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From the Wilson Center
Health and Harmony: Population, Health, and Environment in Indonesia
MOREBorneo’s Gunung Palung National Park is a microcosm of both the island’s ecological wealth and vulnerability. More than half of the park is undisturbed forest; the remainder, however, “is being torn down day after day” at an alarming rate, said Health in Harmony’s Nichol Simpson at an event on integrated approaches to population, health, and environment (PHE) programs in Indonesia. Alene Gelbard of the Public Health Institute’s Company-Community Partnerships for Health Indonesia (CCPHI) program joined Simpson on September 29 at the Wilson Center. Both speakers emphasized that no matter what issue a group works on, engaging local communities is essential for success.
The Destructive Cycle: Poor Health, Poor Environment
For Simpson, “the intersection between human and environmental health” is at the heart of Health in Harmony’s work. Health in Harmony opened Clinic ASRI in 2007, aiming to provide improved healthcare to villagers throughout Gunung Palung National Park while ending their dependence on illegal logging as a means of financial survival.
The area’s inhabitants were all too easily trapped in what Simpson called “the destructive cycle.” When faced by an unexpected medical emergency, families would go into debt to pay their medical bills. Health in Harmony found that of 232 local households surveyed, 13 percent had recently experienced a major medical emergency, at an average cost of $360. Most households in the area only hold around $260 in emergency savings, so to make up the difference, about a third turned to illegal logging to pay down their debt.
By deforesting the park, illegal logging worsens the health of nearby communities. For example, Simpson said that Clinic ASRI has seen a rise in cases of malaria and tuberculosis in the surrounding communities, in part because deforestation has increased the level of mosquito activity. The link between human and environmental health is clear, said Simpson: the people ASRI serves are “living it every day. They know the cause of this. And…they want it to stop.”
Protecting Natural Resources By Improving Health
The Health in Harmony clinic located in Sukadana, a small village sandwiched between Borneo’s coast and Gunung Palung Park, helps break the destructive cycle by treating patients regardless of their ability to pay. If patients do not have cash, they can barter for their care. In one case, a girl named Yani came to ASRI after her family incurred $500 over two months of visiting hospitals and traditional healers, none of whom could treat her condition. ASRI diagnosed and treated Yani for scabies. In exchange, her mother signed a pledge to protect Gunung Palung from logging and made the clinic a floor mat to cover the $1.50 bill.
By providing affordable, high-quality healthcare that is contingent upon pledging to protect the environment, Clinic ASRI improves human and environmental health in one fell swoop, said Simpson. “Because the infant mortality rate has decreased and you’re not overcompensating,” said Simpson, families can choose to have fewer children, using free birth control provided by ASRI.
“When you have fewer and healthier children, you’re investing in your education,” said Simpson. “When you’re investing in your education, you’re investing in your country and your community. This is the virtuous cycle. I didn’t invent it, but we are proving it in Sukadana.”
The communities around the clinic have embraced ASRI’s work, partnering with them to expand their services to address additional community needs, like training farmers in more productive organic methods and providing mated pairs of goats for widows, who pay ASRI back with kid goats and manure for fertilizer.
All but one of the 23 villages that ASRI services have been consistently free of illegal logging, according to monitors who visit them on a regular basis. “We’re proving the theory that we can protect natural resources by improving health,” Simpson said.
“Health Is Key to Sustainable Development”
Gelbard took a step back to talk about CCPHI’s experience establishing multi-sector partnerships among NGOs and corporations by building trust and enabling dialogue between the communities.
With corporate responsibility becoming more popular, “everyone’s talking about partnerships these days, and everybody’s partnering with everyone,” said Gelbard. “I don’t care what they call it – I care what they’re doing” and what results they achieve, she said. A successful partnership involves “all partners doing something more than just giving money.”
Gelbard said the 2004 tsunami reinforced the notion of corporate responsibility for a lot of companies operating in Indonesia. They saw that unless they branched out beyond their own walls and “did things to help strengthen communities,” efforts at corporate responsibility simply “would not benefit them in the long-run,” she said.
Through CCPHI, companies and NGOs have partnered on a wide range of efforts, including improving access to and funding for reproductive health services, improving sanitation by increasing access to water, and combating human trafficking by empowering girls and women.
Achieving the Millennium Development Goals will require increasing access to health care in a manner that reflects the needs of communities, she said. At its core, CCPHI’s work and the partnerships it facilitates are “based on the knowledge that health is key to sustainable development,” said Gelbard.
Event Resources
Sources: Alam Sehat Lestari, American Journal of Tropical Medicine and Hygiene, Company-Community Partnerships for Health Indonesia, ExxonMobil, The Guardian, Health in Harmony, National Geographic, PBS News Hour, Public Health Institute, Republic of Indonesia Ministry of Forestry, United Nations, World Wildlife Fund
Photo Credit: Used with permission courtesy of ASRI and Nikki See, Under-told Stories. -
PHE Is One Great Idea That Won’t Be On the Rio Agenda, Says Roger-Mark De Souza
October 17, 2011 // By Sean PeoplesMORE“I am now serving as an example to other women in the community because I am not having any more children. I have received training in sustainable agricultural practices, I’m generating income, and I’m educating others,” said Berhane Ferkade, an Ethiopian farmer, to Population Action International’s Roger-Mark De Souza earlier this year. The 39-year-old mother of 11 become one of the community’s model farmers after working with LEM Ethiopia – a local population, health, and environment (PHE) development organization.
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Jon Foley: How to Feed Nine Billion and Keep the Planet Too
October 12, 2011 // By Geoffrey D. DabelkoMOREJon Foley of the University of Minnesota’s Institute on the Environment is a food security rock star, plain and simple. And he deserves that lofty status in part because he explains our complex 21st century agriculture challenges in such a clear and accessible fashion. See him present (like in the TEDx video above), and you are left wishing all scientists would drop in on the “how to make your work understandable” class that Foley must have aced.
Foley brought that clarity of presentation, mixed with self-deprecating humor, to this past week’s inaugural South by Southwest (SXSW) Eco conference in Austin, Texas. Foley said we must meet three big challenges in the realm of agriculture:- Feeding the population today: One in seven of the world’s seven billion people do not know where their next meal is coming from.
- Feeding the future population: The planet is expected to reach more than nine billion people in just 39 years (and may still continue to grow beyond nine billion, rather than leveling off as expected until recently).
- Farming the planet sustainably: We are a long way from achieving sustainable agriculture, given overuse of fertilizers, soil erosion and degradation, deforestation (leading to loss of biodiversity), and energy-intensive practices (producing excessive carbon emissions).
But Foley and his colleagues retain their scientific union cards while suggesting specific ways the world might meet the three food security goals listed above. In what must be considered the academic equivalent of a walk-off grand slam, they will be featured as next week’s cover story in Nature and a more accessible derivative in the November issue of Scientific American.
“Today, humans are farming more of the planet than ever, with higher resource intensity and staggering environmental impacts, while diverting an increasing fraction of crops to animals, biofuels and other nonfood uses,” Foley et al. write in Nature. “Meanwhile, almost a billion people are chronically hungry. This must not continue: the requirements of current and future generations demand that we transform agriculture to meet the twin challenges of food security and environmental sustainability.”
Their four-step plan in brief:- Slow agricultural expansion to stop deforestation and the huge ecological cost that stems from expanding into new lands, often to grow animal feed rather than food for direct human consumption.
- Grow more food on the acres currently under cultivation. The attention, resources, and innovation applied to the best-producing farms need to also be turned on the least productive farms, where rates as low as 20 percent of potential yields are the norm.
- Improve the resource efficiency of agriculture, through better water use, for example. Places like India, where the energy to pump groundwater is effectively free, are very inefficient in the use of water per calorie grown.
- Close “diet gaps,” where only 60 percent of what is grown is actually for human consumption (the rest for animals and fuel), and reduce food waste, whether it is spoilage on the way to market or the excesses of a food industry that leaves so much uneaten.
Sources: Nature.
Video Credit: “TEDxTC – Jonathan Foley – The Other Inconvenient Truth,” courtesy of Youtube user TEDxTalks. -
On the Beat
Lisa Hymas on Envisioning a Different Future With Family Planning in Ethiopia
MOREECSP caught up with Lisa Hymas, senior editor at Grist, last week during the first South by Southwest (SXSW) Eco conference and she spoke about her recent visit to Ethiopia to see the country’s community health extension program in action. “Ethiopia has a big challenge around population,” Hymas said, “but the government is committed to bringing that down.”
The government extension program places health-workers – young women, for the most part, who have received basic training – directly into each community, where they are able to give out immunizations, provide advice on nutrition, teach families how to properly hang bed nets to prevent mosquito-borne illnesses, and provide family planning services and advice.
Thanks to the program, these health workers and those in the communities they service can “envision very different lives for themselves than their mothers had,” Hymas explained. For instance, one woman recounted that her mother gave birth to 10 children, “and almost died giving birth to the last one, because there was no access to birth control, and there was no good access to health care.” In contrast, she is now able to have a career and to use family planning to delay and space her own childbearing.
For more on Ethiopia’s health extension program, see Schuyler Null’s report on visiting a village health clinic near the town of Fiche last spring. -
From the Wilson Center
Strengthening the Voices of Women Champions for Family Planning and Reproductive Health
MORE“The health, security, and well-being of families depend importantly on the health of women,” said Carol Peasley, president and CEO of the Centre for Development and Population Activities (CEDPA). “When women have the ability to voluntarily space and limit the number of children they have, maternal and newborn child deaths decrease, as do abortions and abortion-related injuries,” she continued.
Peasley was joined by three panelists on September 28 at the Wilson Center: Dr. Nafis Sadik, special advisor to the UN Secretary General; Tigist Kassa Milko, health communications program coordinator for Panos Ethiopia; and Rosemary Ardayfio, a reporter for the Ghanaian paper, The Daily Graphic.
Ardayfio and Milko both recently participated in a CEDPA-led workshop, which is designed to create effective women champions for family planning and reproductive health.
“The voices of women champions may in fact be the best way to influence policymakers and just average citizens around the world,” said Peasley.
Women’s Rights Essential for Development of All
According to Sadik, women have gained some autonomy over their reproductive health:- Maternal mortality around the world is down by 40 percent compared to 1990 levels;
- Family planning reaches over 65 percent of women who need and want it;
- Many developing countries will achieve parity in girls’ and boys’ education by 2015; and
- Women are increasingly prominent in national and international leadership.
- Women’s literacy rates are still much lower than men’s;
- Pregnancy and childbirth still pose major health risks for women;
- Maternal mortality is the single biggest differential between developed and developing countries;
- We are far from reaching the Millennium Development Goal of reducing maternal mortality by 75 percent; and
- The current unmet demand for family planning (215 million women) is projected to rise by 40 percent by 2050 as the reproductive age population grows.
Local Champions for Local Needs
Although Tigist Kassa Milko and Rosemary Ardayfio come from two African countries hundreds of miles apart, their struggles are eerily similar.
In Ethiopia, the more than 1.5 million women who live in pastoral or nomadic areas shoulder many responsibilities, including walking long distances to fetch food and water for their families. The well-being of these women and their families is further strained by the challenges of climate change and limited health service provision.
To help overcome these obstacles, a number of micro-credit associations now offer female pastoralists alternative livelihood options. Panos Ethiopia also provides “reproductive health, family planning, gender-based violence forums” and “trainings on life skills and saving” to those who come for loans, said Milko.
But “when it’s a choice between walking to get water and walking to get contraceptives, water will win,” said Milko, so it is essential to focus on integrating ways to improve livelihoods, health, and ecosystems – also known as population, health, and environment (PHE) programs.
In Ghana, women also grapple with competing issues of development, poverty, healthcare, and cultural barriers. According to Ardayfio, 35 out of every 100 Ghanaian women want to space or limit births but are not using modern family planning methods. As a journalist, she acknowledged that there are many myths about reproductive health that need to be dispelled. The newspaper she writes for, The Daily Graphic, publishes three articles on women’s health each week.
“The stories of women dying from pregnancy-related causes should continue to be told in a compelling manner until our government makes good on the many international commitments it has signed to,” said Ardayfio. “Our decision-makers should be told again and again that it’s time to scale up family planning.”
Event Resources:
Sources: CEDPA, Guttmacher Institute, Population Reference Bureau, UNESCO, UNICEF, USAID.
Photo Credit: Dave Hawxhurst/Wilson Center. -
SXSW Eco Panel: Three Great Ideas That Won’t Be On the Rio+20 Agenda
September 30, 2011 // By Schuyler NullMORESouth by Southwest (SXSW) – the popular music, film, and alternative showcase – is moving into the green space with its first ever “eco” conference, kicking off next week, October 4, with more than 50 panels on “solutions for a sustainable world.” There’s one in particular though you should tune into: “Three Great Ideas that Won’t Be On the Rio Agenda,” featuring Geoff Dabelko, director of the Wilson Center’s Environmental Change and Security Program; Roger-Mark De Souza, vice president of research and director of the climate program at Population Action International; and Aimee Christensen, CEO of Christensen Global Strategies.
The panel will feature discussion on three issues that will likely not be on the table at the Rio+20 UN Conference on Sustainable Development next year: integrated population, health, and environment development programs, climate adaptation as a path to peacebuilding, and how to get the private sector better involved in helping cope with climate change.
If you’re traveling down to Austin, “Three Great Ideas” is scheduled for Thursday, October 6 at 10am CST; if not, stay tuned for webcast information!Topics: climate change, development, environment, global health, PHE, population, Rio+20, SXSW, video -
Friday Podcasts
Aaron Wolf on Water Management, Agriculture, and Population Growth in the Middle East
MOREIn terms of groundwater depletion, “Yemen and Gaza are probably the two places worst off in the Middle East,” Aaron Wolf told ECSP in a recent interview. Wolf, a water expert and geography professor at Oregon State University, said population growth across the broader Middle East region has led to intensified groundwater pumping in recent years. This trend has raised the prospects for water-related conflict down the road, as countries drain their groundwater stocks faster than the aquifers can recharge. Potentially complicating matters further, said Wolf, is that most aquifers in the Middle East cross international boundaries.
Despite the region’s history of water tensions, Wolf said the unprecedented level of demographic change currently being experienced across the Middle East is not necessarily a recipe for future confrontations over the resource, in part thanks to the existence of water-sharing agreements in the area. Nevertheless, mounting demand will likely force water-users across the region – especially within the agriculture sector – to change the ways they utilize the resource.
Accounting for 80 to 90 percent of total water usage in some Middle Eastern countries, agricultural operations have already been forced to adjust to the evolving water-access situation. While moving from flood irrigation to drip irrigation represents one policy option if sufficient funds are available, Wolf said doing away with local food production “is a path that a lot of countries are going to have to take” to ensure a relatively stable water supply for their populations’ drinking, cooking, and cleaning needs.
Wolf added that one frequently discussed but not entirely realistic option for addressing the region’s water-supply concerns involves desalination. To date, widespread deployment of the technology has been hampered by high costs and substantial energy requirements, although that hasn’t stopped a few countries in the region – among them the United Arab Emirates, Saudi Arabia, and Israel – from becoming partially reliant on converted fresh water.
Wolf maintained that desalination’s hefty price tag means the technology is useful only for urban population centers near the coast. Moving converted sea water further inland remains a non-starter, he said, because transporting it requires an enormous amount of energy (a cubic meter of water weighs a metric ton).
For the same reasons, Wolf asserted, using desalinated water for agriculture doesn’t seem to be in the cards any time soon. “Right now a cubic meter of desalinated water costs about 40 cents, and you can’t use that for agriculture unless it drops down to about 8 cents a cubic meter,” Wolf said. “So until you can irrigate with desalinated water, it really doesn’t go a long way towards mitigating the larger water crisis.”
The “Pop Audio” series is also available as podcasts on iTunes.
Sources: American University, International Food Policy Research Institute, World Bank.Topics: agriculture, economics, energy, Friday Podcasts, Israel, livelihoods, Middle East, natural resources, population, water -
On the Beat
Babatunde Osotimehin Answers Seven Questions on Population
MOREPSI’s Impact magazine has an interview up with UNFPA Executive Director Babatunde Osotimehin asking him seven questions about population. It’s not likely this will be the last seven-something-themed story as we approach October and the expected seven billion mark for global population, but Karl Hofmann, president and CEO of PSI, asks some good questions, including on the prospect of harnessing the “demographic dividend” and about the barriers facing more integrated development efforts – a critical topic in population, health, and environment (PHE) circles.
On the demographic dividend:Karl Hofmann: Demography can be a key to progress with the right policy environment in place, but it can also be a burden when we don’t have the right framework in place to take advantage of growing populations. Some have described this as the demographic dividend – growing populations as a potent driver of economic growth and development. Give us your perspective on that.
And on integrated development:
Babatunde Osotimehin: I spoke at the 17th African Union Summit this year and one of my messages was that we have the opportunity right now to take advantage of the demographic dividend of young people. It’s important for African governments to understand that they have a youthful population. Most of Africa is under the age of 35. If 85 percent of the African population is under 35, the implication is that you have to have education, social services, housing, all of that, tailored to meet the needs of this population.
Beyond that, given what we’ve seen with the Arab spring uprising and others in many parts of the developing world, young people who are out of work want education and economic opportunities. We want to appeal to member states to provide skills appropriate to development and also ensure that we have continuing conversations with young people about their reproductive health and rights so they can make the choices that will ensure they plan for their families.KH: There are lots of conversations going on in global health circles these days around the synergy of integration. From your perspective, what are the barriers to this integration?
Read the full interview on Impact.
BO: I think it’s bipolar. Some countries are satisfied with vertical programs. Others are resistant to changing their system at the request of a donor. One argument for integration is that you can have the one-stop shop situation where one, two, three trained providers can deliver services at the same time. These include integration of HIV counseling, testing and treatment with family planning, with health education for non-communicable diseases, with immunization for children or with maternity services.
When you look at the components of an integrated system, it is very easy to sell. In terms of investment, it makes sense for the governments to build and put this together. The supervision becomes a lot easier, and the training of health workers would then capture all of the skill sets that would be required. Some countries, like India, Ethiopia and Nigeria have started this kind of integration.
Sources: PSI.
Image Credit: Adapted from UNFPA.
A Publication of the Stimson Center.
