Showing posts from category livelihoods.
-
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. -
Fistula, Stigmatization, and Development
›Although obstetric fistula may not be as widely recognized as other maternal health issues, the Fistula Foundation estimates that over two million women and girls in developing countries suffer from this condition today. The World Health Organization has labeled it as “the single most dramatic aftermath of neglected childbirth.”
Obstetric fistula is a devastating condition often resulting from obstructed labor that can cause infections, incontinence, and even paralysis. The condition largely afflicts poor, rural, and illiterate women in developing countries who lack resources and access to emergency care and surgery, and sufferers often face an additional burden of social stigma.
Economic Development and Social Standing
Poor infrastructure and poverty significantly increases the occurrence rate of obstetric fistula. Lewis Wall, in an article for The Lancet, writes that “poverty is the breeding-ground where obstetric fistulas thrive.” Wall cites early marriage, low social status of women, malnutrition, inadequately developed social and economic infrastructures, and lack of access to emergency obstetric services as being major contributors of fistulas in developing countries.
Additionally, “postponing the age of marriage and delaying childbirth can significantly reduce the risk of subjecting young women to the arduous labor that induces fistulas,” wrote Sonny Inbaraj of Inter Press Service News Agency (IPS) in an article about how fistula makes social outcasts of child brides.
In most developing societies where child marriage is common, the social standing of women is defined largely in terms of marriage and childbearing. Child marriages are typically arranged without the knowledge or consent of the girls involved. The norms emphasize a girl’s domestic roles and de-emphasize investments such as education.
Stigmatization of Fistula
There is an undeniable link between fistula and social stigmatization. Rather than receiving assistance from their families and communities, women are often ostracized and in many instances exiled from their communities. This is especially true in developing countries where “the role of women is merely limited to providing sexual satisfaction for their husbands, [and] producing children,” said Dr. Catherine Hamlin, founder of the Addis Ababa Fistula Hospital, in an interview with IPS.
“Many women and girls with fistula endure lives of shame, misery, violence, and poverty,” said Agnes Odhiambo, Africa women’s rights researcher and author of ‘I Am Not Dead, But I Am Not Living‘: Barriers to Fistula Prevention and Treatment in Kenya, in a Human Rights Watch article. Human Rights Watch has focused on fistula, recognizing that birth is a human rights issue. Ignoring the issues of women and girls only diminishes progress on human rights and sends a message that says the rights of women do not deserve adequate attention.
Prevention Efforts
Thus far the fight to end fistula has attracted various government agencies and organizations including USAID, UNFPA, EngenderHealth, Maternal Health Task Force, and the Human Rights Watch. Outstanding individuals have also played a key role in fistula prevention efforts, like Drs. Reginald and Catherine Hamlin, Australian gynecologists who came to Addis Ababa in 1959 for temporary medical work, but after hearing heart-breaking stories from fistula patients, they decided to move to Ethiopia permanently and open the Addis Ababa Fistula Hospital. As the only hospital dedicated exclusively to women with obstetric fistula, the hospital provides care free of change, and has done so since 1974.
Although fistula has gotten some support and attention, the need to scale-up the prevention initiatives has never been greater. As a result of the “poverty and the stigma associated with their condition, most women living with fistulas remain invisible to policy makers both in their own countries and abroad,” wrote Inbaraj on IPS.
“Preventing fistula and restoring women’s health and dignity requires more than good policies on paper,” said Odhiambo at Human Rights Watch. Seriously tackling the issue will require much more than traditional medical and public health interventions – prevention efforts must also take into account underlying social issues, food and economic security.
Sources: The Addis Ababa Fistula Hospital, Campaign to End Fistula, The Center for Global Development, The Fistula Foundation, Human Rights Watch, The Lancet, World Health Organization.
Photo Credit: “Hauwa’u, 25, mother from Rogogo community,” courtesy of flicker user DFID-UK Department for International Development. -
Beyond Supply Risks: The Conflict Potential of Natural Resources
›While the public debate about resource conflicts focuses on the risk of supply disruptions for developed countries, the potentially more risky types of resource conflict are usually ignored. As part of a two-year research project on behalf of the German Federal Environment Agency, adelphi and the Wuppertal Institute for Climate, Energy, and Environment have analyzed the risks of international conflict linked to natural resources in a series of reports titled Beyond Supply Risks – The Conflict Potential of Natural Resources.
Resource extraction, transportation, and processing can create considerable crises and increase the risk of conflicts in producing and transit countries. This phenomenon – widely referred to as the “resource curse” – impacts consuming countries only if it leads to shortages and higher prices. However, in the producing and transit countries it can have much wider destabilizing effects – from increasing corruption to large-scale violent conflict. In addition, the extraction, processing, and transportation of resources often create serious environmental risks. Overexploitation, pollution, and the degradation of ecosystems often directly affect the livelihoods of local communities, which can increase the potential for conflict.
The eight reports that comprise Beyond Supply Risks explore plausible scenarios over the next two decades, focusing on four case studies: copper and cobalt in the Democratic Republic of Congo; the Nabucco natural gas pipeline project across Southern Europe and Turkey; lithium in Bolivia; and rare earth minerals in China.
Lithium in Bolivia
Bolivia possesses the world’s largest known lithium deposits, a potentially important resource for the development of electric vehicles. While the development of Bolivia’s lithium reserves could provide major economic benefits for one of the poorest countries in Latin America, our analysis identifies two main potential risks of conflict.
First, the environmental consequences of developing industrial-scale lithium production might have negative effects on the livelihoods of the local population. The local population in the lithium-rich department of Potosí has shown that it is capable of organizing itself effectively in defense of its interests, and past resource conflicts have turned violent, making a conflict-sensitive approach all the more important.
Second, the Bolivian economy is largely dependent on natural resources, and consequently is susceptible to price shocks. At present, this risk is primarily associated with natural gas. But lithium production, if developed, might be subject to the same dynamics, which could potentially destabilize the political system.
For consuming countries, these conflicts threaten supplies of lithium only if local protests or broader destabilization were produce bottlenecks in the supply chain.
Rare Earths and China
Like lithium, rare earths are likewise essential for some new technologies. China’s well publicized monopoly on 97 percent of the global production spurred a heated debate on the security of supply of strategic minerals. While our case study identifies supply risks for consuming countries, it also outlines some of the conflict risks China might face internally.
First, local populations could protest against the severe ecological impact of rare earth mining and production. In addition, conflicts might arise if those who profit from economic development (entrepreneurs or regional power-holders) undermine the traditional centralized party structures and expand their own influence.
International conflicts over access to Chinese rare earth resources, while they dominate the headlines, do not appear to be the dominant risk. Instead, internal political tensions could result in a weakened China that is not able to exploit its monopoly position for foreign policy gains. Or the government could enter into multilateral agreements and thus avoid a confrontational approach towards consumer nations.
Ultimately, the actual rate of diffusion of environmental technologies and the development of new technologies remain the key factors in determining whether relative shortages in global supply of rare earths will in fact occur. If industrialized nations and emerging economies commit to the same technologies to attain climate policy goals, international resource governance and coordinated promotion of (environmental) technology will also play a role in preventing conflict and crisis over rare earths.
The Way Forward
The series concludes with five recommendations to mitigate the risks of future resource conflicts:- Introduce systematic policy impact assessments to understand how policy goals and strategies, especially in regard to climate and environmental policy, interact with resource conflict risks.
- Increase the transparency of raw material markets and value creation chains to prevent extreme fluctuations in prices and improve information on markets, origins, and individual players.
- Improve the coherence of raw material policy by linking raw material policies with security, environmental, and development policies.
- Demand and promote corporate social responsibility along the whole value chain.
- Increase environmental and social sustainability as a means of strengthening crisis and conflict prevention by systematically taking into account social and conflict-related aspects in the resource sector.
The individual reports from the project can be downloaded here:- Conflict Risks (GERMAN only)
- Supply and demand (GERMAN only)
- Case Study: Nabucco Pipeline (GERMAN only)
- Case Study: Congo
- Case Study: Bolivia
- Case Study: China
- Conflict Resolution Strategies (GERMAN only)
- Summary and Recommendations
Sources: Government Accounting Office.
Photo Credit: “Potosí: miners in darkness,” courtesy of flickr user Olmovich. -
Population, Health, and Environment Approaches in Tanzania
›“Quality of life, human health, food security, and biodiversity are all connected,” said Elin Torell, research associate for the BALANCED Project and the University of Rhode Island Coastal Resource Center. Torell was joined at the Wilson Center on July 19 by Patrick Kajubili from the Tanzania Coastal Management Partnership, and Alice Macharia, director of the East Africa Program at the Jane Goodall Institute to discuss the importance of integrated population, health, and environment (PHE) initiatives that work to simultaneously improve health and livelihoods, manage natural resources, and conserve ecosystems in Tanzania.
Building Resilient Coastal Communities
The Coastal Resources Center’s work in Tanzania’s Saadani National Park provides an example of an integrated PHE approach that sustains the flows of environmental goods and services, maintains biological diversity, and empowers and improves the wellbeing of local residents, said Torell. Since 1996, the CRC has focused on protecting sea turtles, promoting energy-saving stoves, and tracking elephants, while at the same time improving livelihoods through savings and credit associations, eco-tourism, and beekeeping.
“Adding family planning makes a whole lot of sense,” said Torell. There is a high unmet need for family planning in Tanzania and the population is growing rapidly with an average number of 5.6 children per woman. Family planning not only helps families limit and space births but indirectly works to improve food security and human health, reduce demand for scarce natural resources, and empower women, she said.
“Integration is key,” concluded Torell: A coordinated and synergistic approach that meets the varied needs of local communities will be more effective and sustainable than if interventions were delivered independently.
Effective Integration in the Field
“Conceptual linking is not enough,” said Kajubili. “Integration also needs to happen at the organizational and field levels.”
On the ground, the Tanzania Coastal Management Partnership integrates family planning education and services into conservation work, said Kajubili. Peer educators deliver information about family planning, health, and coastal resources management; and community-based distributors deliver family planning services and supplies.
“Now people easily access reproductive health services,” said Kajubili. To date, the program has increased referrals to health centers, promoted contraceptive use, and reduced the distance that women need to travel to receive family planning services.
“Integration makes sense and cents,” said Kajubili. By combining resources, health and natural resource management organizations can potentially reach a broader population while sharing costs.
But “reinforcing the linkages between PHE of course takes time and education,” said Kajubili, highlighting a major challenge to implementing integrated approaches. “Advocacy is needed to overcome cultural and institutional barriers.”
“What About Our Needs?”
“Socio-economic development; family planning and AIDS education; sustainable forestry and agriculture practices; and water and sanitation all underpin and support sustainable natural resource management,” said Macharia.
The Lake Tanganyika Catchment Reforestation and Education Project (TACARE) led by the Jane Goodall Institute was initiated in 1994 to arrest the rapid degradation of land through tree planting and forest degradation, said Macharia. “But at some point, the communities raised the question: What about our own needs?” she said.
Community members prioritized the need for health services, education, clean water, and financial capital. But environmental degradation was not seen as a major issue, suggesting a need for a more integrated approach to TACARE’s conservation efforts.
“Integrated programs including population, health, and environment activities are cost-efficient and add value to conservation goals,” said Macharia. By responding to the needs of the community, the integrated approach adopted by TACARE has gained more credibility among local people, while a strong focus on building local capacity has helped to ensure sustainability of the program.
While there are many challenges to implementing and maintaining integrated PHE programs, “partnerships at the local, district, and national level are key to making this a success,” concluded Macharia.
Sources: Population Reference Bureau.
Photo Credit: “Environment near Vumari Village,” courtesy of flickr user treesftf. -
Reducing Health Inequities to Better Weather Climate Change
›In an article appearing in the summer issue of Global Health, Dr. Margaret Chan, director-general of the World Health Organization (WHO), brings to light what she calls the starkest statistic in public health: the vast difference in the mortality rates between rich and poor countries. For example, the life expectancy of a girl is doubled if she is born in a developed country rather than in a developing country. Chan writes that efforts to improve health in developing countries now face an additional obstacle: “a climate that has begun to change.”
Climate change’s effect on health has increasingly moved into the spotlight over the past year: DARA’s Climate Vulnerability Monitor measures the toll that climate change took in 2010 on human health, estimating some 350,000 people died last year from diseases related to climate change. The majority of these deaths took place in sub-Saharan Africa, where weak health systems already struggle to deal with the disproportionate disease burden found in the region. The loss of “healthy life years” as a result of global environmental change is predicted to be 500 times greater in poor African populations than in European populations, according to The Lancet.
The majority of these deaths are due to climate change exacerbating already-prominent diseases and conditions, including malaria, diarrhea, and malnutrition. Environmental changes affect disease patterns and people’s access to food, water, sanitation, and shelter. The DARA Climate Vulnerability Monitor predicts that these effects will cause the number of deaths related to climate change to rise to 840,000 per year by 2030.
But few of these will be in developed countries. With strong health systems in place, they are not likely to feel the toll of a changing environment on their health. Reducing these inequities can only be achieved by alleviating poverty, which increases the capacity of individuals, their countries, and entire regions to adapt to climate change. It would be in all of our interests to do just this, writes Chan: “A world that is greatly out of balance is neither stable nor secure.”
Sarah Lindsay is a program assistant at the Ministerial Leadership Initiative for Global Health and a Masters candidate at American University.
Sources: DARA, Global Health, The Lancet, World Health Organization.
Image Credit: Henry J. Kaiser Family Foundation and the World Health Organization. -
Emily Puckart, MHTF Blog
Maternal Health in Kenya From a Human Rights Perspective
›The original version of this article, by Emily Puckart, appeared on the Maternal Health Task Force blog. This is the second post about MHTF and the Woodrow Wilson Center’s trip to Nairobi, Kenya to host a cross-Atlantic web-cast meeting on “Maternal Health Challenges in Kenya: What New Research Shows.” The first is available here along with video of the conference.
“Do you want to be a pregnant woman or a prisoner in Kenya?” asked Dr. Margret Meme, one of speakers in Nairobi at the recent policy dialogue “Maternal Health Challenges in Kenya: What New Research Shows.” She explained that the last prisoner killed in Kenya through capital punishment was over 20 years ago, yet pregnant women continue to die of treatable causes not just in Kenya, but globally.
As Dr. Meme addressed maternal health through the lens of a human rights perspective she highlighted a number of recommendations in order to more adequately address maternal health challenges in Kenya. She was concerned that pregnancy was treated more like a medical disease with purely medical solutions. Dr. Meme urged maternal health advocates to also focus on the cultural, social, gender, and economic factors that influence maternal health and asked that these factors be addressed along with medical solutions in order to truly address maternal health challenges.
Naturally, addressing maternal health challenges can come with a monetary price. However, instead of viewing that cost as a cost that must come after more immediate government priorities such as infrastructure and defense, Dr. Meme argued that cost should be borne as the government would bear any other cost for public goods. As pregnancy builds a nation, Dr. Meme argued that maternal health is a public good, in the same vein as defense. Therefore maternal health should have a budget allocation that is just as important as the budget line for defense.
Of course, pushing for more public funding of maternal health can lead to other complications. If advocates successfully encourage politicians to increase funding for maternal health programs, the work of maternal health advocates cannot simply end there. Advocates should hold governments accountable; not just in putting aside funding for maternal health, but also for actually making sure that the money reaches the intended beneficiaries. Therefore budget accountability tracking mechanisms should go hand and hand with pushing for increased public funding to maternal health programs.
Finally, Dr. Meme addressed the need for men to be more involved in maternal health. As she clearly stated; the role of men in maternal health shouldn’t stop at conception. Men focused programs which clarify reproductive and sexual health rights, as well as educate men on issues of maternal mortality and morbidity should encourage men to respect the rights of women to space their pregnancies and deliver their babies safely.
Emily Puckart is a senior program assistant for the Maternal Health Task Force (MHTF).
Photo Credit: Jonathan Odhong, African Population and Health Research Center. -
Second Generation Biofuels and Revitalizing African Agriculture
›In “A New Hope for Africa,” published in last month’s issue of Nature, authors Lee R. Lynd and Jeremy Woods assert that the international development community should “cut with the beneficial edge of bioenergy’s double-edged sword” to enhance food security in Africa. According to Lynd and Woods, Africa’s severe food insecurity is a “legacy of three decades of neglect for agricultural development.” Left out of the Green Revolution in the 1960s, the region was flooded with cheap food imports from developed nations while local agricultural sectors remained underdeveloped. With thoughtful management, bioenergy production on marginal lands unfit for edible crops may yield several food security benefits, such as increased employment, improved agricultural infrastructure, energy democratization, land regeneration, and reduced conflict, write the authors.The technological advancements of second-generation biofuels may ease the zero-sum tension between food production and bioenergy in the future, writes Duncan Graham-Rowe in his article “Beyond Food Versus Fuel,” also appearing last month in Nature. Graham-Rowe notes that current first-generation biofuel technologies, such as corn and sugar cane, contribute to rising food prices, require intensive water and nitrogen inputs, and divert land from food production by way of profitability and physical space. There is some division between second-generation biofuel proponents: some advocate utilizing inedible parts of plants already produced, while others consider fast-growing, dedicated energy crops (possibly grown on polluted soil otherwise unfit for human use) a more viable solution – either has the potential to reduce demand for arable land, says Graham-Rowe. “Advanced generations of biofuels are on their way,” he writes, it is just a matter of time before their kinks are worked out “through technology, careful land management, and considered use of resources.” -
Emily Puckart, MHTF Blog
Maternal Health Challenges in Kenya: An Overview of the Meetings
›The original version of this article, by Emily Puckart, appeared on the Maternal Health Task Force blog.
I attended the two day Nairobi meeting on “Maternal Health Challenges in Kenya: What New Research Evidence Shows” organized by the Woodrow Wilson International Center and the African Population and Health Research Center (APHRC). [Video Below]
First, here in Nairobi, participants heard three presentations highlighting challenges in maternal health in Kenya. The first presentation by Lawrence Ikamari focused on the unique challenges faced by women in rural Kenya. Presently Kenya is still primarily a rural country where childbearing starts early and women have high fertility rates. A majority of rural births take place outside of health institutions, and overall rural women have less access to skilled birth attendants, medications, and medical facilities that can help save their lives and the lives of their babies in case of emergency.
Catherine Kyobutungi highlighted the challenges of urban Kenyan women, many of whom deliver at home. When APHRC conducted research in this area, nearly 68 percent of surveyed women said it was not necessary to go to health facility. Poor road infrastructure and insecurity often prevented women from delivering in a facility. Women who went into labor at night often felt it is unsafe to leave their homes for a facility and risked their lives giving birth at home away from the support of skilled medical personnel and health facilities. As the urban population increases in the coming years, governments will need to expend more attention on the unique challenges women face in urban settings.
Finally, Margaret Meme explored a human rights based approach to maternal health and called on policymakers, advocates, and donors to respect women’s right to live through pregnancies. Further, she urged increased attention on the role of men in maternal health by increasing the education and awareness of men in the area of sexual and reproductive health as well as maternal health.
After these initial presentations, participants broke out into lively breakout groups to discuss these maternal health challenges in Kenya in detail. They reconvened in the afternoon in Nairobi to conduct a live video conference with a morning Washington, DC audience at the Woodrow Wilson Center. It was exciting to be involved in this format, watching as participants in Washington were able to ask questions live of the men and women involved in maternal health advocacy, research and programming directly on the ground in Kenya. It was clear the excitement existed on both sides of the Atlantic as participants in Nairobi were able to directly project their concerns and hopes for the future of maternal health in Kenya across the ocean through the use of video conferencing technology.
There was a lot of excitement and energy in the room in Nairobi, and I think I sensed the same excitement through the television screen in DC. I hope that this type of simultaneous dialogue, across many time zones, directly linking maternal health advocates around the globe, is an example of what will become commonplace in the future of the maternal health field.
Emily Puckart is a senior program assistant at the Maternal Health Task Force (MHTF).
Photo Credit: MHTF.
