Comprehensively literates

Nowadays, in many societies a basic literacy standard is the ability to read the newspaper. A more traditional definition of literacy is the ability to read, write and perform mathematical computations. This is the main indicator used worldwide to monitor progress in adult literacy, such as in the Education For All framework. It's understandable that a simple, measurable indicator should be used to track the progress of such program or of any other program targeted to tackle illiteracy. But the outcomes of those programs should be interpreted with caution, without much optimism. To live a productive life, people need to learn much more than read, write and perform calculations.

Public policies should go beyond that simple definition. Should proportion people with adequate tools to achieve more complex, everyday tasks. 

UNESCO provides a broader definition of literacy: "The ability to identify, understand, interpret, create, communicate, compute and use printed and written materials associated with varying contexts. Literacy involves a continuum of learning in enabling individuals to achieve their goals, to develop their knowledge and potential, and to participate fully in their community and wider society."

This concept incorporates other important aspects besides basic tasks. It involves the capability to 'understand' not only texts and writings, but also the environment in which a person lives. It includes the ability to understand a medical leaflet, to operate a computer, to operate an ATM, to understand directions and to move around the city, to vote in democracy, to participate in the country's concerns, to plan their reproductive life, to be healthy, to take care of the environment, to choose a desired job, to understand their rights and duties, and so on.

Based on a broader definition of literacy, it's easy to see the link between literacy and the development process. Only a person who is literate in the aspects mentioned above, has the abilities to become a developed person. Thus, the objective of the development process, and public policies, should be to promote and ensure each and every aspect of literacy for every person, without distinctions of any kind, to be enjoyed now and in the future. And once a population is 'comprehensively literate', the country could be considered 'more developed'.

Cómo aterrizar el enfoque del desarrollo humano en la práctica

La adopción de una perspectiva del desarrollo humano implica el reconocimiento del desarrollo como un proceso que va más allá de las preocupaciones económicas o de un sector en particular, en donde se respetan las decisiones y las libertades de las personas y tratan de ampliarse las capacidades y oportunidades para todos. El enfoque del desarrollo humano concibe a la gente en el centro del proceso de desarrollo, y su calidad de vida como el objetivo final, a diferencia de otros enfoques que se basan en la acumulación de riqueza y la búsqueda del interés propio.

Con el objetivo de operacionalizar el enfoque, y siguiendo a Haq (1995), toda estrategia o política orientada a promover el desarrollo humano debe basarse en cuatro principios o meta-valores: eficiencia o productividad, equidad, empoderamiento y participación, y sosteniblidad.

Eficiencia

Se refiere al uso óptimo de los recursos y la gestión de los procesos para aumentar la base material, con el objetivo último de ampliar las libertades de las personas. Si bien la riqueza material no es el fin del proceso de desarrollo, ésta se considera como un poderoso medio que permite alcanzar otras capacidades y funcionamientos, como el acceder a educación, salud, agua potable, vivienda. La medida del éxito de un programa debe medirse en función de las libertades que permite conseguir, no de los recursos materiales que se logran acumular.

Dado que los conocimientos son un insumo fundamental en la producción de bienes y servicios (junto con el capital, la tierra y la fuerza de trabajo), y los poseedores de conocimientos son las personas, una mayor eficiencia se logra desarrollando a la gente, es decir, invirtiendo en las condiciones de vida y habilidades de los trabajadores.

Ante un programa o política de desarrollo cabe hacerse las siguientes preguntas relacionadas con el principio de la eficiencia:

¿En cuánto mejora la calidad de vida de las personas/habitantes de un país a partir de los recursos que se generen por dicha política? ¿Los resultados conseguidos son los óptimos dados los insumos utilizados? ¿Se demanda mano de obra calificada o de baja calificación? ¿Qué instrumentos posee la política para mejorar las condiciones de vida de los trabajadores? ¿Y de la comunidad donde se desarrolla? ¿Cómo se redistribuyen los recursos generados por la política en la sociedad? ¿Lo recaudado en materia de impuestos y tasas de exportación se reinvierte en inversión social?

Equidad

Se refiere al acceso equitativo a las oportunidades y garantías de igualdad de derechos y deberes. En base a una razón de justicia universal, todas las personas son iguales sólo por su carácter de ser humanas, sin importar su origen, etnia, sexo, religión, clase o cualquier otra distinción. Es decir que sin importar dónde ha nacido una persona, o con qué sexo, o bajo cuál clase social, tiene derecho a disponer de las mismas oportunidades que cualquier otra. Se refiere a “nivelar el terreno” para que todos cuenten con las mismas oportunidades de liderar la vida que desean y valoran. La equidad es a la vez un fin en sí mismo, y un medio para impulsar el desarrollo. Es decir, propugnar por una mayor equidad en las políticas públicas tiene valor en sí mismo, sin importar si esa mayor equidad permite a su vez expandir el ingreso o conseguir otros funcionamientos. Por lo que avanzar en la equidad implica avanzar en el desarrollo humano. Sin embargo, debemos considerar que las desigualdades afectan a su vez el desarrollo. Por lo tanto, tanto por razones constitutivas (fin) como instrumentales (medio), la equidad debe ser un objetivo central de las políticas públicas.

Asimismo, la equidad debe promoverse en dos niveles: equidad intrageneracional u horizontal, y equidad intergeneracional o vertical.

Equidad intrageneracional u horizontal: Es la equidad entre las personas que pertenecen a una misma generación. Entre pobres y ricos, hombres y mujeres, sector urbano y rural, origen indígena y no indígena. Esto es lo que hemos discutido hasta este momento.

Equidad intergeneracional o vertical: Es la equidad entre la generación presente y las generaciones futuras. También se lo conoce como “sosteniblidad” y lo abordaremos más adelante.

Es importante tener en cuenta que la promoción de la equidad, ya sea entre hombres y mujeres, personas de origen indígena y no indígena, etc., debe ser abordada de manera explícita en toda política pública o programa de desarrollo. Para ello deben evaluarse inicialmente las condiciones de desequilibrios existentes y contemplar en el diseño de las políticas las herramientas con las cuales se pretende corregir estos desequilibrios. Asimismo, deben diseñarse indicadores de seguimiento, apoyados con estadísticas diferenciadas para cada grupo, que permitan dar cuenta de la evolución en términos de equidad durante la vida de la política o programa. Ninguna política pública es neutral a los problemas de equidad.

Por último, pero no menos importante, es necesario considerar que las desigualdades de género se originan por los diferentes roles socialmente asignados a los hombres y las mujeres, y que actualmente existen grandes desequilibrios de poder en la mayoría de las sociedades modernas que benefician a los hombres y perjudican a las mujeres. Por ello, las políticas de desarrollo deben abordar explícitamente este problema e incluir herramientas y mecanismos que permitan ampliar las capacidades de las mujeres para que estén en igualdad de oportunidades que los hombres.

Algunas de las preguntas que se deben formular al momento de evaluar el impacto de una política pública en términos de equidad son:

¿La política impacta de igual manera en los hombres que en las mujeres? ¿Qué mecanismos se incluyen para impulsar la equidad de género teniendo en cuenta las desigualdades iniciales sociales, culturales, económicas que perjudican a las mujeres? ¿Cómo se abordan los desequilibrios de poder dentro del hogar? ¿Se incluyen instrumentos que permitan el acceso de las mujeres al crédito y a la propiedad de bienes? ¿La política ayuda a corregir los roles sociales tradicionalmente asignados a los hombres y mujeres? ¿La política tiene el mismo impacto en las áreas rurales que en las urbanas? ¿Por cuáles mecanismos se piensa igualar las oportunidades de acceso a la educación o la salud de las personas en los sectores rurales respecto de los urbanos? ¿Se han considerado las diferencias culturales de los diferentes sectores de la sociedad en el diseño y la implementación de la política?

Empoderamiento y participación

Se vincula con la capacidad de agencia que tienen las personas para participar del proceso de desarrollo. El empoderamiento es el proceso individual y colectivo de adquirir poder para tener la capacidad de optar por aquellas cosas que se valoran. A través del empoderamiento, las personas pueden tener cada vez una mayor participación en los mecanismos institucionales formales o informales, a fin de tomar las decisiones y escoger las opciones que les permitan mejorar su situación de vida. Existen dos dimensiones del empoderamiento, las cuales son fundamentales para impulsar el proceso de desarrollo:

Empoderamiento individual: se relaciona con las capacidades personales y la autovaloración. Permite a cada persona buscar el tipo de vida que desea y valora, así como participar en la comunidad y los asuntos de interés nacional.

Empoderamiento social: se vincula con las capacidades adquiridas como grupo, y requiere del empoderamiento individual de cada miembro.

Asimismo, el empoderamiento permite modificar la distribución del poder existente en una sociedad, equilibrando en el largo plazo las fuerzas de poder. Una estrategia de desarrollo sin empoderamiento implicará replicar y potenciar los desequilibrios de poder existentes entre los sectores de la sociedad. Al igual que la equidad, el empoderamiento tiene un valor constitutivo y un valor instrumental en el desarrollo humano. Empoderar a la gente tiene un valor por sí mismo, permitiendo a la gente realizar todo su potencial, mejorando su autoestima y su capacidad, permitiendo aportar su mayor contribución a la sociedad. Pero también permite acelerar la estrategia de desarrollo, ya que contribuye a modificar la institucionalidad, alterar el diseño de políticas, devolverle su naturaleza a los bienes públicos, crear oportunidades y corregir déficits sociales. Finalmente, cumple la función importante de facilitar el acceso de las personas al proceso de toma de decisiones, sobre todo a aquellas que afectan su propio futuro, y facilitando el logro de la equidad social.

El tipo de preguntas que debemos hacernos al momento de evaluar el principio de empoderamiento y participación de una política pública son:

¿En qué medida la política contribuye a fortalecer el empoderamiento individual de las personas afectadas por la misma? ¿Y el empoderamiento colectivo? ¿Qué herramientas se han contemplado para ampliar ambos niveles de empoderamiento? ¿Durante el proceso de implementación de la política (diseño, alternativas, implementación, monitoreo) se incluyó la participación de todos los sectores representativos de la sociedad vinculados a la misma (comunidad, ONGs, empresarios)? ¿Cómo se incluyó a los grupos que tienen menos voz? ¿En qué medida la política reproduce o amplía los desequilibrios de poder existentes antes de implementarse? ¿Cuáles mecanismos posee la política para nivelar los desequilibrios de poder entre los diferentes sectores de la sociedad? ¿Qué cambios institucionales se originaron a partir de la política y como resultado del empoderamiento individual y colectivo de la gente?

Sosteniblidad

Se refiere a garantizar la equidad entre las distintas generaciones. No debe ser reducida a la dimensión ecológica o ambiental, sino que comprende todas formas de deuda acumulada entre las distintas generaciones que hipotecan el carácter sostenible del desarrollo. Implica que el consumo actual o los planes de desarrollo vigentes no pueden financiarse incurriendo en deudas económicas, sociales, institucionales, financieras o ambientales, las cuales deberán ser pagadas por las futuras generaciones en términos de pérdida de calidad de vida, eficiencia productiva, oportunidades y equidad. Este principio no implica dejar intactos los recursos con los que cuenta la presente generación o limitar las oportunidades del presente para que las generaciones futuras puedan desarrollarse. Sino que lo que debe preservarse es la capacidad general de las generaciones futuras de crear un nivel de bienestar semejante al que disfrutan las generaciones presentes. En este sentido, el Estado tiene el rol de velar por el interés de los no nacidos, dado que el mercado no representa al futuro. Esto justifica, desde el punto de vista de la sostenibilidad, la intervención del Estado mediante impuestos, subsidios o regulaciones destinadas a asegurar que se preserve el potencial mínimo para el desarrollo humano, sin descuidar la garantía de los derechos políticos, civiles y sociales de los habitantes de hoy.

Las siguientes preguntas sirven como ejemplo para evaluar en qué medida una política pública cumple con el principio de sostenibilidad:

¿La política es sostenible desde el punto de vista ambiental? Es decir, ¿promueve una producción del bien o servicio duradera en el tiempo? ¿Incluye una estimación del impacto ambiental en términos de contaminación del aire, suelo y agua? ¿Se incluyen los mecanismos e internalizan los costos asociados con la reparación del medioambiente? ¿Tiene algún impacto irreparable en términos medioambientales? Y en términos económicos, ¿es sostenible o limita la generación futura de ingresos? ¿Es sostenible financieramente, es decir, el país está asumiendo una deuda que será posible financiar en el futuro? ¿Promueve la inclusión o la exclusión social? ¿Respeta las instituciones y promueve la creación de institucionalidad, o en cambio afecta la institucionalidad vigente o futura en el país?

La estrategia

La característica distintiva de este tipo de análisis basado en los principios del enfoque del desarrollo humano es que reconoce la multidimensionalidad de la vida humana, y en concordancia con ello promueve la búsqueda del bienestar de la gente en todos los aspectos y de manera simultánea. Es decir, los principios de equidad, eficiencia, empoderamiento y sostenibilidad son igualmente valiosos, y por lo tanto deben promoverse simultáneamente en toda política o estrategia de desarrollo. Esta aproximación difiere con otros enfoques tradicionales que pregonan que, por ejemplo “primero hay que crecer y luego, distribuir”, indicando la superioridad de un principio (eficiencia) sobre otro (equidad).

Además, la promoción de los cuatro principios simultáneamente no sólo tiene un valor intrínseco (valor por sí mismo), sino que tiene un valor instrumental. La evidencia ha demostrado que existen poderosas sinergias entre los meta-valores, como por ejemplo entre el crecimiento del ingreso y la creación de capacidades humanas. A medida que se amplía la base material se disponen de mayores recursos para invertir en los sectores llamados “sociales” (salud, educación, vivienda), pero también es cierto que quienes generan los ingresos son las personas, con su trabajo y creatividad, por lo que las personas con mejores condiciones de salud, educación y bienestar general pueden a su vez aportar sus conocimientos y habilidades para ampliar el ingreso de un país. 

Asimismo, existen otras sinergias entre los ocho grandes objetivos del desarrollo humano: Crecimiento económico, Igualdad general de oportunidades, Eliminación de la pobreza humana, Igualdad de género, Sostenibilidad intergeneracional, Democracia política, Participación ciudadana e Identidad cultural.

Por ejemplo, el crecimiento económico junto con la igualdad de oportunidades y la participación ciudadana facilitan la eliminación de la pobreza. La promoción de la igualdad de género también tiene efectos positivos en la reducción de la pobreza, la igualdad de oportunidades o la participación ciudadana. Una identidad cultural fuerte facilita la igualdad de oportunidades, la sostenibilidad intergeneracional y le da un carácter incluyente a la democracia política. La democracia, por su parte, permite no sólo la participación ciudadana, sino también la eliminación de la pobreza y la igualdad de oportunidades. Es decir, que a través de las políticas públicas y programas deben buscarse los círculos virtuosos que potencian las estrategias de desarrollo nacionales.

Referencias

Fukuda-Parr, S. (2003). The Human Development Paradigm: Operationalizing Sen’s Ideas on Capabilities. En Feminist Economics, Vol. 9 (2 – 3), 2003 (pp. 301-317).

Haq, M. (1995). The human development paradigm. En “Reflections on Human Development” (pp.13-23). Nueva York: Oxford University Press.

Oficina de Desarrollo Humano, PNUD República Dominicana (2006). Áreas protegidas y desarrollo humano. ¿Por qué proteger a una iguana cuando hay niños desnutridos? En “Foro sobre desarrollo humano” (pp. 13-22). Nov. 2006. [http://pnud.sc17.info/files/forodh/Foro1.pdf]

UNDP Regional Centre for Asia Pacific, Colombo Office (2009). From Development to Human Development. Tool for Applying the Human Development Perspective. Colombo, Sri Lanka. [http://www2.undprcc.lk/ext/pvr/pdf/report_sections/inner-back.pdf]

Fighting TB: Not a one-way solution

After reviewing a number of studies that attempt to explain the historical decrease of tuberculosis (TB), I could argue that the decline of TB incidence and mortality was due to a combination of both improvement of general social conditions and targeted public health interventions.

After being one of the main causes of death in the United Kingdom in the late 17^th century, and reaching a peak in around 1780 when an estimated 1.25% of the population died each year from TB, its incidence started to decline at the beginning of the 19^th century. This declining was observed long before the discovery of M. tuberculosis and a century before the use of antibiotics and other specific therapies. Therefore it’s argued that general improvements in the conditions of living, including better sanitation and nutrition, contributed significantly to the decline in TB incidence and mortality.

One of the leader researcher towards this argument is Thomas McKeown. Since the 1960s he’s been promoting the idea that the decline in TB mortality is due to the incremental changes in people’s standard of living, mainly better nutrition, thus minimizing the impact and effectiveness of direct public health programs, such as sanitary reforms, vaccination and segregation of infected people. For him, “the main reasons for improvement in health in probable order of importance were: a decline in the birth rate; a rise in the standard of living, first in food supplies […]; removals of specific hazards in the physical environment; and specific measures of preventing and treating disease in the individual.” [1]

This idea was revolutionary and changed the way of studying population’s health determinants, putting more emphasis in socio-economic factors than in curative medicine.

Other authors promote the use of multifactorial models to explain the downward trend of TB and other diseases. For example, Szreter cites the “existence of inter-current infections and occupational hazards that weakened host resistance to TB and of overcrowding and poor ventilation in work and home environments that enhanced transmission of the disease”. And then suggests that “these factors were removed not only by rising real wages and better nutrition but by political and social action associated with the public health movement” [2].

For Newsholme, on the other hand, segregation was an effective measure against TB, and he embraced to the idea that “targeted public health actions –including housing policies and public education leading to behavioral changes- could effectively contribute toward the decline in TB incidence and mortality”, and that these programs were “politically feasible, unlike broader social reform affecting nutrition and poverty.” [2]

There’s also evidence that the practice of directly observed therapy (DOT) and DOT short course (DOTS) is effective to control TB incidence, mainly preventing antibiotics resistance. This practice was promulgated by the WHO as its strategy for TB control.

There are many other studies that give us different approaches to the matter, leading me to think that there’s no single formula to explain the evolution of TB, but a combination of factors. It’s true that income is a powerful means to improve people’s health, by providing access to better nutrition, sanitation, housing, and even medicines or treatments for medical conditions. Therefore, poverty and income inequalities are determinants of a population’s wellbeing. But as I said, income is a means, and what’s important is the use and benefits one could obtain with the disposable income. That’s why I believe that wages alone or GDP per capita don’t determine the wellbeing of a population. Money should be put to good use, from the individual point of view, but also from governments that are in charge of the health of the population.

Some articles draw a parallel between high income countries, high health expenditures and low TB incidence [3]. This could be true in part, but there’re countries with modest per capita incomes that show as good health indicators as much richer countries. As I said earlier, money should be spent wisely, meaning from the broadest policies such as education or sanitation, to targeted health programs and research. I believe that a combination of socio-economic improvements and targeted health interventions are applicable as determinants of the declining of TB incidence and mortality.

Do you think that the political environment has any influence in the population’s health? Which political system you believe provides a more favorable environment?

References

[1] McKeown, Thomas, “A Sociological Approach to the History of Medicine”

[2] Fairchild, Amy and Oppenheimer, Gerald. “Public health nihilism vs pragmatism: History, politics, and the control of tuberculosis”. In American Journal of Public Health; Jul 1998; 88, 7; ABI/INFORM Global, pg. 1105 http://www.collphyphil.org/APHA%20Readings/Day%202%20Readings/FairchildandOppenheimer.pdf

[3] Paul D. van Helden, “The economic divide and tuberculosis. Tuberculosis is not just a medical problem, but also a problem of social inequality and poverty”. http://www.nature.com/embor/journal/v4/n6s/full/embor842.html

Szreter, Simon. “Rethinking McKeown: The Relationship Between Public Health and Social Change.” http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1447152

Colgrove, James. “The McKeown Thesis: A Historical Controversy and Its Enduring Influence” http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1447153

Evans, Robert. “Thomas McKeown, meet Fidel Castro: Phisicians, Population Health and the Cuban Paradox.” http://www.longwoods.com/product.php?productid=19916

What does it take to have a better educated Guatemala?

In the past, when Guatemala’s economy relied on agriculture (plantain production and exports), economic growth was achieved through an educated elite and a large amount of unskilled workers. But the current economic model of services demands workers with specialized skills and higher education. In 2002, 25% of workers had no formal education; 49% some primary education; 21% some secondary education, and only 5% some tertiary studies.

A study of the effects of education on economic growth in Guatemala [1] showed that the country needs a better educated labor force in order to achieve a higher economic growth. In that sense, in Guatemala’s production function, human capital variables explain more than 50% of output growth, while physical capital explains only 32%. The level of education that has higher return in productivity is secondary education, followed closely by primary education, and in third place, tertiary education. But in aggregate, workers with secondary and tertiary education together have a greater impact in economic growth than those who only achieved primary.

Education could be a powerful tool to overcome poverty of income. It was estimated that ‘one additional year of schooling increases income per worker by approximately 18.4%.’[1] But we must not disregard that secondary education is key not only for addressing poverty, but also for improving equality, agency, empowerment and participation among the population.

The principal features and challenges of post-primary education in Guatemala are as follows:

- A 20 year-old has only 4.3 years of education on average.

- In secondary education, the gross enrollment rate is 55%, and the net rate is only 26%, while the average in Latin America of the net enrollment rate is 64%.

- Inequalities in access related to gender and ethnicity. Gross secondary enrollment rates in Grades 7-9 (2005): Guatemala 55%; Boys 59%, Girls 51%; Indigenous 26%, Non-indigenous 74%.

- Secondary school is concentrated in urban areas, and rural and indigenous populations have fewer opportunities.

- Secondary enrollment attending private schools is high: 74%.

- Quality of education: ‘learning level is very deficient overall, and especially in rural secondary education models.’ [2]

- Only 22 out of 100 children complete primary education on time, a ‘bottleneck’ for expanding secondary school enrollment.

- Low retention. Gross completion rate in Grade 9: 46%

- Overage and repetition. Enrollment rates drop pronouncedly between ages of 13 and 16, but, because of repetition and overage, these dropouts occur mostly during primary school. 40% of 13-15 year olds were in primary school.

- Teachers are trained during secondary education only (Grades 10-12), thus low quality in primary and secondary education are intertwined.

It seems that the main challenge to increase enrollment in secondary education would be by addressing the low efficiency of primary education through an integrated strategy. ‘The strategic choice of the Government of Guatemala is to start reforms at the secondary education level, but to continue to support primary education, complementing long-term general quality improvements (such as improving the quality of pre-school and the first cycle, Grades 1-3, and support teacher professional development) with short-term efficiency solutions (such as accelerated learning and promotion for overage students).’[2]

Investment in education thus should be a priority. With only 1.7% of GDP invested in education, not much can be addressed. The main justification for public financing relies on the “positive externality” argument [3], especially in poorer countries with high inequalities such as Guatemala. With a gross enrollment rate in secondary school of 55%, and 74% attending private schools, inequalities will rise if secondary education is only a luxury for a few.

References

[1] Loening, Josef L., 2005. Effects of Primary, Secondary and Tertiary Education on Economic Growth. Evidence from Guatemala. The World Bank, Washington D.C. and Ibero-America Institute for Economic Research, University of Goettingen.

[2] World Bank, 2006. Project Guatemala: Education Quality and Secondary Education Project. Project Appraisal Document.

[3] di Gropello, Emanuela (Ed.), 2006. Meeting the Challenges of Secondary Education in Latin America and East Asia. Improving Efficiency and Resource Mobilization. The World Bank.

Rolling Back Malaria, really

Roll Back Malaria is a program launched back in 1998 by the World Health Organization, UNICEF, UNDP and the World Bank to coordinate interventions and funds aimed to reduce and eventually eliminate the burden of malaria. Malaria actually threatens nearly half percent of the entire population worldwide, and is responsible for the death of around 3,000 people every day, one million yearly, most of them children from African countries.

Malaria deaths are considered preventable and curable since the entire chain of transmission is well known, and treatment is also available. P. Falciparum parasite is transmitted to humans through the bite of infected mosquitoes, which reproduce in stagnant water. The Roll Back Malaria program has three main components: distribution of bed nets, combined treatment based on artemisinin, and use of insecticides inside the houses. Despite the resources and continuous efforts for more than 10 years, the incidence and mortality rates of malaria remain steady.

Some researchers like Jeffrey Sachs states that the resources put to work under this program are not enough, that there’s need for more money committed from the wealthiest countries and international agencies to fight this pandemic. This program has become unsustainable in economic terms, because when the funding stopped in some communities, the incidence and deaths caused by malaria rose up.

There’s also evidence that the implementation of the Roll Back Malaria program has been somewhat ineffective because it didn’t took in count cultural practices or beliefs or was introduced without empowering people of the communities. For example, in Brazil a community refused to have their houses sprayed with DDT because it stained the walls and people thought to be ineffective, but accepted another insecticide (lambdacyhalothin) because it didn’t tinted the walls and also killed cockroaches. Likewise, in Papua New Guinea people didn’t accept insecticide in their houses because it killed a wasp which controlled a caterpillar which ate roofs, in consequence roofs had to be replaced more often.

Regarding the use of bed nets, it’s estimated that only one in seven children in Africa sleep under a net, and only 2% of children use an insecticide-treated net. The reasons are many, ranging from lack of access, distribution of resources in the family, lack of knowledge of the benefits or past learnt behaviors.

Another critique to the program has been that it should include other elements besides bed nets, artemisinin and insecticides, like the control and drainage of stagnant water pools that are very common in the poorer, highly populated areas of Africa. Without removing this element from the cycle, the reproduction of mosquitoes P. Falciparium will continue to prevent any program centered on Malaria eradication to succeed.

The program should also incorporate the local internal and external environments to its strategy. The internal environment includes the strategies, staff, skills, style and culture, while the external environment takes in count the economic, social, institutional and political situation existing in the country.

For malaria control to be effective in the long term an integrated approach is required as well. There’s need to coordinate not only the efforts of the international agencies with the national governments, but also among different sectors in the country, such as the ministries of health, education and agriculture, local governments, NGOs and community based organizations, to promote the empowerment of all the agents in the fight against malaria.

Malaria is an example of a well known, preventable illness whose presence depends more on socioeconomic underpinnings, than in high-end curative medicine. Eradicating malaria is as difficult as eradicating poverty. But until all the magic happens and the world can really roll back malaria, still 3,000 die each day from this epidemic, that is more than 2 lives lost per minute.

References

http://apps.who.int/malaria/wmr2008/malaria2008.pdf

http://www.who.int/mediacentre/factsheets/fs094/en/index.html

http://www.who.int/inf-pr-1998/en/pr98-77.html

http://www.unicef.org/supply/index_8748.html

http://www.bmj.com/cgi/eletters/328/7448/1086#59115

People first. But culture first?

After reading some articles about inter cultural communication I clearly realize that it’s very difficult if not impossible to talk about culture and intercultural communication from an objective or culture-free position, what Hofstede calls “cultural relativism”. All of us carry our own set of unwritten rules and behaviors, learnt from our environment and past experiences, which gives us the base for our thinking, feeling and acting, and provides us a unique way of going through life. It’s like each of us has a unique pair of lenses through which perceives and understands what’s going on around, and take decisions accordingly.

In this heterogeneity is where the major complexity of studying inter cultural communication or inter cultural work resides. It’s very difficult to be introduced to and try to comprehend another culture in a not-judging position. Something that is very clear for me is that each society works under certain set of rules or culture, and that these rules are not wrong, they are the best rules for that society. For example, if a society has a linear approach towards time and values punctuality it doesn’t mean that that cultural value is better than having a concept of time more flexible. Or that organizations that are individualistic can achieve more that those that value collectivism.

My major concern is that each person should achieve the most of his/her life and have all the opportunities to do so. Therefore gender, race, origin, social status, or “connections” should not determine anyone’s results in life.

But there are some cultural barriers that can affect this equality in access to opportunities or capabilities. As human beings we all have right to a minimum set of capabilities, such as not dying from preventable diseases, having access to education, a respectable job, a decent income, shelter and clothing, freedom to profess a religion or support certain political view, to participate in the decisions of the community or the country we live in, or enjoying our free time.

When culture and tradition affect any of these capabilities, is still “right” to put culture first? When a society doesn’t value girls to attend to school because there are not “female” jobs in the community, limiting girls’ opportunities in life, or when women are beaten by their husbands if they go out to work, what is right to believe? Up to what point can we respect others cultural values?

When dealing with cultural values such as attitudes towards time or individualism vs. collectivism, there’s no right or wrong position. But when cultural values compromise human integrity, are there some limits?

References

Chapter 3, "Cultural Perception and Values", from Chen, Guo-Ming and William J Starosta. Foundations of Intercultural Communication (2005). Allyn and Bacon, Toronto ON.

Chapter 1 "Introduction: The Rules of the Social Game" Hofstede, G & Hofstede, GJ (2005). Cultures and organizations: Software of the mind. Toronto, ON: McGraw-Hill Books.

Chapter 3 "Culture, Communication, Context and Power" Martin, J. & Nakayama, T (2006). Intercultural communication in contexts. (4th Ed). Toronto, ON: McGraw Hill.

Chapter One "An Introduction to Culture" and Chapter Three "The Meaning of Culture". Trompenaars, F and Hampden-Turner, C (1998). Riding the Waves of Culture: Understanding Cultural Diversity in Global Business 2nd Ed. Toronto, ON: McGraw-Hill.

Nussbaum, M. (2000). Women and Human Development. The Capabilities Approach. New York: Cambridge University Press.

Wouldn't you protect the golden hen? The health care reform in the US

One of the strongest issues during the presidential campaign in the US was the reform of the health care system. This is a great country and the greatness of any country resides in its people. It doesn't reside in a strong economy or in stable macroeconomic indicators. People are the golden hen.

How can the US in all its greatness doesn't have a universal health care system? This is an inconsistency: a healthy population is the foundation for a prosperous country -apart from (and not less important than) having intrinsic value from the point of view of the human rights. What is also inconsistent is that the US does value the provision of public goods, such as education, national and personal security, good administration, accountability, strong institutions, extensive infrastructure, etc., but administrations have systematically forgotten to protect the most basic public good that is the good health and survival of individuals.

I am not against the difference in incomes or personal achievements, as they might result from better "performances", but I believe that everyone should have the same opportunities in life. For example, according to the report The Measure of America, a long and healthy life in the USA is different by gender and ethnicity: Asian females have a life expectancy at birth of almost 89 years, while African American males only reach 69. That’s a 20-year difference! The rest is as follows: Latino females 85, Asian males 84, American Indian females and White females 81, Latino males 79, African American females and White males 76, and American Indian males 75.

Regarding achievement in education (educational attainment and school enrolment) Asians rank higher than the rest, followed by Whites, African American, American Indians, and Latinos at the end, with no significant differences regarding gender.

The ranking of the median income earned by each group follows the same pattern as in education (indicating a strong correlation between opportunities in education and income), but when opened by gender and ethnicity, it is as follows: White males; Asian males; Asian females; African American males and American Indian males; White females and Latino males; African American females; American Indian females; and Latino females.

In conclusion, in the US not everybody has the same opportunities in education, health and income, with important differences across gender and ethnicity. The playing field in the labor market is especially uneven for men and women: Women opportunities are biased by both ethnicity and gender. And depending your ethnicity and sex, you can expect to live 20 years more or less.

Surely, one of the greatest challenges this Administration will have to face is the reform of the health care system. If President Obama is willing to put his hands on these waters (keeping the promise!) and making a real change by providing health care to the 50 million Americans that actually lack health insurance, he will have to face and touch the interests of the current America's health owners. What could be more urgent than protecting people from illness and premature death? Just because somebody can't afford health services or medicines should her and her family suffer? Why cannot every kid, man, woman, young, elderly have the same opportunities in life? What's more important than that? This Administration has the people's power to make that happen. Waiting to write history one more time.

References

Burd-Sharp, Sarah and others, 2008. The Measure of America. American Human Development Report 2008-2009.

What means to be poor in a rich country

“Poverty is hunger. Poverty is lack of shelter. Poverty is being sick and not being able to see a doctor. Poverty is not having access to school and not knowing how to read. Poverty is not having a job, is fear for the future, living one day at a time. Poverty is losing a child to illness brought about by unclean water. Poverty is powerlessness, lack of representation and freedom.” (World Bank)

The United States is considered one of the richest countries in the world. In 2005 it showed a GDP per capita of $41,890 (PPP $), the second largest in the world after Luxembourg ($60,228), and followed closely only by Norway ($41,420). The United States exhibits a 24% higher GDP per capita than the average GDP per capita of high-income OECD countries ($33,831).

Some other characteristics that make the US a rich country are mentioned in the report The Measure of America: “The United Stated is a country of unparalleled opportunities and personal freedom. We have vast natural resources, efficient institutions, tremendous ingenuity, a rich democratic tradition, and a great prosperity. In the past half century, America has become a far more just and inclusive nation.” (Burd-Sharps, 2008, p.11)

On the other hand, the Dominican Republic is considered a lower middle income country, with a GDP per capita in 2005 of $8,217 (PPP $). Income poverty in this country affects the 42.2% of its population, measured by the national poverty line, and 29% suffers hunger. Mortality rates in children under 1 year-old is 32 per 1,000, and maternal mortality is one of the higher of the region (159 per 100,000).

Without further information or analysis, one could say that the US is a rich country and that the DR suffers poverty in many different ways. But a broader definition of poverty can change that assumption if we consider poverty as a “denial of choices and opportunities for living a tolerable life”… “[P]overty means that opportunities and choices most basic to human development are denied –to lead a long, healthy, creative life and to enjoy a decent standard of living, freedom, dignity self respect and the respect of others.” (UNDP, 2007, p.15).

This broader concept leads to a more comprehensive measurement of poverty, as given by the Human Poverty Index (HPI) from UNDP’s Human Development Reports. Under this concept, human poverty is measured differently for developed and developing countries, in order to reflect the different challenges and scenarios that countries should face according to their development stage.

The Human Poverty Index for developing countries (HPI-1) measures deprivations in three basic dimensions: (i) A long and healthy life or vulnerability to death at a relatively early age; (ii) knowledge or exclusion from the world of reading and communications; and (iii) a decent standard of living or a lack of access to overall economic provisioning.

The first dimension is measured by the probability at birth of not surviving to age 40, which in the case of the Dominican Republic is 10.5%. The second dimension, knowledge, is measured by the adult illiteracy rate, which in that country affects 13% of adult population. And finally, to measure a decent standard of living, two indicators are used: the percentage of the population not using an improved water source (which is 5%) and the percentage of children under weight-for-age (which is also 5%). As a result, 10.5% of the Dominican population suffers from any type of human poverty (HPI-1 of 10.5%), ranking 26^th among 108 developing countries (UNDP, 2007).

But the USA, despite being a rich country in economic terms, also shows other aspects of poverty. In this case, the Human Poverty Index for OECD countries (HPI-2) measures deprivations in the same dimensions as the HPI-1 and also captures social exclusion. A long and healthy life is measures by the probability at birth of not surviving to age 60, which affects 11.6% of the American population. Deprivations in knowledge are measured by the percentage of adults (16-65) lacking functional literacy skills, affecting 20% of adult population. To measure a decent standard of living, it is used the percentage of people living below the income poverty line (50% of the median adjusted household disposable income); in the United States 17% of its population is living under this situation. Finally, the fourth dimension, social exclusion, is measured by the rate of long-term unemployment (12 months or more), which was 0.5% in 2005.

The outcome is that 15.4% of the American population suffers any type of privation or poverty (HPI-2 of 15.4%), ranking 17th among 19 OECD countries (UNDP, 2007). And given the current economic crisis, human poverty in the USA has increased. "[J]ob loses were large and widespread across nearly all major industry sectors"... "Over the past 12 months, the number of unemployed persons has increased by about 5.0 million, and the unemployment rate has risen by 3.3 percentage points" from 4.8 to 8.1%. (Bureau of Labor Statistics, February 2009)

As a conclusion it can be said that poverty has many faces, and income alone does not reflect all deprivations that individuals can suffer. Human poverty affects not only developing countries, but also the so called developed or high-income countries. For this article, the HPI was used to illustrate this situation, but this index can be complemented with other indicators such as undernourished population, people without access to a sustainable source of drinking water or improved sanitation, people without access to quality health services or medicines, children with an incomplete immunization scheme, people living with HIV or age-school children not attending school, mainly for developing countries, and adults without functional literacy skill or social exclusion for high-income countries.

Finally, it's important to note that all dimensions of poverty are interrelated and all contribute to the overall fulfilment or failure of people and societies. There aren't developed or underdeveloped countries, but countries with developed or underdeveloped people.

References:

- Bureau of Labor Statistics

- Burd-Sharps, Sarah, 2008. The Measure of America: American human development report, 2008-2009.

- UNDP, 1997. Human Development Report 1997. Human development to eradicate poverty.

- UNDP, 2007. Human Development Report 2007-2008. Fighting climate change: Human solidarity in a divided world.