Category: poverty

U.K. riots: poor parenting or lack of opportunity?

By contributor Sean Carey

Politicians in the U.K. are puzzled about the cause and scope of the recent disorders on the U.K. mainland. Last night, for example, I listened to Baroness Sayeeda Warsi, co-chair of the British Conservative Party, and Harriet Harman, deputy leader of the Labour Party, squaring up to each other on BBC Radio 4’s Any Questions.

London Road looking like a tornado swept up it. Fire tenders still spraying water at lunchtime on Tuesday, more than 12 hours after the fires were set. Image/George Rex.

Baroness Warsi, the daughter of migrants from Pakistan and the first Muslim woman to serve in the cabinet, was clear about her view that the riots were caused by a failure of parenting. She said that when she was a child she would not dream of getting into trouble because of what her parents might do once they found out.

Harman, the daughter of a Harley Street physician, appeared anxious not to be perceived as “soft” on issues of law and order or to be some sort of moral relativist. She said that behind the “criminality” other issues drove the behavior of the rioters, including “lack of opportunity.”

What can we learn from some street-side fieldwork? Continue reading “U.K. riots: poor parenting or lack of opportunity?” →

The grand challenges in global mental health

A consortium of social science and medical researchers, advocates and clinicians announced the major research priorities over the next 10 years for addressing mental illness around the world. They call for urgent action and investment. Medical anthropologist Arthur Kleinman, of Harvard University, is a member of the group. Nature carried a report on the consortium’s conclusions.

depression
Depression. Flickr/shattered.art66
Table 2 presents the 25 Grand Challenges related to mental, neurological and substance-abuse (MNS) disorders.

Cross-cutting themes:

  • research should take a life-history approach
  • suffering from MNS disorders includes family members and communities and thus requires health-system changes
  • all care and treatment interventions should be evidence-based
  • environmental factors such as extreme poverty, war, and natural disasters have important but poorly understood affects on MNS

In conclusion, the report notes that the greatest challenge would be the elimination of MNS disorders. A truly great challenge.

But a challenge that is not likely to be met in the next 10 years given the way things are going with the last factor listed above. Therefore, why not devote the bulk of the research funds to addressing the mental health risks from poverty, war and natural disasters? And, on the way, maybe we should do something about poverty and war?

Five steps against cholera in Haiti

Two children receive oral rehydration treatment for cholera at La Piste camp. Credit: Amanda George/British Red Cross.
Two children receive oral rehydration treatment for cholera at La Piste camp. Credit: Amanda George/British Red Cross. Creative commons Flickr image.

Paul Farmer and colleagues published a plea for urgency and cooperation in Lancet. It involves five steps:

  1. identify and treat all those with symptomatic cholera
  2. make cholera vaccines available through a concerted effort
  3. address water insecurity to promote prevention
  4. strengthen Haiti’s public health system.
  5. raise the goals for health in Haiti and deliver the means to achieve them.

These five goals move from the more micro and immediate to encompassing local, regional and global structural issues. Yet, the micro will be difficult if not impossible to achieve in any meaningful way without change at the macro levels.

As the authors state: “…the goods that are needed to respond effectively to the epidemic seem to be caught in customs” both literally and metaphorically.

Roma: Not all alike

Roma beggar in Paris. Credit: Seb Ruiz, Creative Commons licensed on Flickr
Roma beggar in Paris. Credit: Seb Ruiz, Creative Commons licensed on Flickr

Guest post by Sam Beck

The European Union must be held accountable if European states continue to expel Roma from member countries. The expulsions are taking place because Roma have created settlements not only in designated campgrounds but also within urban boundaries. This is not new. However, the scale and density of such settlements disturbs the sensibilities of Europeans. This is not only a West European phenomenon. Events of intolerable discrimination are also taking place in East Central Europe and the Balkans from which many of these Roma originate. The history of anti-Roma sentiments in both East and West Europe is torturous and long-standing.

A rather unusual situation emerged in Romania where Roma have lived for hundreds of years, where to this day they appear in abundant variation, from people who have resumed migratory lives to people who have been settled at the margins of villages, towns, and cities for as long as anyone can remember. In Romania, Roma were enslaved and indentured for centuries. They played important roles as musicians, miners, and in producing objects necessary for an agrarian society, crafting metals and wood objects. Today, those that we call Roma, were involved in all sorts of labor, agricultural workers and house servants.

Some may no longer speak their Sanskrit based language, or if they do they speak it with lexical-items borrowed from Turkish, Romanian, Bulgarian, Hungarian, Czech, Slovak, Russian, and so on. In Romania, many no longer speak Romani. In Romania, Roma may identify themselves with this “national” identity, or they may identify as “tsigani,” how others have named them. This is a term of derision. Some Roma have integrated themselves into the mainstream of Romanian society and melted into the Romanian ethnic identity. Some Roma sustain their identity and have experienced upward mobility in many different fields.

Roma were persecuted in the Nazi era, large numbers of whom lost their lives; their population decimated in great proportions to their total numbers, referred to as Prajmos. Oddly enough, when mentioned at all as a persecuted population in Germany’s ethnic cleansing effort they are lumped in with Jews, rather than being mentioned outright as a population. No museums exist for them and if there are memorials for them, I do not know of them. They have no homeland with which they can identify. There is no Israel that was created for them as it was for Jews. Their identities are claimed as citizens of their countries of origin.

Continue reading “Roma: Not all alike” →

Thinking outside the pill box

The latest issue of the Journal of Women’s Health includes three articles describing health risks of women in the United States related to social exclusion and cultural factors. They all demonstrate that good health is about a lot more than medical care.

The first article looks at three factors associated with cardiovascular disease–hypertension, elevated cholesterol, and diabetes–among 733 uninsured, low-income rural women in West Virginia aged 40-64 years.  The women were participants in the Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) program.  West Virginia has a high percentage of people 50 years and older, the highest rate of angina and coronary heart disease in the United States, and is tied with Kentucky for first place in prevalence of heart attacks.  Prevalence of hypertension, elevated cholesterol, diabetes, and obesity, are also among the highest in the nation. The study found that large proportions of the women are at risk for cardiovascular disease because of untreated hypertension and high cholesterol. They lack access to regular health care due to the limited availability of health services in rural areas. Women who are less educated, a likely proxy for poverty, are particularly likely to have these untreated chronic conditions.

The second article is about emergency care for women who have been sexually assaulted. According to the National Violence against Women Survey, 18 percent of white women, 19 percent of Black women, 24 percent of mixed race women, and 34 percent of American Indian/Alaskan Native women report a rape or sexual assault at some time in their lifetime. This article reports on findings about the “incident history” of sexual assault from 173 women who sought care in an Emergency Department in an unidentified city (possibly in Mississippi since the lead author is assistant professor in the School of Nursing at the University of Southern Mississippi).  Of the total, 58 percent of the women were black and  42 percent white.  Weapons were much more likely to be involved in assaults on black women, and black women were more likely to be assaulted in the city rather than the suburbs. Substance abuse occurred in about half of the assaults; black women were more likely to report use of illicit drugs while white women were more likely to report alcohol use before the assault.

The third study reports on an evaluation of a community-based pilot intervention in New York City that combined cervical cancer education with “patient navigation” to improve rates of cervical cancer screening among Chinese American women.  In the United States, Chinese American women have higher rates of cervical cancer than white women.  The study compared an intervention group and a control group.  Eighty women received the intervention: two education, sessions,  open discussion with a Chinese physician, educational videos,  and navigation assistance in identifying and accessing low-cost services. The control group of 54 women received two education sessions delivered by Chinese community health educators and written materials on general health and cancer screening. Twelve months later, screening rates in the intervention group were 70 percent compared to 11 percent among the control group. An important factor in the intervention group was greater perception of the severity of the disease.

Continue reading “Thinking outside the pill box” →

Keeping our promises to children

In the words of Nicholas Kristof, “The late James P. Grant, a little known American aid worker who headed Unicef from 1980 to 1995 and launched the child survival revolution with vaccinations and diarrhea treatments, probably saved more lives than were destroyed by Hitler, Mao and Stalin combined.”

The legacy of this “little known American” was the focus of the James P. Grant Lecture at the George Washington University on March 23, a tribute to Grant 15 years after his death. Dr. Jon Rohde delivered the keynote lecture, entitled “An Unfinished Agenda for Children.” Rohde is a professor in the James P. Grant School of Public Health, BRAC University,  Bangladesh, and former representative of Unicef in New Delhi, from 1993 to 1997.

Rohde first offered highlights of Jim Grant’s work with Unicef: putting children on the political agenda of countries around the world, promoting a focused four-point program called GOBI (growth monitoring, oral rehydration therapy, breast feeding and immunization), pursuing universal reach to all children, initiating cease-fires in war-torn countries to allow a few days for immunization of children, and unrelenting energy in carrying forward his vision to put “children first.”

A subtext running through the speech was that UNICEF, since James Grant’s death, has failed to keep his vision alive. The United States, through its lack of support for the United Nations, has turned its back on the world’s children.
Today, we have new hope for a re-commitment to children with Unicef once again taking a strong position under the leadership of Tony Grant. What would James Grant say to Tony Lake as he assumes his new position? Here are Rohde’s thoughts about what he would emphasize:

1. Focus on the unfinished agenda: reach those who are left out in order to erase social disparities in child survival.
2. Keep resources focused on children rather than on particular diseases.
3. Restore UNICEF to what it was: get UNICEF staff out into the field rather than spending most of their time doing paperwork.
4. Defend the rights of children with the same energy as adult rights are defended.
5. Promote community participation to define activities that will respond to local threats and priorities.
6. Strengthen UNICEF’s support for education, especially of girls.
7. Build alliances among all partners to eliminate competition by taking children as the integrating catalyst.
8. Plan now for the next development decade to 2025.
9. Bridge political differences in the US so that Americans can speak in one compassionate voice.
10. End the stranglehold that the military and industrial partners have over our lives and redirect the vast resources now expended on war to keep our promises to children. Rohde commented that Grant typically steered clear of issues not within his mandate for children. “Children first” was one of his mantras. Yet he knew that putting children first was incompatible with a world in which the richest country continues to dedicate vast resources to war.

In closing, Rohde remarked: “Jim Grant saw through children the chance of peace and decency for everyone. Indeed, children are a valid aim in themselves, but even more so as a means to uncover the humanity in us all and bring about a better world in the process. This is the legacy he left us – the challenge lives on.”

Blogger’s note: In a side conversation with Dr. Rohde, I asked him, “How would the US deal with all the soldiers if they are not at war?” His answer: “They can get to work rebuilding America.” Imagine soldiers helping to build schools, providing security in poor neighborhoods so that children can come and go to school without fear, participating in social programs, and providing outreach to those on the social margins. A demilitarized military working for life not death, for child survival and humanity.

Image: “Return to Innocence,” from flickr user sytoha, licensed with Creative Commons.

Mountains of a different kind

Tracy Kidder‘s widely read documentary book about Paul Farmer’s work in Haiti is called Mountains beyond Mountains. The title comes from a Haitian proverb which is translated into English as: “Beyond the mountains, more mountains.” In other words, every challenge is followed by another.

Have you by any chance read Rose George‘s book, The Big Necessity: The Unmentionable World of Human Waste and Why It Matters? If not, I highly recommend it. It will take you where no book (that I know of) has gone before. It’s about human excrement.

In following the excrement, George will guide you through the sewers of London to open defecation in rural India to the biogas revolution in villages of China: all places and situations that are quite “normal.”

Perhaps, in an updated edition, she will add a chapter on the “big necessity” in crisis situations. What happens, for example, when over a million people are displaced from their residences and are forced to survive in “tent camps?”

One things that happens is mountains beyond mountains of excrement. An article in the New York Times points to the sanitation situation and its implications for disease. Not to mention everyday misery and degradation.

The article, however, provides a ray of hope. Viva Rio, a Brazilian nongovernmental group, has launched an operation in one slum area of Port-au-Prince that turns human excrement into biogas that can be used for cooking and electricity.

This project should be replicated throughout the camps, throughout the island: turn the mountains beyond mountains of excrement into something people can use. Thank you, Viva Rio.

Image: Creative commons licensed Flickr content by BBC World Service. Feb. 9, 2010. From Haiti. “There aren’t many latrines, so this is pretty much the only way to dispose of all types of waste – dig a big hole and stick it in the ground.”

Home loss

Losing one’s home has both short-term and long-term negative effects on people. It can disrupt marriages and relationships and produce undesirable behavioral changes in children. The fallout of losing one’s home brings with it the catastrophic loss of investments, dignity, safety, aspirations and the ability to provide basic needs for oneself and one’s loved ones.

Moody’s Economy.com predicts that 1.9 million homeowners in the United States will lose their homes to foreclosure this year.

In Haiti, an article in the Washington Post today notes that more than one million displaced people don’t have “adequate shelter” — meaning? A tent? Or less? USAID has sent 7,000 rolls of plastic sheeting with another 5,000 on the way (Question: how many people can a “roll” cover?). The rainy season is also on its way.

A study conducted by the National Council of La Raza and the Center for Community Capital at the University of North Carolina at Chapel Hill looks at the effects of housing foreclosures on U.S. Latina families. It is based on interviews with 25 families in Texas, Michigan, Florida, Georgia and California.

Half of the parents reported problems in their interpersonal relationship with more than a third considering divorce or separation. Half of the families said that, after the foreclosure, they had more conflicts with their children and their children had more problems in school.

The American dream has turned into a bad one for many thousands of people who invested their savings into buying a home only to lose it all when the economic crisis hit.

And the Haitian dream for more than a million people tonight? Some plastic sheeting, please.

Image: “Sign Of The Times – Foreclosure,” creative commons licensed content by Flickr user

A tale of two op-eds

They are both about Haiti. They are both worth reading. In my view, one is the best of op-eds and one is the worst. Please read them and say what you think and why.

Op-ed #1: In the February 7 New York Times, Ben Fountain takes us to rural Haiti in 1999. After driving for a few hours away from Port-au-Prince, he saw sprawling mansions in the hillsides. “Had oil been discovered in Haiti”? His Haitian friend shook his head: “Drogue. Drugs.” Fountain talks about how Haiti, 10 years ago, had become a major transshipment point for cocaine from South America to the United States. It still is. The Haitian military helps keep this billion-dollar-a-year trade going. Fountain concludes: “So it’s come to this: the richest country in the hemisphere and the poorest, the first republic and the second, trapped together in the New World’s most glaring modern failure: the war on drugs.”

Op-ed #2: In the February 5 Wall Street Journal, Lawrence Harrison writes from Boston about how the Haitian people’s widespread devotion to voodoo is its “curse.” He states that although Haiti has received billions of dollars in foreign aid over the past half-century, its progress indicators are more like those of Africa than Latin America. The reason: the powerful influence of voodoo, which, he explains came from Africa and continues to be an “obstacle to development” there. Harrison avers that that all Haitians feel its influence. His sources of data? A son-in-law of his “who is Haitian and holds a graduate degree from Harvard.” And an American missionary who lived in Haiti for 20 years. Shaky grounds? Not for Harrison, who sums it all up for us: “Haiti’s predicament is caused by a set of values, beliefs, and attitudes…”

Image: “Members of the Jordanian Special Weapons and Tactics (SWAT) team of the United Nations Stabilization Mission in Haiti (MINUSTAH) take position during a drug seizure exercise. 22/Dec/2008. UN Photo/Marco Dormino.” Link. Creative commons licensed Flickr content.

Steps toward rebalancing Haiti

In the late 1970s, Haiti’s rural population was 80 percent of the total population, while today it is 55 percent. This rapid shift has led to Haiti being “terribly out-of-balance” as Robert Maguire testified (PDF transcript) before the Subcommittee on International Development, Foreign Assistance, Economic Affairs and International Environmental Protection of the U.S. Senate Committee on Foreign Relations on Feb. 4.

Robert Maguire is associate professor of international affairs and director of the Haiti Program at Trinity College in Washington, D.C., and Jennings Randolph senior fellow at the United States Institute of Peace. He first went to Haiti in 1974. His most recent visit ended on January 10, 2010, two days before the earthquake occurred.

In his testimony, Maguire laid out five points:

  1. Decentralization: help people displaced from Port-au-Prince to stay in rural areas
  2. Create a National Civic Service Corps
  3. Strengthen state institutions through partnership
  4. Get money into the hands of poor people
  5. Support institutions, businesses, and leaders who work toward inclusion, less social inequality, and socially responsible investment strategies

Image: “Rural life is hard work,” a scene of rural Haiti. Creative commons licensed content by Flickr user danboarder.