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.
Monday, May 21, 2007
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.
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