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Rising wealth in Kenya: is everyone benefitting?

Picture1Looking 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.

Links I liked January 23, 2015

Measles cases by yearSome public/global health things that caught my eye today:

1. A visit to the most sickest town in America, a coal mining town in Virginia. Dear Republicans, pay for health care now and abandon “clean coal” or pay more later. It’s up to you. (The Atlantic)

2. How paid sick leave could boost American productivity. (CEPR)

3. Dealing with antibiotic resistance is going to take more than just technology. We can’t sit by and watch everything burn around us while we wait for new drugs to come down the pipe…. because they aren’t coming. (Project Syndicate)

4. I want to deny vaccine deniers. Generally speaking, I don’t like people who are willing to sacrifice kids for politics. Vaccine deniers stick together and increase risks for everyone. (WP) and this one, which puts it all into a nice picture for you. (WP)

5. Diseases without borders: ignoring the problem of piss poor health care in developing countries won’t help us from Jim Kim of the World Bank. (Project Syndicate)

We have no idea what poor people do

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.

Links I liked, November 18, 2014

I liked so many things I read today that, rather than clutter social media, I’ll make note of them right here:

“Falling” by William McPherson – By far, the most depressing thing I have read in a while. McPherson is a Pulitzer winning writer and former editor at the Washington Post who chose a life of curiosity and is now paying the ultimate price. It’s awful that the brightest people have to be punished for thoroughly embracing life. So many people I know are going to go this way, it is possible that I might, too.

In India, Growth Breeds Waste NYT – Documenting India’s mounting problem of what to do with its waste. Europe went through their urbanization pains centuries ago. Unfortunately, developing countries are rising to the challenge fast enough. The problem, of course, is that elites are sheltered from the problems of waste and weak and corrupt government structures disallow people from demanding that their countries clean up. International environmentalists need to focus less on screaming about corporate polluting (though it is important) and need to start making demands for more boring things, like managing waste on a local level.

Stop calling me ‘the Ebola nurse’ – Kaci Hickox – This lady was a hero. She never had ebola, but was still illegally interned for having it because a few Americans don’t understand science. Anybody who supported her detainment should just stop speaking to me now. It was shocking how readily Americans were willing to lock people up simply because they were scared and even more shocking where the calls for her “arrest” came from. I give up. People like Hickox put their money where their mouths are. She did what most humans wouldn’t do and she was vilified for it. Unforgivable.

Ten Things that Anthropologists Can Do to Fight the West African Ebola Epidemic I think it should be required that every field research project include an anthropologist.

Q Fever Is Underestimated in the United States: A Comparison of Fatal Q Fever Cases from Two National Reporting Systems People are dying of Q, but much of it isn’t recorded.

Today is Jonas Salk’s 100th birthday

100 years ago today, Jonas Salk was born. As the creator of the inactivated polio vaccine, he not only changed the course of human history, he also ushered changed the field of public health forever. We can count the polio vaccines and the elimination of smallpox as probably the two great success of public health.

In its mildest form, polio causes a mild bout of diarrhea. In its worst form, the virus migrates to the spine, impedes development and causes debilitating long term paralysis. My grandfather was struck with the disease and had one of his legs stunted and weakened (though he managed to serve in WWII anyway as a Marine). A carpenter who worked for me a while back died due to long term respiratory complications from a childhood polio infection.

Polio is mostly foreign to anyone born in my generation. We were nearly all vaccinated, and the high levels of vaccination have destroyed opportunities for the virus to persist in the environment, protecting everyone, even those who don’t get the vaccine.

Unfortunately, though Salk’s achievements were great, medical care and attention to polio was hardly equitable and tainted by the racism of the time.

During the 1930s the systematic neglect of Black polio victims had become publicly visible and politically embarrassing. Most conspicuously, the polio rehabilitation center in Warm Springs, Ga, which Roosevelt, himself a polio survivor, had founded, accepted only White patients. This policy, reflecting the ubiquitous norm of race-segregated health facilities, was sustained by a persuasive scientific argument about polio itself. Blacks, medical experts insisted, were not susceptible to this disease, and therefore research and treatment efforts that focused on Black patients were neither medically necessary nor fiscally justified.[1]

It is likely true that African Americans experienced a lower burden of disease than white children. We now know that polio’s worst effect arise from the lack of acquired immunity to the disease. Repeated infections from infancy, most importantly during the first six months, when babies still have maternal antibodies to fight for them. Improvements to sanitation delayed exposure to the virus, so that children were not immune and thus more susceptible to the disease’s worst effects.

In short, polio is a disease of development, not underdevelopment. The horrible racism of the pre-civil rights medical system can’t be denied, but the observed disparities in disease incidence might have not been imagined given the disparities in sanitation and access to clean water.

Presently, we are fighting a battle to insure that all kids in Sub-Saharan Africa are vaccinated. However, there still exist pockets where the medical system so dysfunctional and the politics so chaotic, that vaccination rates are low and disease continues to flourish. In places like Afghanistan and Northern Nigeria, the hope of polio elimination is almost non-existent

 

1.    Rogers N: Race and the Politics of Polio: Warm Springs, Tuskegee, and the March of Dimes. American Journal of Public Health 2007, 97(5):784.

 

Ngugi wa Thiong’o and the language of NGOs

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.

KLM Lounge time

The KLM Lounge in Schiphol is a great place. There’s decent coffee, free papers that I might read, food and you can take a shower. Then there’s the odd 60’s futurist decor that makes you think you’ve stepped onto the set of 2001: A Space Odyssey.

In trying to suppress my ambivalence about going to Kenya, boarding a domestic flight the next day and then flying to Japan four days later, I’m reading Joe Stiglitz’s new book, “Creating a Learning Society: A New Approach to Growth, Development, and Social Progress (Kenneth J. Arrow Lecture Series).”

Though I’ve just started the book, I’m finding it quite interesting. Stiglitz and others attribute development to the sharing of innovations rather than the mere accumulation of capital. Societies grow because their people learn new things, and some countries do better because they are better at learning how to learn.

Noting that private firms often entrench themselves in particular modes of operation which discourages innovation, Stiglitz argues that government investments in education and R&D and the guarantee of a legal framework which protects property can allow innovations to flourish.

In reading the book, I kept thinking about this 2km stretch of road in Nairobi which has been under construction for the past five years. It’s absolutely pathetic. Buses have to pass through a one lane mud road next to the construction site, while workers move at a snails pace, slowly pouring concrete by hand. Though the reasons for the slow tempo of road construction most certainly include corruption and mismanagement (the contractor is Kenyan), one also has to notice that nearly all roads in Kenya are built by foreign companies.

The Japanese built a masterpiece of a road, complete with cross walks, bike lanes and dedicated pedestrian ways in a tenth of the time. To Japan’s credit, they use local workers, unlike the Chinese.

Building roads isn’t complicated, or, at least, the complications have been worked with over and over and road building is now an established discipline, with text books and training programs available all over the world.

So why hasn’t the knowledge of road building been successfully transferred to Kenya? What the hell is wrong?

Perhaps this is what Stiglitz is talking about. Without beating up on Kenya too hard (but why not?), Kenyan schools are a shambles and the government is only marginally interested in improving the educational fortunes of the country. Schools are designed to train low level clerks for the civil service, and don’t aspire to train kids for science, math or engineering. Though many, many technologies are already established the world over, perhaps the poor state of education hampers technology diffusion.

Back to my coffee.

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