Sunday, January 22, 2012

Academia? Action? Translation please, pt. 4

Part 4: Translation

So let's review the questions we asked at the beginning of this series.

- How do we understand the relationship between health and inequity?
- How do we go about building a more healthy and just future?
- Whose ethical responsibility is it to ensure global health?

And some of the core ideas from some answers:

political and economic forces have structured risk for most forms of extreme suffering
only with immediate action can long-term... challenges be contained 
an essential first step to redress global health inequities is to show the injustice of the present situation and make 'explicit the values on which the proposed action is based'
justice in health requires societies to provide individuals with the necessary conditions for achieving the highest possible threshold level of health so they can have flourishing lives
State governments, institutions and actors, along with non-governmental organisations, local communities, businesses, foundations, families and individuals must assume a prior and direct role and responsibility, through a framework of shared health governance, at the level of the nation-state

Have we really said nothing?

Let's try another approach.

What have these authors not said? They haven't said that the challenges are insurmountable. That they're too complex. Impossible to tackle. Something that's okay, or "just life" or "the way things are". Something we can worry about tomorrow. Something where individuals and local communities have no role.

I recognize my incredible privilege in having the opportunity to study abroad and see the ways our actions can affect communities far away from us. But I didn't have to get on a plane in order to vaguely, indirectly, but somehow, know, that my voting, consumer, and everyday behavior affects people on other continents. I also didn't have to get on a plane to know that my actions affect the people in my own community.

Not only do I have the ability to affect the world, but it can happen now, and it can part of the movement for global health equity.

Not only do you have the ability to affect the world, but it can happen now, and it can be part of the movement for global health equity.

I trust that being part of the GlobeMed model to build a nationwide movement towards global health equity is a step in the right direction. I accept the things that are out of my control. But I also accept and celebrate my own agency. That sad day in the library may feel distant from the issues, but it's an exercise of intellect and an investment in that person's future credibility. Similarly, GlobeMed is investing in the future. GlobeMed is training future global health leaders, partnering with international and domestic organizations, and growing the movement for global health equity.

You're a part of all this too.
And if you're reading this as someone is not currently involved with the GlobeMed Brown University chapter, join us! E-mail You can also contribute to our partner organization, U-TENA, or follow us on facebook

Monday, January 2, 2012

Academia? Action? Translation please, pt. 3

Part 3: Does my action matter?

In order to feel relevant, I need to get over a few myths.
[For much more eloquent myth-busting, backed with experience in the real world, read this on Humanosphere, an NPR blog about global health and the fight against poverty.]

1) Working to correct global health inequities means I need to be spoonfeeding oral rehydration therapy to a child in Africa who clearly has had less access to good health than me.

Debunking this myth is a matter of recognizing the utility of distance. Leaving this exotification of distress (the suffering needs to be happening in a place very different from mine for it to be to extreme and real) aside for now, let's all take an honest attempt at humility and remember that the world is complicated. Your individual impact on the world is complex, multi-faceted, and real. And before traipsing off to a community you formerly have had no stake or familiarity with, remember the homeless person at the supermarket, or the coughing woman on the bus. "Global" health inequities include your own community. They're local, and at your doorstep. Which makes action that much more possible and relevant.

Ironically, I didn't gain this appreciation until I went abroad. When I was in South Africa, we worked on a "case study" to do a three-day examination of the elderly's perception and understanding of HIV/AIDS. One day, we conducted a focus group in what would be considered a slum area. While we heatedly discussed the merits and flaws of qualitative and quantitative research methods, which felt incredibly distant from the real needs of the people inhabiting the country we were visiting, the indulgence of our actions dawned upon me. We were going to invite ourselves into the homes of strangers, ask them to consider deep and personal questions, extract what we needed for our presentation, and then leave - all for this abstract goal of "education". I proposed that we bring fruit to eat during the focus group, and bought some before we went to conduct it. As we handed out the fruit before we asked our strategically designed questions, I watched some of the older women smell the skin of guava, or pluck an orange out of the bunch approvingly. As I saw them literally consume this nourishment, I knew this was the only unambiguous good I felt we had done this entire project - to, in a small way, offer a small token of gratitude to those who were so generous with their knowledge.

When I came back to school, I was having an in-depth conversation with a friend in the college bookstore. We might have been talking about the construct of language or the meaning of life - all abstract questions college students can give themselves time to ponder. Sitting near us was a man who clearly had been there for a while, with no indication he was off to anywhere else. I had a box of cherry tomatoes I was sharing with my friend. I offered the man nearby some, and he accepted, graciously. Maybe his tanned skin, weathered hands, and yellowed eyes didn't mean he was homeless or economically disadvantaged - maybe he worked at a job that was extremely trying to the body. Maybe he was just another human being, enjoying tomatoes. I asked if it would be okay if I left the rest of the box with him, since I wasn't able to finish it.

"Oh yes, I would like that," he said. "I would like that very much."
[For another student perspective on how our actions at home at relevant to those abroad, read this well-written post by Critical Development Forum founder Dean Chahim.]

2) So what if I buy this toothpaste instead of that one? This isn't going to change anything.

The hardest part here, for me, and perhaps part of the reason why our generation been heralded as more active, engaged, and concerned about the future compared to those past, is that I/we crave gratification, quickly. If I can't see the results, I can't be sure it worked. Not only do I need to see the results, but they need to happen on a timeline I'm familiar with - two weeks is enough for me to churn out a 12-page research paper, so how is developing effective malaria prevention schemes supposed to take three years? And more realistically, 10 years? I haven't engaged with any life project of my own that recently that has been longer than four years - the only examples I have are high school and college.

But say I take the heart the possibility. The possibility that this $5 purchase of toothpaste is a vote towards a world where consumers are informed of the product's origins, the labor practices that it funds, the environmental impact of the company's practices, and distribution of the profits. To engage with the idea that my choice counts is to admit that this drop in the bucket may be the one that breaks the surface tension and causes an overflow - a critical millivolt of energy in what becomes known as a social movement towards socially responsible business practices. Say this movement is documented in a moving newspaper article that catches the eye of a public relations executive at a multinational corporation that manufactures toothpaste. And say they become alarmed with the competition so that they revise, revisit, and make transparent their labor practices. Say salaries for workers increase, and with the extra income, workers are able to send their kids to school. One day the kid comes home and talks about the importance of hand-washing so as to avoid spreading germs, and their younger sibling doesn't catch a preventable diarherreal disease that might have taken their life under other circumstances.

Maybe it's a far-fetched idea.

But here, I at least vote for these general principles, when indicating my preferences as a consumer, for a world I would like to live in.

I've had the idea in my head that socially responsible consumption was a good thing - maybe for a long time at the beginning for superficial reasons. Maybe I just liked the idea of getting "social good" vibes from something as everyday and easy as buying a Viva Glam MAC lipstick instead of a regular MAC lipstick. I had my healthy suspicions that perhaps through some creative accounting, MAC could claim that "Every cent of the selling price of MAC VIVA GLAM lipstick and lipglass is donated to the MAC AIDS Fund," while $7.50 of my $14 went to running the ads for the Viva Glam campaigns, $5 went to administrative costs, and $1.50 went to a random non-profit who in turn used $0.02 of it to buy 1/10 of a condom that they gave out for free in a place where people already had financial access to condoms anyway.

Cynicism can be healthy. But sometimes, only optimism can sustain your faith. Our study abroad program also took us to India. When we visited YRG Care in Chennai, director Dr. Solomon unveiled their plans in the next year to build a multi-building complex to expand their services and accessibility along a block of the bustling city. Construction, she said, would cost around $1 million, and was funded by the MAC AIDS Foundation.

I still use that MAC lipstick I bought a year ago. I carry it around with me with affection, remembering that in an indirect way, my $14 somehow made possible Dr. Solomon's work in India. From seeing her make presentations twice, and watching her in her workplace, I know her foundation is a worthy cause - a place that delivers results under the charismatic leadership. Even my small signal as a consumer to MAC that I would rather buy make-up products that help finance reputable non-profits could be a blip on the radar.

Sometimes, we just need to trust in our intentions, and stop letting our cynicism be our excuse. 
[For more ways on how your dollars and consumer behavior matters, check out the Better World Handbook.]

3) I threw a recyclable water bottle in the trash today because I didn't want to carry it around, drank a Coke that not only supports a sub-par company but also isn't the best for my health, and would much rather go to the movies in my gas-consuming vehicle than finish reading this blog post. I go to a well-respected school and have a sincere interest in combating global health inequities. If I can't do this, how can I expect others to?

Working for the social good isn't always loud, or obvious, or sexy. And as people, we're not perfect. Sure, we'll have times when we might question if we can do more - likely we should. But at the same time, the first steps are the crucial ones, and giving up is the fastest way to disengage with the idea that you matter. Your commitment is admirable, and important. Keep it up, despite any setbacks. Most importantly, before we change others, we do need to believe we are capable of the change in ourselves. More generally, while we can do our best, there are some things that we need to accept are out of our control - it's just a matter of picking our battles wisely.

I'll admit, I probably have thrown a water bottle in a trash can in the last month. During the summer I was home, I also found out about Recycling for the People, and encouraged our parents to sign up for the program. For two weeks, they were very resistant to the idea. "You want us to pay someone else to make money off of our recyclables?" I had formerly spent a summer living in Taiwan, where I could see my waste shrink to a small mound of compost and plastic wrappers - made possible after happily sorting all my paper products, restaurant to-go containers, bottles, cans, styrofoam, and old clothing into the recycling bins in the basement of the apartment complex. At home in America, seeing plastic to-go containers in the trash can made me frustrated. After days of prodding and asking, my mom agreed we could try it for a month. We've been on the program for six months now, and from my expert guesses from having taken out the trash, our household has reduced the volume of our trash by at least two thirds. Instead of us holding on to plastic bags and styrofoam that we would have to travel miles to process (and get minimal payment, if at all, for), we can give it to someone else who will accumulate a critical mass and process it on a regular basis.

So yes, I'm still a little mad at myself for not recycling that water bottle, but I remember too, that I have made a contribution where it counts more. I pick the important things to hold on to, keep my head up for the future, and let the rest go.

In what ways can you contribute to building a more healthy and just world? What can you do today, or tomorrow, to contribute positively to your neighborhood? Tomorrow we'll post our some concluding thoughts on this mini-series - check back! 

Academia? Action? Translation please, pt. 2

Part 2: Answers from academia

note: The following excerpts are pulled out of their original context but capture what I think very generally what their respective articles aim to achieve. I encourage you to read the original text (links available following the references at the end of this post). 

1) How do we understand the relationship between health and inequity?

"Anthropologists who take these as research questions study both individual experience and the larger social matrix in which it is embedded in order to see how various large-scale social forces come to be translated into personal distress and disease. By what mechanisms do social forces ranging from poverty to racism become embodied as individual experience? This has been the focus of most of my own research in Haiti, where political and economic forces have structured risk for AIDS, tuberculosis, and, indeed, most other infectious and parasitic diseases. Social forces at work there have also structured risk for most forms of extreme suffering, from hunger to torture and rape." - Paul Farmer

2) How do we go about building a more healthy and just future?

"To ensure success, in 2005 the world must start building capacity, improving policies, and delivering the investments needed to meet the goals. This effort will need to be sustained at the global, national, and local level over the next decade. And only with immediate action can long-term environmental challenges, such as climate change and fisheries depletion, be contained before they cause irreparable harm for the poor countries least able to protect themselves." - Jeffrey Sachs

"From a global perspective, an essential first step to redress global health inequities is to show the injustice of the present situation and make 'explicit the values on which the proposed action is based'. (38) A second is to develop principles to guide global and national actions to redress such inequalities... Justice in health requires societies to provide individuals with the necessary conditions for achieving the highest possible threshold level of health so they can have flourishing lives." - Jennifer Ruger

3) Whose ethical responsibility is it to ensure global health?

"In conclusion, international agencies and organisations such as the World Bank, the World Health Organization and the United Nations must work together and in a supportive and facilitative role vis-à-vis state actors and institutions to correct global health injustices. State governments, institutions and actors, along with non-governmental organisations, local communities, businesses, foundations, families and individuals must assume a prior and direct role and responsibility, through a framework of shared health governance, at the level of the nation-state. A moral framework should be applied to all global health policies. Reducing gaps in preventable mortality and morbidity is an essential focus of the global health community in the 21st century." - Jennifer Ruger  

Farmer, Paul . "On Suffering and Structural Violence: A View from Below." Daedalus 125.1 (1996): 261-283. Online. [Link]
Ruger, J P. "Ethics and governance of global health inequalities." Journal of Epidemiology & Community Health 60 (2005): 998-10002. Online. [Link]
Sachs, J D, and J W McArthur. "The Millennium Project: a plan for meeting the millennium development goals."Lancet 365 (2005): 347-353. Online. [Link]
What relevance do these broad answers have to your own life? Consider the ways in which your actions impact global health inequities everyday. Stay tuned for the next post, where I offer a few preliminary answers from my own experiences.