Showing posts from category environmental health.
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Health and Harmony: Population, Health, and Environment in Indonesia
›Borneo’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 Peoples“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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Ben Ramalingam, Aid on the Edge of Chaos
The Complexity of Scaling Up
›October 11, 2011 // By Wilson Center StaffThe original version of this article, by Ben Ramalingam, appeared on Aid on the Edge of Chaos.
Despite increased prominence and funding of global health initiatives, attempts to scale up health services in developing countries are failing, with serious implications for achieving the Millennium Development Goals. A new paper argues that a key first step is to get a more realistic understanding of health systems, using the lens of complex adaptive systems.
Much ongoing work in development and humanitarian aid is based on the idea of “scaling up” effective solutions. Healthcare is one of the areas where this idea has played a central role – from the World Health Organization’s Health for All in the 1960s to UNICEF’s child healthcare programs, from rolling out HIV-AIDS, malaria and TB treatments to the package of interventions delivered to achieve the Millennium Development Goal on health.
However, despite the fact there are many cost-effective solutions to health problems faced in developing countries, many agencies are still frustrated in their attempts to deliver them at scale. This may be because of a widespread failure to understand the nature of health systems.
Continue reading on Aid on the Edge of Chaos.
Image Credit: Adapted from Table 1, “Understanding pathways for scaling up health services through the lens of complex adaptive systems,” Health Policy and Planning, Oxford University Press. -
Babatunde Osotimehin Answers Seven Questions on Population
›PSI’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. -
Karen Seto on the Environmental Impact of Expanding Cities [Part Two]
›“A lot of cities are trying to become green cities,” said Karen Seto in part two of an interview with ECSP about her recently published article, “A Meta-Analysis of Global Urban Land Expansion,” co-authored with Michail Fragkias, Burak Güneralp, and Michael K. Reilly. “I think one of the main policy implications of our study is that how a city urbanizes is critical, because one of the things we are finding is that urban land is growing faster than urban population, and in some cases it is growing much faster.”
Seto said that the cities with the best prospects for implementing green growth and expansion strategies “tend to focus on the low-hanging fruit,” such as planting trees or constructing buildings with green roofs. From the public’s perspective, these types of measures are relatively painless because they “don’t require changing people’s behavior.”
More challenging, said Seto, will be getting rapidly expanding cities to anchor future development around public-transit systems, especially given the changing lifestyle preferences of upwardly mobile urban populations across China and India, for whom private car ownership serves as an important status symbol.
Still, Seto said she is tentatively optimistic about city planners’ ability to grow cities in a sustainable fashion. “We’ve experienced this rapid growth of urban population and urban land areas, but we’re also seeing that over the next 20 years, according to the UN, we’re going to see even more people living in urban areas,” she said.
“We have this window of opportunity to really shape the way in which cities get developed, and I think that’s really one of the big messages of the study.”
Part one of Karen Seto’s interview is available here. The “Pop Audio” series is also available as podcasts on iTunes.
Sources: China Daily, USA Today. -
Karen Seto on the Environmental Impact of Expanding Cities [Part One]
›“When we think about the environmental impacts of rapid urbanization, we really need to unpack what we mean by ‘urbanization,’” said Karen Seto, an associate professor in Yale University’s School of Forestry and Environment Studies, in this interview with ECSP. “There is the demographic component, where more people are living in cities; there is economic urbanization, which is where livelihoods and economies are becoming more urban rather than rural; and then there is the land component – the conversion of land from agriculture and other ecosystems to become urban.”
Seto is the lead author of a new article, “A Meta-Analysis of Global Urban Land Expansion” (with Michail Fragkias, Burak Güneralp, and Michael K. Reilly), which uses satellite imagery to help document the physical expansion of urban areas in developed and developing nations between 1970 and 2000.
Over that period, the population of cities in the developing world boomed. In 1970, there were roughly the same number of city dwellers in developed nations as in developing nations. By the mid-1990s, however, urban residents of the developing world outnumbered their developed-world counterparts by a factor of two to one. Since then, the gap has continued to grow.
According to the report, urban growth sprawled to cover nearly 60,000 square kilometers of previously non-urban areas during the last three decades of the twentieth-century. One of their most interesting finds, said Seto, was that “urban expansion has been occurring in low-elevation coastal zones more than it has been elsewhere.”
“Essentially what that means is that cities are growing precisely in areas that are highly vulnerable to the impacts of climate change, like sea level rise and storm surges,” she said.
Demography and the Environment
Seto acknowledged that many of the today’s discussions surrounding urbanization focus on the negative impacts for the environment and human security – among them the “loss of agricultural land, conversion of forests, biodiversity loss, changes in hydrology, and climate effects.” Ultimately though, she said, urbanization and its attendant land-use changes shouldn’t be viewed through a black-or-white lens.
“Certainly we think about the oncoming demographic transition of something like three billion more people living in cities,” Seto said, but “that means there’s a lot of efficiency to be gained, whether it is in education, energy, sanitation, or health – urbanization allows for opportunities for really efficient use of resources.”
The real challenge to achieving environmentally sustainable urban development, said Seto, is thoughtful city planning: “How we configure ourselves has a big impact on the environment, so it is not the issue of just whether we are urbanizing – the form in which we urbanize [also] has a huge impact.”
Part two of Karen Seto’s interview is available here. The “Pop Audio” series is also available as podcasts on iTunes.
Sources: Population Reference Bureau, UNFPA. -
What’s in a Name? Watch Don Lauro on PHE, HELP, and HELPS
›Population, health, and environment (PHE) expert Don Lauro has worked on integrated projects for decades as a scholar, an implementer, a donor, and an evaluator. He recently visited the USAID-funded BALANCED Project in Tanzania as part of a wider look at this integrated approach. In an interview with ECSP, Lauro said the effort “made me think more broadly…about this area that we call population, health, and environment and what’s really in a name like that.”
“We commonly say PHE, and we all know what we’re talking about,” Lauro said of the population and development community, “but when you look deeply into these projects – or even not so deeply – you see that there’s other things going on as well.”
For example, Lauro pointed to the focus on livelihoods that many PHE programs have: “In the project I saw in Tanzania, there were many microcredit groups on the ground – mostly women – taking small loans for developing little enterprises that they had, like baking bread, raising bees, buying a cow…little enterprises to make their lives a little bit better.”
“Some people don’t use the term ‘PHE’…maybe it’s a ‘HELP’ project; that is health, environment, livelihoods, and population,” Lauro said. “Other people would say it’s maybe something even longer, ‘HELPS’ – health environment, livelihoods, population, and sustainability (or ‘security’ – Ed.).” When he was at the Wilson Center, Gib Clarke coined the “HELP” term in ECSP’s FOCUS Issue 20, arguing that livelihoods is such a critical component that it ought to be more formally recognized.
But, said Lauro, “on the ground they don’t use these terms – they say things like, ‘this is a healthy community program’ or ‘this is a green community program.’”
“I think it’s very important for us to realize what happens on the ground is lot different, and maybe more real, than how we talk about it.” -
Jay Ulfelder, Dart-Throwing Chimp
Public-Health Campaigns as Outsized Threats to Authoritarian Rule
›August 17, 2011 // By Wilson Center StaffThe original version of this article, by Jay Ulfelder, appeared on his blog, Dart-Throwing Chimp.
Are certain forms of popular activism more likely to hasten the fall of dictatorships than others? This question occurred to me after reading a recent Washington Post story describing how one Russian woman, Darya Makarova, has turned her own frustration with the poor health care given to her (now dead) young son into a wider campaign that’s has caught Moscow’s eye:Thousands have turned out for her rallies, written letters, signed petitions or joined in Internet forums. Since Maxim’s death in November, she has raised money to reopen a children’s clinic, with an emergency room, in her community. She has shamed the city into buying three new ambulances, with proper equipment. She has launched a nonprofit organization, Health Care for Children, that has national ambitions. Politicians have sought her out. Pavel Astakhov, who holds the newly created title of children’s ombudsman, came from Moscow to see her – and then appointed her his unpaid deputy, giving her more access and clout. Even officials from the sprawling and notoriously indifferent Health Ministry started to pay attention.
I can see why government officials would be nervous about this still-modest and outwardly apolitical campaign. Popular activism around matters of public health and safety seems like it should pose a special challenge to authoritarian regimes, like Russia’s, that stake their right to rule on paternalistic claims about their ability to deliver both social welfare and social protection.
Movements organized around failures of public health and safety are threatening to these regimes because they call out the paternalistic state for failing at its own game. Whatever the form of government involved, one of the modern state’s fundamental roles is to protect its citizens from public health threats. Even when they serve this function poorly, most autocrats claim to be trying, and these campaigns reveal that they are not succeeding.
Continue reading on Dart-Throwing Chimp.
Photo credit: “Your Health rests with…,” courtesy of flickr user okeos.
