New chapter from myself in a Springer volume: “Access to Health Care in Sub-Saharan Africa: Challenges in a Changing Health Landscape in a Context of Development”
I wrote a chapter for “Health in Ecological Perspectives in the Anthropocene” edited by Watanabe Toru and Watanabe Chiho. I have no idea if they are related. Either way, my chapter “Access to Health Care in Sub-Saharan Africa: Challenges in a Changing Health Landscape in a Context of Development” occupies pages 95-106 in the volume.
Check it out, you can buy the book through Amazon for a cool $109, or just my chapter through the Springer site for $29 or you can simply write me and I’ll give you a synopsis.
Here’s the abstract for the book:
This book focuses on the emerging health issues due to climate change, particularly emphasizing the situation in developing countries. Thanks to recent development in the areas of remote sensing, GIS technology, and downscale modeling of climate, it has now become possible to depict and predict the relationship between environmental factors and health-related event data with a meaningful spatial and temporal scale. The chapters address new aspects of environment-health relationship relevant to this smaller scale analyses, including how considering people’s mobility changes the exposure profile to certain environmental factors, how considering behavioral characteristics is important in predicting diarrhea risks after urban flood, and how small-scale land use patterns will affect the risk of infection by certain parasites, and subtle topography of the land profile. Through the combination of reviews and case studies, the reader would be able to learn how the issues of health and climate/social changes can be addressed using available technology and datasets.
The post-2015 UN agenda has just put forward, and tremendous efforts have been started to develop and establish appropriate indicators to achieve the SDG goals. This book will also serve as a useful guide for creating such an indicator associated with health and planning, in line with the Ecohealth concept, the major tone of this book. With the increasing and pressing needs for adaptation to climate change, as well as societal change, this would be a very timely publication in this trans-disciplinary field.
Looking at some data on socio-economic status (SES) from two regions of Kenya, I was able to compare current levels of household wealth with those of 2007 in the same households.
We measured SES using a method common to studies of developing countries. An accounting of specific material goods including ownership of radios, TVs and bikes along with type of water source, toilet is performed. We then use multiple correspondence analysis to assign weights to each item as they appear in the data set and a total score is calculated for each household (Filmer and Pritchett, 2001 though they use PCA). Each score (ideally) represents the relative level of wealth of each household.
Kenya’s GDP has been increasing rapidly since 2001. During my five years of travelling to this country, I’ve seen the place transform itself. There are more goods on the shelves, people look better, kids die less and women have fewer children. HIV and malaria are down and people are busier. It’s worth noting that Kenya has no real natural resources; its economy is mostly based on a well developed domestic market economy and agricultural exports.
The question, however, is whether these economic gains are being felt by everyone equally. To test this, I compared data from 2007 and 2015 to see if all households experienced an increase in wealth during this period.
I made the graph above. Assuming I’m interpreting the graph correctly, this would suggest that while wealthier households in 2007 consistently continue to be wealthy in 2015, the relationship for poor households is scattered. Some households are doing better, while other may have experience no change, while others may be poorer in 2015.
Clearly, no matter how one interprets these results, we should be explore what types of households might be falling behind, or experience no gains at all.
I was just reading a post from development economist Ed Carr’s blog, where he reflects on a book he wrote almost five years ago. Reflection is a pretty depressing excercise for any academic, but Carr seems to remain positive about his book.
He sums it up in three points:
“1. Most of the time, we have no idea what the global poor are doing or why they are doing it.
2. Because of this, most of our projects are designed for what we think is going on, which rarely aligns with reality
3. This is why so many development projects fail, and if we keep doing this, the consequences will get dire”
Well, yeah. This is a huge problem. In academics, we filter the experiences of the poor through a lens of academic frameworks, which we haphazardly impose with often no consultation with our subjects. Granted, this is likely inevtiable, but when designing public health interventions, it helps to have some idea of what the poorest of the poor do and why or our efforts are doomed to fail.
I remember a set of arguments a few years back on bed nets. Development and public health people were all upset because people were seen using nets for fishing. The reaction, particularly from in country workers was that poor people are stupid and will shoot themselves in the foot at any opportunity.
I couldn’t really understand the condescension and was rather fascinated that people were taking a new product and adapting it to their own needs. Business would see this as an opportunity and would seek to figure out why people were using nets for things other than malaria prevention and attempt to develop some new strategy to satisfy both needs (fishing and malaria prevention) at once. Academics simply weren’t interested.
To work with the poor, we have to understand them and understanding them requires that we respect their agency. If we don’t do this, we risk alienating the people we seek to help.
I just finished reading “Decolonizing the Mind,” a short book from perhaps Kenya’s greatest living writer, Ngugi wa Thiong’o. Ngugi is an interesting figure. Born into a peasant Kikuyu family in the fabricated colonial village of Kamiriithu in Central Province, he managed to take advantage of new educational opportunities during the colonial period and attended Makere University in Uganda and eventually Leeds in the UK. He returned to Kenya and eventually became Chairman of University of Nairobi’s Literature Department.
Though highly critical of colonialism, having been in the heart of the worst of Kenya’s experience with it, he was even more critical of Kenya’s post-colonial trajectory. He started a political theater in his hometown and was eventually jailed under the dictator Daniel Arap Moi.
In “Decolonizing the Mind,” Thiongo seeks to dissociate Kenya’s literature from that of the colonialists. He seeks to create a new African literature, by and for Africans. He would eventually abandon writing in English, choosing instead to write works in his native Gikuyu. Despite Thiongo’s call for an African literature, his European pedigree can’t be denied. He is Brechtian in both rhetoric and action. Hs politics are wholly Marxist and it can even be noted that his medium itself (the novel) is decidedly un-African. Moreover, despite his clear hostility to Europe and the United States, it is interesting the he would be jailed by his own countrymen and then would receive asylum and employment from the US.
I found his ideas of language, however, quite interesting. The colonialists, like the Americans, worked to debase indigenous cultural practices to further an imperialist agenda. Locals were weakened through the apparent dominance of English as a language for communication and business, and the language itself was presented in such a way that social hierarchies were reinforced.
This phenomenon continues to this day. Children are taught from an early age, to greet white people on the street with a scripted “How are you?” “I’m fine, and you?” The formal distance between the stilted Kenyan English spoken in Palirament and the guttural Sheng spoken on the streets of Nairobi is hardly an accident. English the language of oppression, control and government exploitation, and Sheng the language of resistance.
Given my recent experiences at Governmental and NGO meetings, however, what strikes me is how language continues to be used as a tool of control, but hat this vocabulary has been internalized by Kenyans themselves. I grit my teeth now when I head the term “capacity building,” which basically implies that people lack the capacity to help themselves without the good graces of NGOs and governmental organizations. It implies that people are helpless without the assistance of formal authoritarian structures. This is, of course, untrue (though one has to allow for the possibility that people often do things that run counter to their long term self-interest).
People may argue that the term is innocuous, but in my experience “capacity building” is often used in place of “training.” To me, words matter, and where “capacity building” carries with it the implications that there is an inherent defect to be rectified, training implies that the capability exists, but the knowledge not yet there. To put this in perspective, I don’t think that anyone would call any of my academic degrees to have been an exercise in “capacity building.” I can’t help but think that white people are trained, while black people are “capacity built.”
Worse yet is “gender empowerment,” which implies that women weren’t sufficiently capable of managing their own affairs prior to the arrival of some dubious microloan project. Again, in my experience, women all of the world are sufficiently empowered. It’s the men who need to be de-powered. The term is condescending and fails to appropriately recognize the inherent capabilities of individuals while at the same time avoids challenging the paternalistic structures which created economic disparities reprehensible practices like FGM, the buying and selling of women and the inability for women to hold men accountable for violence. In essence, the term blames the victim.
Both “capacity building” and “gender empowerment” reinforce the weakness of the individual and offer that the poor of Africa’s only hope lie in international organizations and their own authoritarian though wholly inept governments. It’s worth noting that the strategy is very similar to that of Christianity, which requires followers to believe themselves powerless and to blame for whatever awful fate has befallen them.
Sadly, both of these terms have worked themselves so deeply into the consciousness of people in SSA, that questioning their validity is futile, which is exactly the nightmare that Thiong’o writes of in “Decolonizing the Mind”. Pointing out that “training” is a more appropriate term than “capacity building” to locals will be met with black stares.