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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. -
Maternal Health Challenges in Kenya: What New Research Evidence Shows
›“Although there have been improvements in the recent past, the status of maternal health care has not met the required international standards,” said Professor at the University of Nairobi Geoffrey Mumia Osaaji during a live video-conference from Nairobi on July 12.
As part of the 2011 Maternal Health Dialogue Series the Woodrow Wilson Center’s Global Health Initiative is partnering with the African Population and Health Research Center to convene a series of technical meetings on improving maternal health in Kenya. The 20 Kenyan experts attending the workshop in Nairobi also shared their strategies and action points with a live audience in Washington, DC during a video conference discussion. [Video Below]
Osaaji was joined by panelists Lawrence Ikamari, director of Population Studies and Research Institute (PSRI), and Catherine Kyobutungi, director of Health Systems and Challenges at the African Population and Research Center to discuss new maternal health research in Kenya. Panelists also shared recommendations for moving the maternal health agenda forward that came out of discussions during the two-day, in-country workshop with Kenyan policymakers, community health workers, program managers, media, and donors. Following the panelists’ presentations, Dr. Nahed Mattta, senior maternal and newborn health advisor at U.S. Agency for International Development (USAID) and John Townsend, vice-president of reproductive health program for Population Council provided reflecting remarks from the Woodrow Wilson Center during the live webcast.
Maternal Health Challenges in Rural Kenya
“Maternal mortality in rural Kenya is still very high,” said Ikamari. “Rural women in Kenya need to have increased access to maternal health services.” Ikamari discussed a number of factors that contribute to high rates of maternal mortality in rural Kenya, including lack of access to quality care and skilled birth attendants, the high burden of HIV/AIDS, and an unmet need for family planning.
Though nearly 90 percent of women in rural Kenya seek antenatal care, according to the UNFPA, many wait until the second or third trimester, limiting the benefits. Additionally, a majority of women in rural Kenya give birth outside of health facilities, oftentimes without the care of a skilled birth attendant, said Ikamari. In a recent survey, many rural women indicated that transportation to often distant health facilities prevented them from seeking adequate maternal health care, he added.
Additionally, “the burden of HIV is really felt in rural Kenya,” said Ikamari. Survey results show that HIV/AIDS prevalence is about seven percent in rural Kenya and because the majority of the Kenyan population lives in rural areas, this adds yet another layer of complications.
“Family planning saves lives,” said Ikamari, stressing the importance of contraception on maternal health outcomes. Only 35 to 40 percent of currently married Kenyan women use family planning, according to the last demographic and health surveys, and unmet need remains particularly high in rural areas. Promoting institutional delivery systems, improving antenatal and postnatal care, and finding other ways to increase access to family planning can help to improve maternal health outcomes and reduce preventable deaths in rural Kenya, concluded Ikamari.
Comparison of Urban and Rural Areas
“The interventions to address maternal health are well known: family planning, increased access to safe abortion services, skilled health workers, health facilities that are accessible, as well as referral systems that work,” said Kyobutungi. “Yet urban averages [of maternal mortality] are becoming either close or worse than rural averages.”
“As much as we appreciate the rural-urban divide that exists for most health indicators, the urban-urban divide (the fact that there are huge intra-urban differences) needs attention”
“Teenage pregnancy is a failure of family planning,” said Kyobutungi. Studies indicate that there are three times more teenagers that are pregnant among the urban poor, compared to the urban rich.
As in rural Kenya, access to quality health facilities and care is also limited in cities. “Health facilities are few and far between and the referral systems are weak,” said Kyobutungi, and “when you remove Nairobi from the numerator, the number of skilled physicians per population is in the decimals.”
Moving forward, there is a need to promote effective integration and improvement of health worker training and monitoring but also development of performance-based incentives to ensure successful programs are properly funded. “It’s not all gloom and doom in urban areas,” concluded Kyobutungi.
Innovative Ideas for Better Results
“By year 2025 there will be 25 percent more people [in Kenya],” said Townsend. “What that means is, when we are planning…we have to think about the scale of solutions that we are proposing in 2025 and 2050.” Therefore, it is essential to acquire new models of data and evidence to better predict future population growth and maternal needs, he suggested.
In addition to expanding services to meet the needs of a growing population, the panelists in Washington emphasized the need to support integration at all levels. Trends are moving in the right direction: Within the Obama administration’s Global Health Initiative, “there is a strong push and recommendation for integration among the health sectors,” said Matta.
But integration is not a magic bullet to improve maternal health, warned the panelists. “Integration is a terrific issue, but when the health sectors are weak, putting more burden on a local community health worker does not usually make sense; we have to think about smart integration,” said Townsend.
Focusing on Kenya’s health sector from all aspects, both at the private and public level, and improving family planning, institutional delivery care, as well as antennal care will help Kenya overcome its maternal health barriers. Additionally, thinking of ways to utilize new models of data and integrating the various sectors will yield substantial benefits, concluded Matta and Townsend.
Following the technical meeting, a public dialogue was held on July 13 in Nairobi to share the recommendations and knowledge gaps identified with members of Kenya’s Parliament, including Hon. Sofia Abdi, parliamentary health committee member; Hon. Ekwee Ethuro, chair of the parliamentary network for population and development; and Hon. Jackson Kiptanui. They joined a group of more than 50 maternal health experts, program managers, members of the media, and donors – such as the UK Department for International Development (DFID) – to identify real solutions and action points for improving maternal health in Kenya.
The formal report from the in-country technical meeting will be available in the near future.
See also the Maternal Health Task Force’s coverage of the event, here and here.
Sources: Kenya National Bureau of Statistics, UNFPA.
Photo Credit: Jonathan Odhong, African Population and Health Research Center. -
Lakis Polycarpou, Columbia Earth Institute
The Year of Drought and Flood
›August 1, 2011 // By Wilson Center StaffThe original version of this article, by Lakis Polycarpou, appeared on the Columbia Earth Institute’s State of the Planet blog.
On the horn of Africa, ten million people are now at risk as the region suffers the worst drought in half a century. In China, the Yangtze – the world’s third largest river – is drying up, parching farmers and threatening 40 percent of the nation’s hydropower capacity. In the U.S. drought now spreads across 14 states creating conditions that could rival the dust bowl; in Texas, the cows are so thirsty now that when they finally get water, they drink themselves to death.
And yet this apocalyptic dryness comes even as torrential springtime flooding across much of the United States flows into summer; even as half a million people are evacuated as water rises in the same drought-ridden parts of China.
It seems that this year the world is experiencing a crisis of both too little water and too much. And while these crises often occur simultaneously in different regions, they also happen in the same places as short, fierce bursts of rain punctuate long dry spells.
The Climate Connection
Most climate scientists agree that one of the likely effects of climate will be an acceleration of the global water cycle, resulting in faster evaporation and more precipitation overall. Last year, the Proceedings from the National Academy of Sciences published a study which suggested that such changes may already be underway: According to the paper, annual fresh water flowing from rivers into oceans had increased by 18 percent from 1994 to 2006. It’s not hard to see how increases in precipitation could lead to greater flood risk.
At the same time, many studies make the case that much of the world will be dramatically drier in a climate-altered future, including the Mediterranean basin, much of Southwest and Southeast Asia, Latin America, the western two-thirds of the United States among other places.
Continue reading on State of the Planet.
Sources: Associated Press, The New York Times, Proceedings from the National Academy of Sciences, Reuters, Science Magazine, University Corporation for Atmospheric Research.
Photo Credit: “Drought in SW China,” courtesy of flickr user Bert van Dijk. -
Top 10 Posts for July 2011
›July was a great month for NSB: we launched the blog anew with a new design and better functionality, with the aim of making content better organized, easier to find, and just plain nicer looking. We also continued to see some great traffic on a number of posts, including Richard Cincotta’s dive into Tunisia’s demographics and the Mr. Y “National Strategic Narrative” launch at the Wilson Center.
Newcomers to the top 10 (according to unique pageviews) were posts on the Nature article detailing rare earth finds in the Pacific, the role of water in “land grabs,” profiles on the climate-vulnerability of the Philippines and an ecological tourism outfit in Cambodia, and Geoff’s look at the UN Security Council’s debate about the security threat of climate change.
1. Tunisia’s Shot at Democracy: What Demographics and Recent History Tell Us
2. In Search of a New Security Narrative: The National Conversation at the Wilson Center
3. Rare Earths No More? Mineral Discoveries a Potential Game-Changer for East Asia
4. India’s Maoists: South Asia’s “Other” Insurgency
5. In the Rush for Land, Is it All About the Water?
6. Beat on the Ground: Ecological Tourism and Development in Chi Phat, Cambodia
7. Consumption and Global Growth: How Much Does Population Contribute to Carbon Emissions?
8. Life on the Edge: Climate Change and Reproductive Health in the Philippines
9. World Population Day 2011: The Year of Seven Billion
10. Eye on Environmental Security: UN Security Council Debates Climate Change -
Cynthia Brady, USAID
The Specter of “Climate Wars”
›July 29, 2011 // By Wilson Center StaffThe original version of this article, by Cynthia Brady, appeared in the June/July 2011 edition of USAID’s Frontlines.
In 2007, many in the advocacy community rushed to categorize the conflict in the Darfur region of Sudan as a “climate war” in the wake of a compelling United Nations report that emphasized the ways climate change and environmental degradation can drive conflict.
In 2009, international media focused significant attention on an academic study that analyzed historical linkages between civil war and temperatures in sub-Saharan Africa and suggested there would be a 54-percent increase in armed conflicts by 2030. [Video Below]
In both cases, subsequent research and analyses conducted by prominent scholars countered those original claims of such direct climate and conflict connections, at least based on existing evidence. Those studies are two examples of the recent spate of analyses on the subject and serve as cautionary tales against alarmism and overly simplistic assumptions about specific connections between climate change and stability.
The reality is far more complicated.
The science and practice of analyzing the interaction of climate change risk and conflict risk is new and still evolving. As a result, there is little certainty over exactly how climatic change will manifest in specific locations and what the consequences will be for economic development, political stability, and peace and security.
Around the world, climate change likely will create both risks and opportunities, making it critical that development and relief organizations like USAID consider climate change not as a monolithic threat but rather as an important influence within a complex web of environmental and social factors.
Responding to climate change effectively means taking action to reduce the threats. It also means harnessing opportunities by helping people and institutions to effectively cope with and adapt to change – environmental or otherwise. Climate-focused interventions, if conducted strategically and with sensitivity to local context, can produce outcomes for conflict prevention and sustainable development as well.
For example, recent USAID-funded research in the conflict-prone Karamoja region of northeastern Uganda found that engaging local communities in the design and implementation of climate change adaptation activities – for example, promoting shared grazing areas and creating small-scale irrigation systems – holds considerable potential to reduce conflict by building social cohesion and addressing feelings of marginalization and disempowerment among local community members.
Since 2008, USAID has invested in research to better understand how specific climate factors contribute to the risk of conflict and affect the resilience of social structures and institutions. The goal is to build a deeper understanding that will enable the agency and its partners to respond most effectively to climate-related stress, reduce the risk of violent outcomes, and maximize the potential for U.S. foreign assistance to prevent conflict and promote stability.
This knowledge also will help USAID make wise investments as part of meeting U.S. Government commitments under the Global Climate Change Initiative as described in President Barack Obama’s September 2010 Presidential Policy Directive on Global Development.
Climate Change and Conflict Prevention
The research thus far points to climate change as an exacerbating factor in situations where political, economic, and social stresses already exist. The risk of conflict is greatest where there is poor governance and low institutional capacity.
The agency, through its Office of Conflict Management and Mitigation (CMM), has identified two basic scenarios under which climate change could combine with other variables and potentially lead to conflict.
First, climate change could intensify existing environmental or resource problems. For example, a series of droughts could reduce the available local water supply, aggravating competition between farmers and pastoralists in already arid regions. Second, climate change could create new environmental or resource problems that contribute to instability. Changing rainfall patterns, for instance, could damage agricultural production in formerly fertile areas, decimating local livelihoods and causing food insecurity.
There is a third area of potential risk for USAID and other donors as well: namely, that climate-related financing, policies, and programs which have not adequately considered local conflict dynamics and context could produce serious unintended negative consequences.
Climate change-related interventions such as incentive payments to stop deforestation – particularly in fragile states and conflict-affected areas – must recognize that both the money and the power to allocate benefits may inadvertently reinforce the social status quo, shift local power balances, or expose governance failures.
In her field work in Nepal, Janani Vivekananda, a researcher with USAID partner International Alert, recently illustrated how certain types of assistance might inadvertently do harm. She explained how a now-defunct village water tap installed in an effort to mitigate the effects of climate variability, did not appropriately consider the local social, political, and conflict context or even basic environmental parameters. In the end, it contributed to local grievance.
The community had requested the tap to be installed during a period of water stress and three consecutive years of drought. The Government of Nepal sponsored the project just before the elections.
Vivekananda explained: “These people are hand-to-mouth farmers. They didn’t know and they wouldn’t know that ground water levels were falling. They wouldn’t know the negative impacts of uncontrolled surface water extraction and so they chased about this tap, and within three months it ran dry. That was the only cash that was injected into the community for development purposes, and it had no impact whatsoever apart from being a stark reminder that the government itself isn’t doing what it ought to.”
This story highlights the reality that local context will define the outcome of peace or conflict and, thus, as CMM’s discussion paper “Climate Change, Adaptation, and Conflict: A Preliminary Review of the Issues” noted, there remains a pressing need for a more robust, fine-grained understanding of the interaction between climate change and the political, social, and economic realities of conflict-prone areas.
To help fill this information gap, USAID is supporting field-based climate change and conflict research in Peru, Uganda, Ethiopia, and the Niger River Basin in West Africa. At the global level, the agency is improving its ability to integrate climate change considerations into conflict early warning models. It is also establishing academic and practitioner partnerships that explore a wide range of environment and security issues.
Today, close to 60 percent of the State Department’s and USAID’s foreign assistance goes to 50 countries that are in the midst of, recovering from, or trying to prevent conflict or state failure. A significant amount of that assistance is slated for Global Climate Change mitigation and adaptation programming. Yet, as CMM’s conflict early warning specialist, Kirby Reiling, observed, “much of that money could be a lost investment if those countries fall into armed conflict.”
With conflict-sensitive development assistance and with smart climate change policies and programs, vulnerable countries will have enhanced opportunities to build stronger societies and more resilient institutions for sustainable development, peace, and security.
Cynthia Brady is a senior conflict advisor in USAID’s Office of Conflict Management and Mitigation.
Photo Credit: Afghan farmers plow a field guarded by U.S. Marines, courtesy of flickr user isafmedia. -
Watch: Alecia Fields on Population, Health, and Environment Advocacy with the Sierra Club
›July 29, 2011 // By Roza Essaw“The issues of population, health, and environment are pretty foreign to a lot of people,” said Alecia Fields, a recent University of Kentucky graduate who participated in a Sierra Club Global Population and Environment Study Tour of Ethiopia last summer as a student fellow.
“I learned about the program, how to be an effective advocate, and I took those tools back to my university on campus and shared it with young people,” said Fields in this interview with ECSP.
Fields came from a women’s health background but found the connections between population, health, and environment (PHE) compelling enough that she wanted to become an advocate on campus. “At first, people don’t think they have a connection to the issue, but once you start talking with people, they really start to see how they are central to a larger issue,” said Fields.
“It is challenging in the United States to see some of the population and environmental issues…but when you go to a developing country, you see the effects right in front of you,” explained Fields. The Sierra Club’s Global Population and Environment Study Tours bring a select group of student advocates abroad to see PHE projects in the field with the aim of creating pro-active messengers of the importance of integrated development in the United States.
Fields visited various sites and organizations in Ethiopia including the Gauraghe People’s Self-help Development Organization (GPSDO), located in the southwest region. “People in Ethiopia have had tremendous success in connecting population, health, and environment within communities and starting integrated programs that work towards development,” said Fields.
Going to Ethiopia provided Fields with concrete examples of the importance of PHE and allowed her to share her experience with young people through meaningful illustrations and moving stories.
“A lot of it deals with figuring out where people are in their attachment to the subject…and try to figure out how that program can connect to them,” she said. -
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.”
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