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.

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).

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