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Meeting the Health Challenges of the Urban Poor
›November 2, 2010 // By Joshua NickellFifty percent of the world’s population now lives in cities, a figure that is predicted to rise to 60 percent by 2030, and 70 percent by mid-century, according to UN figures. The majority of this growth will occur in the Global South, where most of the world’s slums are found.
Why the rampant urban migration? Prospects for better health care, education, and employment are drawing the world’s poor out of rural areas into cities. But as the number of impoverished city-dwellers and slums grows, it is becoming increasingly important for society to consider how it will address the problems associated with this unprecedented degree of global urbanization.
At a recent event, “Meeting the Health Challenge of Urban Poverty and Slums,” co-hosted by the Wilson Center on the Hill program and the Comparative Urban Studies Project, Jacob Kumaresan, director of WHO Center for Health Development in Kobe, Japan, and Richard B. Lamporte, director of new program development, Jhpiego, discussed poverty and health challenges in rapidly growing urban slums.
The chances that the world’s rapidly growing number of city-dwellers will live a healthy and prosperous life depend on the services and opportunities cities can offer. As Kumaresan pointed out, there is currently no shortage of problems. Among other ills, he stated that 170 million urban residents currently do not have access to a latrine, while more than 1.2 million people will die from urban air pollution this year alone. As more individuals migrate to cities, these problems will be compounded.
Kumaresan also noted that cities have the “worst and the most unimaginable disparities when it comes to health.” While urban centers have more hospitals and attract many of the best doctors, the hospitals are often not managed or governed well. As a result, many poor urbanites suffer worse health care than their rural neighbors.
For instance, Kumaresan noted that tuberculosis rates in rural parts of India are half those of urban settings. Kumaresan also emphasized that these disparities are certainly not limited to the Global South: developed cities like New York and Los Angeles contend with similar inequities.
To address these issues, Kumaresan encouraged policymakers to examine the unique circumstances and conditions of their cities. “You’ve got to do analytical work to see what the problems are in each city, and to look not at the averages, but to unmask the differentials,” he said.
In Osaka, Japan, tuberculosis rates are 12 times higher than the rest of the country, said Kumaresan, primarily because of high affliction rates among its homeless population. As such, it is important for Osaka’s policymakers to address its tuberculosis problem by considering related socio-economic factors and following through with concrete policy actions.
Lamporte emphasized the importance of giving aid and development organizations flexible funding in order to allow them to better address unique local urban problems and inequities. He advised international donors to devote a certain percentage of their funding to integrated initiatives. “Certainly the goalposts could be set, but having some element of complementary funding … would be extremely useful,” he said.
As both Lamporte and Kumaresan pointed out, the future of the city is increasingly becoming the future of the world. As such, it is crucial to have “an urban optic going into the future,” according to Lamporte. If not, he argued, it will be at our own peril, as disease and unrest find increasingly sturdy footholds in urban slums. As the transformation from a rural to an urban planet continues, it will be essential for emerging and growing cities must use successful urban development techniques from both the Global North and the South.
Joshua Nickell is an intern with the Program on America and the Global Economy.
Sources: IRIN, Osaka University Graduate School of Medicine, UN, World Health Organization.
Photo Credit: “kibera_photoshow08,” courtesy of flickr user newbeatphoto. -
Rare Earths Intrigue: In Response to Chinese Ban, Japan and Vietnam Make a Deal
›November 2, 2010 // By Schuyler NullThe BBC is reporting that Japan has reached an agreement with Vietnam that will help provide a secure supply of rare earth minerals, after China reportedly stopped exports to Japan during an ongoing territorial dispute last month.
China produces nearly all (97 percent, according to the GAO) of the rare earth minerals used around the world, minerals that are used in many advanced electronics including mobile phones, missiles, and key components of cleaner energy tech. Japanese companies are expected to gain exclusive exploration and mining rights in northwest Vietnam in exchange for technical assistance on nuclear reactors.
China’s reported export freeze on rare earths raised warning flags in the region as well as in Washington, where fears over exclusive supply of the crucial minerals have been growing for some time – particularly in the defense community. (Although Bloomberg reports a new Pentagon study says it’s not such a big deal after all.) Control over and access to resources has become an important concern in East Asian diplomacy, as population and consumption in the region rises. For more, check out The New Security Beat’s coverage of the many diplomatic fault lines at play between the lower Mekong countries, China, and the United States, rare earth minerals and green energy, and the conflict potential of future resource scarcity.
Sources: BBC, Bloomberg, Government Accountability Office, The New York Times, TechNewsDaily.
Image Credit: Adapted from “The Huc Bridge, Hanoi,” courtesy of flickr user -aw-. -
Mobile Phones for Maternal Health in the Developing World
›With rising use in the developing world, cell phones and mobile technologies can create “connected and coordinated health systems that save more lives,” said Josh Nesbit at the GHI event “New Applications for Existing Technologies to Improve Maternal Health,” on October 27. Capitalizing on these new technologies could increase efficiency, cost-effectiveness, and efficacy of public health programs. Nesbit, executive director of FrontlineSMS: Medic, was joined by Alain Labrique, assistant professor at the Johns Hopkins School of Public Health, and David Aylward, executive director of the mHealth Alliance at the United Nations Foundation, to discuss the role of Information and Communication Technologies (ICTs) in the prevention of maternal mortality.
Collaborations for mHealth
While “cell phones can’t save lives, the lack of information does kill,” said Aylward. Using technology that many people already own and use, mobile technology is an appropriate tool for disseminating health data and information. Existing technologies such as mobile phones and SMS text messaging can revolutionize healthcare by improving data collection and disease tracking, expanding patient diagnostics, and advancing education and awareness among health workers and patients.
With 64 percent of all mobile phone users located in the developing world, the use of mobile devices to improve health services in low-income countries is especially promising.
Aylward hopes that mobile health technology (mHealth) will help combat maternal mortality in the developing world. With approximately 350,000 women dying in childbirth each year, and only marginal progresses towards achieving Millennium Development Goal 5, finding such innovative solutions to improve maternal health is crucial.
Public-private partnerships are particularly important when considering the long-term sustainability of mHealth programs. “This didn’t happen because of the World Bank, it happened because people who are very poor voted with their very limited funds to have access to information,” said Aylward.
Aylward is hopeful that government and donor support will continue to become more supportive of mobile technology and coordinated in their implementation of mHealth programs globally.
Mobile Health Solutions in the Developing World
“Through mobile tools, we can act as quickly as possible to improve access to skilled birth attendants, emergency obstetric care, and access to reproductive health commodities,” said Nesbit.
Nesbit’s organization, FrontlineSMS: Medic, is working to eliminate barriers created by the lack of resources and infrastructure in the developing world using mobile health technology. Now working in 20 countries, the organization uses free software “that enables large-scale, two-way text messaging using only a laptop, a GSM modem, and inexpensive cell phones,” explained Nesbit.
“One of the best measures is whether people continue to use your tools, and they will if it impacts their lives positively and they won’t if it doesn’t—sometimes it’s as simple as that,” said Nesbit on why communities in the developing world are eagerly embracing mobile technology.
Moving forward, Nesbit hopes to “scale and replicate, both vertically and horizontally, models that we’ve shown can work, but also to build new tools” and work with the health community “to help identify the needs and the gaps in these systems.”
However, Nesbit stresses that “these are very much tools and not solutions; they become solutions when they are paired with people on the ground who use them.”
Compressing the Time Between Crisis and Care
“The opportunities for mobile phones to act synergistically with existing health systems in low- to middle-income countries are many,” said Labrique. The current challenge is to harness this technology to improve health outcomes in the developing world, where disease burden is disproportionately high.
In the developing world, “decisions influenced by the lack of resources, such as poverty, or lack of information have led to highly convoluted patterns of care-seeking,” said Labrique.
“Delayed decision-making compounded by delayed transport can have tragic consequences for maternal mortality,” said Labrique, and the most immediate use of mobile technology is “getting the necessary care, on time, to where these deaths are taking place.” Cell phones can help women, their families, and local health workers to seek timely, appropriate medical help for an obstetric emergency.
“Addressing equity and access to phones when evaluating the impact or success of mHealth interventions is critical,” Labrique said. Although cell phone use is high and steadily increasing, social and cultural norms in some countries might prevent women from using them. Further, Labrique notes, in Bangladesh, cell phone use among the poorest families is noticeably less than those with higher socioeconomic status.
“ICT and mHealth solutions have tremendous promise to improve maternal health in resource limited settings; however, it’s important not to let the technology guide the public health agenda,” said Labrique. More data is needed to determine how these tools might strengthen and enhance health systems and a clearer research agenda can help ensure evidence-based solutions guide programming.
For more from David Aylward and mHealth, be sure to see “Watch: David Aylward on How Wireless Technology is Changing Global Health and Empowering Women.”
Sources: Lancet, United Nations Foundation.
Photo Credit: “‘SMS till you drop’ — mobile phone ad on van in Kampala, Uganda,” courtesy of flickr user futureatlas.com. -
Top 10 Posts for October 2010
›Nathan Yaffe and Laura Dismore’s post on a Ethiopian land-grab case study, Marc Levy’s response to Halvard Buhaug, and India and China’s thirst for resources topped the list last month:
1. The Beat on the Ground: Ethiopian Case Study Illustrates Shortcomings of “Land Grab” Debate
2. On the Beat: Climate-Security Linkages Lost in Translation
3. India’s Maoists: South Asia’s “Other” Insurgency
4. U.S. v. China: The Global Battle for Hearts, Minds, and Resources
5. VIDEO: Peter Gleick on Peak Water
6. Brian O’Neill: Population Is Neither a Silver Bullet Nor a Red Herring in Climate Problem
7. DRC’s Conflict Minerals: Can U.S. Law Impact the Violence?
8. On the Beat: New Study Finds Lower Population Growth Could Cut Carbon Emissions, Lead Author Presents at SEJ 2010
9. Latin America’s Future: Emerging Trends in Economic Growth and Environmental Protection
10. Welcome Back, Roger-Mark: A Powerful Voice Returns to PHE -
PATH Foundation’s ‘Population, Health, and Environment Leadership as a Way of Life’
›PATH Foundation Philippines, Inc. (PFPI) just released a short documentary, Population-Health-Environment (PHE) Leadership as a Way of Life in All Walks of Life. The video features interviews with peer educators and local government officials who have partnered with PFPI on integrated coastal resource management in the Philippines that combines family planning and reproductive health services with environmental services.
According to those interviewed, an integrated approach is the best way to alleviate food insecurity in the area. “We cannot separate population, health, and environment, they should be implemented hand in hand,” said Marlyn Alcanises, a Fisheries and Coastal Resource Management program officer. “Even if we manage our coastal resources well, if there are many children due to high fertility and population growth, many people are hungry.”
The comprehensive program has been successful in addressing the social and environmental problems in the Verde Island Passage of the Philippines, one of Asia’s most densely populated regions, as well as a marine biodiversity hotspot and sea lane for many commercial ships.
The program uses community-based distribution of contraceptives to increase access to family planning, micro-credit schemes to finance sustainable livelihoods and alleviate poverty, and advocacy campaigns to increase government support for integrated health and environment programs.
Municipal Planning and Development Coordinator Cecilia Zulueta praised the integrated approach, saying “it can slow down population growth, decrease the number of malnutrition cases, lessen the number of out-of-school youth, and it can also decrease the crime rate, because if one does not have a stable source of income it may force him to engage in illegal activities.”
In ECSP’s FOCUS Issue 15, “Fishing for Families: Reproductive Health and Integrated Coastal Management in the Philippines,” Joan Castro and Leona D’Agnes demonstrated that PFPI’s Integrated Population and Coastal Resource Management project (IPOPCORM) was more cost-effective and had a greater impact on the wellbeing of both human reproductive health and coastal resources than non-integrated programs. In a study measuring the impacts of integrated versus single-sector reproductive health (RH) or coastal resource management (CRM) programs, they found the integrated approach met or exceeded single-sector outcomes for 26 out of 27 indicators.
Reducing high fertility rates reduces pressure on natural resources, decreases high rates of malnutrition, crime and HIV/AIDS, and preserves local fisheries, “making life sustainable for both humans and nature,” as PFPI puts it in the documentary. The hope is that the community leaders featured in the documentary will inspire others in similar situations to take the lead on integrated issues in their communities.
“Even if we are doing environmental conservation through population management in our province but the others are not, it will still create conflict somehow,” said Alcanises. “I believe that whatever program is being done in one province should also be done in other provinces, in order to avoid conflict and promote balance in program implementation.”
Julio Lopez, president of the Galera Association of Managers and Entertainers said, “this land is ours, and we are responsible in taking care of it.”
PFPI, along with the University of Rhode Island’s Coastal Resource Center and Conservation International, is part of the BALANCED project, which last year launched the PHE Toolkit as a resource for PHE professionals. For more on PFPI’s IPOPCORM program, see ECSP’s interviews with Joan Casto and Leona D’Agnes on our YouTube channel: “Joan Castro – Integrated Population and Coastal Resource Management (IPOPCORM)” and “Leona D’Agnes on Population, Health, and Environment.”
Video Credit: “Population-Health-Environment (PHE) A Video Documentary,” courtesy of YouTube user PATHFoundationPhils.
Sources: Population Reference Bureau. -
Watch: David Aylward on How Wireless Technology is Changing Global Health and Empowering Women
›“We have millions of young children, babies, dying unnecessarily, hundreds of thousands of women dying in childbirth – most of them unnecessarily – in large part for lack of access to health, lack of access to health information,” said David Aylward, executive director of the UN Foundation’s mHealth Alliance. “And while wireless doesn’t solve any of those problems by itself, it is a conduit, a pathway to solve those problems.”
We spoke to Aylward before the Global Health Initiative (GHI) event “New Applications for Existing Technologies to Improve Maternal Health,” at the Wilson Center earlier this week.
“We’ve gone from a billion subscribers to five billion subscribers in the last six years, and 70 percent of those are in the developing world,” he said. “So almost everywhere you go a woman has a cellphone or has access to a cellphone.”
This access allows women in the developing world to do basic things those in the developed world take for granted, like call for help or set up reminders. The most important thing to think about in the future is to continue empowering women with the tools and knowledge to understand their own healthcare and supporting them with better care.
“All of which are possible in the very near term if we can get the different parties to get together and work on them together,” said Aylward, “and that’s what our mission is.”
Check out the the full event summary from GHI here. -
Energy and Climate Change in the Context of National Security
›“Climate Change and Security,” a short briefing by Paul Rogers of the Oxford Research Group, examines the recent trend of framing climate change in terms of a national security threat and presents some of the pros and cons of this viewpoint. Rogers says the recent uptick in interest by the military is expected – and welcomed – because military planners often perform more long-term analyses than other policymakers. However, Rogers also cautions that the military, in its role as protector of the state, will naturally focus on adapting to the effects of climate change rather than preventing them. Thus, while this willingness to think long-term is appreciated, work remains to convince the international security community of the importance of carbon-cutting measures as well.
“Fueling the Future Force: Preparing the Department of Defense for a Post-Petroleum Era,” by Christine Parthemore and John Nagl of CNAS, is a comprehensive policy paper arguing for the U.S. military to aim for the ability to operate all its systems on non-petroleum fuels by 2040. Parthemore and Nagl outline a broad set of recommendations that address DOD’s consumption habits, leadership structure, finances, acquisition process, and mission goals. Notable, in the context of Paul Rogers’ warning, is that the authors’ argument is essentially one of supply and demand, rather than for cutting emissions to reduce the effects of climate change: “…while many of today’s weapons and transportation systems are unlikely to change dramatically or be replaced for decades, the petroleum needed to operate DOD assets may not remain affordable, or even reliably available, for the lifespans of these systems.” -
Watch: Alex Evans on Natural Resource Supply and Demand, Scarcity, and Resilience
›October 27, 2010 // By Schuyler Null“The backdrop to the whole issue of scarcity is that demand is rising, but on the supply side, we’re increasingly hitting restraints,” said Alex Evans of NYU’s Center for International Cooperation in this interview with ECSP.
“Global population is growing, a kind of new global middle class is expanding, especially in emerging economies, and that means demand is rising across the board – particularly for energy, for food, water, and air space for our carbon emissions.”
Evans joined Mathew Burrows of the National Intelligence Council this September at the Wilson Center to talk about scarcity, natural resources, and conflict. He argued that building resilience and improving governance of natural resources is key to addressing growing demand, particularly in developing countries.
“With the Millennium Development Goals there’s been tremendous emphasis on increasing access to services, like health and education, which is important,” he said. “But we haven’t always brought the risk management aspect to the fore, and I think the emphasis we’re starting to see now on areas like social protection, climate adaptation, disaster risk reduction – these are areas that are much more concerned with resilience and it’s very welcome that they’re moving to the front of the development agenda.”
Poor governance in some developing countries has resulted in cases like in Nigeria and the Democratic Republic of the Congo, where natural resources are seen as more of a curse to the local people than a blessing. The intersection between supply and demand will continue to make these problems more acute.
“Over the last 10 years when international aid agencies have thought about governance, it’s usually been in terms of capacity building in the executive branch – areas like public financial management,” said Evans. “I think increasingly we’ll see more of the very, very political issues surrounding who owns natural resources like land, or water, or fisheries, or forests.”
Evans also highlighted other international governance issues like transboundary agreements (or lack thereof), the resiliency of the international trade system (or lack thereof), and existing legal infrastructure that will be challenged by a changing climate and growing demand.
“We haven’t really begun to think these issues through,” he said, “but these are potential conflict flashpoints for the future.”