Poverty alleviation and healthcare need more people, not more technology

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.



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.


Climate Change Adaptation

Climate Change Adaptation

I read a peripherally related blog post on a book about experiencing local climate change and that set me thinking a bit.

One of the book’s biggest ideas is simply to emphasize what Seidl calls “true-to-life actions” (p.82), actions that discourage one’s habit of living without engagement with the people and the nonhuman around us, individually and in communities

I like this sentiment a lot, and agree wholeheartedly. The book (I haven’t read it) appears to talk about local ecosystem adaptation, which got me thinking about adaptation in general. When we talk about climate change adaptation, we need to be very specific on who/what can/will adapt, and what community engagement will entail. Of course, I believe mitigation, or minimisng the causes comes first, but this post is primarily about adaptation.

Species will adapt, so will ecosystems, and so will many humans. The Earth will, as well. It will just be a different world. Those of us living in affluent countries will feel the pain peripherally and will have enough buffer to change our ways of life. Some of us may even find ways to profit.

Now some investors are taking another approach. Working under the assumption that climate change is inevitable, they’re investing in businesses that will profit as the planet gets hotter. Their strategies include buying water treatment companies, brokering deals for Australian farmland…

Climate Change Vulnerability by region: White means low vulnerability (Ha!) – via

Adaptation is not a choice for the majority of humans on this planet that live in poor, coastal and vulnerable areas. They do not have the money to adapt, the effects on their ecosystems are bigger and faster, and we will not let them move to safer countries like Canada. They will lose land, resource, and when they have to fight to survive, their wars will be treated as caused by their virtue or ethnicity rather than being caused by our past and present consumption. Much of the resources that could mitigate effects may already be controlled by those who can profit from the resources. 

Humans will have to adapt, and use any and all strategies, but there’s no “we” in climate change adaptation, there’s the vulnerable and the not-so vulnerable. So, it is insufficient to only think locally. We aren’t the first humans who will be forced to move because of abrupt climate change. But those needing to move this time will face closed borders and hostile states. We have seen time and again, resource stress increases racism and xenophobia, and decreases trust.

What can affluent states do? For starters.

  1. Decarbonize. WIth intention, haste and unilaterally. 
  2. Help less affluent countries increase wealth, quickly.
  3. Help less affluent countries decarbonize, if less quickly because 2 is more important.
  4. Think long and hard about their borders, because current projections call for millions of environmental migrants.

We are, of course seeing the opposite. Carbon infrastructure in US and Canada is being expanded. Resources in less affluent countries are being developed for the use of the affluent (not always from affluent states). Trade wars being fought to protect affluent interests over cheap expansion of non-carbon infrastructure. Of course, race-based immigration policy, while not officially stated as such any more, is still operational.

We have a long way to go as a species to help everyone adapt to climate change. Humans are generally in a better place to take the necessary steps than we’ve been in the past, but the work should have started 20 years ago.


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Green Building in India: NOT

There is a buzz about green buildings. But the question is: what does one mean by building green? And how does one design policies to make the green homes of our dreams?Green is not about first building structures using lots of material and energy, and then fixing them so that they become a little more efficient. Building green is about optimizing on the local ecology, using local material as far as possible and, most importantly, building to cut the power, water and material requirements.

via Green buildings: how to redesign | Centre for Science and Environment.

Sunita Narain makes some excellent points about building in India, and how western architecture influenced glass facades, closed buildings, etc. make little sense in India, and how traditional building concepts, optimised for local conditions would make more sense.

Two points:

  1. Traditional buildings are not necessarily optimised for density. To fit a lot of people in a little space, you need to build up. No, not 100s of stories, but fives and tens? It would be interesting to figure out that contradiction. But I’m no architect and I don’t know the answer
  2. The glass facade concrete skyscraper jungle look is associated with aspirational prosperity, ask any affluent Indian what they like about Hong Kong, or New York, or Singapore, and the shiny buildings will figure pretty high on the list after cleanliness and shopping. This is the kind of building associated with modernity and “class”. Making a sealed glass and concrete hell hole work in regions of high heat and humidity without large amounts of energy use for air conditioning is difficult.

It appears, though, that at least some people are thinking about this, as this book, helpfully titled Tropical Sustainable Architecture, would attest to.

Sunita Narain’s editorials for the Down to Earth magazine are always thoughtful, and required reading for anyone interested in India’s development and environmental issues.


India Shining (Not)

The guards at the gate are instructed not to let nannies take children outside, and men delivering pizza or okra are allowed in only with permission. Once, Mr. Bhalla recalled proudly, a servant caught spitting on the lawn was beaten up by the building staff.Recently, Mr. Bhalla’s association cut a path from the main gate to the private club next door, so residents no longer have to share the public sidewalk with servants and the occasional cow.

Inside Gate, India’s Good Life; Outside, the Slums –

You know something’s been going on in India for many years now when the New York Times finally gets to it! But it is an important story to keep in mind. India was always a country of great economic contrasts. But in the last few years, the inequality has exploded. I don’t know if Gini coefficients (a measure of income inequality) provide a true enough picture. India’s 2004 Gini (god knows how much it has changed in 4 years!) of 36.8 puts it as a country less inequal than the United States (40.8) or China (46.9). But as this Economist article points out, if you look at actual outcomes such as availability of water or child health statistics, India’s poor are in very bad shape. As always, a warning not to rely on economists for any mathematical estimates! Look towards public health people to provide the best information.

Add this growing inequality to India’s traditional class/caste based treatment of the not so elite by the elite, the treatment of the not at all elite by the not so elite, the treatment of the poor by the not at all elite, the treatment of the very poor by the poor and the treatment of everyone on the lower rungs of this crazy ladder by the ones higher up on the ladder, you have an inequality problem that no number can quantify and no one can fix in the short term. I do think that regionally, especially around the major metros, class/income based inequality and resentment are taking over from the traditional caste based issues. The rural areas are a completely different story altogether.

What is a blogger to do when faced with such an insurmountable problem? Why, recommend a work of fiction that talks about this issue in a refreshingly unsubtle fashion, I give you The White Tiger by Aravind Adiga. Of all the recent Indian lit I’ve read, this one comes closest to capturing Indian class dynamics and providing a good read in less than 300 pages. The novel most definitely aroused my inner class warrior! Of course, some of its characters are a little one dimensional, but most of their thought processes and attitudes are spot on. at the least, it will give you an easier to grasp picture of India’s inequalities than any World Bank report.

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Sunita Narain on the Tata Nano

nano.jpg Unless you have been living under a rock recently (hey, nice way to start a blog post, insult your reader(s)), you must have heard of the Tata Nano, the much ballyhooed cheapest car ever built. People ask me (after all, I am Indian and pretend to know a lot about the environment) what I think of the Nano. Well, it’s hard to summarize in an elevator pitch. Obviously, given the state of public transportation in the cities, people want private vehicles to travel in, more convenient, fewer people to jostle against, etc. People previously riding scooters and motorcycles (and carrying entire families in a two wheeler) would prefer this car. But, traffic’s going to get worse, and cars occupy a lot of road space while not carrying that many people.

Anyway, my thoughts aside, Sunita Narain (one of India’s most famous environmental activists) and director of  The Center for Science and Environment (India’s most active Environmental NGO) writes one of her typically insightful editorials in Down to Earth, the CSE’s flagship publication.

Let’s take the ‘affordability’ question first. The fact is that cars—small or big—are heavily subsidized. The problem is that when economists (including those who run the government) fret and fume about mounting subsidy bills, they think of farmers—fertilizer, electricity and food—not our cars. But subsidy is what they unquestionably get.The subsidy begins with the manufacture of cars. When we read about the Singur farmers’ struggle to stop government from acquiring their land for the Tata car factory we don’t join the dots. We don’t see this as the first big subsidy to motorization. The fact is, in Singur the manufacturer got cheap land, interest-free capital and perhaps other concessions—the Left Front government in West Bengal never made public full details of its attractive package. This brought down the cost of production and allowed the manufacturer to price the Nano at Rs 1 lakh

The Nano-flyover syndrome | Editor’s Page | Down To Earth magazine

All very true. Cars are heavily subsidized, taxation, parking, you name it, money quote…

Since cars take up over 75 per cent of the road space, even though they move less than 20 per cent of the people, it is obvious whom this expenditure benefits the most.

Yes, cars are not a very efficient way to move people, they’re convenient because Indian cities are not being planned to prioritize public transport that is convenient, safe and clean. India’s  per capita income (nominal) is about a $1000 per year and the nano, even in its cheapest form, is about 3 years worth of the average income. So, your average Indian, even if she lives in a city and makes twice this average, will not buy this car. So, she’s stuck on the bus which crawls ever so slowly due to all these nanos flitting about. Or, she’s on a scooter/bike facing ever increasing pollution due to these cars and risking life and limb as traffic pushes vehicles closer and closer together.

But of course, this seems to be the pattern of development and optimists will argue that at some point in time, the infrastructure will catch up to the point that there will be room for all these cars and money for all the people to buy all these cars. But as Ms. Narain points out, 20% of Delhi is already covered with roads (hard to get that number in context though, I have no idea what percent of NYC is road covered, for instance!), so finding room to build more roads is going to be hard.

Something’s gotta give, I don’t know what!

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Eastern United States vulnerable to climate change
Time to get out of the Eastern United States? A study to be published in the Proceedings of the National Academies of Science tries to quantify the relative risk of climate change using something called a “socioclimatic” risk factor. As always, the redder the worse. A look at the paper would no doubt be more illuminating, but for some reason, press releases about PNAS papers come out way before the papers actually become public. China is in bright red all the way, India in a rather bright orange. Where I live, the Eastern United States, is a nice beet red. No doubt, the unprecedented drought the South is experiencing right now is a nice big red signal.

Interesting stuff, though the actual paper will tell the story. Any technique that tries to integrate all the complex scientific, social and economic variables of climate change into one number is bound to have a flaw or two. But such a metric is useful for estimating relative risk, as the authors themselves say.

He added that the study does not address the absolute degree of impact or risk.

“This study illustrates exposure of one nation relative to another,” Diffenbaugh said. “Thus, it is important to note that a country low on the relative scale could still face substantial risk.”

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A bit of good news – India and Wind Energy

But renewable energy, of which the vast majority is wind power, accounts for more than seven per cent of India’s installed generation capacity – a rate that compares favourably with much of the rest of the world. India is the world’s fourth largest wind-power market.”Wind power is growing tremendously. If you want a wind plant you’ll have to book a year in advance,” said Chandra Bhushan, associate director at the New Delhi-based Centre for Science and Environment.”There’s been years of progressive policies and recognition for a long time that India will face a shortage of fossil fuels.”

Gulfnews: Energy-hungry India slowly becomes wind superpower

Some numbers for comparison: The U.S has about 14,000 MW of installed capacity with 5,000 more on the way. This represents about 1.4% of the > 1 million MW of installed capacity. At least when it comes to one of the cheapest and cleanest forms of renewable energy, India is ahead of the US as far as its renewable energy portfolio goes!

Wind energy in the US has been stymied by objections over the aesthetics of wind turbines. But the American Wind Energy Association has this guide on mitigating buttfugliness issues, including such helpful hints as “do not advertise on your tower, or paint it flaming orange!”

Good stuff, makes this blogger happy.

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Friedman, India and Development

Where Thomas Friedman of the New York Times echoes a blog post of mine from a few months back about cheap cars, development models and India.

We have no right to tell Indians what cars to make or drive. But we can urge them to think hard about following our model, without a real mass transit alternative in place. Cheap conventional four-wheel cars, which would encourage millions of Indians to give up their two-wheel motor scooters and three-wheel motorized rickshaws, could overwhelm India’s already strained road system, increase its dependence on imported oil and gridlock the country’s megacities.

No, No, No, Don’t Follow Us – New York Times

Here’s what I had to say…

Is it necessary that India and China tread the same path as the U.S and Europe? Does India have to make and use cars that are built using technology developed prior to our knowledge of global warming? The same company that gets cautious praise from the Union of Concerned Scientists for its “leadership” role in global warming will turn around and build factories in India that carry the status quo forward for another 30 years. When you’re starting from the foundation, and you know that the plans provided to you will lead to your house crumbling in 20 years, would you use the plans anyway because your contractor provides you with no alternative? The logical answer seems to be no, but is this process logic driven, or enforced by the existing power structure?

The answer should be “NO!!”. But Friedman goes ahead and offers some sensible suggestions via the very excellent Sunita Narain.

Charge high prices for parking, charge a proper road tax for driving, deploy free air-conditioned buses that reach every corner of the city, expand the existing beautiful Delhi subway system, “and then let the market work,” she added.

Good idea. Now, will Friedman turn around and offer the same prescription for the US? Apparently not. If the US cannot kick the car habit, or show other people how to, this kind of lecturing is pointless.

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Canada loves asbestos (in third world lungs)

In a normal world, when something is severely restricted in your country, you would not export it to another country under the pretense that used under certain, very restricted conditions, your product only causes a moderate increase in cancer.

While the federal government projects an image of being a helpful, international Boy Scout on issues ranging from peacekeeping to nuclear proliferation, Canada has a peculiar relationship to asbestos. Asbestos shame

But we don’t live in a normal world, because asbestos is exported from Canada to India where it is added to cement.

Tushar Joshi, a noted New Delhi occupational health expert, is flabbergasted over asbestos sales by a country of Canada’s stature. “As a developed country, you expect more civilized behaviour,” Dr. Joshi says. Canada’s activities are “beyond comprehension,” he adds, calling Ottawa’s promotion of asbestos “a black spot on a sparkling white dress.”

yes, well said. It is very mysterious that asbestos use in India went up in the 1980s just as evidence about its incredibly destructive effects on respiratory systems had curtailed use in most of the first world. Clearly, third world lungs are not as important as Canadian lungs.

Asbestos is one area where Canada lags even behind the US. And Canada’s environmental practices are going to come under increasing scrutiny as climate change unfreezes the great white North and exposes the resources underneath.

Canada, the world is watching.

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Indian children work despite ban

When I mentioned India’s child labor ban last year, I had many obvious questions about the implementation. One year on, this BBC report highlights on findings by Save the Children that the ban has not had much effect.

BBC NEWS | South Asia | Indian children work despite ban

A year after India banned children under 14 from working as domestic servants or in food stalls, millions continue to be employed, a study says.

The study released by Save the Children says these children are routinely subjected to different forms of abuse and a lot still needs of be done.

Many of the child workers are denied food, and are beaten up, burnt or sexually abused, the study says.

According to official estimates, India has more than 12 million child workers.

Of these, about 200,000 are estimated to be working as domestic servants and in teashops, restaurants, spas, hotels, resorts and other recreational centres – the areas from where they were banned last year.

Well, one can’t legislate away decades of a widespread and prevalent practice with one law. This law was always going to be a beginning, a marker that improving social and economic conditions will eventually catch up to (one hopes). So, color me as not surprised at all. The point is to label something as legally unacceptable, work towards making it socially unacceptable, then finally, unnecessary.