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.