DevPolitics

chronic malnutrition and NGO action

I attended a conference held on Malnutrition at Columbia Thursday night. MSF, David Rieff, and Barbara Cooper represented the views regarding Niger and India. My capstone has to do with malnutrition in India, so naturally I had to ask specifics about the work being done. What fascinates me about (and draws me to)  MSF is their constant rule-breaking nature--all in the name of the people, of course. It's admirable, in my eyes. There was a brief mention of the role of advocacy and how it will change the way MSF operates, and frankly I do worry that it will change things. David Rieff brought up OxFam as an example--their incredible field work has been put aside for advocacy...which is a shame, really. Where is the balance? Is there? David Rieff was an interesting character--he actually said that he was there under false pretenses and honestly stated that he did not believe humanitarian work belonged in areas of chronic malnutrition (ie India...or historically, the majority of the malnourished populations). This argument was cut short, but it is interesting to see things from that perspective. Again, where is the balance when it comes to human lives? Malnutrition is generally accepted to have historical connotations. When emergency relief is provided in chronic situations, the services that are generally regarded to be the responsibility of the local government are now receiving support. The root cause (policy, corruption, what have you) is not being addressed, and a problem receives a bandaid in the form of aid and relief. As the roles of organizations start to blend together, I have to wonder when (if, ever??) chronic issues, such as malnutrition, will be addressed.

Pharmaceutical Responsibility

http://www.oxfam.org/en/policy/bp109_investing_for_life_0711

According to the 2008 Fortune 1000 Report, the group of Pharmaceutical companies made a profit of $40.1 billion, despite the low economic climate. Meanwhile, the majority of the world’s population does not have access to essential medicines.

I understand that the process of developing a drug, medication, or vaccine requires large amounts of money and resources. What I don’t understand, are the priorities of the companies. The amount of money spent on instilling the fear of H1N1 into the global population could have been going to finding a cure for cholera. The resources used to develop a flu vaccine each year could go to saving generations from easily curable diseases. I, for one, would much rather get the flu than trypanosomiasis—but I have been receiving emails and phone-calls urging me to get a flu vaccine based on my history of asthma. I don’t have people calling me to get the typhoid vaccine based on my history of travel.

I’m not an expert of pharmaceutical development, but I am almost positive that $40 billion is more than enough to research and develop an essential medicine for developing populations.  Even if this is not the case, $40 billion is certainly enough to warrant a subsidy on expensive medications for poor populations.  The regulations regarding patents have limited the ability to manufacture affordable versions of the drugs, further preventing the work of health workers to gain headway.

Tracy Kidder described the efforts of Paul Farmer in her book, Mountains Beyond Mountains. An essential part of Paul Farmer-philosophy is that if a medication exists, all people deserve to benefit from it, no matter the cost. Farmer also systematically “borrowed” from Harvard University’s supplies in order to get the expensive medications to the populations in need. While Farmer’s methods may be debateable, I whole-heartedly agree with his thought process: just because a person cannot pay for a drug does not mean they should have access to it.  I was under the impression that research and development of medicines were to help people and benefit the world. When did that become attached to a clause of “if the person can afford to pay?”

Another facet of the problem is the pharmaceutical company’s pointed argument of their investment in medicines for malaria, TB, and HIV/AIDs. What they don’t acknowledge is the fact that many of these drugs have been deemed too old and inefficient for use (the most recent drug for TB was developed 30 years ago!). As with any treatment, constant monitoring and development of more effective and efficient forms must be performed to combat drug resistance. This research is not being performed, and global health issues are culminating into multi-drug resistant havens. I was on Larium in 2008 and still got malaria. When I was in India, I caught Chikungunya. These are illnesses people have to live with on a daily basis—a cure, for which, just requires investment in research.

Based on the input from 12 pharmaceutical companies, the World Health Organization, Medicins Sans Frontieres, Voluntary Service Overseas, Save the Children, and other key international health players, OXFAM published a report entitled “Invest in Life.” This 2007 report was a call to action assigning responsibility to pharmaceutical companies to invest in the research and development of common ailments afflicting the developing world. The claims the pharmaceutical companies have made to claim investment in the poor were rectified: barely any research is being done on low-profile or non-communicable, existing drugs go through shameful “ever-greening” practices, donations are largely expired or near expiry, and patent-demands have prevented millions from the medicines they deserve. The twenty-year patents have created a monopoly on many valuable medications, preventing access to treatment for millions based on affordability. Despite the harsh criticism, Oxfam does acknowledge the progress the pharmaceutical companies have made since a report published in 2002 entitled, “Beyond Philanthropy.” Six pharmaceutical companies responded, largely defending the efforts they had contributed.

And yet there is still a $40 billion profit.

In this world of technological advancement and innovation, I see no reason that there have not been cures and/or vaccinations for common ailments such as dengue fever or chikungunya virus. Leprosy and polio are still major problems. Childhood diseases that we westerners were vaccinated for in our youth are still killing millions. When the medical solution exists, why is it not being used to its full potential? The practice of “donating” expired or almost expired medicines is appalling. Pharmaceutical companies are smart enough (or have teams of people that are) to figure out true demand at inflated prices to judge demand for unexpired donations. Just because a person is poor does not mean that they deserve inadequate and inefficient medical “donations.”

            When it comes to access to medicine, I completely support the efforts of Medicins Sans Frontieres. Their Access to Essential Medicines campaign has been a call to action for pharmaceutical companies and a wake up call for any informed consumer. MSF’s campaign urges the pooling of patents in order to create affordable methods of treatment, medical innovation for needs versus market priorities, and the creation of sustainable solutions for the worlds poor.  In typical MSF fashion, an eloquent yet systematic attack is placed on the institutions with the capacity to help the cause to actually help.  As an aside with regards to patent defence, the force with which Nutriset is defending its patent shocks me—I was under the impression that Plumy’nut was developed to help malnourished children, not to create a monopoly on a life-saving medicine.

I believe the work of Oxfam and MSF will eventually be successful—too many consumers are becoming aware of the situation in order to allow it to continue. The question is when. When will the poor be able to access medicines? When will the world be able to eradicate diseases such as polio and smallpox? When will children stop dying from pneumonia? It is already too late for so many…I hope that we don’t waste more lives waiting. Many pharmaceutical companies have the funds and resources necessary to provide medical innovation for people in developing countries. Market demand should be based on need, not financial profitability. I firmly stand by the belief that pharmaceutical companies should be held accountable on more than just ethic and moral terms—this involves fighting sleeping sickness instead of female sexual dysfunction. Public awareness of the disparity between medicinal access for the rich and poor is an essential component—without being held accountable by the public financing operations, how can one expect the pharmaceutical companies to change? The question is, then, how does one go about informing the general public and getting them to care? That’s a battle in itself.

AIDs vaccine--thoughts?

The health sector is going nuts over "promising" results in the clinical trial of the AIDs vaccine.

I have my skepticism, which I recently posted on facebook. With a mixed batch of friends, I naturally got a mixed batch of responses. I'd like to know what people in this class think about it.

My brief thoughts:

• It was tested in Thailand, where 8,000 people received the test and 8,000 people received a placebo. Are there too many underlying conditions in Thailand to deem a difference of ~20 people a success? How ethical is it to conduct a test involving HIV on human subjects, regardless of race or socioeconomic status, anyway?
• If an HIV/AIDs vaccine is successful, how will this affect the work that has been done on prevention and education? Will all of the progress that has been made with access to knowledge and education go down the tube? Will people become more careless?
• The clinical trial can not explain reasons for the difference in rates of infection--the infected people who received the vaccine did not have any less of a viral load than the control group. Generally in partially successful trials, the viral load would have decreased in the test group.
• If a vaccine is found to be successful, how will this change the stigma against HIV/AIDs? Will people start to see it in the same light of smallpox and typhoid?
• In my work, HIV/AIDs research on access to communities and education has led to breakthroughs in a plethora of other sectors--how will this affect "development" work in the future?

I'm curious to know what people think about this.

From "illegal immigration" to "labor immigrants"

Currently, most of the debates about immigration are focused on “illegal immigration”.  Therefore, arguments such as the need of border enforcement, the hike of criminality rates or the large amount of taxpayers' money being spent on health and education of “illegal immigrants” seem to be guiding the debate. One could also hear claims about displacement of white communities and the shrink of property values with the arrival of the newcomers.  However, it seems that if the debate continues to be focused on these issues, policy proposals will remain ambiguous and without really addressing the reasons that drive immigration. Additionally, and even most importantly, discrimination against Hispanic low skill workers will be reinforced and the fracturing of immigrants’ families will continue. In other words, there seems to be the need to approach immigration from a different perspective. Therefore, it is worth asking: what do people mean when they refer to “illegal immigrants”?  Are “illegal immigrants” exclusively those low skill workers that cross the Mexican border? What about the Chinese, Malaysian or Ethiopians that enter the US legally but stay illegally?  Are these people also “illegal immigrants”?

A good starting point in the discussion is what the speakers at the recent IPSA Conference  “Living Migration: Spanning the Local and Global Divide” agreed on: that a vast majority are labor immigrants seeking job opportunities in the United States.  This means, on hand, that they are not necessarily criminals, and on the other, that there is the need to recognize that this group constitutes an important labor force for the American economy. One of the speakers, Janice Fine Professor of Labor Studies at Rutgers University, addressed the audience with the following question: Is migration an immigration problem or a labor standards issue?.”  Among the speakers were also Michael Piore, Professor of Political Economy at MIT and Devesh Kapur, Director of the Center for Advanced Study of India at the University of Pennsylvania.  

For all of them, the recognition of the labor immigrants category means reframing the discussion. Thus, they suggested a “changing context” that needs to be reinterpreted. Fine argued that: 1) grassroots organizations that seek to support immigrant workers and to advocate for migratory reforms are gaining more political power, 2) there is an increasing confusion and lack of knowledge about the nationality of these immigrants, and 3) the legal category of “undocumented” seems to be a problem rather than a solution.

On the other hand, Michael Piore argued that the principles and ideas that have governed the market in the last years have had negative impacts not only for these labor immigrants, but also for the average middle class citizen.  He argued the importance of reexamining the idea according to which CEOs of big companies and creative and innovative persons such as Bill Gates are the ones responsible of creating economic growth. For Piore, economic growth and innovation are the result of a collective process in which we all participate, rather than the exclusive input of some individuals. In terms of the immigration debate this means that low skill workers contribute in different ways to create economic growth with their “invisible” work in restaurant kitchens or as janitors. The policy effect would be to increase the minimum wage in an attempt to benefit not only labor immigrants but also low skill Americans.

How to build a policy framework in this “changing context”?  Ideas are on the table but there are still many political and economic challenges to overcome.  Additionally, it is important to recognize the role that racism plays in the debate.  I personally celebrate the initiative of IPSA in including migration as a key aspect in the Wagner agenda with such an interesting panel of speakers.  I hope this initiative could have a larger impact not only within Wagner, but also as an attempt to aim those grassroots movements and local governments interested in progressive policy frameworks to help immigrants and their families.  


 

Disasters and Peacemaking: Creating Opportunities for Peace

I wanted to comment - a few weeks after the fact - on one of the talks in the Conflict, Security, and Development series at Wagner (March 5th). Michael Renner, the speaker, is the Director of the Global Security Project at WorldWatch Institute. The focus of this talk was the opportunities for peacemaking which can exist in the wake of a disaster. These opportunities arise from a crisis which cuts across conflict lines and can mobilize people to work together to address a common threat - and moreover, conflicts also mean that more international attention is focused on that region, which can provide some pressure - and resources - for peacemaking.

Renner went on to examine the aftermath of the tsunami in Aceh (where relative peace resulted) in in Sri Lanka (where conflict escalated after the tsunami and has carried on to this day). The factors that make a difference are things like timing and the political context. Who is gaining from conflict? Are all sides involved in and benefiting from rebuilding efforts? Is aid perceived as being distributed equitably? Is there a domestic commitment to peace?

In the end, "it depends" on a wide variety of factors. However, since it seems that the frequency of large scale disasters is increasing (due to climate change, etc), this will be an interesting area for future research. While there must be an internal impetus for peace, is there anything that outside institutions can do to promote, or at least not hinder, this? For example, at the very least, efforts should be made to not exacerbate tensions through haphazard and inequitable relief efforts.

Failed States: Fixing a Broken World

This week's Economist has an interesting article, Failed States: Fixing a Broken World which ties in with some of our readings this week on history and geography. As the title suggests, the author focuses on failed states such as Somalia, Afghanistan, and the DRC. The US and EU direct great amounts of attention on these states, recognizing that these states are a source not only of human rights abuses and suffering within their borders, but they can be havens for terrorists and threaten security beyond their borders.

The article provides a good overview to some of the measures and definitions of state failure or weakness. The Brookings Institute uses twenty indicators, from government effectiveness and control of corruption to income inequality and child mortality, which it synthesizes to measure the degree of state weakness in the developing world.

The article then goes on to discuss the correlations between countries' rankings on the state weakness scale and a variety of other issues. It turns out that terrorist groups seem to prefer countries with weak but not failed governments (after all, they too need an effective communication infrastructure and methods for transferring money in order to operate). Not surprisingly, measures of corruption and drug trafficking correlate strongly with state weakness (though there are exceptions). There does not, however, seem to be a strong connection between dysfunctional states and pandemics.

Anyways, you can also read more about the Brookings Institutes study on state weakness here, I found it pretty interesting.

Drs. Epstein's and Halperin's panel discussion on HIV/AIDS at NYU

On October 24^th I had the pleasure of attending the panel discussion on HIV/AIDS at NYU, which included Drs. Helen Epstein and Halperin. I had previously read Epstein’s, The Invisible Cure: Africa, the West, and the Fight Against AIDS, so I was quite excited about hearing her discuss the book and current issues in HIV/AIDS in Africa. As a public health student, the book was particularly elucidating and interesting. For example, the circumcision theory (male circumcision significantly reduces HIV prevalence) was novel to me and logically, made a lot of sense. Dr. Halperin especially expanded on this point, showing graphs and figures that in fact illustrated how HIV prevalence has been reduced in sub-Saharan Africa among circumcised males.

I was also particularly interested in hearing more about Epstein’s view that large amounts of international aid and interventions have not been as effective in reducing HIV prevalence as small grass-roots movements that wholly involve solidarity among and local participation by sub-Saharan Africans. So when Dr. Epstein finally spoke, I was thoroughly disappointed. I am convinced that her lackluster tone was induced by some sort of sleep aid or barbiturate. At least I hope there is some explanation for her monontonic discussion. A woman who had written such a fine piece of epidemiological analysis on HIV/AIDS could not be so profoundly humdrum! As I looked around the audience in sheer perplexity, I saw that I was not alone. My cohorts seemed equally unimpressed and almost perturbed.

Not particularly an impressive or eloquent public speaker, I do however recommend Epstein’s book, The Invisible Cure: Africa, the West, and the Fight Against AIDS. And Dr. Halperin, on the other hand, is a captivating speaker that sheds light on the issues surrounding HIV/AIDS in sub-Saharan Africa.

Stolen DVDs offer time-passing, passive entertainment.

So one of my old roommates left all these DVDs in my apartment that she "borrowed" while interning at the National Labor Committee. One night last month with horrible insomnia I watched a couple of them dealing with cheap foreign labor and the impacts of out-sourcing.
The director of the NLC is quoted in one of the documentaries in saying when it comes to raising awareness about labor issues, "If you do it right, you can take the American public with you." Although I of course see his point and believe that in some cases "awareness raising" can be hugely beneficial, I don't think that labor activists have yet to "get it right" when it comes to retaining public concern over this issue.
I wonder if getting it right is merely a matter of framing issues. Take for instance the trend in purchasing "free trade" coffee. Few people even knew that human rights violations existed in the coffee industry, yet attach an attractive label to something such as "free____" and before you know it Whole Foods is carrying free trade coffee and college students are rocking stickers that say "support free trade." However, what do we really know about the state of workers in this industry and the influences free trade has had on their working conditions? 
One documentary, titled "Human Cost Behind Bargain Shopping" (an NBC-Dateline investigation), includes even more disturbing footage and individual interviews with factory workers in Bangladesh. It really brings to mind the number of stories I have seen recently about how Wal-Mart is benefiting from the current economic crisis. It appears to me that wherever there are people suffering that this company will find a way to profit off it. I truly think that although they are a power house of a company, that there is a way to regulate them and that is must be done. One idea that I have and may serve as an additional blog post, is for clothing and plastic toys to have similar labeling requirements as do organic foods. Making the issue of human rights visible to people while they are digging through bargains on DVDs and cheap children's toys may be the only way to begin curbing this problem.

Go learn a language and join the foreign service. Yes please! But really?

Last night Senators Barak Obama and John McCain, candidates for President, participated in the Presidential Forum on National Service at Columbia University.  To hear the candidates address the topic of national service is a very exciting for me as a Wagner student since this is an issue I study on a daily basis.  McCain spoke first of supporting public service by encouraging Americans to join the military, AmeriCorp, PeaceCorp, Teach for America and expanding these programs, especially the military, to increase opportunities.  After McCain, Obama agreed with McCain on expanding the military and also expanding the military’s civilian counterparts, the State Department and USAID. 
Expanding these opportunities would be exciting and would also help the United States aboard. There are many willing Wagner students ready to sign up.  However, expanding these programs will be difficult to pass thru Congress.  Both candidates did mention the large, thriving part nonprofits play in providing opportunities for Americans to serve.  This area will continue to grow, and as Wagner students enter the workforce, it’s also most likely where they’ll find employment.   

Zalmay Khalilzad

I found Zalmay Khalilzad's talk the other day at Wagner quite interesting and not solely because of the excellent buffet of free food.  What struck me most was the fact that Khalilzad seemed to be advocating for exactly the same sorts of reforms that major critics of the Bush Administration are clamoring for.  Khalilzad described how we need to be building capacity within Iraq's government and civil society, and not simply relying on American contractors to do all of the work of rebuilding the government.  He also stressed the importance of bringing in multiple stakeholders into the process of rebuilding the country.  Ironically, many would argue that many of these problems developed or greatly worsened during his two years as the ambassador to Iraq.  This poses the question of whether Mr. Khalilzad truly meant what he said, or was simply pandering to the liberal university audience.  A less cynical perspective may be that perhaps he learned a great deal from his time as ambassador to Iraq and that the tide is beginning to shift.  Regardless it should be interesting to see how the Bush Adminsitration's policies in Iraq shift during his last 8 months in office.