Poverty alleviation and healthcare need more people, not more technology


Atul Gawande writes eloquently, about why certain advances are taken up very quickly. and some aren’t. Seven pages of crisp prose full of stories, examples and personal experience mixed with science later, I (re)learned a couple of important lessons.

via Atul Gawande: How Do Good Ideas Spread? : The New Yorker.

 

One

This has been the pattern of many important but stalled ideas. They attack problems that are big but, to most people, invisible; and making them work can be tedious, if not outright painful. The global destruction wrought by a warming climate, the health damage from our over-sugared modern diet, the economic and social disaster of our trillion dollars in unpaid student debt—these things worsen imperceptibly every day. Meanwhile, the carbolic-acid remedies to them, all requiring individual sacrifice of one kind or another, struggle to get anywhere.

The nature of the problem being fixed is important. Issues not immediately apparent to human perception, and which require human behaviour changes to fix are difficult.

We’re infatuated with the prospect of technological solutions to these problems <snip>As with most difficulties in global health care, lack of adequate technology is not the biggest problem. <snip> Getting to “X is what we do” means establishing X as the norm. <snip> To create new norms, you have to understand people’s existing norms and barriers to change.

Two, clearly, inventing new technology/interventions is only second or third in a series of steps needed to actually solve a problem. We often laud the technological aspect, awarding prizes for new inventions and new science, while ignoring the much more challenging human dimensions to changing behaviour and norms.

What would happen if we hired a cadre of childbirth-improvement workers to visit birth attendants and hospital leaders, show them why and how to follow a checklist of essential practices, understand their difficulties and objections, and help them practice doing things differently. In essence, we’d give them mentors.

We are going in the opposite direction. Government spending, especially on hiring people to solve difficult problems over a medium-long term is now almost taboo. Take poverty, for example. Yesterday, there was a report of a groundbreaking study confirming that, contra the billions of dollars spent trying to win the “war on drugs”, poverty is much more harmful to children than their mothers’ cocaine usage. Clearly, Canada has enough money that no one has to suffer from poverty. Yet, my wonderful “heaven on earth” province BC has Canada’s worst child poverty. The BC government is running headlong in the opposite direction, consolidating services, and making assistance services almost impossible to reach.

We know what to do, give people money to live, give them cheap and accessible child care, help people with acute and chronic physical and mental health issues including substance use, and employ people they can talk to and learn from, mentors and more. Take the uncertainty out of their daily lives, take out some of the incredibly taxing daily decisions they have to make every day, and see what happens.

Instead, it is easy politically to spend billions on shiny cars, bazookas, drones, heat sensing equipment, computers, and more for cops to police poverty. My city’s cops ride around in cars that seem ridiculously over-designed given the city’s speed limit of 50 kmph, and Victoria is not even close to being excessive. Yet, it is impossible to spend money on the harm reduction workers that can actually provide the support services people need. We routinely criminalize poverty and hope that we will somehow solve it by harassing people for being poor.

Real poverty reduction starts with giving more money to the poor, unconditionally and non-judgmentally. But it also involves hiring many more people to act as advocates, teachers and mentors for people who will greatly appreciate and benefit from this increased social connection. If we want change, we need more people whose job it is to make the change happen.

 

The India Pakistan Partition in Indian Textbooks

Partition_of_Punjab,_India_1947Via Kafila, Shivam Vij on how India’s National Council of Educational Research and Training (NCERT)’s history curriculum for 12th graders (They publish the entire curriculum on the web for free, read/download) addresses the violence that accompanied India and Pakistan’s independence from British rule (the partition), and its aftermath.

I’m startled to see that a government textbook has progressed so much that it begins talking about Partition with oral narratives, that too from 1992 and not 1947. In one go, it has told 17-year-olds the importance of oral history, introduced them to the idea of Partition as a continuing event and showed them how their own family narratives about Partition have a mirror image across the border. The chapter’s last four pages discuss oral history and its limitations in understanding the past.

What I learned about Partition – The Express Tribune.

Class12 IndianHistory3 Unit14 NCERT TextBook EnglishEditionIndiaPakistanPartition

Read embed here.

Wow, oral histories, neutral points of view, narrative and people-based history, this is definitely not my history textbook. The history I learned in school (10th grade and below) was simplistic, date and event based, and painted Jinnah and the British as caricature villains dividing South Asia on religious lines during the partition. I remember the year the Brits massacred thousands of unarmed meeting attendees in Jallianwala Bagh (1919), not what it led to, and why it happened. Divide and Rule was all you needed to know about the partition.

I really enjoyed reading this more nuanced and sophisticated treatment and look forward to reading more of the curriculum on Indian history, all the textbooks are online for free. Well done, Indian government!

Only Indians choosing the “arts” stream would be exposed to this curriculum. The overwhelming majority of those who take science or economics streams would not see this at all. I wonder what kind of history is being taught to 13-14 year old kids taking required social science courses, hopefully, better that what I was exposed to.

Is BC’s agriculture Minister Pat Pimm a climate denier?

pimmFrom Minutes of Wednesday’s Committee C meeting, to me via Torrance Coste on facebook (can’t link), some disturbing words.

 

N. Simons: Does the minister agree that climate change is human caused?

[D. Plecas in the chair.]

The Chair: Minister.

Hon. P. Pimm: Thank you very much, and welcome to the discussion this afternoon.

The Chair: Good afternoon.

Hon. P. Pimm: I think there are many varying opinions on climate change, and we all have our opinions. I’m sure you have your opinion, I might have my opinion, and I think we’ll just leave it at that.

via Hansard — Committee C Blues — Wednesday, July 17, 2013 p.m..

Very troubling if true. Climate change will have many impacts on agriculture in BC and worldwide and a minister who thinks climate change is a matter of opinion doesn’t belong in positions of power regardless of portfolio.

Stay tuned. I hope this is some kind of transcription error.

School Meals and Child Death in India

Hunger

Like most, I am appalled and saddened by the death of 20+ (and rising) children in Bihar, poisoned by pesticide in their state-provided school lunch. This guardian article has a good run down on the issues that beset the program.

The fear is that attention is being diverted from what is an acute problem in many of India’s state-run or state-assisted schools. While the ruling party in the state looks for excuses, the harsh reality is that food provided to children all over the country is often substandard, and sometimes not even fit for human consumption.

Indias deadly problem with school meals | Kishwar Desai | Comment is free | guardian.co.uk.

What is missing from the analysis is the magnitude of the hunger problem India is trying to solve. It is estimated that over 40% of children are undernourished in IndiaSchool meals have large public health benefits if done right. So it is vitally important that this program work, as this Indian teacher so eloquently details in her blog post.

It’s this absence of monitoring, I believe, that’s sabotaging a scheme that’s helped bring millions of children into school. The scheme was originally envisaged as government-run, but community aided and supervised. In practice, because parents and teachers are both busy, the whole system lacks anyone to ensure hygiene and quality.

The entire post is worth a read.

India reduced its global hunger index by about 24% since 1990. But note that Bangladesh’s percent reductions have been higher. As The Week points out, the last thing you want is for parents to pull their kids out of school because their kids will get poisoned, and for this program to end because it cannot be implemented without poisoning the kids.

What is especially egregious in this case was that the children noticed something was amiss, and alerted authorities, who did not listen. India’s authoritarian school institutions do not abide any feedback from children, especially the children of low/no privilege that attend government schools. Hunger and lack of choice probably played a part as well. There’s also early evidence that the school administrator ignored warnings from the cook about the cooking oil, calling it “home made”.

In the end, like everything else in India, it comes down to institutional quality and money. For all the complaints about excessive “regulation”, programs like Food Safe in BC are designed to ensure that people working with food know how to handle food, what to avoid, and how to identify and prevent dangerous situations. It takes effective institutions to ensure that quality and safety are maintained consistently and the people involved do the right thing most of the time. India’s performance in providing reliable services for its poor is also complicated by vast state-to-state disparities in institutional quality. India’s so called growth has also been top-heavy. People living in villages and the urban poor have not been a part of India Shining (or its new incarnation Bharat Nirman).

Can regulations on food safety, quality and delivery be enforced in the absence of a good monitoring and accountability system? Can India use the money it gets from “developing” to provide better services for its people? It will take time, and hopefully, eventually tragedies like the one above will be less frequent.

Canadian Citizenship Oath in Court, and Royal Baby!

royalbabyA number of Canadian immigrants want the right to NOT swear allegiance to the Queen (of Canada). Their reasons are varied, they don’t believe in a monarchy, they moved from recently decolonized countries where atrocities were committed in the name of the queen, their religion doesn’t permit it, and more. They have lost their case at every step, and the originator of the case, Charles Roach, passed away recently, but they persist, and it is now going back to court. The globe and mail reports rather breathlessly with a heavy handed dose of editorializing. 

But with a royal baby on the way, and a federal government under Prime Minister Stephen Harper that has dedicated itself to reviving the country’s connection to the monarchy – restoring the word Royal to the Royal Canadian Air Force, among other measures – the dissenters may have their work cut out for them.

Would-be Canadian citizens set to fight oath to Queen – The Globe and Mail.

The hilarity of the Globe and Mail thinking that the unborn Royal Baby(tm) has anything to do with a serious court case should be the topic of a much longer rant on the sorry state of this newspaper. More importantly, this is an interesting and brave protest by the litigants.

Here’s the oath:

I swear (or affirm) that I will be faithful and bear true allegiance to Her Majesty Queen Elizabeth II, Queen of Canada, Her Heirs and Successors, and that I will faithfully observe the laws of Canada and fulfil my duties as a Canadian citizen.

The oath is a strange and anachronistic beast that literally puts allegiance to a hereditary, unaccountable set of people who won a birth lottery in front of duty to the country and its laws. It’s completely understandable that some would balk at swearing this oath. Only half of Canadians surveyed in 2012 supported the notion of Canada remaining a monarchy. It seems unfair to ask a set of people to swear to something only half of the country supports. Would the settlers and descendants of settlers who acquired citizenship through birth like their citizenship to be contingent on pledging allegiance to the British (and Canadian) royal family? I don’t understand how it is acceptable to make one group of people swear an oath, while exempting a whole other group of people.

This troubles me: The notion that the grant of citizenship is a one-way privilege, something that immigrants should be so grateful for that they don’t exercise their charter rights to dissent.

“Canadian citizenship is an honour and a privilege,” spokeswoman Sonia Lesage said.

Immigration is a two-way arrangement, one that benefits the people immigrating and the country. Repeated studies show this, so while immigrants are generally happy to become citizens, the country should be equally honoured and privileged that they chose to stay here rather than elsewhere. A country ruled by the descendants of those who colonized by displacing the original inhabitants of this land through force, spreading disease and attempted assimilation should be more humble in its pledges. It is especially troubling to hear this one-sided understanding of who is privileged by immigration coming from a country with this history.

I swore my oath sincerely because for me, the benefits of being a Canadian citizen outweighed my distaste for the monarchy. As a recent immigrant and recent citizen, my desire to stay socially engaged, commitment to acting for change, and being the best family member, partner, friend, coworker and activist matter way more than an anachronistic pledge, and those are the standards I would want to be held to.

Update: An interesting article on how close PM Chretien came to scrapping the oath and making it something more meaningful.

More Update: My partner pointed out in conversation that the citizenship ceremony’s focus and tone were quite the opposite of all this honour and privilege language spouted by the conservative government mouthpiece. Multiple speakers specifically talked about how happy and lucky the country was to have us become citizens,and how much the country would benefit. They also talked about responsibility and civic engagement, which is as it should be. Multiple speakers specifically acknowledged our presence on Lekwungen and Coast Salish homelands.

Princely Privilege

I recently became a subject of the British (and Canadian) Royal Family, so I guess I should start taking interest in their affairs, as it were. This made me laugh (emphasis mine).

The attorney general said there was a risk that the prince would not be seen to be politically neutral by the public if the letters were published.

“This risk will arise if, through these letters, the Prince of Wales was viewed by others as disagreeing with government policy. Any such perception would be seriously damaging to his role as future monarch because if he forfeits his position of political neutrality as heir to the throne, he cannot easily recover it when he is king,”

Prince Charles’s letters to ministers to remain private, court rules | UK news | guardian.co.uk.

CharlesApparently, writing 27 letters about political issues (in bad handwriting, oh, the shame!) in an attempt to influence policy makers is okay. However, if the public saw them, it would not be okay, so we can’t see them.

I would like to use this defence next time I am a scofflaw.

Officer: I am going to give you a ticket for riding on the sidewalk.

Me: But Ma’am, if you do so, there’s a risk that I would not be seen to be law abiding by the public!! Any such perception would be seriously damaging to my role as future bicycle policy maven!

Officer: Yeah, that makes sense, have a good evening!

Me: Woohoo!

In all seriousness, I think the royals should use their enormous bully pulpit to champion important issues. They should be talking about climate change. They should be lobbying zoning boards! But, they need to do it out in the open just like their subjects.

Image of the prince of Wales used with thanks from Rizzato’s flickr stream under a creative commons licence.

 

My take on Hansen’s cautious nod to nuclear power

Nuclear energy has a bad reputation for many good reasons. It is expensive, nuclear waste is a problem we still do not know how to deal with, and accidents, while luckily rare, have catastrophic health consequences. I have not considered nuclear energy a viable alternative primarily because of cost and waste disposal issues. The considerable effects of accidents on human and ecosystem health, and the psychological burden of living near a nuclear power plant given the perception of ever present danger are also big factors.

However, I am going to have to look at this issue in greater detail. Kharecha and Hansen (2013) (yes, that Hansen) published a recent study (Open Access) that argues some of the benefits of nuclear power.

In the aftermath of the March 2011 accident at Japan’s Fukushima Daiichi nuclear power plant, the future contribution of nuclear power to the global energy supply has become somewhat uncertain. Because nuclear power is an abundant, low-carbon source of base-load power, it could make a large contribution to mitigation of global climate change and air pollution. Using historical production data, we calculate that global nuclear power has prevented an average of 1.84 million air pollution-related deaths and 64 gigatonnes of CO2-equivalent GtCO2-eq greenhouse gas GHG emissions that would have resulted from fossil fuel burning. On the basis of global projection data that take into account the effects of the Fukushima accident, we find that nuclear power could additionally prevent an average of 420 000–7.04 million deaths and 80–240 GtCO2-eq emissions due to fossil fuels by midcentury, depending on which fuel it replaces. By contrast, we assess that large-scale expansion of unconstrained natural gas use would not mitigate the climate problem and would cause far more deaths than expansion of nuclear power.

via Prevented Mortality and Greenhouse Gas Emissions from Historical and Projected Nuclear Power – Environmental Science & Technology ACS Publications.

NuclearPower

The big argument made here is that coal (and fossil fuel) combustion is linked to millions of excess deaths from air pollution. Kharecha and Hansen modelled the effects of replacing all the power generated by nuclear reactors with coal and natural gas and widely accepted correlations between fossil fuel combustion and increased death to come up with this number of lives saved from nuclear power use, about 1.8 million. In contrast, they calculate nuclear power to have caused about 5000 deaths, a few orders of magnitude lower!

Kharecha and Hansen use this fairly compelling data based a simple, easy to understand analysis, to caution countries against shuttering existing nuclear power plants, as Germany has proposed, or changing plans based on the Fukushima catastrophe.

My comments:

  • If you needed more confirmation that coal and natural gas combustion cause many many deaths, this helps. They also make the compelling argument that natural gas is not really going to save us at all, it does reduce air pollution deaths, but only on the margins.
  • The work adds valuable context on fossil fuel combustion related death by comparing it with a source of energy universally tagged as “dangerous”. It is easy for people to visualize, personalize and react viscerally to nuclear energy because our culture and recent history are filled with images and instances of horrific nuclear damage. The bombs dropped by the US on Japan affected millions and are still imprinted in people’s minds. I assume the word “nuclear energy” mostly bring up images of mushroom clouds and five eyed fish in people. These effects are real. It is, however, very difficult to visualize and personalize the slow, but persistent drip of deaths from air pollution. A heart attack, or heart failure, or pneumonia bout that kills an already vulnerable person cannot be positively attributed to air pollution. Only long term, big population epidemiological studies can show even a measurable increase in death rate (Dockery et al, 1993) when air quality deteriorates. But disasters like Chernobyl and Fukushima are acute and affect whole populations instantly. To show that nuclear power actually saved lives when compared with coal pollution is thought provoking, and enabled me to take a second look at nuclear power.
  • The argument to keep existing sources of nuclear energy going, while spending the money and time it takes to keep the infrastructure safe is convincing to me. Nuclear energy plants are very expensive to build, but relatively cheap to operate. A plant that is operating well, and is considered safe shouldn’t just be shut down in reaction to a single accident.
  • Given the declining cost trajectory of renewables, and the absolute necessity of humanity to become more energy efficient first, the authors do not make a compelling case for new nuclear power as an alternative to a more aggressive approach on renewable energy, efficiency. and reconsidering the “infinite growth on finite planet” paradigm. For example, see this video from Mark Jacobson on providing humans with electricity using a 100% renewable energy strategy.

  • Nuclear power plants cannot be built without extensive government intervention and planning because they are cost prohibitive, and huge potential liabilities. When that level of government intervention and support is required and needs to be mobilized, why not use it to deploy energy efficiency measures and renewable energy? Governments that push nuclear energy aggressively tend to become unpopular on a local level very fast, too easy to organize against. If short-term conventional economic cost is the only consideration, only coal and natural gas plants would get built anyway.
  • Nuclear waste disposal, and the horrors of uranium mining are a big stumbling block, and the authors do not have a ready answer for this problem. This makes the development of nuclear energy a nightmare for communities adjacent to plants, waste sites and mining operations. In a 2010 paper, Kharecha and Hansen (2010) argued that “High-priority development and demonstration of fourth-generation nuclear technology (including breeder reactors) is needed to provide a solution to nuclear waste disposal and eliminate the need to mine more uranium for many centuries”. Note, none of this technology is available, or even close to fruition. So, to argue for expanding nuclear power in the absence of waste management/mitigation strategies is unwise.
  • The stockpiling of nuclear weapons and the security apparatus around the offensive uses of nuclear power stand in the way of realistic cooperation or information sharing on research. Nuclear diplomacy is an antagonistic world of haves, want to haves, and have-nots, and countries like India that need power desperately do not have access to more modern technology and research because of their foolish offensive endeavours and the hypocrisy that is the nuclear “non-proliferation” regime (I can have 5000, you can’t have any).

This paper is an interesting contribution that shows us very clearly that we need to move away from fossil fuel combustion quickly for many reasons. I agree on not unwisely shutting down nuclear infrastructure that is performing well, but cannot go along on expanding nuclear power generation significantly because we really do not have a handle on the siting, waste disposal and constant sense of dread that pervades a neighbourhood with a nuclear plant.

Update: Andy Revkin writes about whether the “dread to risk” ratio is a good thing to measure, or keep in mind. I don’t agree with his casual lumping of complex, emerging issues like fracking, or low level chemical exposure into the same pile as nuclear radiation, which is a relatively easy to understand physical phenomenon studied for many years.

Peer Reviewed References

Kharecha, P.A., Hansen, J.E., 2013. Prevented Mortality and Greenhouse Gas Emissions from Historical and Projected Nuclear Power. Environ. Sci. Technol. 47, 4889–4895.

Kharecha, P.A., Kutscher, C.F., Hansen, J.E., Mazria, E., 2010. Options for Near-Term Phaseout of CO2 Emissions from Coal Use in the United States. Environ. Sci. Technol. 44, 4050–4062.

Dockery, D.W., Pope, C.A., 3rd, Xu, X., Spengler, J.D., Ware, J.H., Fay, M.E., Ferris, B.G., Jr, Speizer, F.E., 1993. An association between air pollution and mortality in six U.S. cities. N. Engl. J. Med. 329, 1753–1759.