Development as a faith-based activity: the role of the RCT in alleviating poverty
The essence of epidemiologic field trials is the RCT (randomized control trial). A random set of people get some sort of treatment (like a new drug), another random set of people don’t and we compare the results. It’s pretty simple stuff.
The trouble with RCTs is that they don’t necessarily work well when people from the two groups are able to influence each other’s outcomes. As a simple example, a trial of a vaccine which prevents people from getting infected with some pathogen might have impacts on people who don’t get the vaccine, since the number of opportunities for transmission are reduced. This is a welcome outcome (and may even be the point of the study), but it doesn’t help us to understand exactly how effective the vaccine is in the individuals who actually receive the vaccine.
Many RCTs make the (flawed) assumption that individuals are independent entities, following a long tradition of statistical analysis. This is a reasonable assumption to make in some cases, but entirely wrong in others (i.e. most public health outcomes).
Development economists have recently adopted the RCT as a means of evaluating the effectiveness of programs intended to relieve poverty or improve human well-being. On the surface, there’s nothing wrong with adopted public health methods to deal with economic problems, as most public health problems have their roots in economics. Jeff Sachs, or course, would argue that many economic problems have their roots in public health problems.
The major problem with RCTs is that while we do our best to control for all of the possible other factors that might impact outcomes given a particular treatment, without a trove of detailed data and prior knowledge of context and contingencies, we really have no idea at all whether and how some public health intervention works. Epidemiology tends to fall back on the “reasonable suspicion” argument, backing up claims of effectiveness with potentially reasonable assumptions of causal pathways. This is clearly quite easy when doing drug trials, where animals models and a century-plus of medical research has given us a reasonably clear pictures of the pathophysiological pathways that might lie between drug and outcome.
But with issues of human behavior and economics (which is essentially a science which seeks to uncover mysteries of human behavior), the causal pathways are much more difficult to assess and the factors which lie between intervention and outcome are for more difficult to measure. For example, assessing the outcome of an education program on reproductive behavior is really, really difficult without monitoring all of the possible things that happened between the time that a woman attended an NGO sponsored event at a clinic and the time when she chose to use or not use a condom. In fact, we can’t even really verify that she used the condom, since we weren’t around to observe it.
But we assume, and assume to the point of falling back to faith that our efforts did what we intended them to do.
Lant Pritchett, a Harvard economist that I’m a great fan of for his work on economic measurement in developing countries, penned an interesting article on the website of the Center for Global Development seemingly questioning the merit of the RCT as an rigorous and necessary evaluation tool for poverty alleviation development programs.
First of all, the argument that RCTs had, until recently, been used sparingly, if at all, and yet are important in achieving good outcomes sits in kind of embarrassing counterpoint with the obvious fact that lots of countries have really good outcomes. That is whether one uses the Human Development Index or the OECD Better Life Index or any social indicator—from poverty to education to health to life satisfaction—there is a similar set of countries near the top. (In the HDI the top five are Norway, Australia, USA, Netherlands, and Germany. In the OECD Better Life Index they are Australia, Sweden, Canada, Norway, and Switzerland.) No one has ever made the arguments that these countries are developed and prosperous because they used rigorous evidence—much less RCTs—in formulating policy and programs. While one might have faith that RCTs can help along the path to development, RCTs didn’t help for those that are there now.
It is very true that development in the United States occurred without the help of RCTs. In fact, malaria elimination in the United States occurred without any of the complex set of interventions that we’re so desperately selling to malaria-endemic countries. It’s even true that, despite more than a decade of research on ITNs, that we aren’t really sure whether the declines in malaria that we’ve seen all over Sub-Saharan Africa are due to ITNs or just simply due to processes associated with urbanization and development (as in the US). Actually, a lot of research is telling us that the declines in malaria might be false and that we are simply suffering from a paucity of accurate measurement in malaria endemic countries.
And this is where Pritchett comes in. He’s right. Research in developing countries is inherently challenging to the point where the conclusions we draw from research are somewhat contentious at best, and the result of blind faith at worst.
But coarse and incomplete data and loose assumptions shouldn’t discourage public health (or even economic) professionals from doing research in developing countries. While I have issues with the condescending, neo-classical nature of RCTs in economics (another discussion, but can a peasant lady’s behavior in Western Kenya be reduced to that of Homo economicus? ), the truth is that policy makers don’t care about data. They care that people are making the case for action in an impassioned and convincing way. While academics should strive to be as rigorous as possible, the sell won’t happen based on our complex data collection strategies and statistical methodologies. They (and the public) are convinced through impassioned calls for action.
Interview with an academic: Megan Hill, ethnomusicologist
Continuing our series of interviews with interesting academics, this time I have Megan Hill, PhD student and ethnomusicologist at the University of Michigan (Thanks for doing this!).
1. Who are you and where do you come from?
Starting off with existential questions… I’m Megan Hill, doctoral candidate in ethnomusicology at UM. I’m originally from Mason City, a town of about 30,000 people in north-central Iowa.
2. What is your current research about?
My research, broadly speaking, concerns contemporary musical practice in Japan, with a secondary specialization in American popular music. Right now I’m writing my dissertation on urban soundscapes. The concept of “soundscape” is usually used to explore the ways that people create and perceive meaning through sound in the places they inhabit, but it has also traditionally been used in an all-encompassing way, assuming a homogeneous and/or pastoral environment.
My dissertation—Asakusa’s Soundscape: Sound, Agency, Place, and Montage—specifically offers a new theoretical apparatus for analyzing the nuanced ways that people experience sound in dense, heterogeneous urban environments. I’m using the Tokyo neighborhood of Asakusa to demonstrate this. I have chosen Asakusa because it is dense and urban, it has a strong unique identity as a particular neighborhood, that identity is defined by a large variety of cultural categories (i.e. “traditional Japan,” religion, international tourism, low-brow entertainment, working-class Tokyo, etc.), and sound and music are fundamental to the ways that people behave in Asakusa and understand what Asakusa is about.
3. Urban spaces are characterized by often contrasting and competing uses of space. Did you find that there was any impact of location on sounds? Did sounds clash or blend in interesting ways?
Yes, absolutely. Certainly “competing” uses of space happen throughout cities, and all around the world, but I think it is particularly interesting how this plays out in Asakusa because of the particular kinds of activities that go on there. Many urban neighborhoods—NYC’s theater district for instance—are defined by one particular kind of activity, but Asakusa is defined by its particular amalgam of several contrasting activities (those having to do with “traditional Japan,” religion, international tourism, low-brow entertainment, and working-class Tokyo). Because of this, I find that the sonic overlap that goes on there is particularly fascinating, and has particular implications for how people perceive the space. You used the word “competing” to describe the use of urban spaces, but what I see going on in Asakusa is often more like juxtaposition. Contrasting sounds overlap, but because all of them “make sense” within the larger space, the resulting sense isn’t one of competition but one of montage.
For example, there is an amusement park called Hanayashiki which is practically bordering the precincts of Sensô-ji Buddhist temple. The screams of people riding the drop tower and roller coaster can be heard easily from the steps of the temple’s Main Hall, and those sounds mix in with the sounds of rituals that take place in the temple, as well as the boisterous sounds of tourists that fill the Main Hall and the rest of the precincts at all hours.
4. I know that you share an interest with things Japanese. All of us Japanophiles have unique set of events which brought us here. What brought you to Japan?
I started out, in my undergrad at Wartburg College (a liberal arts college in Waverly, Iowa), studying music education. Growing up, I knew I wanted to pursue a career in music in some way, but coming from a fairly small town with few visible music careers (high school band director and church musician being pretty much the extent of things), I decided music ed was the way to go for me. I studied that for two years with moderate levels of emotional investment, but along the way I was exposed to the field of ethnomusicology through one of my professors, with which I became totally enamored. I changed my major to clarinet performance (which allowed me to drop the education courses and add electives in ethnomusicology) at the beginning of my third year. At the same time, my dorm roommate was a woman from Tokyo in Iowa to study psychology (long story) who came to be one of my best friends. Studying ethnomusicological / anthropological theory in the daytimes and coming home to talk with my roommate about everyday things—but also Japanese music and culture—in the evenings basically started me out on the road that led me to where I am today.
5. You spent a year (or two?) in Tokyo. What were you doing there?
I’ve lived in the Tokyo area on two occasions, actually. After my undergrad in 2006, I got a job with AEON (national English-conversation school) and was given a teaching position in Koshigaya, Saitama, about 20 minutes north of Tokyo. I basically used the teaching position and visa as an opportunity to live in Japan and learn real-life things for 13 months before pursuing a graduate degree focusing on Japan. I had a great time learning all I could, talking with my fantastic students, making friends, learning to play the koto, and doing research for a paper on the use of gendered pronouns in Japanese popular music.
More recently, I was living in Tokyo doing dissertation fieldwork. I got funding from The Japan Foundation to be there for a year to study the soundscapes of Asakusa, which I’m now using as the basis for my dissertation.
6. You seem to be interested in people who don’t traditionally “belong.” The examples I’m thinking of are that of African-American Enka star Jero, the perception of soundscapes in Tokyo by a Buddhist monk and even Yoko Noge, a blues musician in Chicago. While I could be entirely off the mark, does the breaking of traditional musical belonging play a role in your work?
Interesting interpretation! You’ve been scoping out my academia.edu profile, I see 😉
I would say that you’re on the mark in identifying which topics excite me. I tend to admire people and their work who do interesting things that are against the traditional grain, for sure. And I think your observation that those people are in particular abundance in my research is mostly evidence of my personal taste in that way—Yoko Noge, Jero, and also Japanese female singers like Ringo Shiina, Iruka, Love Psychedelico, and Ayumi Hamasaki wielding gendered-language in pop song lyrics in interesting ways.
I haven’t really approached those topics by focusing on that commonality, necessarily. Contemporary ethnomusicology makes use of all kinds of socio-cultural as well as scientific theories to study musical practice (linguistic, structural, literary, Marxist, cognitive and communication, gender/sexuality, performance, and postcolonial theories, as some examples). I think what you’ve picked up on as a trend in my research is my interest in issues of self and identity, though I am not committed to always exploring those from the same approach. My dissertation focuses on individual agency and music/sound as they intersect with ideas about place, for example, while in my other projects, ideas about self/identity have intersected with music and gender, race, ethnicity, sexuality, psychology, globalization, and postcolonial culture.
7. Have you met Jero yet?
Alas, no…
8. You play a number of instruments. Do you play live at all?
I studied piano and clarinet, each for 12 years. With an undergrad degree in clarinet performance, I played a number of solo recitals, as well as countless concerts as a member of orchestras and wind bands.
I studied koto in 2006-7 and was invited to perform at my local 燈籠流し festival in Saitama with my teacher, which was really fun. I also studied Tsugaru shamisen for about 9 months as a part of my dissertation fieldwork, but I’m still a very rough beginner and have no business on a stage… At this point, I don’t have the time necessary to devote to practice to make performing a reality.
9. How did you find your teachers? I’ve heard that people studying shamisen have to spend the first two years doinng nothing but tuning? Did they cut you slack given your limited time there?
I found my koto teacher with the help of one of my English students. He was the son a friend of hers. I took the bus to his apartment every Friday morning before going to work at the English school, which began at noon. He also taught koto at a local middle school as part of the school’s offerings of “traditional” arts which became mandatory in public schools from 2001 I believe. He is also the member of a small indie band called Shiro Neqo, which includes an Indian sitar and tabla and two vocalists in addition to koto. You can see/hear them here.
I found my Tsugaru shamisen teacher in Asakusa. He owns a restaurant where he—and sometimes his higher level students—perform every lunch and dinnertime for customers. I wanted to interview him for my dissertation research, and when I found out that he teaches lessons too, I asked if I could also study with him. We started out learning how the instrument works, tuning, and practicing a simple folksong right away. I did not get the sense that I was being treated differently than other students. I have also heard the only-tuning-for-two-years story, but I don’t know how widespread that regimen really is.
You can see/hear him here (link is down below) with his band, Ryûjin. His sister is the other person playing shamisen in the video
10. What’s up for the future?
Good question… My husband is applying for academic jobs right now (he will be defending his dissertation within the calendar year), and hopefully something will work out on that front. I will be finishing mine by next spring at the very latest, so I will be applying for jobs come the fall. I’m very open to non-academic positions that would allow me to make some use of my degree (I have a friend who works for the National Endowment for the Humanities, for example), or an academic one that would center on teaching, preferably not in the middle of nowhere. I’m too much in the world of my dissertation to have many thoughts on my next research project, but there’s a lot of music out there!
Financial woes fuel Brucella outbreak in Northern Cyprus
Brucellosis hotspot?
Less known is that Cyprus is actually two countries, one of which is Northern Cyprus, which is only recognized by Turkey. It’s safe to say, though, that Northern Cyprus’ financial health is deeply connected to that of Cyprus’.
Northern Cyprus apparently doesn’t have enough money in it’s budget to adequately monitor, test and deal with an rapidly spreading outbreak of Brucellosis among its livestock because of the Cypriot financial collapse.
Brucella is a nasty bacterial disease which I’ve written on before which includes outcomes such as fever, malaise, miscarriage, chronic arthritis and heart disease, depression, mania and death. It can infect all mammals and is highly transmissible; any contact with a bacterium will result in infection. Though only one case of human to human transmission has ever been recorded (sexual transmission), Brucella is well known as a public health threat to people who work with livestock.
Brucella is ranked among the most economically important zoonotic diseases globally, and presents threats to humans, animals and wildlife.
The chairman of the union of livestock producers, Mustafa Naimoglulari, confirmed that the brucellosis microbe has been discovered at 60 farms and criticized the authorities for not launching a fight against the disease.
He said that blood should have been taken from the animals for analysis in order to establish which of them are contaminated.
In statements to Kibris, the official responsible for agriculture in TRNC, Onder Sennaroglu said that they have taken money from UNOPS to deal with the issue, but they could not eliminate brucellosis.
He noted that he knows that money should not be an excuse, but the cost of this issue is very high. “I have to say that resources are needed, and we have no resources at the moment,” he admitted, adding that they have applied to the EU for money.
The Cypriot financial crisis has its roots in the US subprime mortgage crisis. In fact, the pattern of the precentage of debt to GDP of Cyprus follows that of the Eurozone, but rapidly increases after 2012, where the EU flattened out. Cyprus previously relied heavily on a tourism fueled real estate bubble in addition to revenues from tourism itself. As debt went bad in the US and the Eurozone, debt went bad in Cyprus. Having no other sectors to depend on, the Cypriot economy collapsed.
Now, we are seeing that the financial collapse and the loss of government revenues to support public health efforts and having deleterious effects on animal and, likely, human health.
What I’m reading now
While I was in Kenya, I picked up a number of books from Kwani?, a Nairobi based publisher which (mostly) specializes in Kenyan writers.
Established in 2003, Kwani Trust is a Kenyan based literary network dedicated to developing quality creative writing and committed to the growth of the creative industry through the publishing and distribution of contemporary African writing, offering training opportunities, producing literary events and establishing and maintaining global literary networks. Our vision is to create a society that uses its stories to see itself more coherently.
At the very least, reading these books allows one to see Kenya somewhat more coherently.
One Day I Will Write About This Place: A Memoir
“One Day I Will Write About This Place” is a memoir of growing up in a middle class household in central Kenya, following some of the country’s most tumultuous social and political upheavals. Wanaina experiences Kenya on the periphery, looking in at Kenya through the lens of reruns of the Six Million Dollar Man, formerly colonial schools, local libraries and the staggering complexity of Kenya itself. Wanaina even makes several attempts to leave Kenya for good, jetting off to South Africa for law school during apartheid and after, even coming back to Kenya for the disastrous and bloody 2007 elections. His descriptions of the latter and of supermarkets sold out of pangas are no less than chilling.
Kenya has long been a mystery to me. While the country was set to become on of the world’s economic success stories, it’s progress was rapidly squandered due to a combination of demographics and bad politics. Wanaina might be even more perplexed.
If anything, the book needs to be read for Wanaina’s excellent prose. It doesn’t matter whether one understands or knows anything about Kenya (though it helps). His writing is engaging enough to keep ones attention even without understanding the details. This is one of the best books I’ve read in years.
Kwani? 4
The experience of the diaspora is essential to understanding the state of present day African people, who often lay on the front lines fighting for survival in a world which mostly doesn’t want them, while providing support for all the people who depend on them back home. Immigration nightmares, the loss of connection with home, and the shaping of new identities make up this great collection of stories, poems and artwork.
(Note that the link is for Kwani 4.)
The Stone Hills of Maragoli – Stanley Gazemba I have not finished this one yet (“reading now”), but I was excited to pick up something from Gazemba, who bills himself as a humble gardener living in a slum outside of Nairobi. He is clearly much more than that. He is a prolific writer and journalist, whose works have appeared in many of the major Kenyan newspapers, New African and the New York Times (where I first became aware of him).
“The Stone Hills of Maragoli” follows Ombima as he overcomes his morals to find that stealing food from a garden is delightfully empowering. Mostly, the book is about life in a rural area of Western Kenya, filled with the complexities of daily life and a tightly knit, though deeply divided society.
The book won the Jomo Kenyatta literary prize in 2003. Gazemba apparently has frou other novels waiting to see the light of day.
Kenya Day 9
We visited another rehabilitation facility in Nairobi. We found out that the guy we are looking for has been telling his counselors about his employers, but they thought he was just making it all up. His story was so implausible that his employers were a figment of his troubled imagination.
They are surprised to find these fictional characters standing in the sitting room of their facility. One of them has the same name as a good friend of mine, Justin Farrar. I’m somewhat taken aback by his business card.
Capitalism is the cause of drug problems in Kenya, apparently. The market economy has robbed Kenyans of their culture and they are now turning to drugs for comfort and solace. I’m interested in this. I ask where most of the patients of this $500 a month facility come from. They are mostly children of the wealthy Kenyans, half of which probably have real problems, and the other half of which are sent here to get them out of their parents’ hair.
I’m wondering if all those with brains pickled (or eyes blinded) from changaa (an awful homebrewed alcoholic beverage common in the villages) are the victims of capitalism as well. While it’s important to discuss the causes and roots of social problems, it was an odd aside.
We stop by a new Ethiopian restaurant. The owner is excited because we are the first foreigners at his place, which opened up three days ago. He takes numerous pictures.
I’m told that much of the real estate boom in Nairobi has been funded through proceeds from Somali piracy. I look and find that it’s probably true.
In fact, I reflecting on how Nairobi is in the middle of a real estate bubble. Rents are absurdly high in Nairobi, but then one will pay a premium for security, particularly after Westgate. I keep thinking about what an awful strategy this is. Investors are looking to make a quick buck, building and turning over real estate prices for ever higher prices. I remark that Kenyans are wholly uninterested in developing their country, preferring risky, short term assets like real estate to investment in new manufacturing sectors.
The Kenyan government, of course, is uninterested in encouraging growth through enterprises which create jobs, preferring to skim off the top of real estate in the form of bribes and taxation for imported supplies. It’s all sad, really. I’m wondering when the bubble is going to finally burst.
It turns out the Nairobi Java House that got bombed was the one outside, not the one inside the terminal. I’m looking at it and noticing how dangerous the location is. Anyone could drive by, lob a bomb here and kill five or ten foreigners in a split second.
It’s time to go, though I’m sad. Nairobi is an exciting place, far more exciting than my own boring, though pleasant, Ann Arbor.
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