Photo for the day

Relatives of a person suffering from Hepatitis-B cry after receiving the news of his death at a hospital in Modasa, in India's western Gujarat state February17, 2009. The disease has spread in many parts of the state's Sabarkantha district and has claimed about 19 lives, the Deputy Director (Epidemic) Commissionerate of health services, Government of Gujarat, Dr. Sudhir Gandhi said on Tuesday. (REUTERS/Amit Dave)

CGI U 2009 – Peter’s potpourri of thoughts

Here are some miscellaneous thoughts from last weekend’s CGI U Conference:

• I won’t belabor on points that Jon brought up, but it is worth reiterating the disappointment in the lack of any analysis of the root causes of the challenges faced in the world today.  No mention of history, global political challenges, harmful World Bank and IMF policies, etc.  The conversation solely focused on how we as students could implement small, community-based projects to address the major challenges of the world.  Yes, these types of projects are valuable, but our approach has great potential to be lacking or misaligned unless we as students understand the root causes of such inequities.
• Encouraging to see some university presidents discuss the importance of developing cultures of civic engagement and public service in their institutions.  Bill Powers of University of Texas and Scott Cowen of Tulane both hit this one out of the park.
• “No matter how you want to create change there is absolutely no substitute for working with those directly effected by the problems you seek to address.” Nathaniel Whittemore on a panel with several university presidents.
• How can you have a food panel and not address the deep flaws in US food aid?
• It is upsetting to see a conference that seeks to address energy and climate change use so much damn bottled water.  Laurie Garrett touched on the absurdity of this in a recent Pop!Cast.
• Had some great conversations with people from FACE AIDS, Global Health Corps, Keep A Child Alive, Physicians for Human Rights and others in the global health twittersphere.

Quote for the day

¡Hoy decimos basta! Today we say enough is enough! To the people of Mexico, Mexican brothers and sisters: We are a product of 500 years of struggle – first against slavery, then during the War of Independence against Spain led by insurgents, then to promulgate our constitution and expel the French empire from our soil, and letter [when] the dictatorship of Porfirio Díaz denied us the just application of the Reform laws and the people rebelled and leaders like Villa and Zapata emerged, poor men just like us.  We have been denied the most elemental education so that others can use us as cannon fodder and pillage the wealth of our country.  They don’t care that we have nothing, absolutely nothing, not even a roof over our heads, no land, no work, no health care, no food, and no education.  Nor are we able freely and democratically to elect our political representatives, nor is there independence from foreigners, nor is there peace or justice for ourselves and our children.

- Comandancia General del Ejército Zapatista de Liberación Nacional, 1993

Video for the day: Stephen Lewis, IAS 2006

Bye bye global gag rule

An important step for global health equity, Obama has repealed the Mexico City Policy (also known as the Global Gag Rule) that had prevented federally funded NGOs from performing and even counseling women on abortions.

Here’s part of Obama’s statement on whitehouse.gov:

For too long, international family planning assistance has been used as a political wedge issue, the subject of a back and forth debate that has served only to divide us.  I have no desire to continue this stale and fruitless debate.

It is time that we end the politicization of this issue.  In the coming weeks, my Administration will initiate a fresh conversation on family planning, working to find areas of common ground to best meet the needs of women and families at home and around the world.

What a ladies’ man.

Photo of the day

A customer of a micro finance institution strings beads into necklaces at a workshop in a slum area in Mumbai February 17, 2007. (REUTERS/Prashanth Vishwanathan)

Ch-ch-changes

Received this email from a friend yesterday about Mark Dybul, the US Global AIDS Coordinator, and the head honcho behind PEPFAR:

…we have received confirmation that Ambassador Mark Dybul has been asked to resign, effective immediately. We understand that the office will be run by career staff until a new Coordinator is named.

Rumors are swirling about who will be named by the Obama Administration.  Names that keep coming up seem to be Nils Daulaire, former CEO of the Global Health Council, and Jim Yong Kim, Chief of the Division of Global Health Equity at the Brigham and Women’s Hospital, co-founder of Partners In Health, and other fancy titles.

Of the two (and virtually any other candidate as well), my vote is for Jim Kim.  He brings a pragmatic and passionate understanding of current on the ground realities from his time with PIH.  His grasp of global health policy (especially around HIV and TB) is hard to rival.  And, above all, he is strongly rooted in ideas of equity, human rights, and a preferential option for the poor.

While Daulaire has been a strong advocate for global health in DC, he has deep ties with big pharma and has been largely quiet in condemning the profit-driven industry.

Anxious to see where this goes.  As we have seen, the position has a serious amount of clout to influence global HIV/AIDS treatment throughout the world.

War and mental health

The impact of the destruction in Gaza will extend far beyond the time taken to rebuild public infrastructure, hospitals, universities, and apartment buildings.  Some are predicting that more than half of the children in Gaza will suffer from posttraumatic-stress disorder.  A revealing excerpt from a Newsweek piece:

Our host Hassan says all his three children now climb in bed with their parents, which they hadn’t done in years. His son Abdullah, 14, came to him half way through all this and handed him a letter, which he had carefully and beautifully written out. In it the boy pleas formally with his father to “remember me when I am dead, and promise to bury me near Grandmother and Grandfather, and please visit my grave every week.” The father wept for half an hour after reading it, he says. Abdullah, his 10-year-old son, one long night when the bombing was particularly bad, held his mother and said “please watch my eyes and make sure I don’t go to sleep, mama,” as Hassan related it. “He was afraid he would die and not wake up.”

War has a devastating, long-lasting impact on people’s health, whether they be innocent civilians or soldiers.  War recovery plans must prioritize the treatment of PTSD amongst the efforts to treat the rehabilitate the wounded and rebuild public health infrastructure.  So far, we are failing – both as a country and as a global community.

Natsios Award Nominee

Nicholas Kristof in his recent column, Where Sweatshops Are a Dream:

..the central challenge in the poorest countries is not that sweatshops exploit too many people, but that they don’t exploit enough.

He continues:

The best way to help people in the poorest countries isn’t to campaign against sweatshops but to promote manufacturing there.

In this January 14 column in the NYT, Kristof makes an argument for the importance of sweatshops as a key part of poverty-alleviation.  In the presence of jobs like rickshaw pulling, he states that sweatshops ain’t that bad relative to the alternatives that one might depend on for one’s income.  Kristof rails against poltical groups that push for greater labor standards claiming (perhaps accurately) that these types of standards often push manufacturers out of the poorest countries and into better off countries, leaving a significant portion of the population jobless.

While Kristof’s basic premise that an increase in labor is a key form of poverty-alleviation, his acceptance and encouragement of sweatshops is ludicrous without condemning the all too frequent use of unfair wages, union-busting tactics, and dangerous working conditions.  To give a thumbs up to sweathshops, simply based on the argument that they are a lesser evil than other available jobs (or no job at all) is both deconstructive and unacceptable in a push for a truly better living standard for the poor in developing countries.

This type of argument is akin to similar ones that have plagued the push for global health equity for too long.  Arguments like early WHO policy on MDR-TB treatment that opted for the “lesser of two evils” solutions, declaring treatment too expensive and even stating that it “distracts attention and resources” away from other diseases.  Little progress comes from arguments like these that have pushed for sub-standard care as a solution to sub-sub-standard care.  Just as in the case of MDR-TB treatment, progress comes from those individuals or groups that rise up, demand the status quo inequitable and unjust, and advocate and act for a better option for the poor.

Sweatshops do provide important labor for many people throughout the developing world.  But, simply providing a job to the jobless does not make it just nor does it warrant celebration.  According to a 2004 IPS report titled Wal-Mart’s Pay Gap, a Bangladeshi woman in a factory producing goods for Wal-Mart gets paid 17 cents/hour.  Such a low wage drives these workers to demand on health, food, and housing aid.  In contrast, the Wal-Mart CEO, H. Lee Scott, Jr., was paid $8,434.49/hour in 2004.  I feel its safe to assume that H. Lee is able to provide the highest quality health care, food, and housing for himself and his family, and perhaps even live exorbitantly on the side.

What are the implications for a continuation of the current use of sweatshops throughout the developing world?  While I am without an economic Ph. D., B.S. or anything of the sort, common sense tells me that such extremely low wages in the developing world in the presence of absurdly high salaries of Wal-Marts senior staff will not lead to a more equal world.  Money will  continue in the direction of the the rich Westerners and away from the hardworking laborers of the developing world.  The rising rates of inequality will continue along on their current trend.  Writing absurdities like those in Kristof’s column will allow for the continuation of people living without basic rights and will deter a push for more radical change rooted in equity and justice for the world’s poor.

Change has come

Kenyans who gathered at the grounds of the University of Nairobi to watch in giant screens the inauguration ceremony where Obama was sworn in as the 44th President of the United States of America celebrate the ocassion on January 20, 2008. Barrack Obama's father was born in Kenya. (via Boston Globe)

From Obama’s inauguration speech:

To the people of poor nations, we pledge to work alongside you to make your farms flourish and let clean waters flow; to nourish starved bodies and feed hungry minds.

And to those nations like ours that enjoy relative plenty, we say we can no longer afford indifference to the suffering outside our borders, nor can we consume the world’s resources without regard to effect. For the world has changed, and we must change with it.

Now it is our responsibility to hold him to these words.