Showing posts from category economics.
-
An Integrated Climate Dialogue
COP-16 Cancun Coverage Wrap-up
›December 13, 2010 // By Schuyler NullAfter focused last-minute negotiations, the UNFCCC COP-16 parties meeting in Mexico finally reached an agreement on a package being called “The Cancun Agreements” on Saturday. One of the most important impacts of the agreement (also referred to as the “balanced package”) is the establishment of a green climate fund which will help developing countries adapt to and mitigate the effects of climate change.
For more on the green fund as well as the integration of gender, population, development, and even a little bit of security in the broader climate dialogue, see The New Security Beat’s coverage of Cancun below.- Interview with Karen Hardee: Climate-Proofing Development
- Pop Audio: From Cancun: Roger-Mark De Souza on Women and Integrated Climate Adaptation Strategies
- Guest Contributor Alex Stark: From Cancun: Getting a Climate Green Fund
- The Number Left Out: Bringing Population Into the Climate Conversation
Kicking off our coverage was an email interview with Karen Hardee, visiting fellow with the Population Reference Bureau, on “climate-proofing” development. Hardee gives a brief overview of the UN National Adaptation Programmes of Action system and the current state climate adaptation integration in international development. She points out that one of the enduring positives from COP-15 was a renewed focus on financing tools that has permeated to the top levels of the UN.
Hardee also touched on the nascent but largely unfulfilled connection between population growth and resilience, noting that “of the first 41 programs submitted to the UNFCCC…37 noted that population growth exacerbated the effects of climate change, but only six explicitly stated that meeting an unmet demand for RH/FP should be a key priority for their adaptation strategy and only two proposed projects that included RH/FP.”
Next, Population Action International’s Roger-Mark De Souza was kind of enough to speak with us briefly over the phone from the conference itself, providing a run-down on a PAI-sponsored side event focusing on empowering women in climate debates.
“When you look at the negative impacts of climate change, the impacts on the poor and the vulnerable – particularly women – increase, so investing in programs that put women at the center is critical,” De Souza said.
Leaving gender issues, like child and maternal health and education, out of deliberations like those COP-16 are missed opportunities to get more “power for your peso,” he said.
Alex Stark, formerly of CNAS and now with the Adopt a Negotiator program in Cancun, provided an update and a strong argument for one of the most critical elements of the “balanced package” that many are hoping will come out of Cancun – the establishment of an international fund to help pay for adaptation and mitigation programs in developing countries.
Stark provides an insight into some of the chatter on the floor at COP-16 and also outlines the moral, development, and security advantages to supporting a green fund, pointing out that “by managing displacement, migration, and violent conflict driven by the effects of climate change, such as water scarcity, climate change adaptation can help bolster international security and stability.”
“Within the UN process itself,” she writes, “a robust, well-run, equitable green fund would help rebuild the trust lost between developed and developing countries at Copenhagen last year.”
Lastly, Bob Engelman, of the Worldwatch Institute, provides a broad argument for more inclusion of a key variable in climate debates – population (and not in the Ted Turner mold). He enumerates the common pitfalls of population debates, from sensitivities about personal choices to squeamishness about sexuality and reproductive health, and just plain gender bias.
But despite these barriers, says Engelman, population – and not just growth but demographics too – matters in the climate debate and therefore needs to be part of the conversation (an argument he makes more comprehensively in a new report, Population, Climate Change, and Women’s Lives). Echoing De Souza, he concludes by pointing out that although the discussion may be difficult, the solution is relatively simple: “On population, the most effective way to slow growth is to support women’s aspirations.”
“As societies, we have the ability to end the ongoing growth of human numbers – soon, and based on human rights and women’s intentions,” Engelman said. “This makes it easy to speak of women, population, and climate change in a single breath.”
Sources: Population Action International, Slate, UN Framework Convention on Climate Change, The Washington Post, Worldwatch Institute.
Photo Credit: Adapted from “Trees Dead on Shore of Timor-Leste Lake,” courtesy of flickr user United Nations Photo; Roger-Mark De Souza, courtesy of David Hawxhurst/Wilson Center; “Will you back a climate fund?,” courtesy of flickr user Oxfam International; and “Met Office Climate Data – Month by Month (September),” courtesy of flickr user blprnt_van. -
Expanding Access to Maternal Health Commodities
›“This is not just about getting quantities of drugs out, this is about saving women’s lives with really simple products that work,” said Julia Bunting, team leader of AIDS and reproductive health at the UK Department for International Development and coalition chair of the Reproductive Health Supplies Coalition, at the ninth meeting of the Global Health Initiative’s 2009-2010 Advancing Policy Dialogue on Maternal Health series. Joined by panelists Melodie Holden, president of Venture Strategies Innovations (VSI), and Elizabeth Leahy Madsen, senior research associate at Population Action International (PAI), the panel discussed the challenges and strategies for expanding access to maternal health commodities.
Integrating Maternal Health and Family Planning Supply Chains“It is often said that the family planning and the maternal health communities have very different views of supplies… but actually [both communities] recognize that we need to explore the continuum,” said Bunting, addressing the need to integrate maternal health commodities into existing reproductive health supply chains. “I really think the stars are aligned right now for advancing this agenda,” added Bunting.
“Many of the commodities that we talk about in terms of reproductive and maternal health cost tiny amounts to deliver, but actually save lives and are some of the most cost-effective interventions we have both in public health and in broader development,” said Bunting.
No Product, No Program
“Supplies are a key element in programs to improve maternal health and they are also a tangible and visible hook to increase awareness and commitment,” said Madsen. “Policymakers whose eyes glaze over when they hear the term ‘health systems strengthening’ can grasp… much better when they learn that supply shelves in clinics are bare and that women are making great efforts to reach facilities, only to leave empty- handed,” said Madsen.
Presenting research conducted by PAI, Madsen discussed the availability of four key maternal health medicines and products in Bangladesh and Uganda including:
By focusing on supplies that target the three leading causes of maternal mortality, Madsen and her colleagues identified factors that inhibit access to these commodities and developed recommendations for strengthening maternal health supply chains.- Oxytocin: used to prevent post-partum hemorrhage
- Misoprostol: used to prevent post-partum hemorrhage
- Magnesium Sulfate: used to treat pre-eclampsia
- Vacuum Aspirators: used for treatment of early and incomplete abortion
Madsen identified several strategies to strengthen supply chains for maternal health commodities including forecasting and preparing for growing demand, advocating for government and donor support, encouraging scaling-up of community-based approaches, promoting family planning, and focusing on human resource training.
“In maternal health, if a supply to prevent or treat a life-threatening complication is in stock, there must also be a way for a woman to reach it in time… and in most cases a provider who knows how to administer it,” said Madsen.
“This research is intended to lay the groundwork for future advocacy and policy initiatives by providing an evidence base that is informed by local expertise,” said Madsen. “We hope that this information will inform program implementation, funding decisions, and awareness raising.”
Getting the Product to People: The Case of Misoprostol
“The story of Misoprostol is still being written. The goal is to invest in creating access to interventions that are low-cost and relatively simple to use,” said Holden. By sharing lessons learned, Holden described VSI’s experience registering and procuring Misoprostol and demonstrated how community mobilization is imperative to overcoming major challenges for large-scale implementation.“Making products available is not without challenges,” said Holden. To increase access to Misoprostol in rural communities, maternal health experts must work to “engage communities, educate and mobilize women, train providers at all levels of the health care system, and provide support to distributors to jump start sales,” said Holden. “By looking holistically across entire health systems, bringing in great interventions, addressing the components of supply and demand, and working with local partners, we can have lasting impact.”
While the price of Misoprostol has decreased significantly, Holden stressed the need to identify creative ways along the supply chain that reduce costs to the end user. Additionally, “establishing policies around this new intervention not only establishes its reach, but also makes its use institutionalized, which means it will be part of the system even if governments or individuals change,” said Holden.
“If there is a gap between what could be achieved with Misoprostol and what is being achieved, we need to go back to the model and figure out what pieces aren’t working,” concluded Holden. “The work is complex and takes time, but it’s worth it.”
Photo Credit: “Rapid HIV testing,” courtesy of flickr user DFID – UK Department for International Development. -
Hans Rosling Double Feature: ‘The Joy of Stats’ on BBC and Population Growth at TED
›Hans Rosling, creator of Gapminder and professor of international health at Sweden’s Karolinska Institute, hosts a new documentary on the BBC called The Joy of Stats that takes a look at the breadth and depth of data available today to analysts and private citizens alike.
In the clip above, Rosling demonstrates his primary interest in world health, tracking life expectancy and income over the last 200 years to show both the remarkable progress that has been made but also the tremendous gap that remains between those at the top (the very rich and healthy) and those at the bottom (the very poor and sick).
Rosling has been a vocal (and visual) advocate for expanding people’s knowledge of the world by presenting statistics in innovative ways. “Statistics should be the intellectual sidewalks of a society, and people should be able to build businesses and operate on the side of them,” he said at a discussion at the Wilson Center in May 2009.
In particular, Rosling’s focus has been on health, poverty, and the developing world, where he’s advocated for increased focus on child and maternal health and education. “The role of the old West in the new world is to become the foundation of the modern world – nothing more, nothing less,” he said during a TED talk on population growth (see below) where he broke from his more flashy visuals and went analog – using IKEA boxes to illustrate population and consumption growth. “But it’s a very important role. Do it well and get used to it.”
Rosling’s Gapminder software has been incorporated into Google’s Public Data Explorer, where many development indicators from the World Bank, World Health Organization, and others can now be easily tracked by anyone. For more on Google Data and to see an example set of indicators (agriculture as a percentage of GDP vs. fertility rates over the last 50 years), check out this previous Eye On, on The New Security Beat.
Video Credit: “Hans Rosling’s 200 Countries, 200 Years, 4 Minutes – The Joy of Stats – BBC Four,” courtesy of BBC, via YouTube, and “Hans Rosling on global population growth,” courtesy of TED. -
David Lawson, Wildlife Conservation Society
Afghanistan’s Non-Confrontational Conservation
›December 7, 2010 // By Wilson Center Staff
Excerpt from the Center for a Better Life:
Afghanistan is more than war and turmoil; it has a long and colorful history, strong cultures and a stunning landscape. It has enormous biodiversity, as it sits at the crossroads of what biologists call “biological realms.” The country, therefore, has plants and animals that also occur in Europe, northern Asia, India, south Asia and Africa. It has nine species of wild cats, which is the same as the whole of sub-Saharan Africa, as well as an estimated 800 plant species that occur nowhere else in the world. In other words, Afghanistan is worth attention in terms of its biodiversity alone.These natural resources are also critically important from the people’s perspective. After 30 years of conflict, more than 80 percent of Afghanistan’s population relies directly on natural resources for their livelihood. Most of the inhabitants are rural and desperately poor by world standards. Child mortality is the highest in the world, and their infrastructure is mostly broken down and inoperable. The economy is donor-dependent, and the Afghan government is still in its infancy. Outside the capital of Kabul, governance sometimes seems non-existent. As a result, movement away from the major population centers can be very risky due to the presence of various insurgent groups.
And yet, what is seldom mentioned in newscasts and media is that the Afghans are proud and resilient. They want what everyone else wants: education for their children, healthcare for the young and elderly, and reliable livelihoods to support their families. Then they want to get on with their lives in their own unique, culturally diverse way, free of violence and conflict.
Understanding Cultures
Understanding these things is one reason why the Wildlife Conservation Society (WCS) has been successful in Afghanistan. When hearing of the Society’s field work in this war-torn country, most people are surprised. They wonder how, with its pressing problems, Afghanistan can afford the time, let alone the resources, to conserve its remaining wildlife and wild places. But this is one of the core strengths of WCS – to offer assistance in conserving natural resources at a practical level within a country in need, like Afghanistan. As one of the oldest conservation organizations in the world, with more than 100 years of field conservation experience, the Society has extensive seasoning under extreme circumstances. Currently, WCS has more than 600 projects in place with 3,000 staff; and, many of these projects are in the most remote areas of the world.
Since 2006, USAID has supported WCS’s work in Afghanistan within three geographical areas – the northeast in Badakhshan Province’s Wakhan District, Bamiyan’s central province and the eastern, forested Nuristan province. Experts chose these areas because they believed they held the largest numbers of untouched remaining wildlife; this presumption generally proved correct. Through the years, WCS has created trust by having conservation teams on the ground and working year-round with local communities. Similar trust has been established with the relevant ministries by WCS’ central office, located in Kabul, through continuous presence and assistance.
Results are impressive. More than seven pieces of environmental legislation were enacted; 10,000 Afghans received conservation training; the first biological surveys in 30 years were completed (which doubled as crucial skills development exercises for Afghan scientists); the first wildlife/domestic stock disease assessments were accomplished, with corresponding human health effects, plus many more exemplary achievements. One of the more intriguing results was WCS’ ability to build local governance in the most remote communities, thus connecting communities that had seen no real government representatives for years. This link extended to district authorities then to provincial authorities, and finally to the Kabul central government. This extension of Afghanistan’s rule-of-law is paramount because it improves governance, which is one of the more crucial strategic needs in the country today.
How was a non-governmental conservation organization able to contribute to governance and rule-of-law? It is simple. Wildlife conservation is usually a non-confrontational issue, and most people, when exposed to the process, take an active interest and express opinions. Rural people have grown up with and are surrounded by wildlife everyday; they have local knowledge and feel comfortable discussing how things have changed. They want to be empowered to make natural resource decisions in the areas in which they live. WCS staff encourages local people to discuss species protection with their local and provincial governments. In some instances, WCS workers have taken government officers into communities that cannot recall ever seeing a government official. These processes and contacts evolve and can be used as basis for non-conservation related discussion. These processes and relationships become the building blocks for extending governance and empowering local communities. And, the process works.
Continue reading on the Center for a Better Life.
David Lawson is the Wildlife Conservation Society Afghanistan country director.
Photo Credit: “Bamiyan Band-e-Emir,” courtesy of flickr user USAID Afghanistan. USAID and WCS have been working in the Band-e-Amir lakes region since 2006 to create a national park. -
Joydeep Gupta, ChinaDialogue
Nervous Neighbors: China-India Water Relations
›December 3, 2010 // By Wilson Center StaffExcerpted from the original article, “Nervous Neighbors,” on ChinaDialogue.net:
Only five rivers in the world carry more water than the Yarlung Zangbo, or Brahmaputra, as it is known when it reaches India. Only one carries more silt. Rising at a height of 5,300 meters in the Kailash range of the Middle Himalayas – an area holy to both Hindus and Buddhists – the river flows east through Tibet for 1,625 kilometers before taking a horseshoe bend, changing its name and flowing as the Brahmaputra into north-eastern India.
There, for 918 kilometers, it is both a lifeline, due to the water it carries, and a scourge, because of the floods it causes almost every year. It then takes a southward turn and flows into Bangladesh for 363 kilometers before it merges with the Ganges, together forming South Asia’s largest river, the Meghna, and flowing into the Bay of Bengal. This huge river, with its 25 large tributaries in Tibet and 105 in India, drains much of the eastern Himalayas.
As the world’s youngest mountain range, the Himalayas are particularly unstable – and so is the river. It has changed its course significantly at least once in the last 200 years, following a major earthquake. Smaller changes in course are common, wiping out farms and homes on one bank while depositing fertile silt on the other. Now humans are changing the course of this river: Chinese engineers have started to build the Zangmu hydroelectric power station in Lhoka prefecture, 325 kilometers from Lhasa, Tibet’s capital. The development has led to serious expressions of concern, particularly in India but also in China.
Continue reading on ChinaDialogue.net.
Joydeep Gupta is the project director (South Asia) of ChinaDialogue’s Third Pole Project.
Map Credit: Google Maps. -
Empowering Women in the Muslim World
›December 2, 2010 // By Wilson Center StaffOriginally featured in the Wilson Center’s Centerpoint, November 2010.
For decades, women in the Middle East have actively struggled for equal status before the laws of their respective countries. They have strived to attain equal participation in politics and society, and progressive justice throughout the region. While they have made progress in some parts of the region, many challenges remain. The Wilson Center’s Middle East Program recently held three meetings to discuss challenges as well as progress to empowering women across the Muslim world.
A Modern Narrative
The American Islamic Congress (AIC) recently published a report, “A Modern Narrative for Muslim Women in the Middle East: Forging a New Future,” that highlights past and present triumphs and difficulties – economic, legal, political, religious, and social –for women’s rights throughout the region. On September 30, the Middle East Program co-sponsored a meeting with the AIC to review the status of women in Saudi Arabia and Jordan, based on findings in the AIC’s report.
Fawziah Al-Hani, manager of the Gherass Center for Social Education in Saudi Arabia, expressed frustration about the progress women have made in her native Saudi Arabia. She said women there are perceived as second-class citizens by the country’s legal, economic, political, religious, and social institutions. Women’s issues are rarely discussed in Saudi political and social spheres, and women are not represented in government or the business sector. She said if women are allowed to be active outside the home, they are mostly restricted to educational and health activities.
While she is frustrated about these restrictive Saudi policies toward women, Al-Hani said she maintains hope, as changes take place within the society and government through new initiatives and movements.
Rana Husseini, a human rights activist, author, and journalist, detailed the changes to the status of women in Jordan over the past 20 years. Husseini, whose human rights activities over the past two decades in Jordan have focused on honor crimes and other women’s issues, said Jordan has made substantial progress on women’s rights as a result of intense media and civil society activism. While there is room for improvement, she said women are now participating in government and significant reforms have been made to the judicial system.
Though the effectiveness of quotas for women in government may be debated, Husseini noted that quotas facilitate women’s participation in elections and government service. In fact, she said, there are some 50 women judges in Jordan. She noted that honor killings, except in extreme cases, are becoming rarer, and harsher sentences are being imposed for honor crimes.
With constant pressure on the government and society, reforms will continue, said Husseini, who is optimistic about the future for women rights in Jordan and in the Middle East as a whole.
Demographic Realities
Why do many Middle Eastern women not enjoy the same economic opportunities as women of other regions? Can they be empowered to participate at a greater level? Nadereh Chamlou, a senior adviser at the World Bank, attributed the gender inequality to restrictive social norms. She said the region’s women must be empowered to participate in a more significant way if their countries are to effectively exploit, instead of squander, the current economic “window of opportunity.”
At a September 13 discussion, Chamlou said the good demographic news is that there are high numbers of working-age people and thus the potential for rapid economic growth. However, Middle Eastern countries have the highest dependency rates in the world, a fact that Chamlou attributed to the low economic participation of Middle Eastern women relative to female citizens’ participation in other parts of the world. This reality means the Middle East’s demographic composition will not be exploited to its full potential.
Increasing economic opportunities for women will require changing social norms, said Chamlou. She cited a study conducted by the World Bank in three Middle Eastern capitals – Amman, Jordan; Cairo, Egypt; and Sana’a, Yemen – that revealed the biggest reason for the poor representation of women in the workforce is the negative male attitude regarding women working outside the home. Notably, social norms and such negative male attitudes proved to restrict women’s participation far more than the need to attend to child-rearing duties. Despite the successful efforts of most Middle Eastern states to improve education opportunities, conservative social norms still pose a barrier to female empowerment.
Some simple changes could have a substantial impact. Chamlou recommended focusing on educated, middle-class women, undertaking more efforts to bring married women into the workforce, and emphasizing changing attitudes – particularly among conservative younger men – toward women working outside the home.
Lessons from Tunisia
In Tunisia, the progress of women’s empowerment can serve as a model for the region, noted women’s rights advocate Nabiha Gueddana, president and director-general of the National Agency for Family and Population in Tunisia.
Speaking at a September 8 meeting, Gueddana said the Arab world can learn much from her native Tunisia regarding the positive effects of empowering women. Gueddana, also a candidate for undersecretary-general of UN Women at the United Nations, described how Tunisian women have been empowered politically, economically, and socially, and how this empowerment has benefited Tunisian society.
Tunisia has undergone substantial changes since achieving independence from France in 1956. Tunisian women had second-class status in the years prior, a time Gueddana described as one that relegated them to a life of constant child-rearing, illiteracy, and economic dependence.
Yet Tunisia has become a beacon for other Muslim societies: the country’s labor code allows full female participation in the economy and education is open equally to boys and girls. Family planning programs and important strides in health have considerably lowered the birth rate and lengthened the life expectancy of the average woman. Gueddana also noted that Tunisia’s economic growth is now five times greater than the growth rate of its population.
Measures to empower women in Tunisia have benefited not only women but Tunisian society as a whole, with significant shifts in men’s attitudes regarding women’s rights and roles in society. Gueddana indicated that her efforts extend beyond Tunisia, as she strives to help empower women throughout the world. She said such efforts will persist so long as women anywhere find themselves disadvantaged, dependent, and living as second-class citizens.
Women’s empowerment in society rests increasingly not in the political but in the economic and business domains (Editor’s note: one could add that women’s empowerment has the potential to considerably impact the environmental domain as well). While women have made considerable progress in the political arena, economic power is still male-dominated throughout the region.
Gueddana said the discussion of women’s rights should take place within the broader context of human rights. Violence against women, particularly sexual violence, is a widespread phenomenon across all societies and, unfortunately, often considered taboo for discussion. She said all citizens benefit when all have equal rights and can use them to expand their opportunities and achievements to enhance their societies.
Dana Steinberg is the editor of the Wilson Center’s Centerpoint.
Photo courtesy of Centerpoint. -
What’s Good for Women Is Good for the Planet
›Ammi, my mother-in-law, was 16 years old when her marriage was arranged. Before she was 18, she had borne her first child, who died within the year, and by 30, she had given birth to six more. She had a fourth-grade education, and like other women in the new state of Pakistan, she knew little about contraceptive choices.
More than 50 years later, contraception still remains inaccessible for millions of women in Pakistan, such as Rani, the young woman who cleans Ammi’s Karachi home. Illiterate and married off to a cousin at age 15, Rani already has three children, and, like the majority of married Pakistani women who have never used modern contraception, will most likely have at least one more.Giving women the ability to determine whether and when to become pregnant is fundamental to the realization of their basic human rights. It is also a proven health and development strategy, substantially reducing maternal and infant mortality by allowing women to space their pregnancies. And now, for the first time, two studies offer compelling evidence that it has another benefit: What is good for women is also good for our planet.
These groundbreaking studies have rigorously quantified the effect on the environment of helping women and girls control their reproductive destinies. The studies – “The World Population Prospects and Unmet Need for Family Planning,” by the Futures Group, and, “Global Demographic Trends and Future Carbon Emissions,” by the National Center for Atmospheric Research and the International Institute for Applied Systems Analysis – demonstrate that giving women and girls access to contraception offers a precious co-benefit: a substantial reduction in carbon emissions.
The logic is simple: When women have the power to plan their families, populations grow more slowly, as do greenhouse gas emissions. The cost of providing these needed family planning services worldwide is minimal compared with other development and emissions reductions strategies – roughly $3.7 billion per year.
More than 200 million women in the United States and developing countries are sexually active and do not want to become pregnant, yet are not using modern contraception. The results are staggering: One in four births worldwide is unplanned, leading to 42 million abortions each year (half of them clandestine) and 68,000 women’s deaths.
Moreover, the large number of women who become pregnant when they do not want to is a significant source of population growth. Read in tandem, the studies show that a reduction of 8-15 percent of essential carbon emissions can be obtained simply by providing modern contraception to all women who want it. This reduction would be equivalent to stopping all deforestation or increasing the world’s use of wind power 40-fold. Although this is just one piece of the emissions reduction puzzle, it is a substantial piece.
The world is now facing multi-layered challenges of economic distress, rising inequality, and environmental devastation caused by climate change. International climate negotiations have repeatedly stalled as powerful nations play the blame game and block progress. Meanwhile, a series of severe weather events has buffeted the earth from Moscow to Iowa to Pakistan, each one hitting women and children hardest. This is the reality that rich nations must reckon with – and commit to changing – today.
In my 14 years at the Global Fund for Women, I have observed the wave of change that comes from empowering women – what some call the “girl effect.” Making information, education, and contraception easily available offers us an affordable, no-regrets strategy that can be implemented now.
Meeting the need for family planning services is not a complex challenge. We know how to provide the commodities, services, and education that women and their families want. There are thousands of programs around the world with successful track records in every conceivable religious, cultural, and political setting.
Investing in family planning has already been proven as an essential strategy to ensure the health, safety, and development of societies. Now we know that it is also an effective way to safely steward Mother Earth through one of her most challenging crises.
Kavita N. Ramdas is chair of the Expert Working Group of the Aspen Institute’s Global Leaders Council for Reproductive Health and senior adviser and former president and CEO of the Global Fund for Women.
Sources: Futures Group, National Center for Atmospheric Research and the International Institute for Applied Systems, Science, UNFPA, WHO.
Photo Credit: “Chaco: Madre pilagá,” courtesy of flickr user Ostrosky Photos, and Kavita Ramdas, courtesy of Global Fund for Women. -
Disease in the Developing World
Poverty, Politics, and Pollution
›November 15, 2010 // By Ramona GodboleA look at the most common illnesses that kill people in the developing world reveals, for the most part, easily preventable and/or treatable diseases and conditions, highlighting the deep disparities between health systems in rich and poor countries. But many of the causes and solutions to these common diseases are also linked to political and environmental factors as well as economic.
Cholera: “A disease of poverty”
Ten months after the earthquake that killed more than 230,000 people, Haiti is facing yet another disaster – a cholera outbreak. The current health crisis highlights broader structural and political issues that have plagued Haiti for years.
Cholera, an intestinal infection caused by bacteria-contaminated food or water, causes severe diarrhea and dehydration, but with quick and effective treatment, less than one percent of symptomatic people die according to the World Health Organization. According to BBC, as of November 15, more than 14,000 people have been hospitalized and over 900 deaths have been attributed to cholera in Haiti thus far.
Even before the earthquake, conditions in Haiti, the poorest country in the Western hemisphere, were bleak. The country has very high maternal and child mortality rates (again, highest in the Western hemisphere), and is in the midst of an ongoing environmental crisis, due to deforestation, soil loss, and flooding.
Less than 40 percent of the Haitian population has access to appropriate sanitation facilities and clean water is scarce, according to UNICEF. Displacement, rapid population growth, and destroyed infrastructure in the wake of the earthquake exacerbated already poor conditions and public health officials warned of the increased risk of cholera and other diarrheal diseases after the disaster.
Today these fears have become reality. While public health messages urging Haitians to wash their hands, boil drinking water, and use oral rehydration salts are working to control the current outbreak, long-term solutions to prevent future outbreaks will require much more systematic changes.
As Partners in Health Chief Medical Officer Joia Mukherjee puts it, cholera is “a disease of poverty.” Citing a joint report from Partners in Health and the Robert Kennedy Center for Human Rights, Mukherjee notes that in 2000, loans from the Inter-American Development Bank to improve water, sanitation, and health (including the public water supply in the Artibonite Valley, where the cholera outbreak originated) were blocked for political reasons by the U.S. government, in an effort to destabilize former President Aristide.
The failure of the international community to assist Haiti in developing a safe water supply, writes Mukherjee, has been a violation of the basic human right to water. To halt the current cholera epidemic and prevent future outbreaks, providing water security must become a priority in the reconstruction efforts of the international community.
Politics and Polio
Recent reports have indicated that the global incidence of polio, a highly infectious, crippling, and potentially fatal virus, is significantly declining and a new vaccine is renewing hopes of eradication. Nigeria, one of the few countries where polio continues to be endemic, has also made major progress over the last few years.
But the situation was very different just a few years ago. In 2003 religious and political leaders in Northern Nigeria banned federally sponsored polio immunization campaigns, citing “evidence” that the polio vaccine was contaminated with anti-fertility drugs intended to sterilize Nigerian women. The boycott led to an outbreak of the disease that spread to 20 countries and caused 80 percent of the world’s cases of polio during the length of the ban, according to a study in Health Affairs.
While the boycott was eventually stopped through the combined efforts of local, national, and pressure, the boycott serves as a useful reminder that global health problems can have political, rather than biological or behavioral, origins.
Combating Climate Change and Pneumonia
Studies from the World Health Organization indicate that exposure to unprocessed solid fuels increases pneumonia risk in children by a factor of 1.8, but today more than three billion people globally continue to depend on coal and biomass fuels for their cooking and heating needs.
Cooking and heating with these fuels creates levels of indoor air pollution that are up to 20 times higher than accepted WHO guidelines, putting people at considerable risk for lower respiratory infections. Women, who are often responsible for collecting fuel and performing household tasks like cooking, and their children, are particularly at risk. Today, exposure to indoor air pollution is responsible for 1.6 million deaths globally including more than 900,000 of the two million annual deaths from pneumonia in children under five years old, representing the most important cause of death in this age group.
A recent study from The Lancet shows improved cooking stoves could simultaneously reduce greenhouse gas emissions and the global burden of disease caused by indoor air pollution in developing countries. Such an intervention, the authors argue, could have substantial benefits for acute lower respiratory infection in children, chronic obstructive pulmonary disease, and ischemic heart disease. The potential health benefits don’t stop there: fuel-efficient stoves can also improve the security of women and children in conflict zones and decrease the risk of burns while improving local air quality.
There would be significant environmental benefits as well. A World Wildlife Fund project in Nepal, which provided loans to purchase biogas units and build improved cookstoves, curbed deforestation for firewood and grazing as well as reduced the incidence of severe cases of acute respiratory infection among under-five children.
Overall, greater access to modern cooking fuels and improved cooking stoves in the developing world could both mitigate climate change and make significant contributions to MDGs 4 & 5, which focus on the reduction of child and maternal mortality.
Prescription for Change
The international community’s experience with cholera in Haiti, polio in Nigeria, and pneumonia around the world shows that health issues in developing countries rarely occur in a vacuum. As these three cases demonstrate, politics, environmental, and structural issues, for better or worse, play an important role in health affairs in the developing world. Yet efforts to combat these conditions often focus only on prevention and treatment.
Antibiotics and vaccines alone cannot provide solutions to these problems. Employing economic, diplomatic and policy tools to address health and development challenges can save lives. More specifically, public health efforts should not only focus on poverty reduction, but also target environmental, political, and structural issues that contribute to disease globally.
Sources: BBC, Bill and Melinda Gates Foundation, CIA World Factbook, Health Affairs, The Lancet, Scientific American, UNICEF, United Nations, USAID, World Health Organization, and World Wildlife Fund.
Photo Credit: “Lining up for vaccination,” courtesy of flickr user hdptcar.
