Poverty

Water and Sanitation, Economic Burden, Inequality, Poverty

Water Risk Perception and the Use of Water Bottles

~Written by Joann Varickanickal (Contact: joann.varickanickal@gmail.com)

It is important to examine how social, organizational and cultural factors of the environment interact to influence health (Laverack, 2014). This has become increasingly evident as water quality and quantity is assessed to determine its impacts on the health of a community. As water is vital to human health, access to clean tap water is important; however, bottled water is often seen as a better alternative to tap water; especially in less developed regions. Many people in low-resources countries, such as Lebanon and Jordan, believe that bottled water is better than their tap water (Massoud, et al., 2013). However, the bottled water is not always effectively monitored for safety, and many are still at risk for various waterborne diseases. Thus, citizens face economic strain to pay for water that is perceived to, but may not be cleaner (Massoud et al., 2013).

Even when bottled water is cleaner than the local tap water, the poor are often unable to afford it, which further increases the gap between the different social classes (Massoud et al., 2013). Citizens should not have to pay for something that is a human right (Parag & Roberts, 2009). Encouraging the use of tap water pushes NGOs and government agencies to improve infrastructure that would make water available to all regardless of social class (Massoud et al., 2013)..

Although tap water in developed regions such as Canada is clean and reliable, bottled water is still popular as it is often purchased for convenience (Mikhailovich & Fitzgerald, 2014). Although the socio-economic implication of using plastic water bottles may not be as severe in such settings, there are still negative environmental consequences (Parag & Roberts, 2009). Manufacturing, packaging, transporting and disposing plastic water bottles is an inefficient use of resources and creates a large amount of waste (Parag & Roberts, 2009). This can have a negative impact on the ecosystem, as this waste can influence plants, animals, minerals and water (Parag & Roberts, 2009). As these systems interact with humans they eventually have a negative impact on the health of a population (Parag & Roberts, 2009). Thus, encouraging the use of re-usable water bottles encourages environmental awareness.

Nevertheless, non-reusable plastic water bottles have been beneficial for emergencies when clean water is not easily available (Canadian Bottled Water Association). With the gradual discontinuation of these bottles, alternative methods need to be determined to ensure that clean water is distributed during emergencies.

Overall, clean water is vital for human health, and easy accessibility is crucial. Thus, clean tap water must be made available and plastic bottles should be phased out in order to allow for greater use of re-usable bottles. This would be a lower burden on the environment, and decrease wealth inequality, consequently, having a positive impact on the health of citizens. 

References:

Laverack, G. (2014). A-Z of health promotion. UK: Palgrave Macmillan.

Massoud, M. a., Maroun, R., Abdelnabi, H., Jamali, I. I., & El-Fadel, M. (2013). Public perception and economic implications of bottled water consumption in underprivileged urban areas. Environmental Monitoring and Assessment, 185, 3093–3102. doi:10.1007/s10661-012-2775-x

Mikhailovich, K., & Fitzgerald, R. (2014). Community responses to the removal of bottled water on a university campus. International Journal of Sustainability in Higher Education, 15(3), 330–342. doi:10.1108/IJSHE-08-2012-0076

Parag, Y., & Roberts, J. T. (2009). A Battle Against the Bottles: Building, Claiming, and Regaining Tap-Water Trustworthiness. Society & Natural Resources, 22(7), 625–636. doi:10.1080/08941920802017248

 

Government Policy, Inequality, Mental Health, Poverty

Uncovering the Realities of Human Trafficking

~Written by Sarah Weber (Contact: sarahkweber@gmail.com)

There is a hidden business of slavery that is tucked away from the untrained eye but alive and thriving today. The word "slavery" most likely conjures up images of African slaves in the United States (US) or Great Britain, a practice that was abolished in the nineteenth century. Although every country in the world now has laws banning slavery (the last being Mauritania in 2007), slavery still exists today in almost every country. Modern day slavery, also known as human trafficking, affects tens of millions of women, men and children around the world in the form of forced labor, domestic servitude, and sex trade [1]. In fact, there are more slaves now than at any other time in human history [1]. While the exact number of people trafficked globally is unknown, research efforts to better understand the magnitude of the issue have estimated that 21 to 36 million people are trafficked worldwide [1]. Human trafficking is the second largest criminal industry in the world after drug trafficking. Yet, the public is often not aware that it is such a significant global issue, affecting people not only in far away countries, but also in the countries, and possibly even the communities in which they reside.

What is human trafficking?

The terms “human trafficking,” “trafficking in persons,” and “modern day slavery” all refer to, "The act of recruiting, harboring, transporting, providing, or obtaining a person for compelled labor or commercial sex acts through the use of force, fraud, or coercion" [2]. A common definition was adopted by the United Nations (UN)'s Protocol to Prevent, Suppress and Punish Trafficking in Persons as:

"Trafficking in persons" shall mean the recruitment, transportation, transfer, harboring or receipt of persons, by means of the threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power, or of a position of vulnerability, or of the giving or receiving of payments or benefits, to achieve the consent of a person having control over another person, for the purpose of exploitation. Exploitation shall include, at a minimum, the exploitation or the prostitution of others or other forms of sexual exploitation, forced labor or services, slavery or practices similar to slavery, servitude or the removal of organs [3].

There are many different types of modern day slavery, including: debt bondage, contract slavery, sex trafficking, forced or servile marriage, domestic servitude, child labor and child soldiers.  According to Free the Slaves, a nonprofit focused on advocating against modern day slavery and liberating slaves, approximately 78% of slavery victims are in forced labor, 22% are in sex slavery, and 26% are children under age 18[1]. Learn more about the types of slavery and global statistics in this Free the Slaves factsheet here.

Source: freetheslaves.net

A key component of human trafficking is the use of force, fraud or coercion to lure victims into positions of exploitation. Traffickers generally prey on people who appear vulnerable, including those who are experiencing psychological or emotional vulnerability, economic hardship, lack of a social safety net, natural disasters or political instability. Women and girls who have been victims of sexual, physical or emotional abuse, and runaway children are particularly at risk. Refugees and/or people living in areas of war or political instability are also at increased risk [2].

Human Trafficking and Health

In addition to human trafficking blatantly violating human rights, it results in devastating long-lasting health consequences for the victims. Since victims are often dependent on their traffickers for their livelihood, receive limited food and are often malnourished. This is especially problematic for the estimated 5.5 million children in slavery today [4]. Women in forced prostitution and child soldiers, are often given drugs by their traffickers to ensure compliance, thus drug addiction is sadly all too common. Women forced into the sex industry are at risk of sexually transmitted infections and unwanted pregnancy and often don't have the agency to negotiate safer sex practices. [7]. In addition to the physical health effects, victims of human trafficking suffer from impaired emotional and psychological health [7]. Traffickers control through fear, physical, emotional and sexual assault, and manipulation [8]. This has negative impacts on victims and often leaves them ashamed, psychologically traumatized, emotionally attached, and afraid to leave their trafficker [8].

Raising Awareness Globally

Although human trafficking still does not receive an adequate amount of global attention or recognition, efforts in the last decade have elevated awareness of the problem. In 2010 the UN General Assembly adopted the Global Plan of Action to Combat Trafficking in Persons and urged countries to take coordinated efforts to combat and eliminate human trafficking [3]. In 2013 the UN General Assembly adopted a resolution, designating July 30 as the World Day against Trafficking in Persons. The resolution was made to, “Raise awareness of the situation of victims of human trafficking and for the promotion and protection of their rights” [5]. In December 2014, the president of the US, Barack Obama, established January as National Slavery and Human Trafficking Prevention Month in the US and January 11th as Human Trafficking Awareness Day, in recognition that modern day slavery or human trafficking still exists in communities across the US and the globe [6].

It is important to remember that human trafficking happens across the globe. It isn't something that just happens across international borders and/or in low- or middle-income countries. The US has an estimated 60,000 victims of slavery and the United Kingdom (UK) has an estimated 13,000 [1]. While a majority of these victims come from overseas, an alarming number of people are trafficked domestically within both the US and the UK, with the Federal Bureau of Investigation estimating that 293,000 American youth are at risk for sex trafficking within the US each year [9]. Given the rise of social media and the Internet, traffickers now use the Internet as a primary mechanism for recruiting victims both internationally and domestically.

Stopping Demand

Efforts to educate the public are an important step in combating the issue. Human trafficking is an industry because there is demand. Traffickers are motivated by high profits, with an estimated $150 billion USD generated by traffickers each year [1]. Therefore, decreasing/stopping the demand is key to eliminating human trafficking. "Sex tourism"- travel planned for the specific purpose of sex, generally to a country where prostitution is legal - fuels the demand for human trafficking, as does large events which bring in crowds of people [10]. In fact, the US Super Bowl is one of the largest magnets for sex trafficking globally [10]. Efforts to hold accountable both the traffickers and those purchasing the services are needed to stop the demand. Global efforts such as the UN's Protocol to Prevent, Suppress and Punish Trafficking in Persons, tougher sentencing for traffickers and purchasers in many countries, and local efforts to raise awareness in communities are helping to combat the issue. However, vigilance and awareness from all people and continued united global efforts are needed to end human trafficking.

References:

1. Free the Slaves. http://www.freetheslaves.net/about-slavery/  

2. United States Trafficking in Humans report, July 2015. http://www.state.gov/documents/organization/243557.pdf 

3. United Nations Office of Drugs and Crime. https://www.unodc.org/unodc/en/human-trafficking/what-is-human-trafficking.html?ref=menuside

4. Anti-Slavery International. http://www.antislavery.org/english/slavery_today/child_slavery/default.aspx

5. United Nations World Day Against Human Trafficking in Persons. http://www.un.org/en/events/humantrafficking/

6. United States Department of Homeland Security. http://www.dhs.gov/blog/2015/01/20/national-slavery-and-human-trafficking-prevention-month

7. Center for Disease Control and Protection. http://wwwnc.cdc.gov/travel/page/sex-tourism

8. Polaris Project. https://polarisproject.org/victims-traffickers

9. Federal Bureau of Investigation, Law Enforcement Bulletin. https://leb.fbi.gov/2011/march/human-sex-trafficking

10. Federal Bureau of Investigation. https://www.fbi.gov/phoenix/press-releases/2015/super-bowl-sex-trafficking-operation 

Climate Change, Disease Outbreak, Infectious Diseases, Poverty, Water and Sanitation

The Environmental Cost that Living in this World Puts on Our Health

~Written by Sarah Khalid Khan (Contact: sk_scarab@yahoo.com)

As revolting as it sounds, there are places in the world where the chances of consuming one’s neighbours’ faeces are quite high if one is not vigilant regarding sanitation and hygiene. That being the condition of many areas in low and lower-middle income countries does not mean that high and higher-middle income countries are exempt from any environmental conditions that are harmful to health.

But, what is environment health? The World Health Organization (WHO) defines the term as, “All the physical, chemical, and biological factors external to a person, and all the related factors impacting behaviours”. It, however, excludes genetics and the social and cultural environment.

In low-income settings, concerns for environmental health may arise in the context of sanitation and hygiene, as well as indoor and outdoor pollution. In high-income countries, many chronic diseases like diabetes and cardiovascular disease, are associated with sedentary lifestyles. While these might be attributed to behaviour, one must consider that such behaviours can arise from changes in the environment. Over 80% of communicable and non-communicable diseases can be attributed to environmental hazards.  Overall, conservative estimates indicate that about one quarter of the total global burden of disease is owing to this cause (WHO, 2011). Furthermore, the biggest killers of children under 5 years are all environmental-related diseases, including diarrhoea, respiratory infections, and malaria.

Other diseases of concern are helminthic infections, trachoma (a bacterial eye infection), Chagas disease, leishmaniosis, onchocerciasis, and dengue fever. All of which are associated with impoverished conditions and can be mitigated by improving sanitation, hygiene, and housing. Although conflicts and natural disasters might be catastrophic for any country, struggling economies tend to suffer more because disasters worsen the poor conditions which directly affect sanitation and hygiene practices, creating conducive conditions for various infectious diseases, and ultimately feeding into the vicious cycle of poverty.

Many interventions are underway to address these conditions, including Water, Sanitation and Hygiene (WASH) initiatives, Integrated Vector Management, Programme on Household Air Pollution, International Programme on Chemical Safety, Health and Environment Linkages Initiative, and Intersun Programme for the effects of UV radiation. The acknowledgement of the effects of the environment has grown. One of the Millennium Development Goals (MDGs) was, “To ensure environmental sustainability.” The Sustainable Development Goals (SDGs) are more extensive and thorough in placing focus on the environment. Goal 1 is to end poverty, goal 6 is to make provision of clean water and sanitation possible, and goal 13 is to stop climatic change resulting in floods and drought (United Nations, 2014).

The Sustainable Development Goals. Source: United Nations System Staff College

It is encouraging to see steps being taken to control environmental hazards; however, the journey to measuring and eradicating such conditions still remains a challenge, which will hopefully be overcome through future endeavours.

References:

United Nations (2014). Sustainable Development Goals. doi:10.1017/CBO9781107415324.004

World Health Organization (2011). WHO Public Health & Environment Global Strategy Overview


Poverty, Water and Sanitation, Children

Access to Toilets: Not as Common as You Might Think

~Written by Theresa Majeski (Contact: theresa.majeski@gmail.com; Twitter: @theresamajeski)

There are over seven billion people on the planet and 2.4 billion of them do not have access to proper sanitation. Almost one billion people still defecate in the open. The risk of disease and malnutrition increases with poor sanitation, especially for women and children. This year’s World Toilet Day on November 19 highlights the impact of poor sanitation on malnutrition.

 

Figure 1 : World Toilet Day poster, 2015. http://www.worldtoiletday.info/wp-content/uploads/2015/10/wtd-artist-poster-724x1024.jpg

 

Every day, over 1,000 children die from preventable water and sanitation related diarrheal diseases. Half of all cases of under-nutrition associated with diarrheal or intestinal worm infections are directly due to inadequate water, sanitation, and hygiene. Stunting and wasting, which cause irreversible physical and cognitive damage, have been linked to poor (water, sanitation and hygiene (WASH) conditions. In 2014, almost 1 in 4 children under five years of age suffered from stunting globally. 58% of all cases of diarrheal disease are directly related to inadequate water, sanitation, and hygiene.

Access to proper sanitation, hygiene, and potable water is so important that it was included in the 2000 Millennium Development Goals (MDG). Since 1990 an additional 2.1 billion people have started using basic toilets, and today around 68% of people have access to proper sanitation. However, the final MDGs Assessment report shows that the world has fallen short of the MDG goal by 700 million people. This means that there is still work to be done, which is why access to sanitation and clean water is Goal 6 of the Sustainable Development Goals.

There are many innovations occurring in the WASH area. One example is a project by Give Water that promotes child health by developing child-sized latrines and teaching children about proper sanitation and hygiene practices in school. This ensures that proper WASH practices start from a young age. The WASH Impact Network website provides a lot of information about additional innovative WASH projects. 

Access to proper sanitation and clean water is a human right. While progress is being made towards this goal, there is still work to be done. World Toilet Day highlights the continued effort to provide proper sanitation facilities to every person on the planet.

Climate Change, Infectious Diseases, Poverty, Research, Disease Outbreak

Climate Change and Health, Part 3: Infectious Disease

~Written by Joann Varickanickal (Contact: joann.varickanickal@gmail.com)

This is my final post of a three part series on climate change and health. The first post looked at how climate change will influence the onset and severity of droughts in some areas. The second post examined how some regions are predicted to see an increase in droughts, which would decrease food supply; thus, increasing nutrient deficiencies in those areas. This post will briefly discuss the influence of climate change on waterborne diseases.

Change in climate, including the increases in temperature and changes in rainfall patterns may lead to an increase in waterborne diseases, where insect vectors contaminate the water (Shuman, 2010). Often, higher temperatures are needed for some insects to complete their life cycle. This is the case for mosquitoes, as they live in warm, aquatic habitats (Shuman, 2010). With an increase in temperature and more flooding, there will be an increase in mosquitoes (Shuman, 2010). Thus, there may be an increase in the transfer of dengue and malaria (Ramasamy & Surendran, 2011). These warm, aquatic habitats will also be ideal for snails, which transfer schistomiasis (Ramasamy & Surendran, 2011). Furthermore, with a rise in sea levels, there is likely to be an increase in saline levels (Ramasamy & Surendran, 2011). Certain types of mosquitoes and snails have a high tolerance for salt water and are thus able to breed in water with high salt concentrations (Ramasamy & Surendran, 2011).

Taken from: Watts N, Adger W N, Agnolucci P, Blackstock J, Byass, P, Cai W, Costello A (2015). Health and climate change: policy responses to protect public health. The Lancet, 6736(15)

The relationship between climate change and health is complex because there are many different contributing factors and there is limited scientific evidence for many regions, several of which are under-resourced (New York Times, 2015). Furthermore, areas of high-resource have not been impacted in the same way, due to advantages as simple as air conditioning (New York Times, 2015). Thus, more scientific evidence is needed, to determine more ways in which climate change could possibly influence the health of a population. More recognition also needs to be given to this issue so that contingency plans can be made for possible outbreaks of diseases that were discussed in this blog post.

References:

Shuman, E. K. (2010). Global Climate Change and Infectious Diseases. The New England Journal of Medicine , 362 (12), 1061-1063.

Ramasamy, R., & Surendran, S. (2011). Possible impact of rising sea levels on vector-borne infectious diseases. BMC Infectious Diseases , 11 (18).

Tavernise, S. (2015, July 13). Unraveling the Relationship Between Climate Change and Health. Retrieved September 10, 2015, from http://www.nytimes.com/2015/07/14/health/unraveling-the-relationship-between-climate-change-and-health.html?_r=0

Poverty, Children

Highlighting Childhood Disability: DiaBlog with Priyam Global

~Written by Jasmine L. Hamilton (Contact: lajuaniehamilton@gmail.com; Twitter: @jasminogen) with Michaela Cisney (Twitter: @priyamglobal)

A mother supports her son during a therapy session in Hope Special School, Chennai, India.

Disability affects an estimated 1 billion persons worldwide (1). An estimated third are children, the majority of whom (>80%) live in low and middle income countries (LMICs) (1-2). Children affected by disability and their families face significant challenges, including social isolation and stigma, high risk of poverty and violence, minimal resources and programming, and inadequate services, to name a few (1-2). Further, although the convention on the rights of the Child (CRC) and the Convention on the Rights of Persons with Disabilities (CRPD) (3-4) state that children with disabilities are entitled to the rights of all children and should be provided access to health care, education and protection from violence, abuse and neglect, the current challenges faced by children with disabilities demonstrate failures in translating these values at policy, national and international levels (5-6). The millennium development goals (MDGs) for example, excluded disability from its agenda, a major oversight with dire consequences on children worldwide. For example, a recent report by Human Rights Watch revealed that in South Africa, the second largest economy in Africa, over 500,000 disabled children are unable to access primary education, an issue thought to be a prevalent problem in LMICs (1,5-6). The World Health Organization, UNICEF, and others have repeatedly outlined the shortage of research, policy, or action on behalf of children affected by disabilities in developing countries.

Fortunately, recent developments at the policy level indicate movement towards a more equitable approach for addressing disability. Most importantly, the inclusion of targets toward improving access to education and employment for disabled persons in the sustainable development goals (SDGs), stands to profoundly affect the way disability is perceived worldwide, with a significant possibility of increased access to healthcare, education, and other services available to children affected by disability.

These developments are bringing optimism and a surge of hope to organizations and volunteers that have been working tirelessly to bring about positive change in this area. I recently spoke with the director and co-founder of Priyam Global (http://www.priyamglobal.org/#who-we-are) a new NGO working to improve quality of life, opportunity, and global perception of value for the world’s poorest children who have disabilities, in an effort to outline major challenges and steps that can be taken towards creating a more equitable world for children affected by disability. What follows are her comments on some of the challenges and hopes that she has for Pryiam Global and the children with disabilities in Chennai, India who inspire her work.

Q1: What does Priyam stand for, when was it founded and what is your vision for the organization?

Michaela Cisney: Priyam is a word meaning ‘love’ that is shared among the Tamil, Hindi, and Sanskrit languages. The name was selected through a collaborative process with the children’s home we partner with in Chennai and reflects what is essential to the success of our work: a simple, abiding love for all of humanity, but especially for its children. I co-founded Priyam in July 2014, with the vision of bringing childhood disability to the heart of global health by creatively and attractively reframing the ways we look at children, ability, and value.

Q2: How many disabled children are you currently reaching and what assistance do you provide?

Michaela Cisney: Our collaborative work with a special education school and a children’s home currently reaches about 200 children affected by disability in India. We’ve been able to support and increase special nutrition initiatives to combat India’s severe child malnutrition rates, cost-share the expenses of additional therapists, provide start-up funding to selected families for self-employment opportunities, train and place national and foreign volunteers, and—importantly—take a critical role in increasing awareness and understanding of childhood disability as an urgent and relevant global maternal and child health issue.

Q3: What is your biggest challenge working in the area of CD?

Michaela Cisney: As a connector organization and catalyst, the greatest challenge we face is general low awareness in high-income countries of childhood disability realities, contexts, and opportunities for change in developing countries. Disability makes people uncomfortable, reflecting a great need for disability issues to be framed as secondary to universal values that resonate with all of us: a child’s beautiful personality, a toddler’s wellbeing and ability to thrive, a mother’s love bound by her inability to provide for her children in extreme poverty. Disability is somehow seen as “other” to these issues and so it’s a challenge to gently dismantle prejudices many of us are not even aware we hold, to then attractively frame CD in positive contexts of change and growth while also portraying urgent realities in a balanced way.

Q4: What is your greatest hope for Priyam Global and the children in Chennai that you currently work with?

Michaela Cisney: My greatest hope is that every child, in Chennai and beyond, would see the full and beautiful realization of her rights and dreams: a family that loves her without limits, a body and mind that are cared for and well, and the opportunities to explore her interests and thrive using her strengths.

To learn more about the work of Priyam Global visit www.priyamglobal.org For information on the global plan to address the challenges faced by persons with disabilities visit: http://www.un.org/disabilities/default.asp?id=1618

 

About Michaela Cisney

Michaela earned a Master’s in Public Health in Behavioral, Social and Community Health from Indiana University, focusing on maternal and child health, and nutrition and disease interactions. Before launching Priyam Global, she worked with Timmy Global Health to develop culturally-relevant monitoring and evaluation plans for a WASH program in rural Ecuador. In addition to her role as Executive Director for Priyam Global, Michaela works as a consultant for World Vision International (WVI), where she helps WVI communicate critical impact of community health worker programming globally for marketing and advocacy. She has also worked with WVI to design and launch a global training on individual/household health behavioral counseling (ttC). Follow her on Twitter: @priyamglobal

 

References:

  1. www.un.org/disabilities/documents/review_of_disability_and_the_mdgs.pdf
  2. http://www.who.int/disabilities/media/news/2012/13_09/en/
  3. Convention on the Rights of the Child. New York: http://www.ohchr.org/en/professionalinterest/pages/crc.aspx
  4. Convention on the Rights of Persons with Disabilities: http://www.un.org/disabilities/convention/conventionfull.shtml
  5. https://www.hrw.org/sites/default/files/report_pdf/southafrica0815_4up_0.pdf
  6. http://www.theguardian.com/global-development/2015/aug/18/disabled-children-poorer-countries-out-of-primary-education-south-africa-human-rights-watch-report

Climate Change, Poverty, Economic Burden, Economic Development, Government Policy

Climate Change and Health, Part 2: Droughts, Food Insecurity and Culture

~Written by Joann Varickanickal (Contact: joann.varickanickal@gmail.com)

In my last blog post, I highlighted how climate change has impacted the frequency, severity and onset of floods, thus, have various impacts on the health and well-being of flood victims. In this blog, I will be discussing how food security will be impacted by climate change.

Overall, an increase in temperature would lead to a decrease in nutrient acquisition in crops and could disturb general nutrient cycling (St.Clair & Lynch, 2010). This would also cause an increase in the decomposition of soil organic matter, thus, reducing the fertility of soil and possibly impacting crop nutrition (St.Clair & Lynch, 2010).

"Representation of the 11 Signs of Climate Change." Source: A Students Guide to Global Climate Change, Environmental Protection Agency (EPA)


Borana, Ethiopia is one region where droughts have been severe (Megersa et al., 2013). In this area, cattle ownership not only provides milk, an important part of the diet, but also indicates attaining the socio-cultural status set by the community. With an increase in temperatures, rangelands in this area have dried up. As there is less land for grazing, there has been a great loss in the number of cattle, and a reduction of milk produced by surviving cattle. This has led to negative health consequences as stunting has become more prevalent among children (Megersa et al., 2013). There has also been an increase in physical ailments among adults (Megersa et al., 2013). With this, 77 percent of households have claimed to be food insecure for over five months per year (Megersa et al., 2013).


As revealed in the above example, issues of food security can be closely associated with cultural norms, as diet is often influenced by the local tradition. Thus, when there is a decrease in what is considered to be a staple-food in the region, a diversification in diet can help alleviate food insecurity (Megersa, Markemann, Angassa, & Valle Zárate, 2013). However, adapting to dietary changes can be a difficult process, especially when diets are so deeply rooted in traditions (St.Clair & Lynch, 2010). Cultural norms also influence how vulnerable populations are impacted by food insecurity. For example, issues of food insecurity related to climate often leads to more issues for women and children because they are already lower on the “food hierarchy” (Watts et al., 2015).


The recent article on climate change and health published by the Lancet discussed many potential options for adaption (Watts et al., 2015). For example, efforts should be made to improve ecosystem management (Watts et al., 2015). Investments should also be made in agricultural research in order to increase food security for the long-term (Watts et al., 2015). Furthermore, early warning systems and food reserves also need to increase in order to potentially avoid issues of nutritional deficiencies (Watts et al., 2015).


As often, this issue is complicated, and there are several questions that can be asked. For example, how can policies be formed to alleviate the impacts on the most vulnerable populations? Furthermore, should those in high-resourced countries be concerned about how those in low-resource regions could be impacted by an increase in droughts? Or even how those living in developed countries could also be impacted by these droughts? 
Or is the problem maybe too far from home to be a concern in the first place?


References:
Megersa, B., Markemann, A., Angassa, A., & Valle Zárate, A. (2013). The role of livestock diversification in ensuring household food security under a changing climate in Borana, Ethiopia. Food Security, 6(1), 15–28. doi:10.1007/s12571-013-0314-4


St.Clair, S. B., & Lynch, J. P. (2010). The opening of Pandora’s Box: climate change impacts on soil fertility and crop nutrition in developing countries. Plant and Soil, 335(1-2), 101–115. doi:10.1007/s11104-010-0328-z


Watts, N., Adger, W. N., Agnolucci, P., Blackstock, J., Byass, P., Cai, W., … Costello, A. (2015). Health and climate change: policy responses to protect public health. The Lancet, 6736(15). doi:10.1016/S0140-6736(15)60854-6


Children, Government Policy, Health Systems, Infectious Diseases, Vaccination, Poverty

Life after Polio: Towards Improving the Situation of Polio Survivors

~Written by Hussain Zandam (Contact: huzandam@gmail.com, twitter: @zandamatique)

 A woman paralyzed by polio, Rotary International (2010)

A woman paralyzed by polio, Rotary International (2010)

here is a surge of excitement among international development communities and global health partners as the World Health Organization announced that the battle against polio is gradually coming to an end (WHO, 2013). The Global Polio Eradication Initiative (GPEI) has set out a new strategy (Eradication and Endgame Strategic Plan), which hopefully will be the final onslaught that will result in a global certificate eradication of the disease by 2018 (GPEI, 2013). The eradication will be a significant victory for the global population, as future generations will also be saved from polio's devastating toll of death, morbidity, and disability.

 Map of the world comparing countries with polio cases in 1988 and 2014. Centers for Disease Control and Prevention, CDC (2014).

Map of the world comparing countries with polio cases in 1988 and 2014. Centers for Disease Control and Prevention, CDC (2014).

While a vast amount of resources has been disbursed to prevent polio since 1952, inadequate attention has been devoted to understanding the devastations left behind in the lives and households of polio survivors. The damage is more severe in those permanently disabled by the disease and those recently identified with post-polio syndrome (PPS). Post-polio syndrome is characterized by a renewal or new experience of polio symptoms including disability and functional deterioration after years of recovery and functional stability. PPS usually occurs 30-40 years after original infection and affects about 40% of polio survivors including those who developed permanent disability and those who recover from initial affectation with no or few symptoms (Lin and Lim, 2005). 

Although the situation of polio survivors in high-income countries is relatively well documented, there is a dearth of information in low and middle-income countries. This has profound political, economic and social implications for local, national and international policy-making. While the number of individuals disabled by polio will begin to disappear in the next few decades in the developed world, those in the developing world will continue to be a major concern for at least another generation (Gonzalez et al., 2010). And as the population of younger polio survivors reaches middle and old age, a new wave of individuals with PPS will begin to make additional demands on developing countries’ health systems.

Generally, individuals disabled through polio confront not only a range of physical disabilities but also significant social, financial and human rights barriers hindering integration and participation in families and communities. These barriers in turn, lead to chronic ill-health, social marginalization, limited access to education and employment, and high rates of poverty (Groce et al, 2011). Women are impacted disproportionately, as are individuals from poorer households, minority communities and from rural and urban slum areas (WHO/World Bank, 2011). 

To design effective programs and policies that improve life course outcomes for polio survivors, more research is essential. To begin, more accurate estimates of regional prevalence of polio survivors and the degree of residual disability sustained will be useful for efficient planning and appropriate resource allocation. In particular, addressing the stigma and prejudice encountered by persons disabled by polio must be part of long-term strategies to address the needs of people living with PPS and must be linked to broader efforts to confront disability and stigma faced by all people with disabilities. Ratification by countries of the Convention on the Rights of Persons with Disabilities (CRPD) and progressive national legislation are not enough - inclusion of polio survivors in community awareness campaigns and increased support by DPOs is also needed. And given the disproportionate impact of polio on women, DPOs must pay particular attention to gender sensitive research.

 

References:

Global Polio Eradication Initiative, 2013. Polio Eradication and Endgame Strategic Plan: 2013e2018.

Groce, N., Kett, M., Lang, R., Trani, J.F., 2011. Disability and poverty: the need for a more nuanced understanding of implications for development policy and practice. Third World Quarterly 32 (8), 1493e1513.

Gonzalez, H., Olsson, T., Borg, K., 2010. Management of postpolio syndrome. The Lancet Neurology 9 (6), 634e642.

Lin, K.H., Lim, Y.W., 2005. Post-poliomyelitis syndrome: case report and review of the literature. Annals-academy of MEDICINE SINGAPORE 34 (7), 447

WHO, 2013. Poliomyelitis. Fact Sheet No. 114. WHO, Geneva. http://www.who.int/ mediacentre/factsheets/fs114/en/index.html (accessed 11.08.15.).

WHO/World Bank, 2011. World Report on Disability. WHO, Geneva. http://www. who.int/disabilities/world_report/2011/en/index.html (accessed 12.08.15.).


Economic Development, Government Policy, Inequality, International Aid, Political Instability, Poverty

Aid Dependency: The Damage of Donation

~Written by Victoria Stanford, University of Edinburgh (Contact: vstanford@hotmail.co.uk)

  "The Culture of Aid Dependency Need to Change," David Sengeh, Sierra Leone. Photo Credit: www.engineeringforchange.org

"The Culture of Aid Dependency Need to Change," David Sengeh, Sierra Leone. Photo Credit: www.engineeringforchange.org

Aid has long been the response of richer countries to the imbalance of economic development seen across the globe. In the last two decades however, relatively non-intrusive in-kind giving has been re-branded and intensified to the point where aid today is arguably used as a strategic force in increasingly interventionist global development policy. The aid industry has seen a rapid expansion, characterised by an increase in the number of organisations, amounts of funding and geographical reach (Collinson and Duffied, 2013). The question of aid dependence is an important one; many argue that international assistance paradoxically poses a barrier to recipient country development and sustainable economic growth (Moyo, 2009).

Recent rhetoric surrounding aid dependency is clear- it is an unwelcome and unfortunate side effect of aid and its diminishment is high on the aid policy agenda (Thomas et al., 2011). What is becoming increasingly clear however is that there is an emerging type of aid-related dependency that does not refer to economic or financial factors, but political. Cases of corruption in recipient country governments have been met with the development of more complex modes of donation, including direct programme funding, conditionalities, tied aid, and grants, which give donors more control over the direction and ultimate use of their funds. This often means that those providing aid are increasingly entwined in political processes. This combined with aid uncertainty, questionable sustainability, and a tendency of top-down approaches to political involvement, create a situation where countries in need of aid are dependent upon foreign agendas.

How has aid caused dependency?

Aid dependency refers to the proportion of government spending that is given by foreign donors. Since 2000 this has in fact decreased by one third in the world’s poorest countries, exemplified by Ghana and Mozambique where aid dependency decreased from 47% to 27% and 74% to 58% respectively (3). Aid is not intrinsically linked to dependency; studies have shown that dependency is influenced by many factors, mostly length and intensity of the donation period, and 15-20% has been identified as the tipping point where aid begins to have negative effects (Clemens et al., 2012). What causes dependency is when aid is used, intentionally or not, as a long-term strategy that consequently inhibits development, progress, or reform. Food aid is particularly criticised for this; increasing dependency on aid imports disincentivises local food production by reducing market demand. This is compounded when declining aid is replaced with commercial imports rather than locally-sourced food, either because of cheaper prices or a lack of recipient country food production capacity because of long-term aid causing agricultural stagnation (Shah, 2012). This is exemplified in the situation of Haiti, which is dependent on cheap US imports for over 80% of grain stocks even in a post-aid era, or countries such as the Philippines where aid dependency has forced an over-reliance on cash crops. Dependency relates not only to commodities but also technical expertise and skills which donors often bring to specific aid schemes and projects, which when not appropriately coupled with education create an over-reliance on donors (Thomas et al., 2011).

A more concerning type of dependency

The nature of aid almost intrinsically causes what is increasingly known as ‘political dependency’ by encouraging donor intervention in political processes. Donors need to satisfy the interests, values and incentives of the home country, whilst also providing them with expected results in order to maintain the cash flow. This has resulted in donors either bypassing and therefore destabilising government service provision processes to establish donor projects, a strategy often favoured by USAID and the World Bank (Bräuntigam and Knack, 2004), or intervening directly in policy-making and implementation (Bräutigam, 2000).

The involvement of donors, either foreign governments or international agencies, in recipient country political processes has been shown to reduce the quality of governance (Knack, 2001). It reduces leader accountability; the government is “playing to two audiences simultaneously”- the donors and the public (Hayman, 2008). This means the direction of accountability is between government and donor rather than the public, risking government legitimacy and delaying the progress of political reform and development (Bräutigam, 2000). This is particularly damaging in countries where the need for aid stems from political upheaval or civil unrest such as the Democratic Republic of Congo or Zimbabwe, which have a lengthy history of aid dependence (Moss et al., 2006). The risk here is that donors have political leverage, thus decisions and planning become reliant on donor involvement whose motivation and values may not necessarily align with those of the public or government.

Furthermore, ‘earmarking’ is a strategy favoured by many international donors who fear corruption in recipient governments, therefore ‘earmark’ direct sector or programme funding rather than general government budget support (Foster and Leavy, 2001). This not only shifts the agenda-making power to donors who have the authority to set priorities and direct funds accordingly, but also creates patchy and unsustainable development where some sectors outperform others.

An additional significant problem of dependency upon international agenda-making for countries receiving aid is that globally recommended ‘best practice’ policies often lack appropriate contextualisation to cultural, religious, or social values. A top-down, uniform approach to policy implementation by donors also has logistical barriers whereby local infrastructure is incapable of carrying out donor projects effectively and producing satisfactory results. A good example of this is the widely-disseminated policy encouraging syndromic management of sexually transmitted diseases, which was coercively incorporated into aid channels in Mozambique, despite the clear lack of the technical expertise and human resource capacity that such a robust policy requires (Cliff et al., 2004). This then perpetuates aid dependency because donors do not receive satisfactory project results and may consequently reduce funding without actually solving the problem, thus the poverty cycle continues and aid is required once again.

Demolishing aid dependency

Ending or preventing aid dependency will be contingent on affirmative action from both donors and recipients. Botswana is a key example of recipient-led aid policy that effectively resulted in rapidly reducing aid and therefore dependency. Botswana began receiving aid shortly after gaining independence in 1966 (Bräutigam and Botchwey, 1999). Of primary importance here is that Botswana largely decided the direction and use of funding; areas of priority were identified and donors were matched accordingly, thus avoiding reliance on donor ideas and agendas. Only projects that the predicted government capacity could absorb once aid was reduced in the long-term were undertaken, which ensured sustainability. In contrast, the relative ‘success story’ of Taiwan can be explained by donor-led project planning. Taiwan received much aid from the US in the early 1960’s which focused mainly on building infrastructural capacity-docks, railways, factories-with the aim to increase trading systems and boost the economy. In fact, this scheme was so effective that the US eventually withdrew aid for fear of creating competition (Chang, 1965).

It seems evident that recipient-led schemes and projects are more effective and reduce the risk of dependency. Technically speaking, some argue that aid should only ever be in the form of general government budget support rather than selective sector or project aid because it reduces donor involvement in political processes. It is also less bureaucratic, is less influenced by donor missions who need to produce and report results, and avoids the risk of uneven service provision (Moss et al., 2006). Ideologically speaking, the aid industry today is at risk of forming a novel kind of colonialism where ‘Western’ ideas of development and progress are used to influence and hold power over governments of countries receiving aid.

Concluding thoughts

The aid industry must respond to the problem of economic and political dependence. Coordinated efforts to more effectively monitor donor-recipient relationships, using a widely implemented human rights-based legal and moral framework for aid policy should be the ultimate, collective goal (Ooms and Hammonds, 2008). The reality is however that with increasingly complex humanitarian disasters and the destructive forces of climate change looming, the aid industry will be called upon to increase capacity and intensity which may perhaps re-direct focus from implementing ideological change. Nevertheless, the opportunity to ‘get things right’ in aid policy and practice persists, and it is a moral imperative that the industry and its participants make the attempt.


References:

Bräutigam D and Botchwey K (1999) The institutional impact of aid dependence on recipients in Africa. Chr. Michelsen Institute;Working Paper 1.

Bräutigam, D. (2000). Aid dependence and governance, Almqvist & Wiksell International;Stockholm pp.14.

Bräuntigam D and Knack S (2004) Foreign aid, institutions and governance in Sub-Saharan Africa, Economic Development and Cultural Change, Vol 52;2, pp.255-285.

Chang D (1965) US Aid and Economic progress in Taiwan, Asian Survey, Vol 5;3, pp.152-160.

Clemens MA, Radelet S and Bhavnani R (2012) Counting Chickens when they Hatch: Timing and the Effects of Aid on Growth, The Economic Journal, 122(561), 590-617.

Cliff J, Walt G and Nhatave, I (2004) What's in a Name? Policy transfer in Mozambique: DOTS for tuberculosis and syndromic management for sexually transmitted infections. Journal of Public Health Policy, 25;1, p.38-55

Collinson S and Duffied M (2013) Paradoxes of Presence:Risk Management and aid culture in challenging environments, Humanitarian Policy Group, Overseas Development Institute [Online] Available at: http://www.odi.org/sites/odi.org.uk/files/odi-assets/publications-opinion-files/8428.pdf [Accessed 02 January 2015].

Foster M and Leavy J (2001) The choice of financial aid instruments. London: Overseas Development Institute, pp.4.

Hayman R (2008) Rwanda: milking the cow. Creating policy space in spite of aid dependence. The Politics of Aid, 156.

Knack S (2001) Aid dependence and the quality of governance: cross-country empirical tests, Southern Economic Journal, 310-329.

Moss T, Pettersson G andVan de Walle, N (2006) An aid-institutions paradox? A review essay on aid dependency and state building in sub-Saharan Africa, Centre for Global Development; Working paper No. 74.

Moyo D (2009) Dead Aid, Penguin; London, pp.12

Ooms G and Hammonds R (2008) Correcting globalisation in health: transnational entitlements versus the ethical imperative of reducing aid-dependency. Public Health Ethics, 1(2), 154-170.

Shah A (2012) Food aid, Global Issues [Online] Available at: URL: http://www. globalissues. org/article/748/food-aid [Accessed January 02 2015]

Thomas A, Viciani L and Tench J et al (2011) Ending Aid Dependency, Action Aid; London.

Built Environment, Economic Development, Government Policy, Innovation, Poverty, Water and Sanitation

Climate Change and Health, Part 1: Floods

~Written by Joann Varickanickal (Contact: joann.varickanickal@gmail.com)

The Lancet recently published an article on climate change and health, extensively examining the types of health risks related to climate change as well as recommendations for policy changes, in order to address these risks (Watts et al., 2015). This article re-emphasized how complex this issue is because there are several contributing factors, and elements that can be potentially impacted (Figure 1).  As there are so many aspects of this topic, for my next few blog posts I will focus on briefly highlighting some of the health risks associated with climate change. This post will focus on natural disasters, specifically looking at floods.

Figure 1: Relationship between health, climate change and greenhouse gas emission (Watts et al., 2015)

Since 1900, floods have left more than 88 million people homeless, $595 billion in damages, and the deaths of nearly 7 million people (Khedun & Singh, 2013). Overall, climate change will have a direct impact on human health through natural disasters, such as flooding. South Asia is especially at risk as there is already regular flooding. A change in climate can affect the onset of monsoons. For example, in Kerala, a state in southern India, the monsoon season generally begins on June 1st and ends in early September, with a standard deviation of about seven days (Mirza, 2011). However, in the last 50 years this has more than doubled with the earliest onset on May 14th, and the latest date of onset on June 18th (Mirza, 2011). While this may not seem significant, it can influence the level of preparedness in communities that are at risk. Furthermore, the frequency and intensity of rainfalls will also increase. According to climate models, monsoon intensity increases during the summer, as the air over land is warmer than air over the oceans (Mirza, 2011). Floods, that result from the monsoon weather, not only increase the risk of drowning, but also affect the quality of water, thus increasing the exposure to waterborne diseases such as dysentery and diarrhea (Mirza, 2011).

Mental health issues, such as anxiety and depression, can also develop after losing property or facing a financial crisis after a flood (Khedun & Singh, 2013). Furthermore, the impacts of climate change, such as increased flooding, disproportionately influence certain populations such as marginalized communities, women, children, and the elderly (Watts et al., 2015). Thus, they suffer most of the negative health consequences associated with flooding and other disasters related to climate change (Watts et al., 2015). This highlights the complexity of the issue in terms of trying to address how to help those who are most impacted by floods.

There are several mitigation efforts that can be taken in order to reduce the impact of floods. For example, urban planners and engineers can work to ensure that forested areas are preserved and development occurs in areas where soil and vegetation conditions work best to reduce the risk of flooding. Many non-structural methods can also be implemented. For example, in some areas it may be beneficial to create zoning laws that would prohibit development in areas that are prone to flooding (Watts et al., 2015). Government officials and private officials can also work together to improve early warning systems and develop better policies for flood-insurance and emergency preparedness (Watts et al., 2015). Taking these steps can help to ensure that health issues associated with floods will not be exacerbated.


References:

Khedun, C. P., & Singh, V. P. (2013). Climate Change, Water, and Health: A Review of Regional Challenges. Water Quality, Exposure and Health, 6(1-2), 7–17. doi:10.1007/s12403-013-0107-1

Mirza, M. M. Q. (2011). Climate change, flooding in South Asia and implications. Regional Environmental Change, 11(SUPPL. 1), 95–107. doi:10.1007/s10113-010-0184-7

Watts, N., Adger, W. N., Agnolucci, P., Blackstock, J., Byass, P., Cai, W., … Costello, A. (2015). Health and climate change: policy responses to protect public health. The Lancet, 6736(15). doi:10.1016/S0140-6736(15)60854-6