MethodLogical

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Shout outs Posted: 08 Apr 2011 04:16 PM PDT In the process of looking through the research paper that underlies the Michael Clemens post I linked to, I realized that the RA for the paper was Paolo Abarcar, who is actually one of my classmates here at Michigan economics. Even better, he has a blog with a development focus, which I have added to the blogroll over on the right-hand side of the ML homepage. Also on the brand-new blogroll list is Naman Shah, who provided an expert counterpoint to my arguments against the use of mefloquine as a malaria prophylaxis for travelers. He runs the Malaria blog, which has great links and commentary about the disease I increasingly believe may be the most important challenge in development. 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 major internet fame: methodlogical at gmail dot com.

Legalizing Bribery to Reduce Corruption? Posted: 07 Apr 2011 09:30 PM PDT Interesting article on Marginal Revolution 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 here.

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Why the Poor Don't Soak the Rich in the U.S.

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:

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: why don't we see similar uprisings of the poor against the rich right here in the United States? Or in other words, why don't the poor soak the rich in the U.S.?
 

This morning, Harvard Kennedy School Professor Tarek Masoud, 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.

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 it is the very people that would benefit from redistributive policies such as the inheritance tax that are voting against them! Why is this so? He posed a few different explanations:
 

One explanation he dubbed "empathy gulf". 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.

Second, Masoud posed that people in the U.S. may harbor irrational beliefs about their own upward mobility. 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 Pew Research Center. 41% of Americans making less than $20,000 identify as "middle class", as well.

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 the free market is a fair distributive instrument. 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.

Being Big Becoming a Bigger Problem

This week Lancet published a model reviewing changes in average BMI 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 western diets deserve a good deal of the blame), as are the consequences. But it merits reiterating the point Seema made in a previous blog post: 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 Niger it is an annual reality. But we must be vigilant about the hazards of excess as well as scarcity.

Note: For those unfamiliar with statistical jargon, the "posterior probability" referred to in the article is not a reference to study subjects' backsides.

Articles about obesity trends always seem to feature a picture of an overweight person from behind. That doesn't seem very nice, does it?

Global Fund Rebutall

An interesting editorial in the Washington Post by Michael Gerson responds to the criticism the Global Fund to Fight AIDS, Tuberculosis and Malaria has been receiving recently. As mentioned on this blog, 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.

Revolution in 140 Characters: Thinking About Information Technology and Politics

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.
 

The problem at hand in discussions of Facebook, Twitter, or the internet more broadly is technological determinism. 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.
 

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.
 

One of, if not the most infamous critical assessment of the use of social media in social movements comes from Malcom Gladwell’s 2010 piece for the New Yorker. 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.

Whatever happened to the Iranian "Twitter" revolution?

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 coordinating group actions or in trying to garner international support. Indeed communication technologies sometimes do play vital roles in popular uprisings.
 

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 tempered his stance. In contrast to Gladwell, Morozov focuses on the fact that internet technologies are not inherently liberating. Far from ushering in an “open society”, 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 Facebook group to support the cause. There is nothing inherently progressive about the internet and its effects and uses will always depend on context.
 

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—the telegraph, 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 “receiving context” 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.

Serious politics or playing FarmVille?

 

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 invention of those outside the country. 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.

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 fetishization of media technology a more nuanced, context sensitive discussion that addresses these questions.

Don't Forget the Ivory Coast

With all the media attention surrounding the political uprisings and regime changes in Tunisia and Egypt, the media seems to have forgotten about the political power struggle in the Ivory Coast, where former president Laurent Gbagbo is attempting to cling to power in the wake of Alassane Ouattara's election victory.

Given the media's relatively short attention span when it comes to news in sub-Saharan Africa, it's important to remember that stories don't end just because coverage does.

King Wolfowitz's Ghost

Paul Wolfowitz's turbulent tenure as World Bank president was marked by an aggressive anti-corruption agenda. Apparently, Germany is also disturbed by apparent corruption.  The BBC 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.

Germany halts Aids fund payment over corruption claims

Germany has suspended its annual payment of more than 200m euros (£172m) to the Global Fund against Aids, TB and malaria, following corruption claims. 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.

 Read the full article here:

Pay the Poor

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 here.

Can Satire Be True?

From our good friends at The Onion

Gap Between Rich And Poor Named 8th Wonder Of The World

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."

Read the full article here.

Motivation

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 Freireian 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.

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 Boy Named Sue,” (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.

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 motivated—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 motivated and write them.”

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.

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 motivated by a sense of “professional conscience,” 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 supportive supervision by superiors at referral levels.

Similarly, Richard Levins writes on our role as “radical health workers”:

“ …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.’”

As several recent Methodlogical posts have discussed, often what motivates us—to vote, or to serve—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 you think we can change our systems—and the incentives inherent to them.

Market-Based Solutions to International Development?

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.

1. LifeStraw. Designed by Swiss company Vestergaard Frandsen, 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).

LifeStraw

2. Banana Leaf Sanitary Pads. Elizabeth Scharpf, founder and CEO of Sustainable Health Enterprises (S.H.E.), 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 D.I.Y. Foreign Aid Revolution.

S.H.E. Sanitary Pads Being Manufactured in Rwanda

3. ClickDiagnostics. 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. ClickDiagnostics 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.

Community Health Worker Using ClickDiagnostics Mobile App

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 Harvard Social Enterprise Conference, March 5-6, 2011.

The Other Middle Class

Foreign aid is a tricky thing. While it can often be a shining example of humanitarianism and compassion, it can also smack of real politik; 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 William Easterly) 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?

For the first time in history, more poor people live in middle-income countries than in poor countries. This was not the case when the World Bank was founded nor when the Gates Foundation was founded.  Think more around the time MethodLogical was founded. While there is no perfect definition for poor or rich countries (or those in between), the World Bank takes a stab at it. 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.

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 hefty amount of incoming aid dollars). Disproportionately large though they may be, China and India are not alone.  27 countries have made the shift since 2000. And by and large, this is a good thing.

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?

Is she doing her part to aid her countrymen?

Firstly, we must ask if they are fully able to address their own needs. China has the money to spend a ton on its military, 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?

We also have to look at inequality. Though maligned, the Gini index is the best estimate of income inequality in a country. China and India fall in the middle third of nations, 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 advocate redistribution while others prefer to let the free market do the heavy lifting. 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.

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 Jason Kerwin has argued that these economic measures are far from perfect, while MethodLogical contributor Jason Hopper has mused on the usefulness of other measures, such as the Human Development Index or the Multidimensional Poverty Index. 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.

Excuses, excuses

Andrew will not be posting today because he is recovering from malaria.

Did you know you could get malaria even if you're on prophylaxis?

Don't worry- he's recovering nicely, so please enjoy this article.

Please note, exposing our contributors to lethal pathogens will NOT become a regular feature on MethodLogical.

Is Democracy a Universal Ideal?

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?

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 Joseph Schumpeter’s writings. Others, like Robert Dahl, 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.

A book I am finding very thought provoking on this topic is Frederic Shaffer’s Democracy in Translation. 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.

Demokaraasi, 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).

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. 

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?

Tackling Non-Communicable Diseases in 2011

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.

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 (WHO, 2008). 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 less than 3% of the global development assistance for health.

[WHO Global Burden of Disease: 2004 Update (2008)] 

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.

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 excluded from the World Economic Forum 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 commitments 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. 

A major advocate from civil society is the NCD Alliance (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, Framework Convention on Tobacco Control 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 MDG successor goals. The earlier referenced BMJ blog post by Richard Smith describes the WHO having similar priorities, and also emphasizing ensuring sustainable funding.

What I find promising are the goals to improve health systems at a primary care level (Alma Ata Declaration still going strong) and national capacities strengthening (including sustainable funding), which address the root structural and socioeconomic factors of poor health (pertaining to any condition). 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. In this way, developing countries have the opportunity to learn from the epidemiologic transition (Omran, 2005) of developed countries and apply the necessary interventions to at least blunt the rise of NCDs.  

(More references: This recent review article summarizes the elements needed for a context-specific national NCD policy. The Lancet also had a series in November 2010 regarding NCD intervention strategies.) 

To help the cause: The NCD Alliance has put together a summary on how to get involved. There’s also a dynamic web-based group of young professionals focused on chronic disease issues. 

For Profit/Non Profit Model

I was going to publish a post today on Muhammad Yunus' Op-Ed 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.

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.

In the meantime, a few questions I haven't thought about much but am curious about:

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? BRAC and Grameen come to mind quickly.

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?

3. Will the Jets beat the Steelers next week?