Showing posts from category *Blog Columns.
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The Contradictions That Define China
›As a China follower who has visited the country numerous times over the past 40 years, I have an enduring love affair with the “old” China, which prided itself on balancing the harmony of nature with its decision-making. It is tragically ironic that despite this impressive historical and cultural backdrop, current choices have pushed the country’s harmony with nature beyond the tipping point.
The atmosphere in Chengdu, the capital of Sichuan Province in central China, tells a cautionary tale of China’s current emphasis on economic growth at the expense of its citizens’ health. With lower annual sunshine totals than London, Chengdu’s perpetually grey, cloudy horizon graphically illustrates the massive industrial waste and coal-fired pollution that plague this booming city.
In April, global health experts convened in Chengdu at the 5th International Academic Conference on Environmental and Occupational Medicine, which was co-sponsored by the U.S. Centers for Disease Control and Prevention and Chinese CDC offices, to report on the impact of climate change on public health.
Because of its geography, the mountain-encircled basin in which Chengdu sits is the natural point of release for daily deposits of air pollutants and dust blown in from India and other countries to the west. A rapid series of satellite views presented by John Petterson, director of the Sequoia Foundation, brought gasps from conference attendees, as these accumulated industrial wastes were shown concentrating against the massive southern Tibetan mountain range, then turning grey and black as they moved east, before being deposited on Sichuan’s vulnerable (and already heavily polluted) basin.
Environmental risk factors, especially air and water pollution, are a major–and worsening–source of death and illness in China. Air quality in China’s cities is among the worst in the world, and industrial water pollution is a widespread health hazard.
And although air pollution is clearly a complex global problem, individual nation-states continue to approach this dilemma as though it lies between its borders alone.
Luckily, this conference was prefaced by a number of timely scientific articles on China in the Lancet. The predominantly Chinese authors clearly take the critical risks that we expect from the Lancet, which is a defender of accountability and transparency in global health. This issue brings shame to other publications who still consider their “place” to be protecting the conventional politico-economic emphasis on decision-making inherent to most industrialized countries.
At the conference, public health and climate experts openly voiced their frustration at the blatant privileging of economic priorities over the health of unknowing populations. China–the fastest growing economy in world history, with unprecedented growth driven by external “demand” and precipitous acceleration of domestic consumption–has become the poster-child for global ignorance. However, the West is an equal and essential partner, having moved their manufacturing to China for cheap labor, lax environmental regulations, and higher profits.
Dr. Mark Keim, senior advisor for the CDC’s National Center for Environmental Health, presented irrefutable evidence that root structure erosion from advancing saltwater has led to starvation in Polynesia, the first recorded evidence-based outcome measure of climate change’s public health effects.
At Mark’s request, I presented evidence on the worsening health impacts of rapid urbanization, specifically within urban enclaves that expand due to dense population growth before protective public health infrastructures and systems are in place (forthcoming in Prehospital and Disaster Medicine). Currently, the megacities in Asia and Africa–where sanitation is ignored and infectious disease is prevalent–now have the highest infant and under-age five mortality rates in the world.
Today, we face the largest gap in health indices between the haves and have-nots since the alarming days before the Alma-Ata Declaration. This new health data was an uncomfortable surprise to many conference attendees, most of whom were experts in the physical and environmental sciences.
We have become too “vertical” in our research over the past 50 years, and thus we fail to recognize that solutions to problems facing the global community must be trans-disciplinary and multi-sectoral, and serve multiple ministries and decision-makers.
If not undone by human decisions, global climate change and climate-warming greenhouse gases will rapidly intensify. This effort requires the best collaboration between science and the humanities, as well as the harmonious lessons of the “old” China.
Frederick M. Burkle, Jr., MD, MPH, DTM, is a senior public policy scholar at the Woodrow Wilson Center and a senior fellow of the Harvard Humanitarian Initiative at the Harvard School of Public Health.
Photo Credit: Chengdu skyline in smog, courtesy Flickr user lonely radio. -
Visualizing Human and Natural Resources
›In the policy world, statistics, percentages, and budgets on the order of millions and billions are routinely thrown around. But what do six and a half billion people, 957 tonnes per second, or three trillion dollars really look like?
A visualization of London’s natural resources – grass, trees, and water only – by Adam Nieman.
Visual artist Adam Nieman recently received attention from The New York Time’s Dot Earth Blog for his illuminating scale models of hard-to-envision quantities such as the volume of oil being leaked from the Deepwater Horizon wells, global carbon emissions as measured in “UN Building units per second,” and the relatively small amount of air and water on Earth.
Demographers and sustainability experts often warn about the increasingly smaller allotment of natural resources per capita, but few have illustrated that reality at such a human scale as Nieman does.On a global level, Nieman’s work shows the tremendous population density of the world’s “urban island.” Over half of the global population now lives in cities, which is represented by the grey dot, just 616 km across in “Land-Cover Islands.”
Others seeking to improve quantitative visualizations include David McCandless of the site Information Is Beautiful. Among other things, McCandless has tackled the daunting task of accurately comparing spending in an age of trillion dollar budgets, with his “Billion Dollar Gram.”
Another group, the Dutch firm TD Architects, highlights the disparity between global demographics and the distribution of wealth with “Walled World.”
Nieman’s blog examines the confusion that often occurs at the interface between the political and scientific worlds. This confusion is amply demonstrated by debates over contentious issues such as budget priorities, population growth, and climate change.
Politicians often ask that complex problems be distilled into simple bullet points for speeches and policy documents. However, when it comes to problems of such complexity and scale, pictures like these may be worth a thousand bullet points.
Sources: New York Times, Reuters.
Photo Credit: “Green London (wide)” and “land cover islands” courtesy of flickr user JohnJobby. -
Look Beyond Islamabad To Solve Pakistan’s “Other” Threats
›After years of largely being ignored in Washington policy debates, Pakistan’s “other” threats – energy and water shortages, dismal education and healthcare systems, and rampant food insecurity – have finally moved to the front burner.
For several years, the Woodrow Wilson Center’s Asia Program has sought to bring these problems to the attention of the international donor community. Washington’s new determination to engage with Pakistan on its development challenges – as evidenced by President Obama’s signing of the Kerry-Lugar bill and USAID administrator Raj Shah’s comments on aid to Pakistan – are welcome, but long overdue.
The crux of the current debate on aid to Pakistan is how to maximize its effectiveness – that is, how to ensure that the aid gets to its intended recipients and is used for its intended purposes. Washington will not soon forget former Pakistani president Pervez Musharraf’s admission last year that $10 billion in American aid provided to fight the Taliban and al-Qaeda was instead diverted to strengthen Pakistani defenses against archrival India.
What Pakistani institutions will Washington use to channel its aid monies? In recent months, the U.S. government has considered both Pakistani NGOs and government agencies. It is now clear that Washington prefers to work with the latter, concluding that public institutions in Pakistan are better equipped to manage large infusions of capital and are more sustainable than those in civil society.
This conclusion is flawed. Simply putting all its aid eggs in the Pakistani government basket will not improve U.S. aid delivery to Pakistan, as Islamabad is seriously governance-challenged.
Granted, Islamabad is not hopelessly corrupt. It was not in the bottom 20 percent of Transparency International’s 2009 Corruption Perceptions Index (Pakistan ranked 139 out of 180), and enjoyed the highest ranking of any South Asian country in the World Bank’s 2010 Doing Business report.
At the same time, the Pakistani state repeatedly fails to provide basic services to its population – not just in the tribal areas, but also in cities like Karachi, where 30,000 people die each year from consuming unsafe water.
Where basic services are provided, Islamabad favors wealthy, landed, and politically connected interests over those of the most needy – the very people with the most desperate need for international aid. Last year, government authorities established a computerized lottery that was supposed to award thousands of free tractors to randomly selected small farmers across Pakistan. However, among the “winners” were large landowners – including family members of a Pakistani parliamentarian.
Working through Islamabad on aid provision is essential. However, the United States also needs to diversify its aid partners in Pakistan.
For starters, Washington should look within civil society. This rich and vibrant sector is greatly underappreciated in Washington. The Hisaar Foundation, for example, is one of the only organizations in Pakistan focusing on water, food, and livelihood security.
The country’s Islamic charities also play a crucial role. Much of the aid rendered to health facilities and schools in Pakistan comes from Muslim welfare associations. Perhaps the most well-known such charity in Pakistan – the Edhi Foundation – receives tens of millions of dollars each year in unsolicited funds.
Washington should also be targeting venture capital groups. The Acumen Fund is a nonprofit venture fund that seeks to create markets for essential goods and services where they do not exist. The fund has launched an initiative with a Pakistani nonprofit organization to bring water-conserving drip irrigation to 20,000-30,000 Pakistani small farmers in the parched province of Sindh.
Such collaborative investment is a far cry from the opaque, exploitative foreign private investment cropping up in Pakistan these days – particularly in the context of agricultural financing – and deserves a closer look.
With all the talk in Washington about developing a strategic dialogue with Islamabad and ensuring the latter plays a central part in U.S. aid provision to Pakistan, it is easy to forget that Pakistan’s 175 million people have much to offer as well. These ample human resources – and their institutions in civil society – should be embraced and be better integrated into international aid programs.
While Pakistan’s rapidly growing population may be impoverished, it is also tremendously youthful. If the masses can be properly educated and successfully integrated into the labor force, Pakistan could experience a “demographic dividend,” allowing it to defuse what many describe as the country’s population time bomb.
A demographic dividend in Pakistan, the subject of an upcoming Wilson Center conference, has the potential to reduce all of Pakistan’s threats – and to enable the country to move away from its deep, but very necessary, dependence on international aid.
Michael Kugelman is program associate with the Asia Program at the Woodrow Wilson International Center for Scholars.
Photo Credit: Water pipes feeding into trash infected waterway in Karachi, courtesy Flickr user NB77. -
21st Century Water
›The Economist published this week For Want of a Drink, its special report on water. The report, a compilation of 11 articles, is a mix of surveys of global management strategies, health impacts, and economic considerations on the one hand, and deeper looks into specific practices in Singapore, India, and China on the other. Most interesting for New Security Beat readers is the article “To the Last Drop: How to Avoid Water Wars.” The article states there have been “no true water wars,” but goes on to question whether the pressures of climate change and population growth could generate different outcomes in the future. While the challenges laid out are manifold, the article concludes that potential for cooperation is equally present. “The secret is to look for benefits and then try to share them. If that is done, water can bring competitors together.”Global Change: Impacts on Water and Food Security, published by IFPRI in collaboration with CGIAR and the Third World Centre for Water Management, is an anthology of focused articles studying “the interplay between globalization, water management, and food security.” While heavily focused on trade and finance, the articles span the spectrum of food and water challenges, from biofuels to the global fish trade. Overall, the book finds that “global change provides more opportunities than challenges,” but taking advantage of globalization’s opportunities demands “comprehensive water and food policy reforms.” -
Interplays Between Demographic and Climatic Changes
›“Impacts of Population Change on Vulnerability and the Capacity to Adapt to Climate Change and Variability: A Typology Based on Lessons from ‘a Hard Country,’” appearing in the journal Population and Environment, is a study of societal resilience by Robert McLeman from the University of Ottawa. Beginning with a literature review of the connections between population growth and greenhouse gas emissions, McLeman then details how demographic changes can negatively affect resilience–the ability of societies to cope and adapt to climate changes. Based on empirical studies of small communities undergoing local climate and demographic changes in eastern Ontario, McLeman finds that simultaneous demographic and climatic change “increased stress on local social networks…critical to climate adaptation.”“Climate Change and Population Migration in Brazil’s Northeast: Scenarios for 2025–2050,” also appearing in the journal Population and Environment, examines “demographic dynamics–particularly migration–driven by changes in the performance of the economy due to climate changes.” The region of study was chosen for its high levels of both population and poverty and its dry climate, “which will be severely impacted by growing temperatures.” The study concludes that predicted climate change impacts on agriculture are potential push migration factors and offers policy and planning recommendations to reduce migrant vulnerabilities.
Both articles are part of Population and Environment‘s special issue on “Climate Change: Understanding Anthropogenic Contributions and Responses.” -
USAID Launches GeoExplorer: Connecting Natural Resource Management Activities, Practitioners, and Communities
›Part of USAID’s FRAMEweb community, GeoExplorer is a visual aggregator of natural resource management (NRM) activities, best practices, success stories, and lessons learned. As of launch, GeoExplorer is home to 43 activities, each searchable by scale (e.g. local, national, or regional), sub-sector (e.g. forestry, water, wildlife), and topic (e.g. governance, livelihoods, and health).
GeoExplorer was designed to foster knowledge sharing among and between practitioners, program managers, and researchers. USAID expects the tool to help avoid cases both of repeating past mistakes and reinventing the wheel, serve as a guide for study trips to the field, build community exchanges, and foster networking. It is built on ArcGIS architecture that USAID hopes will allow for continual expansion, particularly through the addition of GIS layers that can empower users with greater search options and tools for cross-project analytic analyses.
All activities on GeoExplorer are directly uploaded by users and USAID funding is not a requirement for inclusion. A FRAMEweb account (free) is all that is needed to sign-up and start adding your own projects. USAID hopes to make GeoExplorer available to host other NRM sub-sectors and even non-NRM activities in the future. -
Coffee and Contraception: Combining Agribusiness and Community Health Projects in Rwanda
›“Population pressures and diminishing land holdings – due to high fertility rates, war and genocide, and subsequent migration – have caused a rapid decrease in the forested and protected areas and increased soil infertility and food insecurity” in Rwanda, USAID’s Irene Kitzantides told a Wilson Center audience.
Kitzantides, a population, health, and environment advisor and global health fellow, said “the population is projected to reach over 14 million by 2025” – nearly one-third more than today, due to the country’s high fertility rate of nearly 5.5 children per women–which could continue to negatively impact forests and food supplies.
In response to these challenges, USAID supported the Sustaining Partnerships to Enhance Rural Enterprise and Agribusiness Development (SPREAD) Project. SPREAD uses an integrated population-health-environment (PHE) approach to develop the coffee agribusiness and bring family planning, HIV/AIDS, and reproductive health services to coffee workers.
Combining income generation with health services was thought an effective way to “fulfill the overall SPREAD goal of improving lives and livelihoods,” said Kitzantides.
A SPREADing Mandate: Integrating Health and Agribusiness
SPREAD follows USAID’s PEARL I and II Projects, which focused exclusively on agricultural development. Coffee is still at the center of SPREAD’s activities, with $5 million of the project’s $6 million USAID budget earmarked for agricultural development.
However, a broader mandate to include health services emerged after recognition that greater income alone does not ensure greater quality of life. The additional health funding leverages SPREAD’s already established relationships with farming cooperatives to bring health services to traditionally underserved rural communities.
“We really tried to build on the existing assets of the cooperative,” said Kitzantides. “We also really tried to complement local and national public health policy and partners.”
The integration of health with agricultural goals, and the use of already established in-country health programs, has made SPREAD extremely cost-effective, with HIV/AIDS prevention education costing less than $2 per person.
Examples of SPREAD’s integrated work include:Combined health and agricultural lessons: Kitzantides and her colleagues trained nearly 400 animateurs de café, cooperative employees running the agricultural education programs, to incorporate public health objectives into their activities. Combining health and agricultural education into one session takes advantage of workers already trained during previous USAID programs. The combination also attracts more male participants, who traditionally shunned HIV/AIDS, family planning, and reproductive health campaigns and services.
Radio programming: SPREAD worked with the agricultural radio program Imbere Heza (“Bright Future”) to incorporate health messaging at the end of each program.
- Mobile clinics: SPREAD works with cooperatives and local health centers to bring convenient services to farmers when they gather at sales or processing stations during harvests.
Community theater: SPREAD hires local theater groups to perform skits on health. The farming communities “really love community theater and always ask for it,” said Kitzantides.
In its relatively short existence, SPREAD’s health activities have reached over 120,000 people with HIV/AIDS prevention messages; nearly 90,000 with messages discussing family planning/reproductive health; and almost 40,000 about maternal and child health. The project counts 347 women as new users of family planning services.
Lessons learned – which will be examined in more detail in an upcoming issue of Focus – include the importance of using community-based approaches to overcome perceived social barriers; the advantages of integrating cross-cutting activities at the outset of a program; and the need for strong monitoring and evaluation systems to measure the effort’s outcomes.Jason Bremner of the Population Research Bureau said PHE projects such as SPREAD go “beyond what the health sector itself can do and find new ways of reaching underserved remote populations.” He presented a soon-to-be-released PRB map plotting the location of more than 40 PHE projects in Africa.
The success of SPREAD and similar projects demonstrates the potential for PHE approaches to bring reproductive health and family planning services to rural areas, Bremner noted, but there is still much work to be done to scale up this integrated approach – and to document its successes.
Sustaining SPREAD
Kitzantides said it took several years to integrate health activities with the already established agricultural programs. Since USAID funding for the program is scheduled to end in 2011, she is uncertain that the time remaining will be enough for SPREAD’s health partners to develop the logistical and financial capacities to become self-sustaining. But SPREAD has changed attitudes and beliefs, two key objectives that do not require sustained funding.
“We used to talk about growing coffee, making money, buying material things like bikes – not about problems like malaria, HIV/AIDS, etc.,” said one SPREAD agricultural business manager during the program’s evaluation. “Someone could have 5 million Rwandan francs in the house but could suffer from malaria where medicine costs 500 Rwandan francs, due to ignorance. You have to teach people about production, you have to also think of their health to improve their lives.”
Photo Credits: Irene Kitzantides, courtesy David Hawxhurst; condom demonstration, courtesy Nick Fraser; community theater group, courtesy SPREAD Health Program; Jason Bremner, courtesy David Hawxhurst. -
New Maternal Mortality Statistics: A Catalyst for Increased Investment
›Maternal mortality rates in many low income countries, such as India, are declining, according to a recent study by researchers at the Institute of Health Metrics and Evaluation (IHME) at the University of Washington. According to the report, maternal deaths have fallen from 526,000 a year in 1980 to 342,900 in 2008. This news, while welcoming, has caused dissent among some global health activists who fear donors and policymakers will dismiss the issue and call into question the higher maternal mortality rates last reported by the United Nations. While concerns over monitoring and evaluation raise important methodology questions, this news must also serve as catalyst for world leaders and donors to take action and recognize that investing in women pays.
The data reported by IHME only concludes what maternal health advocates already know. “We know how to save women’s lives, we don’t need a cure…this is a political problem and political will is essential,” said Theresa Shaver, director of White Ribbon Alliance, at a Wilson Center event in December 2008. Greater funding for family planning and access to emergency obstetric care and HIV/AIDS services should all be included in a scaling up resources for improved maternal health programs. “Without HIV, annual maternal deaths would have been 281,500 in 2008,” said Richard Horton, editor of The Lancet, in last week’s Lancet comments.
Investing in contraception and family planning services through vertical funding mechanisms can reduce maternal mortality rates by addressing all of a woman’s health needs at the time of service. To widen the platform of comprehensive services for women and their families, efforts to link public health services and offer more at one location should be expanded. “Many women have expressed a need for contraception and family planning services…when you offer family planning services on-site with HIV services, you have a huge uptake in family planning use,” shared Michelle Moloney-Kitts, assistant coordinator at the Office of the U.S. Global AIDS Coordinator at a the Wilson Center in December 2009.
Yet political will remains in short supply. “Despite strong advocacy efforts, political leaders have either ignored the call or failed to make the health of women in pregnancy a priority,” stated Horton. Six countries–Afghanistan, Democratic Republic of Congo, Ethiopia, India, Nigeria, and Pakistan–account for over half of all maternal deaths worldwide, and increased investment in these countries will improve maternal health targets, such as Millennium Development Goal (MDG) 5 seeking to reduce maternal deaths by 75 percent.
Progress is possible and “policymakers are more likely to act on issues that they think they can do something about,” said Jeremy Shiffman, associate professor of public administration at Syracuse University, at the Wilson Center in March 2009. The maternal health community must rally around these positive findings and galvanize support for greater financial contributions. “Two decades of concerted campaigning by those dedicated to maternal health is working,” said Horton.” “[G]reater investment in that work is likely to deliver even greater benefits.”
Calyn Ostrowski is the program associate for the Wilson Center’s Global Health Initiative.
Photo Credits: A woman in India safely delivers her baby in the hospital through the Madhya Pradesh Health Sector Reform program. Courtesy Flickr user Department for International Development
