tag:blogger.com,1999:blog-54183014620577101322024-02-20T18:50:57.081-05:00MethodLogicalGlobal health & development. Social justice & equality. A bit of everything else.Adam Schwartzhttp://www.blogger.com/profile/10009267866977947931noreply@blogger.comBlogger38125tag:blogger.com,1999:blog-5418301462057710132.post-60447536714244204022011-04-09T00:47:00.001-04:002011-04-09T00:47:08.514-04:00MethodLogical<style type="text/css"> h1 a:hover {background-color:#888;color:#fff ! important;} div#emailbody table#itemcontentlist tr td div ul { list-style-type:square; padding-left:1em; } div#emailbody table#itemcontentlist tr td div blockquote { padding-left:6px; border-left: 6px solid #dadada; margin-left:1em; } div#emailbody table#itemcontentlist tr td div li { margin-bottom:1em; margin-left:1em; } table#itemcontentlist tr td a:link, table#itemcontentlist tr td a:visited, table#itemcontentlist tr td a:active, ul#summarylist li a { color:#000099; font-weight:bold; text-decoration:none; } img {border:none;} </style> <div xmlns="http://www.w3.org/1999/xhtml" id="emailbody" style="margin:0 2em;font-family:Georgia,Helvetica,Arial,Sans-Serif;line-height:140%;font-size:13px;color:#000000;"> <table style="border:0;padding:0;margin:0;width:100%"> <tr> <td style="vertical-align:top" width="99%"> <h1 style="margin:0;padding-bottom:6px;"> <a style="color:#888;font-size:22px;font-family:Arial, Helvetica, sans-serif;font-weight:normal;text-decoration:none;" href="http://methodlogical.wordpress.com" title="(http://methodlogical.wordpress.com)">MethodLogical</a> <br /> <a href="http://fusion.google.com/add?source=atgs&feedurl=http://feeds.feedburner.com/methodlogical"> <img style="padding-top:6px" alt="" border="0" src="http://gmodules.com/ig/images/plus_google.gif" /> </a> </h1> </td> <td width="1%" /> </tr> </table> <hr style="border:1px solid #ccc;padding:0;margin:0" /> <table id="itemcontentlist"> <tr xmlns=""> <td style="margin-bottom:0;line-height:1.4em;"> <p style="margin:1em 0 3px 0;"> <a name="1" style="font-family:Arial, Helvetica, sans-serif;font-size:18px;" href="http://methodlogical.wordpress.com/2011/04/08/shout-outs/">Shout outs</a> </p> <p style="font-size:13px;color:#555;margin:9px 0 3px 0;font-family:Georgia,Helvetica,Arial,Sans-Serif;line-height:140%;font-size:13px;"> <span>Posted:</span> 08 Apr 2011 04:16 PM PDT</p> <div style="margin:0;font-family:Georgia,Helvetica,Arial,Sans-Serif;line-height:140%;font-size:13px;color:#000000;"><p>In the process of looking through the <a href="http://www.cgdev.org/content/publications/detail/1422684">research pape</a>r that underlies <a href="http://methodlogical.wordpress.com/2011/04/06/doctors-are-not-property-and-cannot-be-stolen/">the Michael Clemens post I linked to</a>, I realized that the RA for the paper was Paolo Abarcar, who is actually one of my classmates here at Michigan economics. Even better, <a href="http://pabarcar.blogspot.com/">he has a blog with a development focus</a>, which I have added to the blogroll over on the right-hand side of the ML homepage.</p> <p>Also on the brand-new blogroll list is Naman Shah, who provided an expert counterpoint to <a href="http://methodlogical.wordpress.com/2011/04/04/mother-tell-your-children-not-to-take-lariam/">my arguments against the use of mefloquine</a> as a malaria prophylaxis for travelers. He runs the <a href="http://topnaman.com/">Malaria blog</a>, which has great links and commentary about the disease I increasingly believe may be the most important challenge in development.</p> <p>If you have your own development or global health-related blog, shoot us an email and we’ll add it to the list unless you’ve already achieved <a href="http://chrisblattman.com/">major internet fame</a>: methodlogical at gmail dot com.</p> <p> </p> <br /> <a rel="nofollow" href="http://feeds.wordpress.com/1.0/gocomments/methodlogical.wordpress.com/431/"><img alt="" border="0" src="http://feeds.wordpress.com/1.0/comments/methodlogical.wordpress.com/431/" /></a> <a rel="nofollow" href="http://feeds.wordpress.com/1.0/godelicious/methodlogical.wordpress.com/431/"><img alt="" border="0" src="http://feeds.wordpress.com/1.0/delicious/methodlogical.wordpress.com/431/" /></a> <a rel="nofollow" href="http://feeds.wordpress.com/1.0/gofacebook/methodlogical.wordpress.com/431/"><img alt="" border="0" src="http://feeds.wordpress.com/1.0/facebook/methodlogical.wordpress.com/431/" /></a> <a rel="nofollow" href="http://feeds.wordpress.com/1.0/gotwitter/methodlogical.wordpress.com/431/"><img alt="" border="0" src="http://feeds.wordpress.com/1.0/twitter/methodlogical.wordpress.com/431/" /></a> <a rel="nofollow" href="http://feeds.wordpress.com/1.0/gostumble/methodlogical.wordpress.com/431/"><img alt="" border="0" src="http://feeds.wordpress.com/1.0/stumble/methodlogical.wordpress.com/431/" /></a> <a rel="nofollow" href="http://feeds.wordpress.com/1.0/godigg/methodlogical.wordpress.com/431/"><img alt="" border="0" src="http://feeds.wordpress.com/1.0/digg/methodlogical.wordpress.com/431/" /></a> <a rel="nofollow" href="http://feeds.wordpress.com/1.0/goreddit/methodlogical.wordpress.com/431/"><img alt="" border="0" src="http://feeds.wordpress.com/1.0/reddit/methodlogical.wordpress.com/431/" /></a> <img alt="" border="0" src="http://stats.wordpress.com/b.gif?host=methodlogical.wordpress.com&blog=19822809&post=431&subd=methodlogical&ref=&feed=1" width="1" height="1" /></div> </td> </tr> <tr> <td style="margin-bottom:0;line-height:1.4em;"> <p style="margin:1em 0 3px 0;"> <a name="2" style="font-family:Arial, Helvetica, sans-serif;font-size:18px;" href="http://methodlogical.wordpress.com/2011/04/08/legalizing-bribery-to-reduce-corruption/">Legalizing Bribery to Reduce Corruption?</a> </p> <p style="font-size:13px;color:#555;margin:9px 0 3px 0;font-family:Georgia,Helvetica,Arial,Sans-Serif;line-height:140%;font-size:13px;"> <span>Posted:</span> 07 Apr 2011 09:30 PM PDT</p> <div style="margin:0;font-family:Georgia,Helvetica,Arial,Sans-Serif;line-height:140%;font-size:13px;color:#000000;"><p>Interesting <a href="http://marginalrevolution.com/marginalrevolution/2011/03/reduce-bribery-make-it-legal.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+marginalrevolution%2Ffeed+%28Marginal+Revolution%29">article</a> on <a href="http://marginalrevolution.com/">Marginal Revolution</a> suggesting that by making it legal to give a bribe (but illegal to accept one), countries could reduce corruption. Basically, by decriminalizing bribe-giving, people who were forced to bribe officials can report it without legal discourse. This asymmetry would significantly discourage officials from demanding bribes, as their risk of penalty would increase. Full text <a href="http://marginalrevolution.com/marginalrevolution/2011/03/reduce-bribery-make-it-legal.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+marginalrevolution%2Ffeed+%28Marginal+Revolution%29">here</a>.</p> <br /> <a rel="nofollow" href="http://feeds.wordpress.com/1.0/gocomments/methodlogical.wordpress.com/428/"><img alt="" border="0" src="http://feeds.wordpress.com/1.0/comments/methodlogical.wordpress.com/428/" /></a> <a rel="nofollow" href="http://feeds.wordpress.com/1.0/godelicious/methodlogical.wordpress.com/428/"><img alt="" border="0" src="http://feeds.wordpress.com/1.0/delicious/methodlogical.wordpress.com/428/" /></a> <a rel="nofollow" href="http://feeds.wordpress.com/1.0/gofacebook/methodlogical.wordpress.com/428/"><img alt="" border="0" src="http://feeds.wordpress.com/1.0/facebook/methodlogical.wordpress.com/428/" /></a> <a rel="nofollow" href="http://feeds.wordpress.com/1.0/gotwitter/methodlogical.wordpress.com/428/"><img alt="" border="0" src="http://feeds.wordpress.com/1.0/twitter/methodlogical.wordpress.com/428/" /></a> <a rel="nofollow" href="http://feeds.wordpress.com/1.0/gostumble/methodlogical.wordpress.com/428/"><img alt="" border="0" src="http://feeds.wordpress.com/1.0/stumble/methodlogical.wordpress.com/428/" /></a> <a rel="nofollow" href="http://feeds.wordpress.com/1.0/godigg/methodlogical.wordpress.com/428/"><img alt="" border="0" src="http://feeds.wordpress.com/1.0/digg/methodlogical.wordpress.com/428/" /></a> <a rel="nofollow" href="http://feeds.wordpress.com/1.0/goreddit/methodlogical.wordpress.com/428/"><img alt="" border="0" src="http://feeds.wordpress.com/1.0/reddit/methodlogical.wordpress.com/428/" /></a> <img alt="" border="0" src="http://stats.wordpress.com/b.gif?host=methodlogical.wordpress.com&blog=19822809&post=428&subd=methodlogical&ref=&feed=1" width="1" height="1" /></div> </td> </tr> </table> <table style="border-top:1px solid #999;padding-top:4px;margin-top:1.5em;width:100%" id="footer"> <tr> <td style="text-align:left;font-family:Helvetica,Arial,Sans-Serif;font-size:11px;margin:0 6px 1.2em 0;color:#333;">You are subscribed to email updates from <a href="http://methodlogical.wordpress.com">MethodLogical</a> <br />To stop receiving these emails, you may <a href="http://feedburner.google.com/fb/a/mailunsubscribe?k=4PqXFGqcP0RaDODmKqkLYxeTTiY">unsubscribe now</a>.</td> <td style="font-family:Helvetica,Arial,Sans-Serif;font-size:11px;margin:0 6px 1.2em 0;color:#333;text-align:right;vertical-align:top">Email delivery powered by Google</td> </tr> <tr> <td colspan="2" style="text-align:left;font-family:Helvetica,Arial,Sans-Serif;font-size:11px;margin:0 6px 1.2em 0;color:#333;">Google Inc., 20 West Kinzie, Chicago IL USA 60610</td> </tr> </table> </div> Jason Kerwinhttp://www.blogger.com/profile/11446743337803791862noreply@blogger.comtag:blogger.com,1999:blog-5418301462057710132.post-75870162781160446322011-02-10T04:00:00.004-05:002011-02-10T07:02:44.058-05:00Why the Poor Don't Soak the Rich in the U.S.<div style="font-family: "Trebuchet MS",sans-serif; text-align: left;"><span style="font-size: small;">If you're like me and have been struggling simply to understand the events that are transpiring in Egypt, have no fear - this adorable little girl will explain it all:</span></div><div style="font-family: "Trebuchet MS",sans-serif;"><br />
<div class="separator" style="clear: both; text-align: center;"><iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='320' height='266' src='https://www.youtube.com/embed/XyYMVbk2zHg?feature=player_embedded' frameborder='0'></iframe></div><br />
<span style="font-size: small;">One of the root causes behind Egypt protests is income inequality and lack of economic opportunity in the youth-bulging country under Mubarak's rule. But what I find most fascinating is that Egypt's Gini coefficient is far from abnormal relative to other countries. In fact, the U.S.'s Gini coefficient is higher than Egypt's. This raises an interesting question:<i> why don't we see similar uprisings of the poor against the rich right here in the United States? <b>Or in other words, why don't the poor soak the rich in the U.S.?</b></i></span><br />
<span style="font-size: small;"><i><b> </b></i></span> </div><div style="font-family: "Trebuchet MS",sans-serif;"><span class="Apple-style-span" style="color: #0000ee; font-size: small;"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5571875044868170450" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiOi1DACVYmNaDS6GfVhoaHPJb_VVtrYFda4rL_03WabviPXGNdL2jfD1UXJ5q5NLVOBuyctVmCfNO7bebtCkgJNHmbYup8__fMDIjmSUAhh25hkov0pkBXkS9orOTxCjAq58IlRNEsio8/s400/Gini_Coefficient_World_Human_Development_Report_2007-2008.png" style="cursor: pointer; display: block; height: 182px; margin: 0px auto 10px; text-align: center; width: 400px;" /></span></div><div style="font-family: "Trebuchet MS",sans-serif;"><div style="text-align: center;"><span class="Apple-style-span" style="font-size: small;"> </span></div><br />
<span style="font-size: small;">This morning, Harvard Kennedy School Professor <a href="http://www.hks.harvard.edu/about/faculty-staff-directory/tarek-masoud">Tarek Masoud</a>, who is basking in his 15 seconds of fame as one of the foremost academics on politics in Egypt, attempted to answer that very question this morning. </span></div><div style="font-family: "Trebuchet MS",sans-serif;"><br />
<span style="font-size: small;">According to traditional logic, one might think that poor people would vote in support of redistributive economic policies if they believe that the policies will one day benefit them. What is puzzling to Masoud is that <i>it is the very people that would benefit from redistributive policies such as the inheritance tax that are voting against them!</i> Why is this so? He posed a few different explanations:</span><br />
<span style="font-size: small;"> </span></div><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">One explanation he dubbed "<b>empathy gulf</b>". Everyone wants to be, or at least wants the one-in-a-billion lottery ticket odds of one day being, the next Bill Gates. Core to the American ideals is the concept of opportunity and rags-to-riches stories. America is where dreams come true, and anything is possible. Redistributive policies, higher tax rates, and spending on social programs are at odds with the entrepreneurial spirit of making it big.</span></div><div style="font-family: "Trebuchet MS",sans-serif;"><br />
<span style="font-size: small;">Second, Masoud posed that people in the U.S. may harbor<b> irrational beliefs about their own upward mobility</b>. It's not me who will need to cash in food stamps soon, it's the Jones's next door. Or I am not going to be one of those uninsured Americans Obama keeps talking about, so Obamacare is not something I support. 55% of Americans identify themselves as "middle class" according to a <a href="http://pewresearch.org/pubs/983/middle-class-by-the-numbers">Pew Research Center</a>. 41% of Americans making less than $20,000 identify as "middle class", as well.</span><br />
<br />
<span style="font-size: small;">Finally, another reason the poor may not be inclined to collectively organize and riot against the rich in the U.S. despite massive inequalities is that there is a general belief that <b>the free market is a fair distributive instrument.</b> Both household-level and country-level economic growth requires individuals to shift some of their output from consumption to investment. This is very distinct from a subsistence economy, where the majority of the population consume all available output. The U.S. has done a fairly effective job of providing a tax and regulatory framework that incentivizes investment over consumption, and thus fuels growth.</span></div><div style="font-family: "Trebuchet MS",sans-serif;"></div>Pamela Sudhttp://www.blogger.com/profile/06215100014424853266noreply@blogger.com1tag:blogger.com,1999:blog-5418301462057710132.post-30402996203638747122011-02-09T04:30:00.003-05:002011-02-09T07:05:37.430-05:00Being Big Becoming a Bigger Problem<div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">This week <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2810%2962037-5/abstract">Lancet published a model</a> reviewing changes in average <a href="http://en.wikipedia.org/wiki/Body_mass_index">BMI</a> from 1980 to 2008. Unsurprisingly, the model found that people have gotten bigger. Given that the data was from 199 countries, the trend was seen in rich and poor countries alike. Potential causes for this trend are diverse (though <a href="http://circ.ahajournals.org/cgi/content/short/CIRCULATIONAHA.107.716159v1">western diets</a> deserve a good deal of the blame), as are the consequences. But it merits reiterating the point <a href="http://methodlogical.blogspot.com/2011/01/tackling-non-communicable-diseases-in.html">Seema made in a previous blog post</a>:</span><span style="font-size: small;"> chronic, non-communicable diseases—particularly those related to cardiovascular disease and diabetes—will play a larger and larger role in developing countries. This is not to say that famine is a thing of the past- for countries like </span><span style="font-size: small;"> <a href="http://www.bbc.co.uk/news/world-africa-10976093">Niger</a> it is an annual reality. But we must be vigilant about the hazards of excess as well as scarcity. </span></div><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;"><br />
</span></div><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">Note: For those unfamiliar with statistical jargon, the <a href="http://en.wikipedia.org/wiki/Posterior_probability">"posterior probability"</a> referred to in the article is not a reference to study subjects' backsides.</span></div><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;"><br />
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<tr><td style="text-align: center;"><span style="font-size: small;"><a href="http://beautyeditor.ca/wp-content/uploads/feet-on-scale.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="http://beautyeditor.ca/wp-content/uploads/feet-on-scale.jpg" width="320" /></a></span></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: small;">Articles about obesity trends always seem to feature a picture of an overweight person from behind. That doesn't seem very nice, does it?</span></td></tr>
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</span></div>Adam Schwartzhttp://www.blogger.com/profile/10009267866977947931noreply@blogger.com1tag:blogger.com,1999:blog-5418301462057710132.post-42320429633375366812011-02-09T04:30:00.000-05:002011-02-09T04:30:00.841-05:00Global Fund Rebutall<span style="font-size: small;"><span style="font-family: "Trebuchet MS",sans-serif;">An interesting </span><a href="http://www.washingtonpost.com/wp-dyn/content/article/2011/02/03/AR2011020306558.html" style="font-family: "Trebuchet MS",sans-serif;">editorial in the Washington Post</a><span style="font-family: "Trebuchet MS",sans-serif;"> by Michael Gerson responds to the criticism the </span><a href="http://www.theglobalfund.org/en/" style="font-family: "Trebuchet MS",sans-serif;">Global Fund to Fight AIDS, Tuberculosis and Malaria</a><span style="font-family: "Trebuchet MS",sans-serif;"> has been receiving recently. As mentioned </span><a href="http://methodlogical.blogspot.com/2011/02/king-wolfowitzs-ghost.html" style="font-family: "Trebuchet MS",sans-serif;">on this blog</a><span style="font-family: "Trebuchet MS",sans-serif;">, corruption and misuse of funds has led Germany and Sweden to withhold contributions. Gerson counters by pointing out how uncommon such misuse is (about 0.3% of outlays to date- though surely other cases have yet to be detected). More impressively, he states, this is actually a victory for accountability, as it was the Global Fund itself that detected the malfeasance. While eliminating corruption is an important goal, designing mechanisms for detecting such fraud may be more realistic and more essential.</span></span>Adam Schwartzhttp://www.blogger.com/profile/10009267866977947931noreply@blogger.com0tag:blogger.com,1999:blog-5418301462057710132.post-46481998158904246452011-02-02T14:45:00.010-05:002011-02-03T08:39:45.279-05:00Revolution in 140 Characters: Thinking About Information Technology and Politics<div style="font-family: "Trebuchet MS",sans-serif;"><style>
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</style> </div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"></div><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">With Egypt and Tunisia in the midst of some fairly radical political change the role of the internet, particularly social media like Twitter and Facebook, in social movements has again become a topic of popular discussion. Sometimes it can seem the options are either naïve optimism about “twitter revolutions” or a jaded cynicism that scoffs at the effects of social media. What I hope to convince you of here is that internet technology is not inherently democratic, and to make the argument that the effects the internet has are always the product of a specific context.<br />
</span></div><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">The problem at hand in discussions of Facebook, Twitter, or the internet more broadly is <a href="http://en.wikipedia.org/wiki/Technological_determinism">technological determinism</a>. As the name might suggest, technological determinism explains society and social change primarily through the lens of technological change. Technology, in other words, acts as the independent variable or agent of change and society is the dependent variable. Frequently this involves claiming certain technologies contain inherent effects due to the nature of the technology itself. Whether or not certain effects are realized, the technology always pushes in a particular direction. Analyses that assume the internet has an inherently democratic nature or that essentially boil down to “no twitter, no revolution” are examples of technological determinism.<br />
</span></div><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">There are obvious problems with such a perspective. Technological determinism undervalues the context in which a technology is used and the agency of those using it. Tools and technologies are always repurposed according to individual preferences and cultural norms. In the end technological determinism assumes what needs to be proven—the effects of technology. <br />
</span></div><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">One of, if not the most infamous critical assessment of the use of social media in social movements comes from <a href="http://www.newyorker.com/reporting/2010/10/04/101004fa_fact_gladwell?currentPage=1">Malcom Gladwell’s 2010 piece for the New Yorker</a>. In it he argues that popular movements for social change rely on strong social ties and a high level of commitment. The reason being, social change, especially radical change, is often dangerous and requires participants be willing to risk personal wellbeing. The internet, Gladwell argues, especially social media like Twitter, doesn't work like this. Rather, he claims that, “social media are built around weak ties”. Facebook, for example, allows us to make broad, weak connections with many people but is neither a necessary nor a sufficient condition for fueling a social movement. Gladwell also supports those who criticize foreign media for paying too much attention to English language posts on Twitter and ignore the long-standing causes or more substantial legwork needed on the ground to make a revolution happen. In countries where English is not the first language and internet access may not be widespread, how much do we learn from Twitter? In other words, we see Twitter and Facebook as important because they are so ubiquitous in our own lives not because they actually matter. </span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif; text-indent: 0.5in;"><span style="font-size: small;"><br />
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<tr><td style="text-align: center;"><span style="font-size: small;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg613O5a4nRTrA44kV6q8Fb9m5hYFhZJz1SU-9yZ4QNaKdZIHP5n7DkrXIn_ERX14y7lsrX2IcBhyaWjAltn4bujA_gOUkZXyD8Gq2IitMesoIukX2tewBasoilNTdPFw-xV8DRCstGraBZ/s1600/twitter_iran_400.jpg" style="margin-left: auto; margin-right: auto;"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5569173322772256722" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg613O5a4nRTrA44kV6q8Fb9m5hYFhZJz1SU-9yZ4QNaKdZIHP5n7DkrXIn_ERX14y7lsrX2IcBhyaWjAltn4bujA_gOUkZXyD8Gq2IitMesoIukX2tewBasoilNTdPFw-xV8DRCstGraBZ/s320/twitter_iran_400.jpg" style="display: block; height: 240px; margin: 0px auto 10px; text-align: center; width: 320px;" /></a></span></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: small;"><i>Whatever happened to the Iranian "Twitter" revolution?</i></span></td></tr>
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Good polemics are supposed to make you think, so I have to admit to enjoying Gladwell’s article, but it falls into its own sort of determinism. According to Gladwell social media never produces the sorts of strong ties needed for popular movements. Essentially Gladwell argues that social media are inherently shallow forms of social networking. This ignores the ways our virtual and meat-space lives overlap. Gladwell also ignores the fact that in some circumstances social media may well play an important role in either <a href="http://neteffect.foreignpolicy.com/posts/2009/04/07/more_analysis_of_twitters_role_in_moldova">coordinating group actions or in trying to garner international support</a>. Indeed communication technologies sometimes do play vital roles in popular uprisings.<br />
</span></div><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">Another popular critic of the role of the internet is Evgyeny Morozov. One-time enthusiast for the transformative role of the internet and Twitter, he has since <a href="http://www.amazon.com/Net-Delusion-Dark-Internet-Freedom/dp/1586488740">tempered his stance</a>. In contrast to Gladwell, Morozov focuses on the fact that internet technologies are <a href="http://www.blogger.com/o%09http://motherjones.com/interview/2011/01/evgeny-morozov-twitter-tunisia">not inherently liberating</a>. Far from ushering in an <a href="http://en.wikipedia.org/wiki/Open_society">“open society”</a>, the internet can and has been used by authoritarian states and reactionary movements. China, for example, is an undemocratic state that has figured out how to handle the internet. As far as popular movements go, we can turn to recent events in Pakistan. After the assassination of the governor of Punjab motivated, it seems, for his stance of blasphemy laws, many took to the streets in support of the assassin even forming a <a href="http://www.nytimes.com/2011/01/11/world/asia/11pakistan.html?pagewanted=all">Facebook group to support the cause</a>. There is nothing inherently progressive about the internet and its effects and uses will always depend on context. <br />
</span></div><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">So where do these critiques leave us? To begin, it means we need to beware of a simple progressive view of history and look more critically at the actual roles and effects of new technologies. The internet may not be as newfangled as we suppose it to be—<a href="http://www.amazon.com/Victorian-Internet-Remarkable-Nineteenth-line/dp/0425171698">the telegraph,</a> after all, created some of the same effects often attributed as unique to the internet. Indeed, in China the older technology of the telegraph was part of a popular, revolutionary uprising whereas the internet has so far has not been. Yongming Zhou (one of my professors at UW-Madison) attributes this to the <a href="http://www.amazon.com/Historicizing-Online-Politics-Telegraphy-Participation/dp/0804751285/ref=sr_1_1?ie=UTF8&s=books&qid=1296672996&sr=1-1">“receiving context”</a> of a technology. In contrast to the relative strength of the PRC today, the Qing dynasty was weak, lost legitimacy after the Sino-Japanese war, and faced a growing nationalist sentiment. In the midst of this apparent weakness a shift in regime, constitutionalism, was seen as the best way to save China and restore its greatness. Telegraphic circulars did not cause the uprising rather, “it was the need to publicize and broaden the reach of the idea of constitutionalism that made sending circular telegrams an imperative political practice” (233). A similar situation may well be true of what we’re now seeing in Egypt and Tunisia.</span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif; text-indent: 0.5in;"><span style="font-size: small;"><br />
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<tr><td style="text-align: center;"><span style="font-size: small;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiScOLQhgIlb_4ZddAacSaM5tovatq1fmj5XckdCekOz1NWnJ-Xvtmo1CmCEk6A88fmcQHvuzLMmEqGFJz2fs8Qz2FNItTmJQjPAjOJTyvVdbWU7wHiSMPLXQLsb4qMGgi1-DurRR_jDqZt/s1600/Chinesisches_Internetcafe_Lijiang.jpg" style="margin-left: auto; margin-right: auto;"><img alt="" border="0" height="240" id="BLOGGER_PHOTO_ID_5569176530881734898" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiScOLQhgIlb_4ZddAacSaM5tovatq1fmj5XckdCekOz1NWnJ-Xvtmo1CmCEk6A88fmcQHvuzLMmEqGFJz2fs8Qz2FNItTmJQjPAjOJTyvVdbWU7wHiSMPLXQLsb4qMGgi1-DurRR_jDqZt/s320/Chinesisches_Internetcafe_Lijiang.jpg" style="display: block; margin: 0px auto 10px; text-align: center;" width="320" /></a></span></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: small;"><i>Serious politics or playing FarmVille?</i></span></td></tr>
</tbody></table><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif; text-indent: 0.5in;"><span style="font-size: small;"> </span></div><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">Likewise we need to be more sensitive to the interaction between local and global contexts. NPR ran an amusing bit on how the names we know revolutions by may be the <a href="http://www.npr.org/2011/01/28/133293523/Name-That-Revolution">invention of those outside the countr</a>y. Tunisia’s “Jasmine” revolution is, supposedly, a French media invention—not a term coming from the people of Tunisia. Despite being removed from the on-the-ground perspectives these names may eventually gain popularity in country as a way to curry international attention and bring people together. The point is that although connected to the global discourse, the local understandings of the revolution may be quite different from our own. Our images of a revolution may reflect both our own biases and the active cultivation of an image for international consumption by those involved. </span></div><div style="font-family: "Trebuchet MS",sans-serif;"><br />
</div><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">What do Tunisians or Egyptians or members of any other social movement make of their uprising? How has internet technology been involved in their experience or understanding of political events? Have there been long-term effects from the use of social media in other places like Iran? I’ve been following the recent events pretty closely, but these are questions that still remain inadequately answered for me. What we need is to step back from our <a href="http://en.wikipedia.org/wiki/Commodity_fetishism">fetishization</a> of media technology a more nuanced, context sensitive discussion that addresses these questions.</span></div>Jason Hopperhttp://www.blogger.com/profile/03684719735097637389noreply@blogger.com0tag:blogger.com,1999:blog-5418301462057710132.post-32110202313103158902011-02-02T07:35:00.001-05:002011-02-02T07:51:01.463-05:00Don't Forget the Ivory Coast<div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">With all the media attention surrounding the political uprisings and regime changes in <a href="http://www.bbc.co.uk/news/world-africa-12335692">Tunisia</a> and <a href="http://www.bbc.co.uk/news/world-middle-east-12345656">Egypt</a>, the media seems to have forgotten about the <a href="http://www.bbc.co.uk/news/world-africa-12319381">political power struggle in the Ivory Coast</a>, where former president Laurent Gbagbo is attempting to cling to power in the wake of Alassane Ouattara's election victory.</span></div><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;"><br />
</span></div><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">Given the media's relatively short attention span when it comes to news in sub-Saharan Africa, it's important to remember that <a href="http://www.theonion.com/articles/well-i-guess-that-genocide-in-sudan-mustve-worked,11145/">stories don't end just because coverage does</a>.</span></div>Adam Schwartzhttp://www.blogger.com/profile/10009267866977947931noreply@blogger.com0tag:blogger.com,1999:blog-5418301462057710132.post-43764657899310774922011-02-01T04:30:00.006-05:002011-02-01T13:43:43.852-05:00King Wolfowitz's Ghost<div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;"><a href="http://en.wikipedia.org/wiki/Paul_Wolfowitz">Paul Wolfowitz's</a> turbulent tenure as World Bank president was marked by an aggressive anti-corruption agenda. Apparently, Germany is also disturbed by apparent corruption. <a href="http://www.bbc.co.uk/news/">The BBC</a> is reporting that Germany is suspending its contributions to the Global Fund citing misuse and mismanagement. Looking forward to a robust discussion about the impact of corruption on development in the comments section.</span></div><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;"><br />
</span></div><div style="font-family: "Trebuchet MS",sans-serif; text-align: center;"><span style="font-size: small;"><a href="http://www.bbc.co.uk/news/world-europe-12294232">Germany halts Aids fund payment over corruption claims</a></span></div><div style="font-family: "Trebuchet MS",sans-serif; text-align: center;"><span style="font-size: small;"><br />
</span></div><div class="separator" style="clear: both; font-family: "Trebuchet MS",sans-serif; text-align: center;"><span style="font-size: small;"><a href="http://news.bbcimg.co.uk/media/images/50972000/jpg/_50972284_010457586-1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://news.bbcimg.co.uk/media/images/50972000/jpg/_50972284_010457586-1.jpg" /></a></span></div><div style="font-family: "Trebuchet MS",sans-serif; text-align: center;"><span style="font-size: small;"><br />
</span></div><div style="font-family: "Trebuchet MS",sans-serif; text-align: center;"><span style="font-size: small;"><br />
</span></div><span style="font-size: small;"><i style="font-family: "Trebuchet MS",sans-serif;">Germany has suspended its annual payment of more than 200m euros (£172m) to the Global Fund against Aids, TB and malaria, following corruption claims. </i><i><span style="font-family: "Trebuchet MS",sans-serif;">Germany is the third-biggest donor to the UN-backed fund, which has an annual budget of more than $20bn (£12bn). It has been alleged that the fund's controls are poor in some countries and possibly billions of dollars have been siphoned off.</span></i></span> <br />
<div class="introduction" id="story_continues_1" style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;"><br />
</span></div><div style="font-family: "Trebuchet MS",sans-serif; text-align: left;"><span style="font-size: small;"><i> </i>Read the full article <a href="http://www.bbc.co.uk/news/world-europe-12294232">here</a>: </span></div>Adam Schwartzhttp://www.blogger.com/profile/10009267866977947931noreply@blogger.com1tag:blogger.com,1999:blog-5418301462057710132.post-73491436220707702172011-01-31T14:40:00.000-05:002011-01-31T14:40:45.731-05:00Pay the Poor<span style="font-size: small;"><span style="font-family: "Trebuchet MS",sans-serif;">The Bangladeshi city of Chittagong has come up with an interesting way of getting rid of beggars: Paying them. Read the full article from the BBC </span><a href="http://www.bbc.co.uk/news/world-south-asia-12320172" style="font-family: "Trebuchet MS",sans-serif;">here</a><span style="font-family: "Trebuchet MS",sans-serif;">.</span></span>Adam Schwartzhttp://www.blogger.com/profile/10009267866977947931noreply@blogger.com2tag:blogger.com,1999:blog-5418301462057710132.post-15662359580925920462011-01-28T04:30:00.004-05:002011-01-28T06:35:09.520-05:00Can Satire Be True?<div style="font-family: "Trebuchet MS",sans-serif; text-align: left;"><span style="font-size: small;">From our good friends at <a href="http://www.theonion.com/content/index">The Onion </a></span></div><div style="font-family: "Trebuchet MS",sans-serif; text-align: left;"><span style="font-size: small;"><br />
</span></div><div style="font-family: "Trebuchet MS",sans-serif; text-align: center;"><span style="font-size: small;"><a href="http://www.theonion.com/articles/gap-between-rich-and-poor-named-8th-wonder-of-the,18914/">Gap Between Rich And Poor Named 8th Wonder Of The World</a></span></div><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;"><br />
</span></div><div class="separator" style="clear: both; font-family: "Trebuchet MS",sans-serif; text-align: center;"><span style="font-size: small;"><a href="http://o.onionstatic.com/images/articles/article/18914/Gap-Between-R_jpg_600x345_crop-smart_upscale_q85.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="184" src="http://o.onionstatic.com/images/articles/article/18914/Gap-Between-R_jpg_600x345_crop-smart_upscale_q85.jpg" width="320" /></a></span></div><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;"><br />
</span></div><div style="font-family: "Trebuchet MS",sans-serif;"><i><span style="font-size: small;">PARIS—At a press conference Tuesday, the World Heritage Committee officially recognized the Gap Between Rich and Poor as the "Eighth Wonder of the World," describing the global wealth divide as the "most colossal and enduring of mankind's creations."</span></i></div><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;"><br />
</span></div><span style="font-family: "Trebuchet MS",sans-serif; font-size: small;">Read the full article<a href="http://www.theonion.com/articles/gap-between-rich-and-poor-named-8th-wonder-of-the,18914/"></a> <a href="http://www.theonion.com/articles/gap-between-rich-and-poor-named-8th-wonder-of-the,18914/">here</a>. </span>Adam Schwartzhttp://www.blogger.com/profile/10009267866977947931noreply@blogger.com0tag:blogger.com,1999:blog-5418301462057710132.post-46714004444316851192011-01-28T04:00:00.004-05:002011-01-28T06:45:31.800-05:00Motivation<div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span class="Apple-style-span" style="font-size: small;">While an undergraduate, I used to volunteer with an adult literacy program at a nearby men’s homeless shelter. The weekly “lesson” topic was established by the shelter staff, and the student volunteers would prepare materials accordingly. These followed a <a href="http://books.google.com/books?id=xfFXFD414ioC&printsec=frontcover&dq=paulo+freire+pedagogy+oppressed&hl=en&ei=WElCTfHdJIP68AbLt6C3AQ&sa=X&oi=book_result&ct=result&resnum=1&ved=0CDAQ6AEwAA#v=onepage&q&f=false">Freireian</a> methodology, in that the men explored themes of interest to their own daily lives, and we, the “instructors” served mainly as facilitators for the discussion or interspersed reading/writing exercises.</span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;"><br />
</span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;"><o:p><span class="Apple-style-span"> </span></o:p></span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span class="Apple-style-span" style="font-size: small;">Topics were often general, but lead into unexpected, yet illuminating discussions. For example, one week’s topic was, “Music.” We played Johnny Cash’s rendition of “<a href="http://www.youtube.com/watch?v=-1BJfDvSITY">A Boy Named Sue</a>,” (one of Shel Silverstein’s darker works). One man commented that the opening lyrics resonated with his own personal experience living with an alcoholic father. When we asked the group if anyone else shared this experience, every single had went up. It was a living, breathing sociology class.</span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;"><br />
</span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;"><o:p><span class="Apple-style-span"> </span></o:p></span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span class="Apple-style-span" style="font-size: small;">The most uncomfortable topic I was ever tasked with was: Motivation. Motivation is a loaded topic, especially as a class facilitated by privileged college students with a group of homeless men. I almost backed out. The men however, loved it. What surprised me was how incredibly positive they were. Motivation and strength derived from religious faith was a huge theme. In fact, in the entire group, there was one man who gave any hints at negativity, or expressed challenges to motivation. He had just lost his job as an electrician, and had three kids at home. He voiced his frustrations with his current job search. The other men responded in a positive—though perhaps naively so—fashion. One man exclaimed, “That’s why you need to work for yourself! Be your own boss [so that you don’t have to worry about getting fired],” to which another man responded “Right! You just need to get <i>motivated</i>—write letters to the government in Washington, they have all this money they will just give you to start a business. You just have to be <i>motivated</i> and write them.”</span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;"><br />
</span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span class="Apple-style-span" style="font-size: small;"> </span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span class="Apple-style-span" style="font-size: small;">Meanwhile, everything in my academic courses (in sociology, critical theory and constructivism) were screaming out: from the internalization of a systemic failure as an individual problem of motivation, to differential knowledge of how political and economic networks are structured and accessed.</span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;"><br />
</span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;"><o:p><span class="Apple-style-span"> </span></o:p></span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span class="Apple-style-span" style="font-size: small;">The men had very high expectations of themselves and their social systems. This may serve as a source of motivation initially, but it is unlikely to be sustained it if these expectations aren’t met. Similarly, in my current work with human resources for health, while many health workers enter <a href="http://www.hrhresourcecenter.org/taxonomy/term/81">motivated</a> by a sense of “<a href="http://www.human-resources-health.com/content/4/1/24">professional conscience</a>,” or desire to better their communities, many become de-motivated when their efforts are continuously defeated by larger, systemic issues. For example, chronic medical supply shortages, or lack of <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1450300/">supportive supervision</a> by superiors at referral levels.</span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;"><br />
</span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;"><o:p><span class="Apple-style-span"> </span></o:p></span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span class="Apple-style-span" style="font-size: small;">Similarly, <a href="http://datacritica.info/ojs/index.php/datacritica/article/view/15/20">Richard Levins</a> writes on our role as “radical health workers”</span><span style="font-size: small;">: </span></div><blockquote><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span class="Apple-style-span" style="font-size: small;">“ …We are also workers. We are hired to create and apply knowledge within the constraints set by our employers. But we are a special kind of worker in that our labor is not completely alienated from us: we are really concerned with the product of our labor, with what it does in the world, unlike the employees in an ammunitions factory who do not seek out that job for the joy of helping to kill people. As workers, a major concern is to keep our jobs and receive reasonable compensation and benefits. But as intellectuals we want our work to be meaningful and effective. We are terribly frustrated when we lack the resources to do what obviously needs to be done, when class size or number of patients to care for guarantees that we cannot do what we entered the profession to do and when our best ideas are not fundable or not even mentionable, when our activism is condemned as unprofessional, when our tasks are constrained by wrong or narrow theories, when we may contribute to deep studies of the problem but the reports end in banal recommendations such as ‘we should pay more attention to questions of equity’ or the almost inevitable ‘more research is needed.’”</span></div></blockquote><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;"><o:p><span class="Apple-style-span"> </span></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-size: small;"><span style="font-family: "Trebuchet MS",sans-serif;">As several recent Methodlogical posts have discussed, often what motivates us—</span><a href="http://methodlogical.blogspot.com/2011/01/steve-levitt-recently-raised-ire-of.html" style="font-family: "Trebuchet MS",sans-serif;">to vote</a><span style="font-family: "Trebuchet MS",sans-serif;">, or </span><a href="http://methodlogical.blogspot.com/2010/12/what-motivates-one-to-serve.html" style="font-family: "Trebuchet MS",sans-serif;">to serve</a><span style="font-family: "Trebuchet MS",sans-serif;">—is complex, and far from rational. It seems to me that motivation is as much a product of our social systems as it is of our individual predilections and personal sense of fulfillment. I’m interested in your own experiences with motivation, and how</span> you think we can change our systems—and the incentives inherent to them. </span></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5418301462057710132.post-91620318901719519802011-01-27T04:00:00.006-05:002011-01-27T06:29:26.198-05:00Market-Based Solutions to International Development?<div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjgCXt5G9iGCj1H8_psStD4iPYJDPEh93ZNR_sCz8Gk8_Xwa6g2o3TXnyV5h7sGzYMj75QMjB-SZ5RvqRoc_91SratkPSgrjQFwWW4JMg07aKB5aDyRZOJsmrMcTxrcqnbrxrqlh5cpun8/s1600/social_enterprise.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5566621264818979682" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjgCXt5G9iGCj1H8_psStD4iPYJDPEh93ZNR_sCz8Gk8_Xwa6g2o3TXnyV5h7sGzYMj75QMjB-SZ5RvqRoc_91SratkPSgrjQFwWW4JMg07aKB5aDyRZOJsmrMcTxrcqnbrxrqlh5cpun8/s320/social_enterprise.jpg" style="cursor: pointer; float: right; height: 216px; margin: 0pt 0pt 10px 10px; width: 320px;" /></a></span></div><div style="font-family: "Trebuchet MS",sans-serif; text-align: left;"><span style="font-size: small;">If you walk around the Harvard Business School, you can't go more than 2 days without hearing certain buzz words: "market-based solutions," "base of the pyramid business models," and "social entrepreneurship" to name a few. The common theme is integrating private sector approaches to international development and poverty alleviation efforts. The concepts are certainly fascinating, and even I find myself intrigued by conversations about venture philanthropy firms, private equity firms working in emerging markets, and cool business ideas that serve the poor. We can talk the talk, but what sort of companies out there have really walked the walk? Here are 3.</span></div><div style="font-family: "Trebuchet MS",sans-serif;"><div><div><div><br />
<span style="font-size: small;"><b>1. LifeStraw. </b> Designed by Swiss company <a href="http://www.vestergaard-frandsen.com/lifestraw">Vestergaard Frandsen</a>, LifeStraw makes dirty water clean. It is a 25 cm long, 29 mm diameter plastic straw that contains of point-of-use water filter in its base. The manufacturers have priced it at US$2. LifeStraw removes 99.999% of waterborne bacteria, 99.99% of viruses, and 99.9% of parasites. It can be used for approximately 1 year (700 liters) before the filter must be replaced. As a result of killing disease-causing microorganisms, it can prevent diarrhea, dysentery, typhoid, and cholera. LifeStraw is a for-profit product, for sale both directly to consumers but also many non-profits have worked with LifeStraw to purchase and distribute it in humanitarian crises (most recently the 2010 Haitian earthquake and the 2010 Pakistan floods).</span><br />
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<tr><td style="text-align: center;"><span style="font-size: small;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEibhv_9l1tnHuwkAXyktqjn5FIoI5cQ3aPKVlr_f4cSiBKOLKMWuQb7s7NyRhMt1FdIU-rk0_n6K8wIVp8oJ8G528LYMJKMolWVskIvRsu8OGBMHDaGB2mLk29sTSIvikZR05a7Jd1GkQ8/s1600/Lifestraw.jpg" style="margin-left: auto; margin-right: auto;"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5566602864526980962" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEibhv_9l1tnHuwkAXyktqjn5FIoI5cQ3aPKVlr_f4cSiBKOLKMWuQb7s7NyRhMt1FdIU-rk0_n6K8wIVp8oJ8G528LYMJKMolWVskIvRsu8OGBMHDaGB2mLk29sTSIvikZR05a7Jd1GkQ8/s400/Lifestraw.jpg" style="height: 400px; width: 376px;" /></a></span></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: small;">LifeStraw</span></td></tr>
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<span style="font-size: small;"><b>2. Banana Leaf Sanitary Pads.</b> Elizabeth Scharpf, founder and CEO of <a href="http://www.sheinnovates.com/">Sustainable Health Enterprises (S.H.E.)</a>, is working to address a major underlying cause of female absenteeism in school and in the workplace: mensutruation. The alarmingly high rates of absenteeism in schools and in the workplace that resulted from women reluctant to come during their menstrual periods is a reality in many developing countries. The #1 reason? Sanitary pads are too expensive. In order to create a more affordable option, S.H.E. now works with local Rwandan women to manufacture and distribute affordable, quality, and eco-friendly sanitary pads made from banana tree fibers. Since 2009, S.H.E has also trained 5,000 Rwandan women to set up their own sanitary napkin micro-enterprises. Scharpf has become part of the movement that Nicholas Kristof calls the <a href="http://www.nytimes.com/2010/10/24/magazine/24volunteerism-t.html?_r=3&scp=1&sq=harvard%20kennedy%20business%20menstruation&st=cse">D.I.Y. Foreign Aid Revolution</a>.</span></div><div><span style="font-size: small;"><br />
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<tr><td style="text-align: center;"><span style="font-size: small;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjOhn6tf2qJMwaqq8sCDE_4Htk84rbu23Oa7Fj0wHka4p0Iup3fIhgFe_F4uIcAQQ0dMFOvlIq88MlDRIC5Fu_7N7WBcBHP2mBudgCMEiaSduNSGIi2iO2W1IdDPOXc1FSaEFCFtaiyli4/s1600/SHE2.jpg" style="margin-left: auto; margin-right: auto;"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5566611922973031106" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjOhn6tf2qJMwaqq8sCDE_4Htk84rbu23Oa7Fj0wHka4p0Iup3fIhgFe_F4uIcAQQ0dMFOvlIq88MlDRIC5Fu_7N7WBcBHP2mBudgCMEiaSduNSGIi2iO2W1IdDPOXc1FSaEFCFtaiyli4/s400/SHE2.jpg" style="height: 299px; width: 400px;" /></a></span></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: small;">S.H.E. Sanitary Pads Being Manufactured in Rwanda</span></td></tr>
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<span style="font-size: small;"><b>3. ClickDiagnostics.</b> One of several companies competing in the telemedicine space, ClickDiagnostics is a software program that allows for community health workers to use a hand-held interface to do a quick differential diagnosis and send photographs to remote physicians. <a href="http://clickdiagnostics.com/">ClickDiagnostics</a> has experimented with several interfaces/platforms for the software, ranging from smartphone apps to more basic flip phone mobile technology. The for-profit company sells their technology to Ministries of Health, NGOs (including BRAC), universities, and hospitals for use in Bangladesh, Botswana, Kenya, Uganda, and Ghana. If anyone knows more about the telemedicine market, I'd love to learn more about how ClickDiagnostics measures up to its competitors. Maybe the MD's out there can also shed some light on the scale-ability (or lack of scale-ability) of telemedicine.</span><br />
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<tr><td style="text-align: center;"><span style="font-size: small;"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5566619255630194546" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEitLj1SdgVb0v8bfi9Ny9g-ttiPzAxaUwQblDHa9Ea2JC6s9q6dTjvwK0s-ewdyEwT_FP5zRq5o3Jhyphenhyphen4fcZ_mESCNRaKjYaQlZaECV_2XUcR_uBm4aVFsx31GL0-MQr1TYrAD9QofpPwBk/s400/ClickDiagnostics1.jpg" style="display: block; height: 400px; margin: 0px auto 10px; text-align: center; width: 301px;" /></span></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><div style="text-align: center;"><span style="font-size: small;">Community Health Worker Using ClickDiagnostics Mobile App</span></div></td></tr>
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<div style="text-align: left;"><span style="font-size: small;">Would love for others to add to my list of favorites, as well. For those interested in exploring social entrepreneurship further, check out the upcoming <a href="http://socialenterpriseconference.org/">Harvard Social Enterprise Conferenc</a>e, March 5-6, 2011. </span></div></div></div></div></div>Pamela Sudhttp://www.blogger.com/profile/06215100014424853266noreply@blogger.com2tag:blogger.com,1999:blog-5418301462057710132.post-17120172999129207892011-01-26T04:30:00.026-05:002011-01-26T04:30:00.335-05:00The Other Middle Class<div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">Foreign aid is a tricky thing. While it can often be a shining example of humanitarianism and compassion, it can also smack of <i>real politik</i><span style="font-style: normal;">; who gives to whom, how much, and when is often more a reflection of geopolitical strategy than of objective need. Further, various development types (notably <a href="http://williameasterly.org/">William Easterly</a>) will tell you that aid doesn’t do a whole lot of good for its recipients. Nonetheless, most of us would broadly agree on the importance of development assistance and humanitarian aid. But who should pay for it?</span></span> </div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><br />
</div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">For the first time in history, <a href="http://www.ids.ac.uk/index.cfm?objectid=D840B908-E38D-82BD-A66A89123C11311F">more poor people live in middle-income countries than in poor countries</a>. This was not the case when the World Bank was founded nor when the Gates Foundation was founded. Think more around the time <a href="http://methodlogical.blogspot.com/p/welcome-to-methodlogical.html">MethodLogical was founded</a>. While there is no perfect definition for poor or rich countries (or those in between), <a href="http://data.worldbank.org/about/country-classifications">the World Bank takes a stab at it</a>. What it and others have been finding is that countries are rapidly industrializing and ascending from the “poor” category to the "middle-income" one, resulting in this demographic shift.</span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><br />
</div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">It should be noted that this trend may be somewhat exaggerated. Given that China and India account for about a third of the world’s population, any demographic shift that includes both of them is likely to have a significant global impact. And indeed, both China and India have recently graduated to middle-income status, bringing loads of poor citizens along with them (as well as a <a href="http://www.moneynews.com/Economy/china-aid-foreign-economy/2010/09/26/id/371580">hefty amount of incoming aid dollars</a>). Disproportionately large though they may be, China and India are not alone. <a href="http://beyondprofit.com/poor-people-not-poor-countries/">27 countries have made the shift since 2000</a>. And by and large, this is a good thing.</span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><br />
</div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">The problem is—as anyone who has traveled to India or China or Brazil could tell you—a surging economy doesn’t erase all poverty. National growth may be good for most people (including the poor), but it’s no silver bullet. But as these countries add to their coffers, is it still the responsibility of wealthy nations to give them aid? Or is it time for these blue-collar countries to take care of their own?</span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><br />
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<tr><td class="tr-caption" style="text-align: center;">Is she doing her part to aid her countrymen?</td></tr>
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<span style="font-size: small;">Firstly, we must ask if they are fully able to address their own needs. China has the money to <a href="http://www.bbc.co.uk/go/rss/int/news/-/news/world-asia-pacific-12266973">spend a ton on its military</a>, but if redirected, would it be enough to radically help the hundreds of millions of poor people inside its borders? If so, is it still the responsibility of developed nations to step in if a middle-income country is using its wealth irresponsibly? But what about Botswana, which spends quite a bit less on its military, but is still groaning under the weight of its HIV epidemic and widespread unemployment?</span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><br />
</div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">We also have to look at inequality. Though maligned, <a href="http://en.wikipedia.org/wiki/Gini_index">the Gini index</a> is the best estimate of income inequality in a country. <a href="https://www.cia.gov/library/publications/the-world-factbook/rankorder/2172rank.html?countryName=India&countryCode=in&regionCode=sas&rank=79#in">China and India fall in the middle third of nations</a>, though the top third features quite a few middle-income countries. Addressing inequality has been a vexing question for all countries, rich and poor alike; some <a href="http://www.infobarrel.com/media/image/28030.jpg">advocate redistribution</a> while others <a href="http://www.thehypertexts.com/Mysterious_Ways/Images/Ronald_Wilson_Reagan_Cowboy_Poet.gif">prefer to let the free market do the heavy lifting</a>. Regardless of method, it doesn’t hurt to have good governance, human capital, and an efficient bureaucracy in place. Capacity to address inequality does not materialize just because a country is manufacturing and/or exporting a lot. Perhaps this is an area where some newly minted middle-income countries suffer, as economic gains may outpace a nation’s ability to train the personnel necessary. It is reasonable to expect this capacity to lag behind economic growth (especially if the growth is a result of private sector success and takes time to translate into revenue for the state), and international assistance may be a reasonable bridge in this period.</span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><br />
</div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">I remain pretty agnostic on most of this, mostly for lack of definitive data. Perhaps more critical is the issue of how accurate the World Bank’s categorizations are. MethodLogical contributor <a href="http://methodlogical.blogspot.com/2010/12/ppp-income-statistics-as-worthwhile.html">Jason Kerwin has argued</a> that these economic measures are far from perfect, while MethodLogical contributor <a href="http://methodlogical.blogspot.com/2010/12/how-does-happiness-measure-up-in.html">Jason Hopper has mused</a> on the usefulness of other measures, such as the <a href="http://en.wikipedia.org/wiki/Human_Development_Index">Human Development Index</a> or the <a href="http://beyondprofit.com/a-new-definition-of-poor/">Multidimensional Poverty Index</a>. But as countries (if not individuals) acquire wealth, the dynamic of developed-developing countries will continue to evolve. The question of how best to aid the poor remains the same, but perhaps our methods must evolve as well.</span></div>Adam Schwartzhttp://www.blogger.com/profile/10009267866977947931noreply@blogger.com5tag:blogger.com,1999:blog-5418301462057710132.post-30187952491684211092011-01-21T06:50:00.003-05:002011-01-21T06:53:22.496-05:00Excuses, excuses<div class="separator" style="clear: both; text-align: center;"></div><span style="font-size: small;"><span style="font-family: "Trebuchet MS",sans-serif;">Andrew will not be posting today because he is recovering from malaria.</span></span><br />
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<tr><td style="text-align: center;"><a href="http://www.todayifoundout.com/wp-content/uploads/2010/08/mosquito_malaria.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="230" src="http://www.todayifoundout.com/wp-content/uploads/2010/08/mosquito_malaria.png" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: "Trebuchet MS",sans-serif;">Did you know you could get malaria even if you're on prophylaxis?</span></td></tr>
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<span style="font-size: small;"><span style="font-family: "Trebuchet MS",sans-serif;">Don't worry- he's recovering nicely, so please enjoy <a href="http://www.bbc.co.uk/news/uk-scotland-edinburgh-east-fife-12129090">this article</a>.</span></span><br />
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<i><span style="font-size: small;"><span style="font-family: "Trebuchet MS",sans-serif;">Please note, exposing our contributors to lethal pathogens will NOT become a regular feature on MethodLogical.</span></span></i><br />
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<span style="font-size: small;"><span id="goog_653456115"></span><span id="goog_653456116"></span></span>Adam Schwartzhttp://www.blogger.com/profile/10009267866977947931noreply@blogger.com1tag:blogger.com,1999:blog-5418301462057710132.post-73413671695093373932011-01-19T05:47:00.006-05:002011-01-20T07:12:57.489-05:00Is Democracy a Universal Ideal?<div style="font-family: "Trebuchet MS",sans-serif;"><style>
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</style> </div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">I’ve been spending a fair bit of time reading up on civil society, democracy, and politics more generally in a cross-cultural perspective. Being an anthropologist, but also someone committed to the idea of social justice, I am left in a bit of a dilemma: Do our ideals of democracy apply universally? How far and in what ways is cultural relativism relevant when discussing topics like democracy?</span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><br />
</div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">Certainly in both American foreign policy and in the social sciences the term tends to get used as a universal ideal. There’s a certain evangelical ring in a lot of the official policy discourse about spreading “democracy and freedom” around the world. In the social sciences, some writers tend to reduce democracy to a few institutions or a method of decision making such as elections—a tradition that grew out of <a href="http://en.wikipedia.org/wiki/Joseph_Schumpeter">Joseph Schumpeter</a>’s writings. Others, like <a href="http://en.wikipedia.org/wiki/Robert_Dahl">Robert Dahl</a>, have defined ideals first and gone out to test to see if certain institutions realizes these ideals, but with little sensitivity to the fact that the ideals chosen may be influenced the scholars own social and cultural background.</span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><br />
</div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">A book I am finding very thought provoking on this topic is Frederic Shaffer’s <a href="http://www.amazon.com/Democracy-Translation-Understanding-Politics-Unfamiliar/dp/0801433983"><i>Democracy in Translation</i></a>. Political Scientist by training, Schafer uses linguistic and ethnographic methods to try to understand how native Wolof speakers in Senegal speak and think about democracy. Schafer then compares these ideas to elite discourses in Senegal, to American understandings of democracy, and to academic theories of democracy. His focus is on understanding Wolof perceptions of democracy in their own terms and the variety of ideals that may guide democratic institutions (8). What he finds is that both popular ideals and academic theories of democracy differ substantially from understandings of democracy on the ground in Senegal.</span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><br />
</div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;"><i>Demokaraasi, </i>the Wolof term, although etymologically related to the term “democracy” focuses on consensus, even handedness, and solidarity (84). In other words, a common Senegalese conception of democracy does not focus on individual freedom to decide who to vote for, breadth of participation, keeping elected officials accountable, or the creation of at least an ostensibly equal political sphere. Instead, maintaining community solidarity and networks of reciprocity; a sense of fair treatment from those higher in the political hierarchy; and general amicable agreement are considered more important. The implications of this difference can be profound. For example, people in Senegal often choose their vote so as to maintain smooth social functioning rather than for a particular candidates platform (98). Even vote-buying can be a completely ethical form of exchange if it is perceived to be part of a properly reciprocal relationship (98).</span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><br />
</div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;"> </span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">However, Schaffer does not argue that democracy is untranslatable or that some cultures simply cannot conceive of democracy. Rather he argues that: “Democracy,”…is unique in the particular combination of its features; but each individual feature may still have analogues in other languages and cultures” (145). The ideals that come to be associate with democracy in any particular case are a mix of more familiar, internationally recognizable forms, and local concerns and culture. Which ideals become important and how they shape politics, however, and mean every case deserves its own attention. Schaffer’s approach has the advantage of not reducing democracy to simply elections nor relying on the uncritical use of measurements that rely on culturally specific political ideals. </span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><br />
</div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">However, the book never resolves the issue of whether these cultural forms are sometimes a type of false consciousness, or ideology, or veneer that hide exploitative or authoritarian realities. What are your experiences with democracy or discussing democracy with other people? Do you think democracy is universal or culturally relative? </span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"></div>Jason Hopperhttp://www.blogger.com/profile/03684719735097637389noreply@blogger.com3tag:blogger.com,1999:blog-5418301462057710132.post-90394362702155059442011-01-18T10:07:00.003-05:002011-01-20T07:11:36.189-05:00Tackling Non-Communicable Diseases in 2011<style>
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</style> </div><div style="margin: 0.1pt 0in;"><div class="separator" style="clear: both; text-align: center;"><a href="http://asweetlife.org/sitefiles/wp-content/uploads/2010/06/Caveman1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="220" src="http://asweetlife.org/sitefiles/wp-content/uploads/2010/06/Caveman1.jpg" width="400" /></a></div><br />
<span style="font-family: "Trebuchet MS"; font-size: 10pt;">2011 is going to be a turning point for making non-communicable diseases (NCDs) prevention/control a priority on the global agenda. The UN Summit on Non-Communicable Diseases will take place on September 19-20th, 2011 in New York, and will bring together UN Member States along with representation from the civil society to hammer out a global plan to respond to the growing threat of NCDs.</span></div><br />
<div style="margin: 0.1pt 0in;"><span style="font-family: "Trebuchet MS"; font-size: 10pt;">The major NCDs (cardiovascular diseases, diabetes, chronic respiratory diseases, major cancers) are the leading cause of mortality world-wide. They account for 60% (35 million) of global deaths, with the major burden (80%) in low- and middle-income countries (LMIC), 26% of which are premature deaths (before the age of 60 years). As shown in the table below, the NCD burden (as % of total DALYs) is projected to be the leading sources of DALYs by 2030 (<a href="http://www.who.int/healthinfo/global_burden_disease/2004_report_update/en/index.html">WHO, 2008</a>). Thus, NCDs are also a threat to the economies and development of nations, and the progress of the Millenium Development Goals. Despite this sobering information, funding for NCDs has represented <a href="http://www.cgdev.org/content/publications/detail/1424546">less than 3% of the global development assistance for health</a>. </span><span style="font-size: 10pt;"><a href="http://www.cgdev.org/content/publications/detail/1424546"><span style="font-family: "Trebuchet MS";"></span></a></span><span style="font-family: "Trebuchet MS"; font-size: 10pt;"></span></div><div style="margin: 0.1pt 0in;"><span style="font-size: 10pt;"><a href="http://www.who.int/healthinfo/global_burden_disease/en/index.html"></a></span><b><span style="font-size: 10pt;"> </span></b></div><div style="margin: 0.1pt 0in;"><br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjhZlxV7lcLW_WfMswo3FQk_eDxcsj8UnJrRdgNRnHKB5EjLK96BdHnmGSDlGQLT5ypFvDKVktNPOjD3Ot2bWcvgS19FjAUfvbAnDzSYX6SvkxLcWMzCUxH_7bDbxbXWBKGqqcIBNbs8g/s1600/Slide23.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjhZlxV7lcLW_WfMswo3FQk_eDxcsj8UnJrRdgNRnHKB5EjLK96BdHnmGSDlGQLT5ypFvDKVktNPOjD3Ot2bWcvgS19FjAUfvbAnDzSYX6SvkxLcWMzCUxH_7bDbxbXWBKGqqcIBNbs8g/s400/Slide23.jpg" width="400" /></a></div><div style="text-align: center;"><b><span style="font-size: 10pt;">[WHO Global Burden of Disease: 2004 Update (2008)]</span></b><span style="font-size: 10pt;"> </span></div></div><style>
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<div style="margin: 0.1pt 0in;"><span style="font-family: "Trebuchet MS"; font-size: 10pt;">Yet, all the statistics, evidence and good will won’t change the status quo without the political/social commitment and money, so a UN meeting is a major opportunity. The last UN Summit on a health issue was HIV/AIDS in 2001, which led to the establishment of the Global Fund and developed international efforts to address the disease. </span></div><div style="margin: 0.1pt 0in;"><br />
</div><div style="margin: 0.1pt 0in;"><span style="font-family: "Trebuchet MS"; font-size: 10pt;">However, the case of NCDs is a different beast, especially when it comes to creating consensus with the industries (tobacco, alcohol, and food/beverage). Apparently, the tobacco industry, which is considered part of the problem, was <a href="http://blogs.bmj.com/bmj/2010/11/26/richard-smith-the-moment-is-coming-for-chronic-disease/">excluded from the World Economic Forum</a> gathering in November 2010 to plan for the September 2011 UN Summit on NCDs. I am curious as to how the tobacco and alcohol industries will actually be tackled; tobacco will have to be invited to the table at some point for negotiations. On the other hand, major food and non-alcoholic beverage industries seem to be on board and have already made <a href="https://www.ifballiance.org/commitment-1-product-composition-and-availability.html">commitments</a> to help consumers have balanced diet and healthy lifestyles (such as food marketing, nutrition labeling, creating ‘healthier’ products). Yet, this social responsibility seems superficial, since the ‘unhealthy’ products they make are still being sold (although banning candy or soda sales, for example, is pretty unrealistic; outside restriction in school and work environments). Moreover, the economies of countries may depend on the sales of these products (i.e. China and tobacco), so finding a compromise for NCD prevention with industry will not be simple. </span></div><div style="margin: 0.1pt 0in;"><br />
</div><div style="margin: 0.1pt 0in;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2G7pG2J56akzD6n1iuEFbD4RBhnBRsIZ-aWps_WY-2UDqxI4ZWcm1vutlg7HZ7TSQuUtQqnNpixzTX0dQF6PFPXkB7Be78Sgn3jn7IoEcMI4uGnYAo8FJZLAZ4IjBnXpcJxNwCm7Sog/s1600/Slide1.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2G7pG2J56akzD6n1iuEFbD4RBhnBRsIZ-aWps_WY-2UDqxI4ZWcm1vutlg7HZ7TSQuUtQqnNpixzTX0dQF6PFPXkB7Be78Sgn3jn7IoEcMI4uGnYAo8FJZLAZ4IjBnXpcJxNwCm7Sog/s320/Slide1.jpg" width="320" /></a></div></div><div style="margin: 0.1pt 0in;"><span style="font-family: "Trebuchet MS"; font-size: 10pt;">A major advocate from civil society is the <a href="http://www.ncdalliance.org/node/51">NCD Alliance </a>(coalition of major international NCD groups: International Diabetes Federation, World Heart Federation, Union for International Cancer Control, International Union Against Tuberculosis and Lung Disease), established in May 2009. In preparation for the meeting, the group has been conducting research, collaborating with governments, NGOs and businesses for coordinating planning, engaging the media and raising awareness. Their ‘asks’ for the UN Summit include: governments be accountable and measured on NCD plans, <a href="http://www.who.int/fctc/en/">Framework Convention on Tobacco Control</a> to be fully implemented, global commitment to prevent the preventable, globally agreed approaches to NCD treatment and care, resources to deliver NCD interventions, and NCDs in the <a href="http://www.un.org/millenniumgoals/">MDG</a> successor goals. The earlier referenced <a href="http://www.blogger.com/post-edit.g?blogID=5418301462057710132&postID=9039436270215505944">BMJ blog post by Richard Smith</a> describes the WHO having similar priorities, and also emphasizing ensuring sustainable funding. </span></div><div style="margin: 0.1pt 0in;"><br />
</div><div style="margin: 0.1pt 0in;"><span style="font-family: "Trebuchet MS"; font-size: 10pt;">What I find promising are the goals to improve health systems at a primary care level (<a href="http://www.who.int/hpr/NPH/docs/declaration_almaata.pdf">Alma Ata Declaration</a> still going strong) and national capacities strengthening (including sustainable funding), which</span><span style="font-family: "Trebuchet MS"; font-size: 10pt;"> address the root structural and socioeconomic factors of poor health</span><span style="font-family: "Trebuchet MS"; font-size: 10pt;"> (pertaining to any condition). </span><span style="font-family: "Trebuchet MS"; font-size: 10pt;">These changes no doubt take time, but maybe efforts will speed up now, since the nature of NCD prevention requires creating conducive environments for healthy living. This means pushing for primary prevention solutions of the shared risk factors (tobacco, unhealthy diet, physical inactivity and harmful alcohol use) of NCDs, and addressing access to essential medicines and proper health services for secondary and tertiary prevention. </span><span style="font-family: "Trebuchet MS"; font-size: 10pt;">In this way, developing countries have the opportunity to learn from the epidemiologic transition (<a href="http://www.milbank.org/quarterly/830418omran.pdf">Omran, 2005</a>) </span><cite></cite><span style="font-family: "Trebuchet MS"; font-size: 10pt;">of developed countries and apply the necessary interventions to at least blunt the rise of NCDs. </span><span style="font-family: "Trebuchet MS"; font-size: 10pt;"> </span><br />
<br />
<span style="font-family: "Trebuchet MS"; font-size: 10pt;">(More references: <a href="http://bmb.oxfordjournals.org/content/early/2010/11/08/bmb.ldq037.full">This recent review article</a> summarizes the elements needed for a context-specific national NCD policy. <a href="http://www.lancet.com/series/chronic-diseases-and-development">The Lancet also had a series in November 2010</a> regarding NCD intervention strategies.) </span><br />
<br />
<span style="font-family: "Trebuchet MS"; font-size: 10pt;">To help the cause: The NCD Alliance has put together a summary on <a href="http://www.ncdalliance.org/node/54">how to get involved</a>. There’s also a dynamic <a href="http://ypchronic.org/partners/">web-based group of young professionals</a> focused on chronic disease issues. </span></div><div style="margin: 0.1pt 0in;"></div>Seema Shahhttp://www.blogger.com/profile/15892133127088008931noreply@blogger.com0tag:blogger.com,1999:blog-5418301462057710132.post-59605584888332715022011-01-17T14:00:00.006-05:002011-01-18T06:52:05.274-05:00For Profit/Non Profit Model<div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">I was going to publish a post today on <a href="http://www.nytimes.com/2011/01/15/opinion/15yunus.html?_r=1&scp=1&sq=yunus&st=cse">Muhammad Yunus' Op-Ed</a> in the New York Times this weekend but I'm still trying to figure out my own opinion on a number of Yunus' points. Don't get me wrong, putting a cap of Cost of Funds + 15% on interest rates is pretty stupid. 1, we don't all live in Bangladesh where population density is so high that even microfinance operating costs are low. 2, this strikes me a bit like price-setting but without controlling the apparatus to force it to work anyways. With a cap on rates in areas it is expensive to operate, microcredit would simply dry up. There wouldn't be any private profit-making but only because there wouldn't be much/any microcredit activity. </span></div><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;"><br />
</span></div><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">But I think Yunus has a point on, at least partial, community ownership of microfinance institutions. And I think he also has a point with regards to the role NGOs once saw themselves in the financial lives of their borrowers and the role new for-profit MFIs see for themselves. With all of that said, I'm undecided on whether private, for profit funding for microfinance is a net good. And regulation has a decidedly mixed record in the sector. So I'm going to take a few more weeks to think about this all and try to post on it in 2 weeks.</span></div><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;"><br />
</span></div><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">In the meantime, a few questions I haven't thought about much but am curious about:</span></div><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">1. Why does Bangladesh have a significant number of big, multi-sectoral, and domestically created community based organizations whereas few African countries do? Or am I suffering from a selection bias in those orgs I know of? <a href="http://www.brac.net/">BRAC </a>and <a href="http://www.grameen-info.org/index.php?option=com_content&task=view&id=465&Itemid=547">Grameen </a>come to mind quickly.</span></div><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">2. When will more South Asian NGOs and companies make big pushes into Africa and will they kill off less efficient, locally grown organizations/companies? Is this a good thing?</span></div><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">3. Will the Jets beat the Steelers next week?</span></div><div style="font-family: "Trebuchet MS",sans-serif;"></div><div style="font-family: "Trebuchet MS",sans-serif;"><div></div></div>BenElbergerhttp://www.blogger.com/profile/02501189348826302073noreply@blogger.com1tag:blogger.com,1999:blog-5418301462057710132.post-3402684455713619682010-12-20T04:00:00.045-05:002010-12-20T04:00:05.968-05:00Happy Holidays from MethodLogical and Band Aid!<div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">MethodLogical is going on hiatus for the holidays. We'll be back on January 17th with regular posts from our contributors. Over the next few weeks, we'll try to post interesting links and brief items as they arise and then pick up where we left off on the 17th.</span></div><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;"><br />
</span></div><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">As a holiday gift to you, our loyal readers, we offer the video below, Band Aid's "Do They Know It's Christmas?", our favorite catchy, well-intentioned, somewhat misguided, but pretty effective song to raise money for Africa. Written in 1984 by Bob Geldolf and Midge Ure and performed by an all-star lineup of British and Irish artists (many of whom have long been forgotten), the song sold 3.5 million copies and raised millions of dollars for famine-stricken Ethiopia.</span><br />
<br />
<span style="font-size: small;">Its lyrics, appealing for African relief, feature such gems as:</span></div><ul style="font-family: "Trebuchet MS",sans-serif;"><li><span style="font-size: small;">"The only water flowing is the bitter sting of tears" <i>(Sung, of course, by Sting himself)</i></span></li>
<li><span style="font-size: small;">"Where nothing ever grows, no rain or river flows"</span></li>
<li><span style="font-size: small;">"The Christmas bells that ring there are the clanging chimes of doom"</span></li>
<li><span style="font-size: small;">"Do they know it's Christmas time at all?" <i>(Spoiler Alert: They do.) </i></span></li>
</ul><div style="font-family: "Trebuchet MS",sans-serif;"><br />
</div><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">But hey, it's a good tune and raised a lot of money for people who really needed it. So enjoy the song and happy holidays from the MethodLogical team:</span></div><br />
<object height="385" width="480"><param name="movie" value="http://www.youtube.com/v/w5cX_ncZLls?fs=1&hl=en_US&rel=0"></param><param name="allowFullScreen" value="true"></param><param name="allowscriptaccess" value="always"></param><embed src="http://www.youtube.com/v/w5cX_ncZLls?fs=1&hl=en_US&rel=0" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="480" height="385"></embed></object>Adam Schwartzhttp://www.blogger.com/profile/10009267866977947931noreply@blogger.com0tag:blogger.com,1999:blog-5418301462057710132.post-31514035655337668042010-12-17T04:00:00.014-05:002010-12-26T07:06:16.769-05:00Defining Skilled Care: Assessing the Effectiveness of Community Health Workers<div style="font-family: "Trebuchet MS",sans-serif; text-align: left;"><span class="Apple-style-span" style="font-size: small;">The <a href="http://www.who.int/whr/2005/whr2005_en.pdf">2005 World Health Report</a> estimated that an additional 700,000 skilled birth attendants are needed to provide universal coverage of maternal and newborn services in the 75 countries where maternal and neonatal mortality is highest.<sup> </sup>The shortage of skilled health workers is particularly salient as the interventions which have the greatest effect on neonatal deaths are <a href="http://www.ncbi.nlm.nih.gov/pubmed/15781104">most dependent on skilled assistance</a>, rather than technology and products. Global actors advocate for a woman’s right to choose to deliver with a skilled attendant present, as well <span class="Apple-style-span">as for a reserved right to access safe professional care in case of emergencies or complications for either her or her baby. However, this right is greatly unfulfilled in developing countries. In south Asia and sub-Saharan Africa, where two-thirds of neonatal and maternal deaths occur, only about <a href="http://www.ncbi.nlm.nih.gov/pubmed/15781104">a third of women</a> deliver in the presence of a skilled attendant. These disparities persist within developing countries as well, as the richest women have six-times higher skilled attendance coverage than the poorest women.</span></span><br />
<br />
</div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;"><div style="text-align: center;"><span class="Apple-style-span"><span class="Apple-style-span"> </span></span></div></span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">In response to these huge shortages—and their implications for equitable access for the poorest—the use of community health workers has long been championed as cornerstone of PHC. Surrounding Alma-Ata in the 1970s and 1980s mass training of community health workers and traditional birth attendants was promoted by the WHO and others. As conceived within the principles of CBPHC, the CHW combines promotional, preventative and curative service functions for comprehensive health and wellbeing, including intersections with agricultural and economic needs of the community. CHWs were viewed as a much-needed link between formal health services and poor and marginalized communities. Indeed, several studies show that CHWs may be <a href="http://books.google.com/books?id=XetzQgAACAAJ&cd=1&source=gbs_ViewAPI">the only feasible and acceptable link to improve health in the near term</a>.<sup> </sup>And, these bridging activities can close gaps in preventative and curative care for greater effectiveness of services in the long term as well.</span><br />
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</div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><span style="font-size: small;"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5551389899044583634" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiak93JMzMTjMdfBh6F7kdzBGoI2t3LJ30BTe0i5zrGbbDq44zJqKgFXIOK8OKWsjFv50lqNlPfXz_RJJ9DkCef5thM_X3alzB95aoEqDWeUVqKeDYIOQzzPAniMvDKtwJNXlRuAuSbVUk/s400/tba+search.jpg" style="display: block; height: 400px; margin: 0px auto 10px; text-align: center; width: 300px;" /></span></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><div align="center" class="MsoNormal"><span style="font-size: small;"><i>A village health worker in Gadchiroli, India monitors newborns' growth. </i></span></div></td></tr>
</tbody></table><span style="font-size: small;"> </span></div><div align="center" class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><br />
<span style="font-size: small;">CHWs are also less susceptible to brain-drain and co-option into vertical programs. This is because their skills are specific to their community, and less transferrable than the skills of nurses or physicians. Additionally, CHWs often work to increase community management and ownership of health-related programs, and thus are accountable to their own communities, rather than an external organization. This, and the great sense of pride CHWs feel for their work, as well as the elevated status and respect they receive, further contribute to their desire to remain within their communities over time.</span><br />
<br />
</div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;"> </span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">While there is <a href="http://www.who.int/hrh/documents/community_health_workers.pdf">robust evidence</a> that <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2947035/pdf/BLT.09.064469.pdf">CHWs have been effective</a> in improving health—<a href="http://www.un-ngls.org/IMG/pdf_1273182834_71.179.158.10_FinalCBPHCReporttoERP-7July2009.pdf">especially child health</a>—implementation of CHW programs has been variable. Overall, CHW programs have been faulted for insufficient focus on training and supervision, and inadequate links with the health system, e.g. via referral systems. This has severely limited CHWs impact on neonatal health. A <a href="http://www.ncbi.nlm.nih.gov/pubmed/15020027">meta-analysis</a><sup> </sup>of mainly observational studies notes a small decrease in perinatal mortality (8%) and birth asphyxia-specific neonatal mortality (11%) in those cared for by trained traditional birth attendants. While positive, this impact suffers from the inadequate implementation constraints mentioned above.</span><br />
<br />
</div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;"> </span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">Due to differential quality of care in CHW programs, the 1990s witnessed a <a href="http://www.ossyr.org.ar/pdf/bibliografia/2.20.pdf">major reversal in policy</a>, with the WHO and other UN agencies strongly discouraging the use of traditional birth attendants and exclusively promoting facility births with skilled attendants. This remains the preferred option today, with calls for major investments in scaling-up midwifery, nursing and physician programs.</span><br />
<br />
</div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;"> </span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">While the need for quality, skilled care with linkages to the health system is crucial, the current global strategy creates a vacuum for poor communities currently experiencing the highest neonatal and maternal mortality rates. Training of midwives will take decades, and in the meantime communities will suffer.</span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;"> </span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">CHW programs are still relevant; as CHWs have a role to play that can be fulfilled neither by formal health services nor by communities alone. Furthermore, unlike the purely technical functions of midwives, CHWs are much-needed advocates for social change in the systemic causes of ill-health. However, better tools for measuring progress on these goals are needed to inform and support CHWs’ work.</span><br />
<br />
</div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;"> </span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span style="font-family: "Trebuchet MS",sans-serif; font-size: small;">We can learn from failed CHW programs in the past, and develop new innovative approaches to link the role of CHWs with a strong continuum between community and facility care. This sort of <a href="http://www.ncbi.nlm.nih.gov/pubmed/17933651">linking of care</a> has been demonstrated as much <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2806%2969387-2/fulltext">more effective</a> in reducing maternal and newborn deaths than focusing on either the community or facility alone. </span><span class="Apple-style-span" style="font-family: "Trebuchet MS",sans-serif; font-size: small;"><span class="Apple-style-span">For example, evidence shows that <a href="http://heapol.oxfordjournals.org/content/3/1/48.abstract">bringing traditional birth attendants into facilities</a> for training has been effective in promoting <a href="http://www.ncbi.nlm.nih.gov/pubmed/15279931">emergency obstetric referrals</a>.</span></span><span class="Apple-style-span" style="font-size: small;"><sup style="font-family: "Trebuchet MS",sans-serif;"><span class="Apple-style-span"> </span></sup><span class="Apple-style-span" style="font-family: "Trebuchet MS",sans-serif;">Additionally, skills of various cadres of workers can be combined into </span><a href="http://www.ncbi.nlm.nih.gov/pubmed/10361757" style="font-family: "Trebuchet MS",sans-serif;">collaborative teams</a><span class="Apple-style-span" style="font-family: "Trebuchet MS",sans-serif;">, with nurse-midwives supervising CHWs in community-based delivery, to raise access to skilled care over time. This “frontline health worker” team approach can also ensure focus on both maternal and neonatal health needs. For </span><a href="http://www.ncbi.nlm.nih.gov/pubmed/10622298" style="font-family: "Trebuchet MS",sans-serif;">example</a><span class="Apple-style-span">, tasking traditional birth attendants with primary responsibility for mothers, and village health workers with the health of the newborn. The creation of new cadres of community-based health workers for more comprehensive care across the lifecycle has also been undertaken; for example </span><a href="http://www.unicef.org/infobycountry/ethiopia_55449.html">multipurpose health extension workers</a><span class="Apple-style-span"> in Ethiopia.</span></span><br />
<br />
<span style="font-size: small;">WHO has recently held talks revisiting the role of traditional birth attendants and other community-level health workers. How can we continue to learn from the past, and find new ways of strengthening health workforce for the future?</span><br />
<span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span"> </span></span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;"> </span></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5418301462057710132.post-51338344281525955992010-12-15T02:20:00.002-05:002010-12-16T08:42:40.224-05:00Smoking is Still Really, Really Bad for You<div style="font-family: "Trebuchet MS",sans-serif;"><style>
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</style> </div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">Long before I entered medical school, the harms of smoking were drilled into me. For better or worse, as an elementary school kid, I stood by cigarette vending machines and told people not to smoke. At the risk of confusing correlation with causation, I must have been awfully successful, because <a href="http://www.gallup.com/poll/109048/us-smoking-rate-still-coming-down.aspx">smoking rates in the U.S. fell from 44% in the 1950s to 32% to the 1980s, all the way down to 21% in 2008</a>. Or perhaps it had something to do with legislation, taxes, restrictions on advertising, class action lawsuits, and public health outreach campaigns.</span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><br />
</div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">At any rate, if I spent my childhood learning that cigarettes were bad for you, medical school has shown me that they are even worse. Cigarettes are the <a href="http://www.inforesearchlab.com/smokingdeaths.chtml">cause of death in 33% to 50% of smokers</a>. And <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC437139/?tool=pmcentrez">smokers die an average of 10 (or more) years earlier than non-smokers</a>. Every American schoolchild should know that smoking causes lung cancer. Emphysema and heart disease get some attention too, though probably not enough. But did you know that smoking also causes bladder cancer? Pancreatic cancer? Gangrene? Erectile dysfunction? Osteoporosis? The list goes on. I won’t even get into the fact that <a href="http://www.bbc.co.uk/news/health-11844169">secondhand smoke accounts for 600,000 deaths annually, a third of those in children</a>.</span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;"> </span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;"> </span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><br />
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<tr><td style="text-align: center;"><a href="http://www.gearfuse.com/wp-content/uploads/2007/10/smoking.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="312" src="http://www.gearfuse.com/wp-content/uploads/2007/10/smoking.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Seriously, why would you even do that?</td></tr>
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<span style="font-size: small;">Smoking has gone from being a problem of rich countries to a problem of the developing world. Of the over <a href="http://www.inforesearchlab.com/smokingdeaths.chtml">5 million smoking-related deaths per year</a>, about <a href="http://www.cbsnews.com/stories/2003/09/12/health/main572833.shtml">half are in the developing world</a>. In India alone, almost <a href="http://www.nejm.org/doi/full/10.1056/NEJMsa0707719">1 million people a year die from smoking-related causes</a>. All told, <a href="http://www.avert.org/worldstats.htm">tobacco kills two to three times as many people a year as HIV</a>.</span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><br />
</div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">These figures don’t take into account the staggering morbidity of smoking- patients living with chronic disease, unable to breath due to emphysema or demented secondary tobacco-related strokes. All of this occurs in the context of strained health systems that lack the capacity to aid those living with disease; smoking-related illness simply taxes an already inadequate primary care infrastructure. (If health systems in the developing world were stronger, doctors and nurses at local clinics could educate and counsel people on the harms of smoking and the benefits of quitting.)</span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><br />
</div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">Why is this shift happening? Largely because of economics. The harder it is to sell cigarettes in America or Europe, the more appealing it is for tobacco companies to set up shop in countries with more lax regulations. Deficiencies in education and lack of knowledge of the adverse effects of smoking also help: in a <a href="http://quitsmoking.about.com/cs/antismoking/a/statistics_2.htm"> survey conducted in China</a>, 60% of people were unaware that smoking causes lung cancer and 96% of those surveyed did not know smoking causes heart disease. To wit, <a href="http://www.hsph.harvard.edu/news/press-releases/archives/2003-releases/press09122003.html">heart disease accounts for a third of smoking deaths, lung cancer for 17%, and emphysema for 20%</a>. (As an aside, I think it merits noting that heart disease kills more smokers than lung cancer and that people may "recognize" the effects of smoking in themselves and their friends/family more readily if they connect tobacco and cardiovascular disease.)</span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><br />
</div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">And while it’s more than fair to attack tobacco companies, did you know that <a href="http://en.wikipedia.org/wiki/China_National_Tobacco_Corp">the largest producer of tobacco in the world is the Chinese government</a>? It’s true: the China National Tobacco Corporation peddles more cigarettes than our good friends over at Phillip Morris or R.J. Reynolds.</span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><br />
</div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">It’s easy to point out a problem, but much harder to solve it. Smoking deaths are preventable, but only if the international community makes a concerted effort to curb tobacco use. First, we need to recognize smoking as a global health problem, like HIV, cholera, and malaria. Then, we need to enact international regulations like those we put into place in the U.S. It won’t be easy—standing up to American corporations AND the Chinese government is a tall task—but the benefits are painfully clear. Not without a struggle, the U.S. has decided that smoking prevention and cessation is vital to its national interests. It’s time we take that same view on smoking in the developing world. With the myriad health problems industrializing nations have to face, why should we tolerate millions of more deaths caused by a preventable, man-made product?</span></div>Adam Schwartzhttp://www.blogger.com/profile/10009267866977947931noreply@blogger.com4tag:blogger.com,1999:blog-5418301462057710132.post-23746167222821433612010-12-10T05:00:00.005-05:002010-12-10T07:33:35.126-05:00Paying for Health and Development Services for the Poor: Taking an Agnostic View<div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">Who </span><span style="font-size: small; font-style: italic;">should</span><span style="font-size: small;"> pay for health and development services in poor countries, especially for the poorest of the poor? Let’s just take that question for granted and look at the major views. Essentially this comes down to a battle of: Free Services vs. Cost-Recovery.
The “free services” logic goes like this: Poor people are, well, poor and they can’t really afford expensive health and development services. Human rights exist demanding that these services are provided, and therefore someone else has gotta pay. It’s an appealing argument. After all, many people believe that everyone is entitled to high quality health and education at the very least and these services are sure to cost more than the fewer than $2 a day that so many millions of people live on. But several questions can be raised. Who delivers this care? Because the care is provided free, what is the delivery organization’s incentive to provide quality care, to innovate, to be efficient? How can we transfer such large amounts of money (likely from outside poor people’s country) without <a href="http://www.dambisamoyo.com/deadaid.html">resulting in corruption</a>?</span></div><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;"><br />
</span></div><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;"><a href="http://t3.gstatic.com/images?q=tbn:ANd9GcRmqfpO4mciD5CWjk9xoxKmakoFqamQvAAHxSSg0KTHd8jdGGX3" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" src="http://t3.gstatic.com/images?q=tbn:ANd9GcRmqfpO4mciD5CWjk9xoxKmakoFqamQvAAHxSSg0KTHd8jdGGX3" style="cursor: pointer; display: block; height: 279px; margin: 0px auto 10px; text-align: center; width: 180px;" /></a></span><span style="font-size: small;"> </span></div><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">The “cost-recovery” logic goes like this: Poor people are poor, for sure, but health and development services need not be expensive. Just as markets have been used to improve computers and make them orders of magnitudes cheaper, so can the power of the markets be brought to bear on issues facing those at the bottom of the economic pyramid. And the only reason these markets don’t already exist is because we are only now beginning to recognize the vast fortune that could be made by businesses offering services to the poor. And this, of course would mean that we have to charge for our services (AKA have a business model that recovers costs through fees or insurance, not through external donations). This, also, is an appealing argument. After all, we have seen many governments and non-profits without a business model find themselves unable to pay for services, and worse, irresponsibly dealing with the money they do have because of perverse incentives. But again, several questions can be raised. If the service only goes to those who can pay, then how will the poorest within a country actually receive services? For services like healthcare, there are strong economic arguments against a system of fee-for-service at the point of service because the economics of healthcare are different as compared to most products. But despite these questions, there is success on both sides.</span></div><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;"><br />
</span></div><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">Most notably on the free care side is Partners in Health. Working with approximately $90 million a year to serve approximately 3 million people worldwide, PIH by most accounts is providing high quality, relatively comprehensive services for less than $30 a person per year while responsibly handling donations. Importantly, they have been able to use their success and human rights-based philosophy to leverage more donations. Some say PIH is unique (and with about 50% of their budget from individual, mostly unrestricted donations they are). But PIH isn’t just using their celebrity status to get their own funding. PIH is an advocacy organization in addition to a service delivery organization, and they are using this advocacy to create pots of money for other NGOs and governments to use for diseases like cancer and diabetes and for building underlying health systems, including surgical capacity.</span></div><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;"><br />
</span></div><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">Some of the most inspiring examples of organizations using cost-recovery are non-profits like <a href="http://brac.net/">BRAC</a>, Aravind Eye Care Hospitals (see the <a href="http://www.ted.com/talks/thulasiraj_ravilla_how_low_cost_eye_care_can_be_world_class.html">TED talk</a>), and <a href="http://www.narayanahospitals.com/brief.html">Narayana Hospitals</a>. These organizations have reached gigantic scale, at low-cost and high quality. Furthermore, they do serve the poorest of the poor by cross-subsidizing (charging the poorest of the poor less or nothing and getting away with it by charging more for those who can pay). While cross-subsidizing is a great model for these non-profits, it does speak to the fact that a for-profit offering these services would likely miss the truly poorest.</span></div><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;"><br />
</span></div><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">What do you think about this? Who should pay for these services, and how? Personally, I am agnostic. I added the word “should” to my questions because for many people this is a normative question. But for me, the only funding and delivery mechanisms that should be done are whatever funding and delivery mechanisms that actually work and in different places, that may well mean different things. We should be distrusting of any view that espouses a one-size-fits-all mentality.</span></div><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;"><br />
</span></div><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">Empirically speaking, some governments, some donors, some non-profits, and some business are extremely well-run, can find funds from someone (the poor, a government, an insurance program, donors), and offer a good product. Others are not capable of this. So in some places, one payment and delivery model will work great, in another place it would fail. Likely this is due to local ecologies of money, power, culture, and people. For health and development, my ideology is simple: having a bottom line that is impact for the poorest billions. When researchers look at interventions, they investigate for marked improvements to an individual or a community, but they are (or rather, should be) relatively agnostic to what the intervention is. When we look at organizations or systems, we should look to see if at scale it is offering a high quality, low cost product to the poor and that it has the capacity for adaptability, for innovation, and to be well-governed, but we can be agnostic to how it is funded and by whom. In that light, PIH, BRAC, Aravind Eye Hospitals, and Narayana Hospitals all make the cut (Who else do you know that makes it, and how have they worked on the funding issue?). So let’s stop focusing on ideologies of who should pay and how. These dialogues force us into simplistic and nonconstructive debates. We need to look at the nuances of local contexts and the nuances of various mechanisms, see what might work best, and if it fails, try try again.</span></div><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;"><br />
</span></div><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">But while I am ultimately agnostic, and I don’t believe in a one-size-fits-all approach, I admit that I have a bias for one approach that would seem to work in many place, and is worth a try. Here’s my personal view for making healthcare for the poor happen taking what I consider the best parts of PIH + the Global Fund + Single payer systems + Michael Porter’s value-based healthcare: </span></div><ol style="font-family: "Trebuchet MS",sans-serif;"><li><span style="font-size: small;">The PIH Step: PIH and other advocates focus their efforts on creating funds dedicated to ensuring equity in global healthcare delivery (and outside of delivery directly, these funds could be used for public goods key to health like healthcare worker training, water and sanitation, electricity, and roads). </span></li>
<li><span style="font-size: small;">The Global Fund/<a href="http://www.pnhp.org/facts/what-is-single-payer">Single Payer Step</a>: Donor funds are channeled to funding pools which no longer go directly to budgets for government or non-profit healthcare delivery, but instead go to government-administered (or in the case of weak governments, NGO delivered) national health insurance programs that ensure that the poor have coverage. It’s like single payer healthcare systems in poor countries, except instead of being entirely internal taxes, large contributions come from donors.</span></li>
<li><span style="font-size: small;"><a href="http://www.hbs.edu/rhc/">The Michael Porter Step</a>: These programs reimburse any institution (be it government, non-profit, or for-profit) that provides certain standardized care that is proven to be effective. This funding environment would be fertile ground for organizations like Narayana Hospitals, Aravind Eye Care Hospitals, and other organizations that have found better business models through high volume, low cost, high quality standardized care. </span></li>
</ol><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;"> This way of doing things is appealing to me because it disaggregates funding, payment, and delivery to parties that can do each well. Donors and advocates are typically better at building movements and securing funds. Governments are typically pretty good at pooling funds and reallocating them. Businesses (and some well-managed, cost-recovering non-profits) can typically achieve low-cost, high quality service delivery. And most importantly, as to our original debate, it’s a system I think human rights and market based folks can BOTH get behind because care can be free for the poor, but a market is created for service delivery. What do you think?</span></div>AndrewGhttp://www.blogger.com/profile/06130621118340208629noreply@blogger.com1tag:blogger.com,1999:blog-5418301462057710132.post-60299538065246708962010-12-08T07:31:00.005-05:002010-12-09T00:27:13.823-05:00How Does Happiness Measure Up in Development?<style>
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<div class="MsoNormal"><span style="font-family: "Trebuchet MS"; font-size: small;">Happiness is everywhere in development these days. France called in a team of hotshot economists to reorient its </span><span style="font-size: small;"><a href="http://www.guardian.co.uk/world/2010/nov/17/france-happiness-index"><span style="font-family: "Trebuchet MS";">economic policy</span></a></span><span style="font-family: "Trebuchet MS"; font-size: small;"> and now the Prime Minister of the UK says he wants to develop </span><span style="font-size: small;"><a href="http://www.guardian.co.uk/lifeandstyle/2010/nov/14/happiness-index-britain-national-mood"><span style="font-family: "Trebuchet MS";">a happiness measurement for the UK</span></a></span><span style="font-family: "Trebuchet MS"; font-size: small;">. But before France, and before the UK, the idea of happiness was making a name for itself in a much smaller and out of the way place—Bhutan.</span></div><div class="MsoNormal"><span style="font-size: small;"><br />
</span></div><div class="MsoNormal"><span style="font-family: "Trebuchet MS"; font-size: small;">Gross National Happiness (GNH), the Bhutanese incarnation of the idea, came about after the 4<sup>th</sup> King’s glib remark about the limits of Gross National Product (GNP). GNP was the dominant measurement of development at the time, one very similar to GDP. Bhutan, the king said, cared more about GNH than GNP, because economic growth alone was not what was </span><span style="font-size: small;"><a href="http://www.grossnationalhappiness.com/gnhIndex/intruductionGNH.aspx"><span style="font-family: "Trebuchet MS";">important</span></a></span><span style="font-family: "Trebuchet MS"; font-size: small;">. Even back in the 1970s when he made the comment, Bhutan’s king was far from the first to remark on the limitations of GNP, GDP, and the models of economic growth that accompanied them. Many before had noted that GNP and its successor GDP left out negative externalities, environmental impacts, and inequality. </span></div><div class="MsoNormal"><span style="font-size: small;"><br />
</span></div><div class="MsoNormal"><span style="font-family: "Trebuchet MS"; font-size: small;">The main point of GNH was that it questioned the ends of development and the conventional wisdom of the time. Should we place limits on growth? Was economic output the only measurement that concerned a developing country? What should a just society look like? In Bhutan’s case these were more about <i>Bhutan’s </i></span><span style="font-family: "Trebuchet MS"; font-size: small;">development and direction. In fact Bhutan developed its own vision of development that included inequality, the environment, and cultural preservation alongside economic growth. Although designed for Bhutan, the thinking behind it was more broadly relevant which is part of the reason I think it caught on globally. </span></div><div class="MsoNormal"><span style="font-size: small;"><br />
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<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: "Trebuchet MS",sans-serif; font-size: small;">Word to the wise: Do not try to pay your hotel bill in happiness.</span></td></tr>
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<span style="font-family: "Trebuchet MS"; font-size: small;">What GNH did, essentially, was remind us that it is not wealth itself we value, but what it brings us and our concern should be on how well we are meeting those ends. To get old school for a minute, this insight goes all the way back to Aristotle. In </span><span style="font-size: small;"><a href="http://people.wku.edu/jan.garrett/arisne1.htm"><span style="font-family: "Trebuchet MS";"><i>Nichomachean Ethics</i></span></a></span><span style="font-family: "Trebuchet MS"; font-size: small;"> Aristotle states that “wealth is evidently not the good we are seeking; for it is merely useful for the sake of something else.” It is also an insight that has not been lost on <i>some</i></span><span style="font-family: "Trebuchet MS"; font-size: small;"> modern economists—</span><span style="font-size: small;"><a href="http://www.amazon.com/Development-as-Freedom-Amartya-Sen/dp/0385720270"><span style="font-family: "Trebuchet MS";">Amartya Sen’s work</span></a></span><span style="font-family: "Trebuchet MS"; font-size: small;"> comes to mind.</span><br />
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<span style="font-family: "Trebuchet MS"; font-size: small;">However, recently in Bhutan, as well as in France and the UK, the idea of GNH has been reduced to a metric. This is, I think, a problem for several reasons. To begin, economics and economists already have alternative metrics to deal with other elements of development we may care about. For inequality, there are measurements like the Gini coefficient, and for the environment, well, there's a lot of literature devoted to just how to value the environment and its degradation. Similarly, there are a plethora of alternative measurements for development, <a href="http://en.wikipedia.org/wiki/Physical_Quality_of_Life_Index">PQLI</a> and <a href="http://en.wikipedia.org/wiki/Human_Development_Index">HDI</a> to name two, that try to incorporate elements of development other than economic output. So, to begin with I’m skeptical about the need for another metric.</span><br />
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</span></div><div class="MsoNormal"><span style="font-family: "Trebuchet MS"; font-size: small;">Perhaps more fundamentally, there’s the problem of measuring happiness itself. I have to admit the very idea of measuring happiness as a basis of economic policy is preposterous to me. Much like </span><span style="font-size: small;"><a href="http://www.guardian.co.uk/commentisfree/2009/dec/13/catherine-bennett-happiness-society"><span style="font-family: "Trebuchet MS";">Catherine Bennet</span></a></span><span style="font-family: "Trebuchet MS"; font-size: small;"> at <i>The Guardian</i></span><span style="font-family: "Trebuchet MS"; font-size: small;"> and </span><span style="font-size: small;"><a href="http://online.wsj.com/article/SB10001424052748704584804575644462228178840.html"><span style="font-family: "Trebuchet MS";">Jamie Whyte</span></a></span><span style="font-family: "Trebuchet MS"; font-size: small;"> at the <i>Wall Street Journal</i></span><span style="font-family: "Trebuchet MS"; font-size: small;">, I find serious problems with the idea of a standardized definition of happiness, both across individuals and cultures within a society and for those individuals and cultures across time. </span></div><div class="MsoNormal"><span style="font-size: small;"><br />
</span></div><div class="MsoNormal"><span style="font-family: "Trebuchet MS"; font-size: small;">In Bhutan this obsession with measurement has led to some fairly absurd consequences. The GNH survey conducted here consists of thousands of questions that take a ridiculously long time to administer. To give you an idea, the shortening of the survey is described like this on the official website: “The pilot survey questionnaire, which was found to be too lengthy, was pared down to a questionnaire that took half a day to interview.” A half a day still seems like an unreasonably long survey to me. The are other problems with the survey, which </span><span style="font-size: small;"><a href="http://www.grossnationalhappiness.com/gnhIndex/intruductionGNH.aspx"><span style="font-family: "Trebuchet MS";">I invite you to explore</span></a></span><span style="font-family: "Trebuchet MS"; font-size: small;">. </span></div><div class="MsoNormal"><span style="font-size: small;"><br />
</span></div><div class="MsoNormal"><span style="font-family: "Trebuchet MS"; font-size: small;">But aside from the specific problems with a GNH survey in Bhutan or the difficulty measuring happiness in general there is something else that bothers me about this way of incorporating happiness into development. To begin, it shifts development from an open and complex discussion about what the ends of development should be and whether they have been achieved to a simple calculation. Instead of discussing just or fair development, or, to note <a href="http://methodlogical.blogspot.com/2010/12/public-healthwhat-is-it-good-for.html">Brad’s post</a>, whether we care about the environment and other species as ends in themselves, and then evaluating, we merely have to see if our GNH index has gone up. </span></div><div class="MsoNormal"><span style="font-size: small;"><br />
</span></div><div class="MsoNormal"><span style="font-family: "Trebuchet MS"; font-size: small;">The second problem is that a GNH metric opens itself up for fundamentally undemocratic misuse. On the one hand, the metric moves discussions of the good life off the table and assumes whoever designed the metric knows what happiness is. Jamie Whyte (mentioned earlier) at the Wall Street Journal notes this is fundamentally illiberal and authoritative. But the other problem is that it opens the possibility of dismissing social problems. Much to my chagrin, my American-written sociology textbook here in Bhutan told my students that people in slums in India were poor, but happy and basically okay with their lot in life. A GNH index that “proves” this with numbers, I worry, would make it all the easier to dismiss concerns like poverty or the slashing of social programs because people are "happy" without them.</span></div><div class="MsoNormal"><span style="font-size: small;"><br />
</span></div>Jason Hopperhttp://www.blogger.com/profile/03684719735097637389noreply@blogger.com4tag:blogger.com,1999:blog-5418301462057710132.post-74127518100614420162010-12-07T11:04:00.004-05:002010-12-08T02:24:57.646-05:00What motivates one to serve?<span style="font-family: trebuchet ms; font-size: 85%;"> </span><span style="font-family: trebuchet ms; font-size: 85%;"><b><o:p></o:p></b><m:smallfrac val="off"><m:dispdef><m:lmargin val="0"><m:rmargin val="0"><m:defjc val="centerGroup"><m:wrapindent val="1440"><m:intlim val="subSup"><m:narylim val="undOvr"></m:narylim></m:intlim></m:wrapindent>I am probably preaching to the choir if you’re reading this blog post...as service is at the foundation of public health and social justice.<o:p></o:p> Yet, I think reflecting on personal motive in any work is healthy. A business school friend recently told me about <a href="http://en.wikipedia.org/wiki/Emotional_intelligence#Mixed_models"><span style="-moz-background-inline-policy: continuous; background: none repeat scroll 0% 0% white;">Goleman’s 4 constructs of emotional intelligence (EI)</span></a>, and <i>self-awareness</i> tops the list, followed by self-management, social awareness, and relationship management. <br />
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<b> </b> <b>Why serve?<u1:p></u1:p></b><o:p></o:p> <br />
A couple months back, I had an email exchange with a friend. She had written: <i>I do wonder what it means to be in service, at the [core], at the intention level.</i><o:p></o:p> She was referring to a deeper attitude of selfless service, called<i> Seva </i>in Sanksrit. Certainly, the concept crosses religions and personal belief systems. <o:p></o:p>Having grown up with an extended family that strongly believes in Seva, my motive to serve lies in a sense of duty, which inherently serves a personal function. This functional motivation of volunteering has been classified by <a href="http://cdp.sagepub.com/content/8/5/156.abstract"><span style="-moz-background-inline-policy: continuous; background: none repeat scroll 0% 0% white;">Clary et al (1998)</span></a> into 6 categories: <br />
</m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac></span><br />
<table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="margin-left: auto; margin-right: auto; text-align: left;"><tbody>
<tr><td style="-moz-background-inline-policy: continuous; background: none repeat scroll 0% 0% rgb(255, 192, 0); border: 1pt solid windowtext; font-family: "Trebuchet MS",sans-serif; padding: 0in 5.4pt; width: 1.2in;" valign="top" width="115"><b>Function</b><span style="font-size: 11pt;"></span></td> <td style="-moz-background-inline-policy: continuous; background: none repeat scroll 0% 0% rgb(255, 192, 0); border-color: -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0in 5.4pt; width: 261pt;" valign="top" width="348"><b>Distinguishing elements of the function</b><span style="font-size: 11pt;"></span></td> </tr>
<tr> <td style="border-width: medium 1pt 1pt; padding: 0in 5.4pt; width: 1.2in;" valign="top" width="115">Values<span style="font-size: 11pt;"></span></td> <td style="border-width: medium 1pt 1pt medium; padding: 0in 5.4pt; width: 261pt;" valign="top" width="348">To express important values<span style="font-size: 11pt;"></span> Feeling that it is important to help others<span style="font-size: 11pt;"></span></td> </tr>
<tr> <td style="border-width: medium 1pt 1pt; padding: 0in 5.4pt; width: 1.2in;" valign="top" width="115">Understanding<span style="font-size: 11pt;"></span></td> <td style="border-width: medium 1pt 1pt medium; padding: 0in 5.4pt; width: 261pt;" valign="top" width="348">Seeking to learn more about the world<span style="font-size: 11pt;"></span> A chance to exercise skills and abilities that might otherwise go unpracticed<span style="font-size: 11pt;"></span></td> </tr>
<tr> <td style="border-width: medium 1pt 1pt; padding: 0in 5.4pt; width: 1.2in;" valign="top" width="115">Social<span style="font-size: 11pt;"></span></td> <td style="border-width: medium 1pt 1pt medium; padding: 0in 5.4pt; width: 261pt;" valign="top" width="348">To be with like-minded people<span style="font-size: 11pt;"></span> To be engaged in an activity viewed favorably by important others<span style="font-size: 11pt;"></span></td> </tr>
<tr> <td style="border-width: medium 1pt 1pt; padding: 0in 5.4pt; width: 1.2in;" valign="top" width="115">Career<span style="font-size: 11pt;"></span></td> <td style="border-width: medium 1pt 1pt medium; padding: 0in 5.4pt; width: 261pt;" valign="top" width="348">To explore different career options<span style="font-size: 11pt;"></span> To look good on one’s CV<span style="font-size: 11pt;"></span></td> </tr>
<tr> <td style="border-width: medium 1pt 1pt; padding: 0in 5.4pt; width: 1.2in;" valign="top" width="115">Protection<span style="font-size: 11pt;"></span></td> <td style="border-width: medium 1pt 1pt medium; padding: 0in 5.4pt; width: 261pt;" valign="top" width="348">To reduce guilt over being more fortunate than others<span style="font-size: 11pt;"></span> To help address personal problems<span style="font-size: 11pt;"></span></td> </tr>
<tr> <td style="border-width: medium 1pt 1pt; padding: 0in 5.4pt; width: 1.2in;" valign="top" width="115">Enhancement<span style="font-size: 11pt;"></span></td> <td style="border-width: medium 1pt 1pt medium; padding: 0in 5.4pt; width: 261pt;" valign="top" width="348">For personal growth<span style="font-size: 11pt;"></span> To develop ‘psychologically’</td></tr>
</tbody></table><div style="text-align: center;"><span style="font-family: trebuchet ms; font-size: 85%;"><m:smallfrac val="off"><m:dispdef><m:lmargin val="0"><m:rmargin val="0"><m:defjc val="centerGroup"><span style="font-size: 78%;">Table modified from://www.voluntaryaction.info/voluntaryaction/freearticles/article1_unstead-joss.pdfi</span></m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac></span> </div><span style="font-size: 85%;"> </span><br />
<div style="font-family: trebuchet ms; line-height: 115%;"><br />
<span style="font-size: 85%;">The functional theory is appropriate to explain simplistic motivation at an individual/immediate level. Below are other theory bits/concepts (not comprehensive) that describe societal factors which affect service culture and volunteerism:</span><span style="font-size: 85%;"> </span></div><span style="font-family: trebuchet ms; font-size: 85%;"> </span><br />
<ul style="font-family: trebuchet ms;" type="disc"><li class="MsoNormal" style="line-height: normal;"><span style="font-size: 85%;">Collectivism vs. Individualism: Collectivism is more strongly related with altruistic motivation and desire to strengthen social ties, and development of a volunteer role (i.e. religious, community groups, cultural norms). Individualism is associated with career-related objectives (i.e. social service for resume)(Finkelstein 2010)<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-size: 85%;">Social origins theory: More volunteering where there is limited government social spending, a fee-dominated revenue structure, a large non-profit sector, and a small paid workforce. Volunteering is mainly service provision. (Salamon and Sokolowski 2001; Hwaung 2005)<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-size: 85%;">Role identity theory: Social norms provide the impetus to start volunteering. With continued service, the individual establishes a volunteer role identity, and this new identity drives further participation. Similar to Individualism. (Grube & Pilivin 2000)</span><span style="font-size: 85%;"> </span></li>
</ul><span style="font-family: trebuchet ms; font-size: 85%;"><b>Developing service ethic </b></span><span style="font-family: trebuchet ms; font-size: 85%;"> </span><br />
<div style="font-family: trebuchet ms; line-height: 115%;"><span style="font-size: 85%;">In the US and India, I have had the pleasure of being involved with amazingly dedicated public health/medical/development workers who embody selfless service. For example, the heads of <a href="http://manzil.in/">Manzil</a> (=destination; youth empowerment) Delhi and <a href="http://www.manavsadhna.org/">Manav Sadhna</a> (=devotion to mankind; community empowerment), in Ahmedabad, Gujarat, inspire others by their example. Their approach is collective (not individualistic) which results in value/social/understanding motivation functions that are adopted by those they help and the staff. These leaders are able to make local, context-specific changes, which are maintained because of high buy-in from the staff and community. In this way, they have actually produced a new generation of service-minded citizens who want to change the vices of society and improve equity.</span> <br />
<span style="font-size: 85%;"> </span></div><span style="font-family: trebuchet ms; font-size: 85%;"> </span><br />
<div class="separator" style="clear: both; font-family: trebuchet ms; text-align: center;"><span style="font-size: 85%;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgjEM3_vnlvos-d8elsfHY6WiwljGsNmEL9TVCu_DhoiMUWJqJOM7LE0-7oEK7D77D9wUf7JkMJx9z9B41v2W9F8Q3XbMbQ6clq7MYMSY3MZov5tiSe0kVxk0n7pgLSZ1C8dtzi9aDJ9A/s1600/December+063.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgjEM3_vnlvos-d8elsfHY6WiwljGsNmEL9TVCu_DhoiMUWJqJOM7LE0-7oEK7D77D9wUf7JkMJx9z9B41v2W9F8Q3XbMbQ6clq7MYMSY3MZov5tiSe0kVxk0n7pgLSZ1C8dtzi9aDJ9A/s400/December+063.jpg" width="400" /></a></span></div><span style="font-family: trebuchet ms; font-size: 85%;"> </span> <br />
<div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">To end, one of the boys, Raju (picture above), who grew up in the slums around Manav Sadhna and was schooled and trained by the NGO, is now in his mid-20s and has returned to his village to address public health and development issues. In the course of 1.5 years, he has implemented a waste management program, personal hygiene programs for school children, computer classes for youth, addressing alcohol abuse and sexual violence...and is going strong.<o:p></o:p></span><span style="font-size: small;"> </span><span style="font-size: small;"><o:p></o:p></span></div>Seema Shahhttp://www.blogger.com/profile/15892133127088008931noreply@blogger.com0tag:blogger.com,1999:blog-5418301462057710132.post-1109731655411427292010-12-06T09:19:00.007-05:002010-12-06T10:33:07.300-05:00Direct Distribution<div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">Two weeks ago I wrapped up some vacation on the island of <a href="http://en.wikipedia.org/wiki/Lamu">Lamu</a> off the coast of Kenya. Friends from Kenya recommended it to see the traditional, Swahili culture of the coast and it was really quite different from the rest of Kenya. We ended up staying in a village close to Lamu called Shela where there were no cars (lots of donkeys) and enjoyed a really relaxing few days amidst one of Kenya's hidden gems. If you're considering going to Lamu, definitely call <a href="http://www.lamutravel.com/">Gabe and Susan</a> to arrange everything.</span></div><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;"><br />
</span></div><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">One of the reasons I made an effort to visit Lamu this past trip is that there is a major upcoming infrastructure project to build a <a href="http://www.stimson.org/spotlight/proceed-with-caution-the-lamu-port-development/">deep water port</a> which many, unfortunately, fear will fundamentally change the character and culture of the area. Kenya already has East Africa's major port in Mombasa, just down the coast, where imports and exports as far as eastern Congo flow through. The Lamu port is intended to manage imports and exports from Ethiopia and South Sudan who both have neighbors to the north they're not too fond of.</span></div><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;"><br />
</span></div><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">All of this got me thinking about South Sudan and the upcoming secession referendum on January 9th. Like nearly all commentary out there on the vote, I can't imagine the South voting for anything other than secession. If all goes as planned, and that is a serious "if" given the North's history of violence in the South, their reliance on southern oil for the economy, and some recent bombings near the <a href="http://www.bbc.co.uk/news/world-africa-11751828">border</a>, Southern Sudan (aka South Sudan aka New Sudan) will be the world's newest country endowed with enormous oil reserves and a quasi-functioning government run by the former rebel SPLM/A.</span></div><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;"><br />
</span></div><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">Todd Moss and others at the Center for Global Development have been writing and talking about an interesting concept in which countries endowed with oil resources directly distribute some or all of the revenue directly to their <a href="http://www.cgdev.org/section/initiatives/_active/revenues_distribution">citizens</a>. It's an interesting idea to attack the oil curse, drain the pool of funds that politicians find nearly impossible not to take from and align the incentives for good and accountable governance. I am not aware if there are plans to do this in South Sudan but where government is least effective, the incentive to directly distribute seems to be highest.</span></div><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;"><br />
</span><br />
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<tr><td style="text-align: center;"><a href="http://www.colorado-video.com/observerapps_files/oil-rig.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="http://www.colorado-video.com/observerapps_files/oil-rig.jpg" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Of the people, by the people, for the people?</td></tr>
</tbody></table><br />
<span style="font-size: small;">Ok, all of that is actually the prelude to 2 questions I won't answer but am curious to hear others' thoughts on: </span></div><div style="font-family: "Trebuchet MS",sans-serif;"><ol><li><span style="font-size: small;">Could/should we directly distribute most aid to the poor and let local NGOs, companies, and international players compete for the poor's business?</span></li>
<li><span style="font-size: small;">Given health's information asymmetries, where might this work and where might it not? When the poor are not fully informed, is it more efficient to administer funds centrally or simply spend to market and educate the poor on good practices (e.g., using malaria nets for kids, etc.)?</span></li>
</ol></div>BenElbergerhttp://www.blogger.com/profile/02501189348826302073noreply@blogger.com1tag:blogger.com,1999:blog-5418301462057710132.post-37301959307658610752010-12-03T04:00:00.003-05:002010-12-03T05:44:05.281-05:00Public health…what is it good for?<style>
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<div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">Before we begin our journey, and before you read below, I want us to close our eyes and think of what <i>public health</i> means to us. What would your definition be? For what end? For whom? By whom? What is “health”, “healthy”?</span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><br />
</div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">What did you come up with? Did anyone expressly think of improving the health of <a href="http://query.nytimes.com/gst/fullpage.html?res=9401E7DA1138F932A35751C1A9649C8B63">sand flies in California</a> ? Of the <a href="http://www.sciencedaily.com/releases/2010/06/100628124611.htm">dead zone in the Gulf</a>? Of <a href="http://oceanworld.tamu.edu/resources/oceanography-book/desertificationinsahel.html">desertification in the Sahel</a>? </span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><br />
</div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">The mouthful, but often heralded, WHO definition of public health is “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” However, it is implicitly accepted that this is anthropocentric. Do we all agree that this is ideal? Humans are animals. Evolution is not over. We are not the end of “progress”, yet we act as if we are the terminus. We tacitly accept and believe that improving the health of <b>humans</b> is the focus of even <b><u>global public health</u></b>; interpreting the <b>global </b>as wherever humans are. </span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><br />
</div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">Now, to state my conflicts of interest outright, I believe that the environment has intrinsic value. If you ask me: “what good is it to save sand flies”, I would reply with <b><i><u>what good are you</u></i></b><i>? </i>Humans seem to think that we have a right to life, liberty, and the pursuit of happiness, regardless of our utility: that we have intrinsic value. Even other humans which we might deem to have negative societal impact deserve these <b>universal <u>human </u>rights.</b> Perhaps this is why we are all in the field of public health, but, what I want to ask is...why are we so <b><u>special</u></b>? We need to move towards a<b> </b>treatise of <b>universal <u>natural or biotic</u> rights. </b></span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><br />
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<tr><td style="text-align: center;"><a href="http://www.sis-tech.com/images/citizenship/we_share.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="262" src="http://www.sis-tech.com/images/citizenship/we_share.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">A nice sentiment, but is it lacking in scope?</td></tr>
</tbody></table><br />
<span style="font-size: small;">Interestingly enough, it seems to becoming more and more clear that a biocentric worldview does in fact improve the health (life) and happiness of individuals more than an approach focused solely on humans. Our society and science imply that the solutions to current environmental problems are not a strong paradigm shift of human behaviors, but only <b>more</b> (attempted) mastery of the Earth and Earth processes. We will solve global warming by <a href="http://books.google.com/books?id=4me_YAJrCqsC&pg=PA101&lpg=PA101&dq=Jeffrey+Sachs+sequester+C02&source=bl&ots=NIISbMxstL&sig=odTHzIRKuFqIzreENBOtVV3sQO0&hl=en&ei=inPpTPGgFcSblge23JR7&sa=X&oi=book_result&ct=result&resnum=1&ved=0CBMQ6AEwAA#v=onepage&q&f=fals">pumping C0<sub>2 </sub>into the ground</a> (á la Jeffrey Sachs). I don’t think there could be a more anthropocentric, arrogant-in-the-possibility-of-science-solving-our-problems-without-us-having-to-change-our-ways “solution” to our behavior caused problem. It will all come around in the end as we realize that our anthropocentric (“unnatural”, [“artificial flavoring”]) way of interacting with the earth leads to unhappiness (depression, phobias), early death (cancers), and the weakening of the <a href="http://www.jstor.org/pss/3545824">rivets</a> in our global ecosystem. We won’t be around to see the distal effects, but the proximal results are already in print, we just don’t know how to read them since we <a href="http://www.harpers.org/archive/2009/09/0082640">systematically eradicate</a> thinking <b>truly</b> (creatively) outside the box. Let us be truly humble humans, realizing that even if we surround ourselves with concrete we are inextricably linked to nature, and with the <a href="http://www.serconline.org/PrecautionaryPrincipleState.html">precautionary principle</a> winning the day. </span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><br />
</div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">I need your help though. What is the answer? If I wish to live in American society I must be ready to sacrifice some of my ideals. How much do we sacrifice? How do we decide what to sacrifice and what to fight? I want to never own a car. People say "good luck". </span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><br />
</div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">How do we change the paradigm? How do we get there from here? What does this mean for <b>global biotic health</b>?</span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><br />
</div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;"><i>Brad Wagenaar is a guest contributor on MethodLogical. He is an MPH student at the Emory School of Public Health, focusing on Global Epidemiology. He is a returned Peace Corps volunteer from Cameroon who loves biking and crazy ideas. </i></span></div><div class="MsoNormal" style="font-family: "Trebuchet MS",sans-serif;"><br />
</div>Bradhttp://www.blogger.com/profile/18264956782668766881noreply@blogger.com1tag:blogger.com,1999:blog-5418301462057710132.post-66861182942595662922010-12-02T04:00:00.022-05:002010-12-02T12:32:53.220-05:00Social Intervention as a Pre-Requisite?<div style="text-align: left;"><span style="font-size: small;"><span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif;">When a doctor sees a patient with schistosomiasis, a common water-born parasitic disease that affects over 250 million children in the developing world, the treatment given is a single oral dose of praziquantel. But the doctor is well-aware that since transmission of schistosomiasis is through water-dwelling snails, the longer-term cure that will prevent that patient from returning next year with the same disease is quite a different treatment -- in fact, a treatment that doesn't involve medicine at all. In fact, the long-term solution lies in water sanitation -- ensuring reliable access to non-contaminated water, combined with continuous mulluscicidal treatments of that water source. Similarly, when a doctor sees a patient with another parasitic disease, such as hookworm, that has oral-fecal transmission, the treatment given is 400 mg of Albendazole. But the answer to ensuring against re-infection in the longer term lies in urban planning and engineering: the installation of a sanitary and effective sewage system. </span></span></div><div><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif;"> </span></span><br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><span style="font-size: small;"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5544730667734477410" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjU3pMRR2tjbogzSBVPblfYoZaeOhfccxzlUSTR9zHDM-jKcTYvRmJcohSdymsngw_bxmjcoF_YixJagJ1byZrnJamYhmFqpFN86at30KbBlQiO2-VPy0-AbMu6Iu2h3DiTYy-lLyQyDu8/s400/schisto.jpg" style="display: block; height: 164px; margin: 0px auto 10px; text-align: center; width: 148px;" /></span></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><div style="text-align: center;"><span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif;"><span class="Apple-style-span" style="font-size: x-small;">Rwandan Boy Infected with Schistosomiasis</span></span></div></td></tr>
</tbody></table><div class="MsoNormal" style="text-indent: 0.5in;"><span style="font-size: small;"> </span><br />
<span style="font-size: small;"><span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif;">Are clinicians and economists alike are too quick to tackle the problems of pandemics like schistosomiasis, hookworms, and other diseases without addressing the basic underlying causes of poverty? What we often call </span><b><span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif;">root causes</span></b></span><span style="font-size: small;"><span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif;"> of poverty, such as hunger, malnutrition, lack access to safe drinking water, are perhaps primary conditions that need to be addressed in order to effectively mitigate disease.</span></span><br />
<span style="font-size: small;"> </span></div><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif;"> </span></span><br />
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<tr><td style="text-align: center;"><span style="font-size: small;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiWs-U2V4cud63PBTfJ2CX5eARmpSPLhAdy6LQtdote-TJ_z_-XqgcT9y4oehdEhAGL0iKD58HdFYOOz1Akpzp5OEOduef8fTbjh2TqVRBlwc-xxp5pkOOyfE25w1Xz6M98C2j0Pm2FEiM/s1600/Praziquantel.bmp" style="color: blue; margin-left: auto; margin-right: auto; text-decoration: underline;"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5544729736206414626" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiWs-U2V4cud63PBTfJ2CX5eARmpSPLhAdy6LQtdote-TJ_z_-XqgcT9y4oehdEhAGL0iKD58HdFYOOz1Akpzp5OEOduef8fTbjh2TqVRBlwc-xxp5pkOOyfE25w1Xz6M98C2j0Pm2FEiM/s400/Praziquantel.bmp" style="display: block; height: 289px; margin: 0px auto 10px; text-align: center; width: 400px;" /></a></span></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><div class="MsoNormal" style="text-indent: 0.5in;"><span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif;"><span class="Apple-style-span" style="font-size: x-small;"><a href="http://endtheneglect.org/tag/sierra-leone/">Schoolchildren in Sierra Leone Eating Before Receiving Praziquantel Treatment</a></span></span></div></td></tr>
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<span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif;">Today, much of the global health literature does place more emphasis on holistic poverty alleviation efforts rather than purely clinical intervention. For example, </span><a href="http://www.amazon.com/Twenty-First-Century-Fully-Revised-Updated/dp/1403997683"><span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif;">Barnett and Whiteside</span></a><span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif;"> argue that neither public health nor clinical medicine pays sufficient attention to what does improve health – escaping from poverty, access to good food, clean water, sanitation, shelter, education and preventative care. They go as far as to say that clinical medicine may have large effects on short-term health, but only marginal effects on people’s long-term health. Jeffrey Sachs puts forth the same argument, saying that people studying health systems should widen their perspective to include links with poverty-alleviation strategies, and vice-versa.</span></span></div><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif;"> </span></span><br />
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<tr><td style="text-align: center;"><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif;"><img alt="© 2009 NEED Communications" height="403" src="http://www.needmagazine.com/Issue03/images/NEED03_Future01.jpg" style="margin-left: auto; margin-right: auto;" width="270" /></span></span></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><div class="MsoNormal" style="text-align: center; text-indent: 0.5in;"><span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif;"><span class="Apple-style-span" style="font-size: x-small;">Contaminated Water Source in Southwestern Ethiopia</span></span></div></td></tr>
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<span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif;">I don’t believe that poverty alleviation is a pre-requisite for clinical intervention. </span><b><span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif;">N</span></b><b><span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif;">either clinical intervention nor social intervention alone can drive progress. The two are inextricably linked.</span></b><span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif;"> Poor people view and value their health in a holistic sense, as a balance of physical, psychological, and community well-being. This view, consistent with the WHO definition of health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity,” is remarkably consistent across ages, genders, cultures, and nationalities. In a qualitative study of over 60,000 poor women and men across the globe, the World Bank and WHO found that people overwhelmingly link disease and ill-health to poverty. No probing questions on health or disease were included in the study’s research guides, yet overwhelmingly health was central to poor people’s lives. The implications of these findings are that perhaps it does not even make sense to discuss clinical interventions in isolation. Instead, clinical interventions should be viewed as one piece of the puzzle in larger social interventions.</span></span></div><div class="MsoNormal" style="text-indent: 0.5in;"><span style="font-size: small;"> </span><br />
<span class="Apple-style-span" style="font-size: small;"><a href="http://methodlogical.blogspot.com/2010/12/hiv-negativity.html"><span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif;">In his post yeseterday</span></a><span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif;">, Adam Schwartz expounded upon this very idea in the context of HIV/AIDS: "If there is funding to provide antiretrovirals to pregnant women with HIV, but no prenatal care, no surgical facilities for emergency caesarian sections, no trained surgeons, and no antibiotics for neonatal infections, then we may erase all the good of our initial interventions." These same sentiments are echoed by Stanford's </span></span><span style="font-size: small;"><a href="http://id.medicine.ucsf.edu/about/facpages/tien.html"><span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif;">Dr. Phyllis Tien</span></a></span><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif;"> when she is scaling up HAART distribution programs. She has a laundry list of “prerequisite conditions” that must be met beforehand -- including adequate infrastructure, minimal lab support, relatively informed communities, counseled patients, and access to OI/symptomatic treatment. She argues that without satisfying these basic economic conditions, a clinical intervention will fall short. </span></span><span class="Apple-style-span" style="font-size: small;"><span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif;">Poor nutritional status is also a prevalent factor that can exacerbate HIV/AIDS. Malnutrition can plague the effectiveness of ARV treatment, increase vulnerability to infections or increase the severity of those infections. Coupling drug therapy treatment with good nutrition not only strengthens the immune system, but can help delay the disease progression and provide the crucial micronutrients the body needs to fight HIV. So without social interventions that fight the underlying malnutrition in HIV/AIDS patients, the clinical interventions would be significantly undermined.</span></span></div><div class="MsoNormal" style="text-indent: 0.5in;"><span class="Apple-style-span" style="font-family: 'times new roman'; font-size: small;"><span class="Apple-style-span"> </span></span></div></div>Pamela Sudhttp://www.blogger.com/profile/06215100014424853266noreply@blogger.com0