challenges we face today the same as those faced by previous generations?
Like most of the class, I agree that the questions we must ask ourselves now, with regard to ethics, are more important than ever before. The impact of technology on our lives is immeasurable, and it's advancing and impacting society on a greater scale than we can quantify. In the face of persistent disparities (rich/poor, north/south, white/ethnic, urban/rural, male/female), there could be a scramble to end the shame that accompanies the fact that the two children pictured above exist in the same era, in the same global community.
To be fair, scientific and technological developments are not always a scramble, nor do they necessarily present ethical dilemmas. But products like ready-to-use therapeutic foods (RUTFs), labs-on-a-chip (LOCs), GM foods (such as Golden Rice), bioremediation techniques and many other recent and imminent advancements do pose ethical questions, particularly when thinking about long-term development. For instance, as my colleague Liyan Moghadam mentioned several weeks ago, one of the pitfalls of RUTFs is the fact that it is designed to nourish those in immediate danger of starving to death. What do we do after the peanut butter? Pat ourselves on the back??? And what about GM foods? Some independent studies have found links between GM potatoes cancer in lab rats. Do we really know what its impact will be on the beneficiaries/victims of (fortified) GM foods?
But we also have to ask ourselves: is this all rich man's talk? Even in our own community, there are populations that can't really afford to talk about ethics the way we do. Living a moral, honest, insulated life is much easier when all your primal needs are met (and then some). Does this mean we should consider different ethical standards for different populations? RUTF factories in Uganda bring jobs to people desperately in need of livelihoods. Inexpensive LOCs give the power of knowledge to people suffering from treatable illnesses they didn't even know existed (but will they get those inexpensive drugs that cure them? the food? the clean water?).
If you ask the people who would benefit, I don't think they would ever say no to a new technology that gives them more tools for life. But I think the developers of these exciting tools (who obviously have some knowledge of their importance to society) have a responsibility to think of not only the benefits but some of the challenges that their innovations present. They should work with organizations like the Institute for Global Ethics to ensure that those worldwide north/south, white/ethnic, urban/rural, educated/uneducated disparities we're seeing are not exacerbated--and are perhaps even diminished--by new technologies.
Because with regard to equality, our track record with science and tech so far raises some serious red flags (eg, read this poem on the global digital divide).
Wednesday, April 11, 2007
Public-Private Partnerships for Global Poverty Alleviation
In a previous post I explored the possibilities of public-public partnerships (PUPs) in establishing vital infrastructure (e.g., water, electricity, city planning) to combat poverty.
This entry is all about public-private partnerships (PPPs), and the case for their potential to alleviate global poverty is unequivocal. PUPs simply cannot compete with the powerful combination of yin and yang that results from public-private collaboration.
First off, for a great list of various PPP models and a diagram of where each lies on the spectrum of public/private risk involvement, see the Canadian Council for PPPs website.
We all know what the public and private sectors stand for. The public sector is concerned with meeting basic needs and ensuring social justice. The private sector is innovative and profit-driven. Inherent in both sectors are problems that endanger human welfare. What happens when you put the two together? With the right leadership, you could have an integrated mechanism for sustained human development.
A little background: in the late 1990s, the IMF and the World Bank implemented the now heavily criticized Structural Adjustment Programs (SAPs) in developing countries to manage debt and reduce poverty. The SAPs emphasized trade liberalization, which, in the way it was implemented, might be described as mutton dressed as lamb...developed nations open up their markets for trade with less developed countries (LDCs), and then heavily subsidize exports so that LDCs with newly open market policies cannot compete. SAPs have been replaced by another acronym, PRSPs (Poverty Reduction Strategy Papers), which are required by the IMF for a country to qualify for aid.
Ugandan President Musevani put it poignantly when he said, "We are asking for the opportunity to compete, to sell our goods in western markets. In short, we want to trade our way out of poverty."
Trade liberalization can do that, but most LDCs are not at the point yet where they can compete with developed nations' subsidies. PPPs could be useful here. What is needed is federal government stewardship over "free" trade. LDC governments must seize back ownership of their economies, develop criteria for collaborating with international partners in the private sector, pick those partners wisely, and ease into financial mechanisms that work toward Musevani's plea.
"Our job is not to give people fish. It's not to teach them how to fish. It's to build a new and better fishing industry."
-Bill Drayton of Ashoka Alliance
On a side note: Where do you and I come in? We can be social entrepreneurs, who seem to be able to harness the yin and yang and everything in between. See these videos of successful innovators for inspiration:
Ashoka Alliance founder Bill Drayton
Grameen Bank founder Muhammad Yunus
Thursday, March 29, 2007
On the Future of U.S. Health Care Financing
No matter how much we talk about global health issues like infectious disease, maternal health, and the role of education, at the heart of every problem we are facing is the question of financing health care initiatives. Perhaps the only other variable so crucial to population health is stewardship, and a large part of stewardship concerns judicious management of funding.
Two videos recommended for this week brought up provocative issues on the future of health care financing in the U.S.: Uwe Reinhardt's lecture and the California OneCare initiative. California OneCare lobbies for universal health insurance, calling for swift steps instead of small changes. The biggest issues we face are administrative costs and lack of access to care for a staggering chunk of the population. Also disturbing are inequities in the quality of care people receive, a measure closely linked to SES and race.
Many other countries use a single-payer system to control administrative costs. Canada and the UK are just two examples. Health care investigators in these countries would be quick to tell us that the single-payer system is no panacea...it has its own disadvantages, like everything else. However, at the heart of the current health care crisis is a civil rights issue that the single-payer system might address: unquestionable inequity in the ability to attain something that is, at least ideologically, universally considered to be a basic human right.
Even developing countries understand (and act on the understanding) that the way we do health care doesn't cover the most vulnerable people. In this country, over half of family bankruptcies filed are a direct result of medical expenses. 3/4 of these people have jobs. They are productive individuals of society crippled by a health care system that's supposed to increase their productivity. Instead, it's leeching it.
If that's not convincing enough, consider this: a 1% decline in income in the U.S. translates into an increase in mortality rate of 22 deaths per 1000. In Canada, no association is found between income inequality and mortality rates. Infant mortality rates show similar results, with the world superpower ranking in the 40's on the list of country-specific rates.
Fundamentally, health is more important than money. Anyone who's ever experienced a serious illness, even a bout of flu, can tell you that without your health, your money doesn't mean much.
Unfortunately, that piece of wisdom is no longer true, and it's least true in places like the U.S., where both health and money are available, but money is infinitely more important than health. Here, money buys health and happiness. What is wrong with this picture???
Back to that paradigm shift we talked about. Sure, we'll have to iron out some kinks in a single payer system to adapt to our needs as a country. But what we're doing right now--taking those kinks and calling them reasons not to act in the best interests of human beings--can't continue. We must first accept that inequality of some sort may always exist, and then go about decreasing it as surely as we can, as other nations--even less developed ones like Korea, Brazil, and India--have done.
And one more thing: an equality of opportunity, as the U.S. has historically been praised for having, is not the same thing as equality. There are several forces, some known and others unknown, working against equality. For instance, racism and SES interact additively to produce poorer health outcomes for certain groups of people. This holds true even when patient characteristics are held constant. What does this mean? It means that somewhere among health care providers and institutions, inequality is being perpetuated. It means that addressing individuals is not enough; the entire establishment must be examined. We must ask important questions: Are doctors giving every patient the same quality of care? Are there good hospitals in largely ethnic areas? Good schools? What are the differences? Our country likes to believe that racial segregation was so long ago that its effects are no longer profound. We have made great strides (remember, in the late 18th century an African-American slave was only roughly 3/5 of a human being). But vigorously addressing contemporary manifestations of these issues will greatly aid a successful reworking of health care financing in this country.
In order to treat some persons equally, we must treat them differently.
-Harry Blackmun
Two videos recommended for this week brought up provocative issues on the future of health care financing in the U.S.: Uwe Reinhardt's lecture and the California OneCare initiative. California OneCare lobbies for universal health insurance, calling for swift steps instead of small changes. The biggest issues we face are administrative costs and lack of access to care for a staggering chunk of the population. Also disturbing are inequities in the quality of care people receive, a measure closely linked to SES and race.
Many other countries use a single-payer system to control administrative costs. Canada and the UK are just two examples. Health care investigators in these countries would be quick to tell us that the single-payer system is no panacea...it has its own disadvantages, like everything else. However, at the heart of the current health care crisis is a civil rights issue that the single-payer system might address: unquestionable inequity in the ability to attain something that is, at least ideologically, universally considered to be a basic human right.
Even developing countries understand (and act on the understanding) that the way we do health care doesn't cover the most vulnerable people. In this country, over half of family bankruptcies filed are a direct result of medical expenses. 3/4 of these people have jobs. They are productive individuals of society crippled by a health care system that's supposed to increase their productivity. Instead, it's leeching it.
If that's not convincing enough, consider this: a 1% decline in income in the U.S. translates into an increase in mortality rate of 22 deaths per 1000. In Canada, no association is found between income inequality and mortality rates. Infant mortality rates show similar results, with the world superpower ranking in the 40's on the list of country-specific rates.
Fundamentally, health is more important than money. Anyone who's ever experienced a serious illness, even a bout of flu, can tell you that without your health, your money doesn't mean much.
Unfortunately, that piece of wisdom is no longer true, and it's least true in places like the U.S., where both health and money are available, but money is infinitely more important than health. Here, money buys health and happiness. What is wrong with this picture???
Back to that paradigm shift we talked about. Sure, we'll have to iron out some kinks in a single payer system to adapt to our needs as a country. But what we're doing right now--taking those kinks and calling them reasons not to act in the best interests of human beings--can't continue. We must first accept that inequality of some sort may always exist, and then go about decreasing it as surely as we can, as other nations--even less developed ones like Korea, Brazil, and India--have done.
And one more thing: an equality of opportunity, as the U.S. has historically been praised for having, is not the same thing as equality. There are several forces, some known and others unknown, working against equality. For instance, racism and SES interact additively to produce poorer health outcomes for certain groups of people. This holds true even when patient characteristics are held constant. What does this mean? It means that somewhere among health care providers and institutions, inequality is being perpetuated. It means that addressing individuals is not enough; the entire establishment must be examined. We must ask important questions: Are doctors giving every patient the same quality of care? Are there good hospitals in largely ethnic areas? Good schools? What are the differences? Our country likes to believe that racial segregation was so long ago that its effects are no longer profound. We have made great strides (remember, in the late 18th century an African-American slave was only roughly 3/5 of a human being). But vigorously addressing contemporary manifestations of these issues will greatly aid a successful reworking of health care financing in this country.
In order to treat some persons equally, we must treat them differently.
-Harry Blackmun
Saturday, March 24, 2007
Internet Access and Health Outcomes
my Grandma:
one of the smartest people I know!
I recently went back to my hometown for a visit and realized that some of my dearest friends and family do not have access to the internet. This may seem obvious and acceptable, but to me it is neither.
Who are these people in my life who are so archaic they don't have internet access even though they can afford it? Well, 1) my grandma and 2) dear family friends who are not-so-recent migrants.
I was studying at my aunt's house the other day when I decided to see what my grandmother thinks of YouTube.com. (This post is supposed to be about health outcomes...we'll get there). I typed in 'Andhra Pradesh' (our home state in India) into the search bar, and six pages worth of videos came up. We watched a few videos on Indian freedom fighters during the time of Gandhi. My grandma was a little girl during India's freedom fight--she recalls witnessing her elder brother being beaten by British-hired Indian law enforcement officers for his revolutionary activities. The videos, which were even narrated in her native Telugu, brought back all sorts of memories for her. She even talked about writing a book about her brother's role in the fight for Indian independence. She was jazzed.
My aforementioned migrant friends could benefit from internet access too. Some of them don't speak English at all. They make enough money to afford a computer and the internet, so the barriers are not financial. They just don't have the freedom to do things like take time off from work to do something frivolous like educate themselves. But there is a crucial point to make here--just as we discussed in the first weeks of class, and just as UK & Netherlands authors Wagstaff and Van Doorslaer (gold standard researchers on poverty and health) point out, the effects (i.e. the cost) of not having things like the internet are much more significant for disadvantaged people. In other words, it would mean a great deal more to my grandma, or to my migrant friends, to have internet access, than it means for someone like me to have it.
What would it mean? The possibilities are endless. For my grandma, maybe it means delayed onset of dementia. Less depression, anxiety and social isolation (she can connect with others and entertain herself as she gets older and cannot move around as much). Fewer medical episodes. For migrants, it also means access to empowering information that may well give them the freedom to see education as a basic right/need rather than a peripheral idea. It would mean access to services that they would otherwise have no way of knowing exist. Faced with all this new technology, it seems that education is more important than ever. Increasing access and utilization are key.
I spent some time teaching my grandma how to use my aunt's PC. She's a quick and eager learner in her mid-80's. Her biggest challenges were learning how to operate the mouse and focusing her eyes on the screen. I wonder why the local senior citizen center offers arts and crafts, but not computer classes? There's so much human potential out there, sometimes in the most surprising places. From that perspective, the field of public health would do something incredible if it focused on ways to give people the tools they need to live productive lives. Because for many (if not most) people, feeling productive = feeling truly happy.
Tuesday, March 6, 2007
Biotech for Development: A promising solution or a pipe dream?
There is no easy answer to the debates over where pro-poor development funds should go. As part of the whole paradigm shift we keep referring to, I think every field has to redefine its priorities. Biotech was the topic last week, and one of the controversies surrounding pro-poor biotechnology is the question of whether the vast amount of funding required to develop a new diagnostic, a new vaccine or a new drug is really worth it. Rich countries can argue that drugs already developed are very poorly distributed. Why fuel new innovations that will only widen the gap?
While committees concern themselves with that, paradigm shifters in the field have showed some promising advances, including new vaccines and low-cost treatments that are showing promise in advanced-level trials (anti-malaria vaccine, paromomycin treatment for kala azar). In a
New York Times article posted by Dr. Shahi awhile ago, Tina Rosenberg points out that vaccines have only been around for 20 years. In 20 years, they've made an enormous difference in a child's ability to survive the first five years of life! Who would have thought that such a labor-intensive project, which requires hunting people down in all corners of the world one by one, could be so successful? Who could have predicted that wars would be halted for vaccination campaigns? And yet it happened, and it changed everything.
Another example: The human genome was discovered two years ahead of time, and well under budget. According to one account I recently read, these unexpected outcomes were largely attributed to competitive cooperation among investigators. Again, it would seem impossible to unravel something as complicated as the human genome ahead of schedule simply because someone wanted to beat everyone else to it. And to do it more cheaply than expected, to boot. But that also happened, and it changed everything.
But we seem to forget history. Or maybe we're unaware that we're the ones making it. It's ironic, but one of crucial ways of achieving a paradigm shift is, I think, examining history in an attempt to understand just how we got to where we are now. There's an astonishingly accurate (and somewhat grim) picture of human nature buried in there, and confronting it proactively may provide some rationale, motivation, and clues to shifting that paradigm.
To learn more about biotech's role in global health, check out this article on the ten most promising biotechnologies for human development.
While committees concern themselves with that, paradigm shifters in the field have showed some promising advances, including new vaccines and low-cost treatments that are showing promise in advanced-level trials (anti-malaria vaccine, paromomycin treatment for kala azar). In a
New York Times article posted by Dr. Shahi awhile ago, Tina Rosenberg points out that vaccines have only been around for 20 years. In 20 years, they've made an enormous difference in a child's ability to survive the first five years of life! Who would have thought that such a labor-intensive project, which requires hunting people down in all corners of the world one by one, could be so successful? Who could have predicted that wars would be halted for vaccination campaigns? And yet it happened, and it changed everything.
Another example: The human genome was discovered two years ahead of time, and well under budget. According to one account I recently read, these unexpected outcomes were largely attributed to competitive cooperation among investigators. Again, it would seem impossible to unravel something as complicated as the human genome ahead of schedule simply because someone wanted to beat everyone else to it. And to do it more cheaply than expected, to boot. But that also happened, and it changed everything.
But we seem to forget history. Or maybe we're unaware that we're the ones making it. It's ironic, but one of crucial ways of achieving a paradigm shift is, I think, examining history in an attempt to understand just how we got to where we are now. There's an astonishingly accurate (and somewhat grim) picture of human nature buried in there, and confronting it proactively may provide some rationale, motivation, and clues to shifting that paradigm.
To learn more about biotech's role in global health, check out this article on the ten most promising biotechnologies for human development.
Thursday, February 22, 2007
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.
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.
Thursday, February 15, 2007
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.
Monday, February 12, 2007
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).
Thursday, February 8, 2007
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
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
Thursday, February 1, 2007
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
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
Tuesday, January 30, 2007
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.
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.
Sunday, January 28, 2007
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
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
Saturday, January 27, 2007
An Anthropologic Approach
I really enjoyed the anthropologic approach to epidemiological transitions in the article assigned last week. The authors seemed to have done a comprehensive review of the current theoretical construct and then re-framed it entirely, just as Dr. Shahi is urging us to do for our topical review papers. The recurring patterns in human history are undeniable and informative--just as hunters and gatherers began to see a spike in infectious disease upon settling into communities, we will likely see new diseases emerge as the rising global population is forced into previously uninhabited areas. The article mentions a history of species jumps from other organisms to humans--as we all know, we're facing this possibility now with H5N1. Migration also has a history of importing disease from one population to another; Columbus may have brought back syphilis from the New World in 1493, and 5 centuries later, a significant percentage of MDR-TB cases are found among immigrants.
It's true that mother nature creates amazing bugs with very interesting properties. Yet, it's also true that we humans have a profound effect on mother nature--our behavior is altering entire ecosystems, which is shocking (e.g., the proliferation of vibrio cholerae due to increased algae blooms from global warming). Better than destroying the entire mosquito population, or pushing for new, stronger, better antibiotics, perhaps we should (also) look for solutions that will last. Whether human behavior changes or not, new bugs will emerge. But changing how we use antibiotics, how we treat the environment, how we live in communities and how we interact globally may determine how well those bugs thrive on us.
It's true that mother nature creates amazing bugs with very interesting properties. Yet, it's also true that we humans have a profound effect on mother nature--our behavior is altering entire ecosystems, which is shocking (e.g., the proliferation of vibrio cholerae due to increased algae blooms from global warming). Better than destroying the entire mosquito population, or pushing for new, stronger, better antibiotics, perhaps we should (also) look for solutions that will last. Whether human behavior changes or not, new bugs will emerge. But changing how we use antibiotics, how we treat the environment, how we live in communities and how we interact globally may determine how well those bugs thrive on us.
Wednesday, January 24, 2007
Empathetic Solutions
I was reflecting on Dr. Shahi's urging us to approach global health with empathy, and one of the things that I didn't mention in my first post on the Mondana community in the rainforest is the roadblocks that FUNEDESIN, the founding organization, had to overcome to get children to come to the school. Parents are reluctant to send their children to school, not because they are against education, but for various reasons. Some families live deep inside the forest ("bien adentro") and it would take a good two hours to get to the school. Other families have so many children that they need the older ones to help care for the younger ones. They rely on their older children for help, and can't afford to lose that pair of hands for 8 hours each day. Still others have no way to pay for an education.
FUNEDESIN designed a successful school with full enrollment (and a waiting list to boot) by taking all these factors into consideration. Families don't pay tuition. Instead, they pay with corn, which the teachers actually eat. They are also given nutritious meals (there are much fewer fish in the Napo river due to oil company activity...plantains comprise a large portion of the diet). The school is set up as a boarding school; perhaps surprisingly, parents found this set-up more agreeable than day school. A group of 32 students comes to board at the Yachana School, and stays for two weeks at a time. Then those students go back to their homes to contribute to family life for the next two weeks, and the second group of 32 comes to school. The two groups rotate in two-week blocks.
Yachana students also get free medical care at the Mondana clinic. Their families are often seen waiting in line to get medical care, too. As I mentioned in my earlier post, the students are now eligible for grants to continue their studies in Quito. This opportunity means that a child from a rainforest community and a child born in the capital city might attain the same level of education (although of course there's a long way to go until that's really true).
One of the students I met there had traveled from a small, nearby city to attend Yachana. I wondered why his whole family would come all the way to this little community just for Yachana, when his hometown was more urban and thus probably had more opportunities. But I think that might be an indication that Yachana is providing for its students and its community something that is hard to find in human development efforts: an empathetic solution.
To learn about another empathetic solution for rural development in Bangladesh, watch this video on the Bangladesh Rural Advancement Committee (BRAC).
FUNEDESIN designed a successful school with full enrollment (and a waiting list to boot) by taking all these factors into consideration. Families don't pay tuition. Instead, they pay with corn, which the teachers actually eat. They are also given nutritious meals (there are much fewer fish in the Napo river due to oil company activity...plantains comprise a large portion of the diet). The school is set up as a boarding school; perhaps surprisingly, parents found this set-up more agreeable than day school. A group of 32 students comes to board at the Yachana School, and stays for two weeks at a time. Then those students go back to their homes to contribute to family life for the next two weeks, and the second group of 32 comes to school. The two groups rotate in two-week blocks.
Yachana students also get free medical care at the Mondana clinic. Their families are often seen waiting in line to get medical care, too. As I mentioned in my earlier post, the students are now eligible for grants to continue their studies in Quito. This opportunity means that a child from a rainforest community and a child born in the capital city might attain the same level of education (although of course there's a long way to go until that's really true).
One of the students I met there had traveled from a small, nearby city to attend Yachana. I wondered why his whole family would come all the way to this little community just for Yachana, when his hometown was more urban and thus probably had more opportunities. But I think that might be an indication that Yachana is providing for its students and its community something that is hard to find in human development efforts: an empathetic solution.
To learn about another empathetic solution for rural development in Bangladesh, watch this video on the Bangladesh Rural Advancement Committee (BRAC).
Sunday, January 21, 2007
Learning From History
In the article"Globalization and Health Viewed From 3 Parts of the World," the author states that international institutions (e.g., UN, WHO, IMF) must re-examine their partnerships to eliminate private interests and to protect international equality.
Is this even possible? If so, how do we achieve it?
The idea of a global health bureau is not new. In fact, the first recorded series of global health meetings was held in 1851 (those of us in PM 566, the China class, are familiar with this). These "International Sanitary Conferences" provided a platform to discuss best practices to control the spread of disease during trade activities. It sounds like a noble goal, but in fact the motivation for seeking global participation was that in an emerging era of international trade, such collaboration was necessary to protect local health interests. 19th century colonialism and imperialism also provided considerable incentive to create global health solutions--Africa, Asia and the Caribbean were seen as exciting European discoveries. So while the Sanitary Conferences symbolized global cooperation, they were at least partially driven by ulterior motives and hegemonic relationships. Sound familiar?
Information is one of the greatest tools for development we have these days, and in terms of global cooperation, transparency is key. Whether the goal is controlling infectious disease, maximizing economic growth, or protecting global security, it is now imperative that information is shared on a global scale. This has not been done, and its effects are perilous (SARS in China, US foreign policy, former Soviet Union's Biopreparat, etc.) and long-lasting. However, enough nations have now united in pursuit of the MDG's to make transparency and accountability in foreign policy matters a logical and necessary next step. Until we, as nations and as international organizations, take that step, personal interest will cloud the proper flow and use of capital toward achieving the MDG's and any significant human development.
Just for reference, the article we were assigned to read in PM 566 is entitled, "International Efforts to Control Infections Diseases, 1851 to the Present" (JAMA, 2004).
Wednesday, January 17, 2007
The Future is Old
As developing countries catch up to the Western world in everything from technology to McDonald's to depression, I think one of the most interesting public health issues to discuss is that of the mounting aging population. According to the article posted under week 1, "Global Aging: The Challenge of Success", by 2050, approximately 80% of the expected population aged 65+ (1.2 of 1.5 billion) will reside in today's less developed regions. As global public health professionals, we must keep this in mind when allocating funds and implementing policies. As social entrepreneurs, we might also recognize an opportunity to create innovative solutions to the anticipated costs of the disease burden of the elderly in developing countries.
In the US, UK, and other European nations, the elderly population is indeed expected to grow, but the bulk of the growth is set to happen in countries like India and China. Other countries with large populations of old people (aged 65+) include the US, Japan, Germany and Russia. Ironically, Russia and Japan are also on the list of countries projected to experience the worst decline in total population—12 and 11 million, respectively. So it is the age structure of the population that is changing. This means that the number of productive people (defined as aged 20-64) in these countries is predicted to drop at an alarming rate, seriously affecting the GDP and creating new health challenges.
In places like India, China, Thailand, Colombia and sub-Saharan Africa, a different phenomenon is developing. With increased buying power, better education and more sophisticated technologies than ever before, these nations are experiencing a similar increase in longevity and a surge in the aging population. According to the article, for instance, Malaysia and Colombia are expected to triple their older populations between 2000 and 2030; sub-Saharan Africa should see an increase of nearly 50% between 2000 and 2015. However, these countries are not experiencing as sharp a decline in their working-age population; while many are seeing ever-decreasing fertility rates, the decrease is not yet reflected in the age structure of these populations to the extent that is seen in more developed countries.
The implications? Developing countries will have more human resources—defined here as sheer numbers of working-age people—than developed countries. Yet simultaneously, the disease burden of the elderly, who in any country consume a disproportionate amount of health resources, will be more of an issue in these less developed nations than in places like the US and Europe. As their economies flourish, and their middle classes expand, will they focus on health care for the elderly? Or will they prioritize instead the health of children and workers, who are the promise, the bread and butter of the nation?
If developing nations do not implement health care policies that care for the elderly, entire countries will suffer from the oversight. India is an example of a country that recognizes this, and responded in 1995 with the centrally funded National Old Age Pension Scheme. While this scheme is 100% government-subsidized, it must be noted that each country is different in terms of its culture, beliefs, resources, history, diversity, form of government and much more. What works in India will not work in nearby Malaysia. What works in an Arab country might be totally inefficient in South America. However, as the article stated, we as future professionals should be thinking in terms of 4 pillars of financial support for health care: public pension, occupational pension, personal savings, and “gradual retirement” of the elderly. Playing with these four forms of funding to find the right formula is and will be an exciting challenge in raising developing economies out of poverty so they can pursue health at each stage of life.
For more information, read "Global Aging: The Challenge of Success."
In the US, UK, and other European nations, the elderly population is indeed expected to grow, but the bulk of the growth is set to happen in countries like India and China. Other countries with large populations of old people (aged 65+) include the US, Japan, Germany and Russia. Ironically, Russia and Japan are also on the list of countries projected to experience the worst decline in total population—12 and 11 million, respectively. So it is the age structure of the population that is changing. This means that the number of productive people (defined as aged 20-64) in these countries is predicted to drop at an alarming rate, seriously affecting the GDP and creating new health challenges.
In places like India, China, Thailand, Colombia and sub-Saharan Africa, a different phenomenon is developing. With increased buying power, better education and more sophisticated technologies than ever before, these nations are experiencing a similar increase in longevity and a surge in the aging population. According to the article, for instance, Malaysia and Colombia are expected to triple their older populations between 2000 and 2030; sub-Saharan Africa should see an increase of nearly 50% between 2000 and 2015. However, these countries are not experiencing as sharp a decline in their working-age population; while many are seeing ever-decreasing fertility rates, the decrease is not yet reflected in the age structure of these populations to the extent that is seen in more developed countries.
The implications? Developing countries will have more human resources—defined here as sheer numbers of working-age people—than developed countries. Yet simultaneously, the disease burden of the elderly, who in any country consume a disproportionate amount of health resources, will be more of an issue in these less developed nations than in places like the US and Europe. As their economies flourish, and their middle classes expand, will they focus on health care for the elderly? Or will they prioritize instead the health of children and workers, who are the promise, the bread and butter of the nation?
If developing nations do not implement health care policies that care for the elderly, entire countries will suffer from the oversight. India is an example of a country that recognizes this, and responded in 1995 with the centrally funded National Old Age Pension Scheme. While this scheme is 100% government-subsidized, it must be noted that each country is different in terms of its culture, beliefs, resources, history, diversity, form of government and much more. What works in India will not work in nearby Malaysia. What works in an Arab country might be totally inefficient in South America. However, as the article stated, we as future professionals should be thinking in terms of 4 pillars of financial support for health care: public pension, occupational pension, personal savings, and “gradual retirement” of the elderly. Playing with these four forms of funding to find the right formula is and will be an exciting challenge in raising developing economies out of poverty so they can pursue health at each stage of life.
For more information, read "Global Aging: The Challenge of Success."
Sunday, January 14, 2007
Thinking Past the MDG's
With the impressive scope of the UN's Millenium Development Goals, it may seem premature to be thinking beyond these eight milestones of global improvement. But to make good on those goals, and to achieve the world vision they represent, that is precisely what needs to be done.
So what do we do after we reach the MDG's? It's 2015. 50% less people (than in 1990) live in hunger and survive on less than $1 a day. There's universal primary education available to every boy and girl in the world. Women are more empowered, mothers and babies are dying less frequently, HIV/malaria/TB infection rates are declining, governments are implementing environmentally sound policies, and the internet is now available to 30% of the world's population (up from 14%).
Have we achieved health for all?
Not yet. Because even if the above is accomplished by 2015--and the verdict is still out on whether it will be--what will those kids do with their primary education? How will women use their newly empowered social status to grow and improve? Will family planning be implemented in time to stave off the surge in population that may result from successfully battling HIV in countries like Africa and India? How will countries steeped in political/social/ethnic conflict be encouraged to collaborate for the wellbeing of their citizens? How will developed countries collaborate with developing countries? These may or may not be poignant issues in 2015, but exploring the path ahead is always useful.
Now, and in 2015, empowered women benefit from group micro-loans, whereby $300 can be invested in a community-based business that manufactures, say, peanut butter. These vendors must be given the freedom to sell their product wherever the demand is. Developing as well as developed countries must recognize the importance of free market economies and lift trade barriers--there are enough money and resources out there for anyone smart enough to figure out how to capture them. Once the MDG's are attained, and the globe is a little more flat (to borrow from Thomas Friedman), it will become increasingly true that this approach can benefit any individual or any country that adopts it.
Technical schools may be another area of focus in another ten years, when the poorest children of the world will (hopefully) be able to take primary education for granted. Literacy, math and geography are useful building blocks, but they are just that--stepping stones to learn professional or technical skills. Developing countries must have quality institutes of higher learning so that it makes sense for the new generation to continue their education in their own nations, and use their skills to build up their own people.
As people start dying less and living longer, efforts must also be made to eliminate urban sprawl and increase city planning. With the advent of the third epidemiological transition, wherein the human race is being revisited by old and new bugs, the disease burden may be doubled. One foreseeable way to limit the spread of infectious disease (apart from better sanitation, part of MDG #7) is through city planning and balancing the urban/suburban population proportions, particularly in places like China, India and Africa. MDG #7 cites improving the lives of at least 100 million slum-dwellers as an objective, yet it doesn't offer any strategies for doing it.
And what about global cooperation? That is, after all, one of the most crucial factors in closing the gap between rich and poor. Debt forgiveness, aid, new loans, incentives for innovation...the degree and quality of international participation will determine how far we can go in making health a resource that is truly available to every human being. Interestingly, it will also determine how important a player each developed nation will be in the world's future.
So what do we do after we reach the MDG's? It's 2015. 50% less people (than in 1990) live in hunger and survive on less than $1 a day. There's universal primary education available to every boy and girl in the world. Women are more empowered, mothers and babies are dying less frequently, HIV/malaria/TB infection rates are declining, governments are implementing environmentally sound policies, and the internet is now available to 30% of the world's population (up from 14%).
Have we achieved health for all?
Not yet. Because even if the above is accomplished by 2015--and the verdict is still out on whether it will be--what will those kids do with their primary education? How will women use their newly empowered social status to grow and improve? Will family planning be implemented in time to stave off the surge in population that may result from successfully battling HIV in countries like Africa and India? How will countries steeped in political/social/ethnic conflict be encouraged to collaborate for the wellbeing of their citizens? How will developed countries collaborate with developing countries? These may or may not be poignant issues in 2015, but exploring the path ahead is always useful.
Now, and in 2015, empowered women benefit from group micro-loans, whereby $300 can be invested in a community-based business that manufactures, say, peanut butter. These vendors must be given the freedom to sell their product wherever the demand is. Developing as well as developed countries must recognize the importance of free market economies and lift trade barriers--there are enough money and resources out there for anyone smart enough to figure out how to capture them. Once the MDG's are attained, and the globe is a little more flat (to borrow from Thomas Friedman), it will become increasingly true that this approach can benefit any individual or any country that adopts it.
Technical schools may be another area of focus in another ten years, when the poorest children of the world will (hopefully) be able to take primary education for granted. Literacy, math and geography are useful building blocks, but they are just that--stepping stones to learn professional or technical skills. Developing countries must have quality institutes of higher learning so that it makes sense for the new generation to continue their education in their own nations, and use their skills to build up their own people.
As people start dying less and living longer, efforts must also be made to eliminate urban sprawl and increase city planning. With the advent of the third epidemiological transition, wherein the human race is being revisited by old and new bugs, the disease burden may be doubled. One foreseeable way to limit the spread of infectious disease (apart from better sanitation, part of MDG #7) is through city planning and balancing the urban/suburban population proportions, particularly in places like China, India and Africa. MDG #7 cites improving the lives of at least 100 million slum-dwellers as an objective, yet it doesn't offer any strategies for doing it.
And what about global cooperation? That is, after all, one of the most crucial factors in closing the gap between rich and poor. Debt forgiveness, aid, new loans, incentives for innovation...the degree and quality of international participation will determine how far we can go in making health a resource that is truly available to every human being. Interestingly, it will also determine how important a player each developed nation will be in the world's future.
Saturday, January 13, 2007
Sustainable Development
Our intro class on emerging trends in global health reminded me of an interesting model for sustainable development I saw in the Ecuadorian rainforest in 2006. While I went there to learn about the practice of rural medicine, I was exposed to a promising business model that exploited the tourist industry to bring healthcare, education and buying power to a small region along the Napo River called Mondana.
Like Dr. Shahi said, 90% of healthcare is not accomplished by physicians. What was impressive about Mondana's set-up was not the high level of medical care available to the community. In fact, the clinic lacks any special equipment and must often refer patients to the nearest city, Tena. Many patients are unable to afford the cost of transportation (about $7 U.S.). What was impressive is the establishment of a boarding school that teaches rural children basic education as well as skills in making jewelry, giving tours of the rainforest, and running a hotel. These children get hands-on experience working at the Yachana Lodge as housekeepers, tour guides and boatmen. Proceeds of Yachana go to fund the school and keep the clinic running. The school is now an accredited establishment, and children are receiving grants to study in the capital city of Quito. A few of these kids will go on to acquire professional skills which they can use to improve the status of Mondana and nearby communities.
Along with Yachana, a gourmet chocolate company was established to supplement the lodge's income. Using slow-roasted cacao beans and other ingredients found in the rainforest, locals have created a unique chocolate product that I was very surprised to find in drugstores in Quito, and in fine health food stores here in the U.S. Like Yachana Lodge, the chocolate caters to the palate of developed countries, and that's how a rural rainforest community has (hopefully) begun its way up the ladder of sustainable development.
Like Dr. Shahi said, 90% of healthcare is not accomplished by physicians. What was impressive about Mondana's set-up was not the high level of medical care available to the community. In fact, the clinic lacks any special equipment and must often refer patients to the nearest city, Tena. Many patients are unable to afford the cost of transportation (about $7 U.S.). What was impressive is the establishment of a boarding school that teaches rural children basic education as well as skills in making jewelry, giving tours of the rainforest, and running a hotel. These children get hands-on experience working at the Yachana Lodge as housekeepers, tour guides and boatmen. Proceeds of Yachana go to fund the school and keep the clinic running. The school is now an accredited establishment, and children are receiving grants to study in the capital city of Quito. A few of these kids will go on to acquire professional skills which they can use to improve the status of Mondana and nearby communities.
Along with Yachana, a gourmet chocolate company was established to supplement the lodge's income. Using slow-roasted cacao beans and other ingredients found in the rainforest, locals have created a unique chocolate product that I was very surprised to find in drugstores in Quito, and in fine health food stores here in the U.S. Like Yachana Lodge, the chocolate caters to the palate of developed countries, and that's how a rural rainforest community has (hopefully) begun its way up the ladder of sustainable development.
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