better health + growing population ≠ societal collapse #7billion

With each additional billion people on Earth, the collective news pundits, academics, development experts, and politicians freak out. Many pundits have been talking about the world’s population hitting 7 billion and how that relates to all the issues that we are seeing today. To many authors, talk show hosts, and even economic and development experts, population is the cause of everything. This is just fear-mongering and bandwagon journalism. The facts give a clearer picture.

If you’ve ever read Jared Diamond’s book, Collapse, the themes are all related to overpopulation and the Earth’s carrying capacity. We are constantly improving our health systems and keeping people alive longer than ever before in human history. As we grow in population there will be a breakdown in our social fabric and we will enter into international civil war over precious natural resources, like vegetation, water, etc. It happened on Easter Island, why can’t it happen on a global scale? In short, and to simplify: we are all screwed. I’m going to leave Malthus out of this conversation, but he is a good guy to read about if you are interested in population.

Environmentalism, Population Health, & Politics

Most of the pundits have talked about the impacts of overpopulation on the environment, but what about the impacts on health? This is an important area where the late Dr. Paul Epstein was world-renowned for his work connecting the growing environmental threats and their serious impacts on human population health.

By connecting climate change, exacerbated weather and environmental conditions, and the deep crises these create for the health of human populations, Dr. Epstein made the critical link between the health of our planet and the health of the people living on it.

Recent years have seen increased famines, droughts, and floods, loss of arable lands and increasing desertification, not to mention the inability of governments to respond to these crises. Some of Epstein’s work highlighted the increase of cholera after severe flooding and the increased range of malarial mosquitos as mountain tops warm up. Climate change and environmental issues are related to consumption, which is disproportionately carried out by wealthy countries consuming the majority of the world’s resources even with smaller percentages of total world population. Likewise, famines aren’t caused by too many people, but rather from bad government, violence, and global inequality.

The issues that many would like to attribute to the growing population are really fueled by politics. Population growth and climate change are above all else a political issues.

Fertility vs. Population Growth: (think incidence vs. prevalence in epidemiology)

Everyone needs to take a step back and look at the numbers. Population numbers are increasing with population growth increasing in a number of key countries, however we need to also look more closely at fertility rates rather than simply population growth numbers.

Many areas that have high birth rates also have high infant mortality rates, so it is not completely implausible that families would have a higher number of children to account for the poor health conditions their children might face and not survive. Likewise, areas with high fertility rates often see high infertility rates due to the increased risk to women of infection from multiple attempts to have children.This is where the debate about family planning and contraceptives enters the discussion.

Helen Epstein writes that if men and women have “frank conversations” that may be the best contraceptive. However, John Seager, President of Population Connection, offers a rebuttal that conversations cannot replace contraceptives. He notes that the need for access to knowledge and adequate health care is just as important. He writes,

“When women can control the timing and spacing of their childbearing, they can get an education and a job, and take better care of their own health and the health of their existing children. What could be more empowering than that?”

Population Control as Development

Following Word War II, population control became an important issue for the US to pursue around the globe. The  world food crisis in 1967 made Congress recognize the importance of population growth and it allocatd $35 million to USAID for population control activities. Today, USAID is single largest funder of population control activities in “developing” countries.

During the World Population Conference of 1974:

“Opposition came not only from traditional Roman Catholic quarters, but also from many Third World countries, which saw the focus on population growth as a way to avoid addressing deeper causes of underdevelopment, such as inequalities in international relations. […] India argued that ‘development is the best contraceptive,’ and criticized the high consumption of resources in the West.”

Many began calling for changes to the status quo, however no one asked why the needs of the poor weren’t being met in the first place. Glaring inequalities in distribution of income, land, and power were avoided. Politics came out on top as Western powers pushed “developing” countries, with the backing of international donors, to deliver family planning to the poor, “without fundamentally altering the social order in which they live.”

Developing countries and activists called for “integrated development” focused on addressing both poverty and population.

Solutions

Nothing is so cut-and-dry or simple when it comes to development, especially in regards to population health which pulls on issues ranging from: climate change, women’s rights, income equality, access to health care, infant mortality, family planning, and the list could go on. The population question touches on so many different issues that it only makes sense that health is at its core.

Seager makes good points about the need for women to be able to care for their own health and that of their existing children. Others have lauded similar ideas, specifically feminist groups who called for “voluntary motherhood” and the idea that unwanted children would become defective.

Recently, Bill Gates has touched on the issue of a growing population. He noted that a greater focus on infant/ child health could have a significant impact on slowing population rates and improving the health of populations around the world. As discussed in “fertility vs. population growth” – more surviving children will decrease population rates, in turn this would ideally improve the quality of health care available with smaller, healthier populations.

Gates pushes the idea that mobile technology can help to register new births and ensure that all children are vaccinated. However, the flip side of his optimism is the need to increase the capacity of health care systems to make this goal a global reality. Women play a critical role in this discussion and too often they are marginalized without the knowledge or resources to make changes. Women and health care systems need to be empowered to provide for newborns and children who will be the future of our world.

young people are the key drivers of social change

Harry S. Truman Scholarship Policy Proposal by: Alex B. Hill

Problem Statement
International development is a vast and complex issue. With over 18 million people dying each year from the lack of development assistance in health infrastructure something new needs to be done. Within the US there is a trend that foreign aid dollars are coming more from private NGOs and nonprofits as opposed to official government agencies. For so many years international development was tackled in simplified single-issue campaigns, which only created any effect in the short-term. This can be attributed to the fact that most Americans have a limited worldview. Most Americans have not traveled internationally, especially to developing countries. Therefore international development issues remain remote and abstract to most Americans. International development is a long-term issue. It is inherently complex and difficult to understand. There is no single enemy, and outcomes are rarely clear-cut or translatable through numbers. Faced with this challenge, some countries have opted to undertake broad-based efforts to build increased public understanding of development issues.4 There are a number of programs that promote volunteering and global engagement, such as the Peace Corps and Volunteers for Prosperity, through USA Freedom Corps. While these programs offer opportunities for highly educated and skilled Americans there exists a great void for those who are inspired and motivated, but may not have the degree or skills to qualify for these programs. The way to bring about increased political will on development issues in the US will lie in the creation of a long-term cultural and social movement, spurred by young people, to change the way in which many Americans think about international development. If this movement is to achieve change, it will be vital to increase the knowledge and understanding of development issues among the public.

Proposed Solution
Young people are the key drivers of social change. Considering this fact, there needs to be a policy focused on engaging young people in order to build a domestic constituency for international development that will create lasting connections. The policies on education and participation related to international development need to change. Young people have grown up with internet, global popular culture, and easier communications and travel, which has made the world smaller, more connected, and more accessible. Young people, specifically college students, have the opportunities to study abroad and are almost constantly encouraged to participate in global exchanges. Young people are left out of the equation when they exist as the greatest asset to making change in the development sector. If the problem is to be remedied then there needs to be a two-step plan. The first step needs to be increased support for a development curriculum in middle and high schools. This is where the US has fallen far behind Europe. European education efforts have focused their resources on offering learning initiatives for young people. Focusing on youth has been a key strategy of both European NGOs and government for many years. Countries that have embraced a long-term vision of youth-focused development education have the highest public awareness and support for development. According to the OECD the US spends less per capita on development education than any other OECD country. The second step needs to combine the learning activities of the school curriculum with action opportunities. The traditional classroom will not be enough to keep the engagement necessary to build an active constituency for change. Having action programs for youth will be a great method of measuring the success of the educational component. Pivotal to both steps will be increased support for a collaborative body dedicated to promoting development education. The US Development Education Alliance has been largely ineffective because it lacks support from both NGOs and the government agencies. This body needs to be coordinated at the national level and networked internationally so that efforts can be combined for maximum effect.

Major Obstacles/ Implementation Challenges
The major challenge facing this policy proposal is the US education system. In the US is largely determined locally, as opposed to Europe, where national governments set education policy standards. This will be the greatest difficulty in implementing a development-oriented curriculum. The next challenge will be government support. Having a coherent government platform to support development education will lend recognition and incredible support to the effort. Without a government backing, the policy will likely fail. Likewise, the US Development Education Alliance will need greater support from NGOs and government agencies, such as the USA Freedom Corps, Peace Corps, and USAID, in order to push for a change in policy.

Check out the Development Education Association, based out of the UK, it is a network of all development education organizations.

snapshot of health in ghana

We are now a week into our second course of out study abroad program, studying the disparities of the Ghanaian healthcare system. These disparitites range from Ghana to the US, urban to rural, and ever North to South. We have seen and learned about a number of different healthcare situations in Ghana. Since my interest is in access to basic healthcare I have been watching health clinics as we traveled around for the first 4 weeks and I have been trying to understand how the healthcare system worked, now all that I have observed is making more sense.

The Statistics
– one third of the 138 districts have no hospital
– high maternal mortality rate (hemorrage & infection)
– beyond the capital the road system is poor
– 40% of population is covered by the national insurance
– life expectancy is 57 (this has fallen with the emergence of HIV/AIDS)
– healthcare is geographically, financially, and culturally inaccessable

The key problem in Ghana is figuring out where the divide should be joined between traditional and western medicine. What is more interesting is the integration of traditional medicine into the very western Ghanaian health system. I noticed from my pre-healthcare course observations that there is a large number of missionary clinics, government hospitals, pharmacies, and other private health service centers in the Accra area. As we traveled from Cape Coast, Volta Region, and Kumasi I noticed that there was a lesser degree of healthcare services advertised or offered. Why was there such a change from the urban to rural was my first question. Even more so why was there such a disparity between the other regions and the Volta Region of Ewe people?

7 June 2007

Our first visit of the health systems in Ghana was to a health clinic and research center that was solely focused on using traditional medicines and herbs for cures of ailments. It was very interesting to observe the research being conducted and see that they were also running a full health clinic with their findings. The center claimed to have WHO (World Health Organization) funding, but I am not sure if that is true anymore. While there we met some students from the US who were interning at the center for the summer. This is a direct linkage between the traditional and western methods of medicine. This also brings up the issue of intellectual property rights – do the communities that the center learns from benefit from its revenue? Sure the health clinic, but otherwise? This is a reason that the center’s director gave for not partnering with large pharmaceutical companies – to not lose IP rights.


From there we went to the Mampong district outside of Accra to view the structure of the health systems and network of regional health services. We first visited the regional administration offices and talked with the head nurses. They gave us a very well run and organizaed outlook on healthcare in Ghana. At the offices there was also a counseling and testing clinic for HIV/AIDS and a peer educator class taking place. Here we learned that USAID (United States Agency for International Development) provided food rations for new mothers and mothers with malnourished children. I asked if this was true at all regional districts. The answer was yes, but I wonder if all the regions are as well established as Mampong. We then went to visit the regional hospital. It was a large, modern building, not very dissimilar from what you would find in America or Europe. But, there were obvious differences in the developed nature of the hospital. It was a nice hospital, but not one that I would want to stay in. We were given a tour of the entire premises and had a near-death experience in the elevator. Twenty plus people in an old hospital elevator in Ghana makes for exciting times. The elevator descended with the help of our weight and gravity – there was a loud bang as we hit the safety catch – there were still three floors to fall. The head nurse was not very keen on what to do next, but eventually we all climbed out from the gap left between the two floors to the wondering faces of what seemed like the entire hospital staff. Its the stairs from now on.
There seems to be a very good system of healthcare in the relatively developed areas of Ghana, but as for the villages I cannot say. It seems that we have visited mostly well put together centers and clinics. This made me think of the situation in Uganda, where it is the private and mission clinics that have all the supplies and the government run centers have absolutely nothing – very different.

At the Mampong regional administrative offices we learned that in many villages where there is no clinic or government hospital there is a nurse that lives in the community and is charged with the health of that community. However, I cannot speak to the degree of training or equipment that these community nurses have. This speaks to the obvious disparity between the urban and rural environments. There is not as much access to healthcare in the rural areas and so I wonder how much access there is in much of the rural North of Ghana? How many people do not have access?

11-13 June 2007
Some of the issues brought up in our classroom lectures about the health systems in Ghana relate to money. Not everything is covered and so some people cannot pay for access to services. There is bribery in medicine, we have not experienced this, but I do not doubt it. The basic insurance policy in Ghana costs about 72,000 cedis a year, this may not seem like a lot to ‘developed’ countries, but to a Ghanaian this could mean a great deal. In its health development, Ghana is still working on eradicating polio and guinea worm – even in metropolitian areas. Sanitation is a big problem. “The world is my toilet,” has become a joking phrase among the males in our group. If you are a male you can urinate just about anywhere, except where it says, “do not urinate here!” However, you still see people urinate by those signs. Sewage drains have stangant water and often do not drain anywhere. Trash is not collected and is often burned by the roadside. This reminded of Uganda where trash is just thrown out the window. In Kampala you cannot get away from the smell of burning trash, and there are not even drainage ditches.

Another issue brought up was that of ‘assembly line medicine.’ In Ghana there is such a high number of out patients (40% due to malaria) that the health workers often diagnos based on perception, not based on evidence. The issue of traditional and modern medicine is also a hotly contested topic. The health worker crisis in Africa seems to have been circumvented slightly in Ghana. Ghana has included traditional birth attendants in their health system and has just set up a new council for traditonal medical healers to have their say. The most fatal health issue in Ghana now is maternal motrality. Why? Good question, Ghana is ery developed in its understanding of health practices and so it makes no sense whatsoever that a mother should die due to complications of childbirth.

We next traveled to Ashesi University, a private, liberal arts university in Ghana (the most liberal in all of Africa, supposedly). Here we met a Fulbright fellow and a former fellow who is a profesor at Eastern Michigan University. Here we talked about the ‘brain drain’ and new ideas for Ghana’s health system. Currently a physician is in charge of managing the health center, but this means that often the physician has no idea how to manage and makes the staff unhappy and then does not practice medicine because he or she is too busy managing the center. The professor from EMU was working on publishing a study to help change this and introduce education for health managers. The incentives for staying in the country to work are minimal, but inticing. If you work in the Ministry of Health (MOH), then you can be sponsored to increase education and degree. The professor also talked of how Africa, “gets under your skin, you keep coming back.” It really made sense to me and I really don’t want to leave.

13 June 2007

Today we visited the Korle Bu hospital, the best government hospital in all of Ghana. We were not able to tour the main clinic becuase we arrived late, but we did get a quick tour of the Department of Child Health. It was a very nice center, as you can tell from the pictures. This was again an amazing compund that constituted a village in itself. It was obvious that this center must receive a large amount of the government funding for health. There were a number of different center, housing for doctors and nurses, a bank, pharmacy, and a teaching hospital for the University of Ghana. Hopefully we can return later and get a tour of the main clinic to see how things are run there.

The recommended health center for the MSU program students, if they are to fall ill on the trip is Nyaho Clinic. It is a private center tucked away in a random area of Accra. We have had a few students go there, but I have not seen for myself the interior. I have heard it is very nice and Ghanaians in the health profession know it as a nice and expensive clinic.

So far most of the health systems we have seen are very well established and well run and seem to be in great condition. We have not seen the failings of the Ghanaian health systems and the picture for now seems very rosy. I have seen the many mission, private, and government hospitals and clinics in the fairly ‘developed’ regions of Ghana. What I have not seen is the lack of healthcare like I saw so vividly in Uganda. The EMU professor at Ashesi University told us stories of his experiences with health in Ghana. He told stories of overrun rural clinics, a family’s inability to pay for lifesaving medication, the long distances traveled wo receive attention when it is too late, the sheer numbers of people who just do not have access to basic healthcare. This is where I feel we should be, this is where it would make sense to me, this is where we can make a difference. We will now be leaving for the village of Otibini near Danfa to do a community health assessment. I think here is where we will get to feel the village life and true health crisis.

Index of blog post series on Ghana.