bicycles are for global health

In many cities across the US, cycling is growing in popularity and local governments are working to implement bike-friendly urban planning initiatives, but is it growing fast enough? The US ranks first in the world for percentage of population that is obese (34% for adults age 20 and older). Not surprisingly, the US also ranks near the low end for bicycle usage with 1% or less of its population using a bicycle.
Graph (above, Figure 2) from: Bassett, Jr., et al.,

Walking, cycling, and obesity rates in Europe, North America, and Australia, Journal of Physical Activity and Health, 5, 795-814

Bicycles have been around for a long time. There is a sketch for an early bicycle design in one of Leonardo da Vinci’s pupils’ notebooks from 1493. Over the years bicycles have been upgraded and modified, moving from being a luxury of the wealthy to the transportation of the masses. The advent of cars slowed bicycle usage in industrialized countries, but in less economically developed countries bicycles are still a primary mode of transporting people and goods. Likewise the production of bicycles has remained nearly double that of cars.

For many countries bicycles are at the front lines of public health, they just may not realize it. The US has been watching a steady rise in obesity rates as a result of inactivity and unhealthy diet choices. Many states and cities are working to implement programs to increase bike usage including: Rails to Trails projects, Bike sharing in Washington DC and Nashville, as well as increased bike lanes linking residential areas to commercial zones. These programs will all have a big impact of the health of the US population. The CDC states that the number on strategy for increasing physical activity is shifting from car trips to walking or biking. Bicycling Magazine notes that new bicycle commuters can expect to lose up to 13 pounds their first year of biking to work.

Graph (above, Figure 4) from: Pucher, J., et al., 2010

Walking and cycling to health: A comparative analysis of city, state, and international data, American Journal of Public Health, published online ahead of print

The benefits are huge, but that doesn’t always make it easy for people to jump right on a bike. A recent study led by Dr. John Pucher of Rutgers University found a direct correlation between percentages of adults with diabetes and percentages of commuters biking or walking to work in 47 of the 50 largest US cities (Walking and Cycling for Health, August 2010). To state the obvious, the increase in programs that promote bike usage and the increase in people biking will have a very positive effect on the health of populations

However, the US isn’t the only country working to get its citizens moving. Copenhagen (Denmark), known for being a biking city, launched “You won’t believe it… You’re safer on the bicycle than on the sofa!” A campaign run by the city’s Public Health office, their goal was to get more people biking to work instead of taking their car for a short trip. The campaign told Copenhagen residents, “Lack of movement in everyday life is harmful to health, while physical activity keeps the body healthy. Daily exercise for at least 30 minutes prolongs life by up to 5 years, and cycling can thus help to prolong life.” Even as a strong biking city even Copenhagen felt the need to better educate and mobilize its population. As can easily be guessed Denmark has a low rate of obesity at 9.5%.

In “developing” countries of the world obesity rates aren’t the greatest health risk, nor is low physical activity often a common unhealthy lifestyle. The health risks in “developing” countries are often related to access to health services and emergency transportation. Surely this isn’t an area where bicycles can have an impact!

In many low resource setting around the world, Community Health Workers (CHWs) travel from village to village, home to home to deliver health education and services. In many places CHWs rely on bicycles as their only means of getting from one place to another. Bikes Without Borders highlights the work of CHWs in Malawi utilizing bikes to increase their effectiveness and to help more people. Bicycles for Humanity collects almost 50,000 bikes a year and sends them to organizations that distribute them most often to healthcare workers and women. Since women do a majority of traveling in “developing” countries, a bike can help them to transport themselves, water containers, and goods to market.

Bicycles have even been modified to serve as ambulances in areas where there is no emergency transportation. The Bicycle Empowerment Network (BEN) in Namibia has implemented a very effective model for faster transportation where there is none. Drivers of the bicycle ambulances come from local organization and they receive training on use and maintenance.

Whether it is in the post-industrial cities of the US, modern cities of Europe, or in some of the world’s poorest regions, the simplest transportation technology can have huge impacts on the future health of our population.

Featured on the Americans for Informed Democracy Blog, where I’m blogging as a Global Health Analyst.

ambulances run in the family

Lights and sirens, high speeds down the expressway, ER doctor drama on top of insane accidents, not to mention Grey’s Anatomy – behind all the loud noises, dramatic depictions, and hit television shows there is a lot to learn before entering the world of emergency medicine.

On September 1st (the same day Nichole started her MPH classes!), I began an Emergency Medical Technician (EMT) course with Huron Valley Ambulance in Ann Arbor. I have longed to have more advanced medical knowledge and skills and this seemed like the perfect avenue. The story of my medical interests begins with my grandpa.

During World War II my grandpa, Myron Schlott, served as a Navy Medic serving in the Aleutian Islands, visiting Hawaii and Australia, and finally on a submarine. In the above picture he is standing on the right with his arms crossed. Behind him is the ambulance that he drove. My grandpa was an important figure in my childhood, Scouting, and in the development of who I am today.

My grandpa was also a strong supporter of my project to fund an ambulance for a rural health center in Uganda. From that project and my trip to Uganda I gained a serious understanding of the need for emergency transportation and medicine in Uganda and at home.

Since the 5th grade I’ve been first aid and CPR trained through the Red Cross and the Boy Scouts, which included: wilderness survival, back country first aid, and cold weather survival training. Last year I completed a Wilderness First Responder (WFR) course with the Wilderness Medical Associates (WMA) and thoroughly enjoyed it.

I knew this was the right next step for me when my fiancee, Nichole, told me that I was getting excited about taking vital signs and blood pressures. Thankfully I have only had rewarding experiences with ambulances thus far and I can only see it continuing to be positive.

A desire to help others was instilled in me at an early age and I can only imagine that is why I have a strong desire to get more involved in medicine.

How many of you reading this are currently involved in or studying health care, medicine, etc.? What are you doing and where?

Why There is No Doctor: the Impact of HIV/AIDS on the Post-Apartheid Health Care System of South Africa

Empty waiting room at Clinic 2 in Zonkizizwe, the doctor was not in (photo credit: Alex B. Hill, 2008)

This research was the culmination of my three month long internship at Vumundzuku-bya Vana “Our Children’s Future,” a center in Zonkizizwe, Katlehong, South Africa (Gauteng Province) for children and youth affected by HIV/AIDS. During my time there I developed an HIV Peer Educators curriculum and taught HIV/AIDS information sessions to the youth. The piece that I am most proud of was the planning and organizing of a area-wide HIV Testing Day where over 80 people were tested in a settlement where there was a very high testing stigma.

What I noticed during my time in Zonkizizwe was the lack Doctors (at government clinics, private clinics, etc.) as well as the lack of a working health system in an informal settlement not far from Johannesburg and Germiston. The research focuses on how and why apartheid and HIV/AIDS impact South Africa’s current post-apartheid health system.

Related blog posts:

the social enterprise: irony and alternative

Over the years SCOUT BANANA’s work has been termed “social entrepreneurship.” Unfortunately, the definition of the social enterprise has slowly become muddled and confused with other ideas. During a discussion last month a friend said that calling someone a social entrepreneur was like “cutting the balls off of a socialist.” He may not have been as far from the truth as I once thought. As the term becomes more prevalent within aid and development we must delve deeper into the history of social enterprise and decide what it really means for the work that we do.

Jeff Trexler wrote an excellent poston the history of social enterprise. He writes that a social enterprise is essentially “a venture with a social purpose.” As many wrongly believe the ideas of social enterprise did not come from capitalism or corporate business models at all.

“In socialist jurisprudence, social enterprise was a term designed to replace the capitalist notion of businesses dedicated to the pursuit of profit. The social enterprise generated revenue in excess of the costs of production, but profit-making was not the goal of socialist business–rather, its fundamental organizational purpose was to serve collective benefit. More over, in keeping with Marxist/Leninist ideology, the social enterprise was owned & controlled not by private shareholders–a hallmark of bourgeoise capitalism–but by workers themselves, from the workers immediately connected to the enterprise to society as a whole.”

Jeff continues to write that “social enterprise” migrated to Western minds and charities much the same way that “civil society” was reborn and co-opted. Meaning “citizen’s society,” the term was used to unite individuals against centralized government power. Now the term is best understood as a descriptor of anything “non-governmental.”

It seems that “social enterprise” has drifted just as far from its original conception. As a social venture that was meant to give power back to people and allow them ownership, much like a cooperative, “social enterprise” has best come to represent corporate philanthropy and cause marketing campaigns. Both of which are focused on turning profits and not helping people. Julia Moulden asks, “is making a difference only for the rich?” She easily gives examples that it is not, but is it? As far as the foreign aid/ international development arena it appears that social enterprise is geared towards engaging wealthy Western populations in feel good campaigns, like Product (RED), that are best defined as image marketing campaigns for corporations to try and look better as a way to bring in more customers. Lucy Bernholz has termed this business model “embedded giving” where “commerce is used to generate funds for a cause.” She writes:

“Embedded giving is just one more example of the blurring of sectors and roles between commerce, philanthropy, and public good. […] Maybe today’s teens and kids who have seen so much embedded giving will grow up to expect that every product and every service comes with a charitable affiliation.”

SCOUT BANANA’s work was first called “social entrepreneurship” in 2004 when I was selected as one of Netaid’s Global Action Awardee and was asked to contribute to a discussion on SocialEdge about young people and making a difference. Then, I was not too sure what the term meant or why it might be significant. More recently Spotlight Michigan has highlighted our work and called us a “social enterprise.” They select “innovative” companies and organizations in Michigan to feature on their website. Their criteria breaks down into three categories: creativity, risk-taking and adaptability. In the true spirit of a social enterprise we are an organization built for adaptation because we operate by members involvement and input. We have always been called creative for our fundraising tactics, use of yellow and bananas, and our ability to connect people. The risk-taking is another story. We never faced any risk in our venture to make a difference. If we failed the only people who would potentially suffer were those relying on our support to access basic health care. Alanna Shaikh wrote an excellent piece on how “global health is not about altruism.” While our actions may have been seen as risk-taking, we really work to create accountable, long-term relationships with communities developing their own sustainable solutions.

Personally I define social entrepreneurship within its original conception; a socialist structure (for social good) that is meant to give power and agency back to people as well as present an alternative to ineffective governments. Civil society still exists because honestly the government can’t do it all and often are not very good at meeting the needs of people. SCOUT BANANA sees the world’s problems as a simple equation of connecting communities; linking the necessary social capital (people and ideas) to social problems. We embrace the idea of “social enterprise” by focusing on presenting an alternative to government aid schemes and other big philanthropy and development programs that go for the quick-fix, band-aid solutions without being people-focused to produce long-term social change.

Is SCOUT BANANA a social enterprise? Yes and no, it depends how you define the term. If you are thinking of an organization cooperatively owned and operated by its members, focused on providing an alternative to what hasn’t worked, and supporting community-based solutions that do work – then, and only then are we definitely a “social enterprise.” In her Spotlight Michigan article I think Caitlin Blair put it best: “A society of entrepreneurs and innovators simply could not exist without social entrepreneurs because where business entrepreneurs typically work to enhance markets, social entrepreneurs completely transform the necessary infrastructure and attitudes of a society.”

See our features on Spotlight Michigan:
photo essay 

Written for the SCOUT BANANA blog.

where are we going, health = security

This is a very exciting month for S.C.O.U.T. B.A.N.A.N.A.! We have taken on 4 new projects dealing with basic health care and we are that much closer to achieving official non-profit status. We have partnered with Blood: Water Mission to help train community workers to build wells for a sustainable clean water in Uganda, Kenya, and Sierra Leone. We have also joined to support the Partners in Health Rwanda Programs which include: recruiting and training administrative and medical staff; rebuilding and equipping clinics; and securing reliable electricity, water, and communications systems. Two amazing organizations, check out their links on the side, all working towards one over arching goal, which is to provide basic health care services to the world’s people disproportionately affected by poverty, disease, and injustice.

And this brings me to question where are we going as a society? What is our real motive – materials, success, fame? Is the most basic human emotion of compassion not relevant anymore? Do people care for their fellow people that reside on the earth? Where has all the love gone? In my day to day work and my work with S.C.O.U.T. B.A.N.A.N.A. I have seen both worlds, I have seen the actions of people for good and for bad, and yet even in my position I still question and wonder. Where are we going? The media and pop culture are winning out over issues of poverty, over disease, over life, over death. How can this be? The world is the way it is because society, people in society have shaped the world as we know it and now more than ever the world is being shaped, but it needs to be molded to fit a different form than the one in which it is being fashioned. The corporations and institutions are increasingly misleading the people to act in the way of self-interest and for their greatest gain. What will happen when people are exploited to the fullest? What will be left? Where are we going?

This is where I tell you, stop, think, and act! This is where you learn that you can change the world! Every single person that reads this blog, that goes to work today, that attends class, that wakes out of bed today has the potential to make a difference in the world. You, who has just awoken, only need to decide now what kind of a difference you will make in the world. What will YOU do? Where will YOU go?

The crisis of basic health care in Africa is a major issue right now, larger than many know or realize. Sure Africa has its problems, but no one understand to what extent. The lack of basic healthcare and health for that matter is a great divider. It tears apart communities as their members suffer and die their economy falls and great economic hardship ensues. Some then turn to alternative methods of income, even sex work. The need to survive and be healthy pushes many people to do things that we here cannot understand. The lack of health, wellness, food to eat, water to drink spurs on war and regional conflict. In some of those conflicts HIV/AIDS is used as weapon of war where infected soldiers are sent to the frontlines to rape and spread their disease. Besides health and its effects producing war and hardship, there is an even more pressing problem of the lack of healthworkers. How can African countries expect to help their suffering populations when there are not enough workers, or healthy workers, to administer aid and treat the dying? How can a country function without a basic healthcare system in place? If health and access to health is so pressing then why is it not pressed for more fervently? S.C.O.U.T. B.A.N.A.N.A. is working to do just that, not necessarily by direct on the ground aid, but we do support the people and organizations working on the ground making the difference while we here work to educate a privileged world of the basic human right to health.