By JULIA DAY, STEPS Centre member
With British summertime underway in the usual fashion (horizontal rain battering the windows) a 16-strong group of MA and DPhil students and visiting fellows from the Institute of Development Studies and SPRU Science and Technology Policy Research are gathered here in Brighton to take part in the STEPS Centre's second Innovation, Sustainability, Development: A New Manifesto project roundtable.
The group will be discussing where we want to go – what they believe are the most urgent sustainability and development objectives – and, crucially, how we are going to get there – the kinds of innovations that can help us meet the sustainability and development objectives that have been identified.
With some of the brightest young brains in science, technology and development together in one room, we are expecting some sparky debates and interesting ideas to emerge.
Video, audio and photographic material will be posted online, on the Manifesto web pages, as will a report from the event. So you will hopefully be able to get a nice, rounded view of what is being discusssed today. Read more
Wednesday, 27 May 2009
By JULIA DAY, STEPS Centre member
Tuesday, 26 May 2009
By BARUN KANJILAL, Institute of Health Management Research, Jaipur and member of the Future Health Systems consortia
The 2009 parliamentary election in India meant a roller-coaster journey for the country in April and May of this year. The results are now out and the Congress Party, with a few other regional parties, has resurged with more seats and confidence. Dr. Manmohan Singh, who is well known for his strong commitment to economic reforms and liberalisation policies, has returned as the Prime Minister.
The current scenario projects a very challenging set of tasks for the new government. On the one hand, there is an urgent need to address the unfinished agenda of market reforms and get the economy quickly back on fast-track growth; on the other, it is necessary to break the dualism between impressive growth and persistent poverty coupled with emergence of newer vulnerabilities and inequalities.
The Indian health sector epitomizes the challenge. There has been an unprecedented structural transformation in the health care market in the last two decades. In the curative care (treatment and therapies) market, the private sector, largely unregulated, has taken a dominant role in place of a miserable public sector. It has a mixed result; while people, especially the middle and richer section, have more choices, they are also more exposed to the risk of catastrophic financial shocks due to the staggering rise in health care costs. Highly subsidized public facilities provide some protective shield, but, as the Future Health Systems (FHS) research reflects, they still fail to protect a significant number (15%) of their client households (i). Clearly, poor people want better governance in service delivery so that public hospitals can play a more protective role; it is, however, not clear how the central government will meet this need since this is primarily a matter for each state in India to decide.
The progress in health outcomes in the last decade, especially in infant and child mortality, has been promising, as are the downward trends in public health problems, such as TB, HIV/AIDS, and leprosy. However, unacceptably big gaps remain in maternal health and child nutrition. The most prominent response of the last (central) government was the National Rural Health Mission - a comprehensive health programme for the rural population which integrates all public health programmes in a single package. The programme has triggered the public expenditure on health to some extent; yet it falls far short of the target (2% of GDP) and is significantly low by even Asian standards. Given that the new government has got the mandate of the people, it is expected that investment on health and education will get a substantial boost as a pay-back strategy.
The direction of public investment in health, however, will depend on how the central government aligns itself to the transforming health market. There are two clear options: (1) it may encourage the state authorities to be a more active market actor (i.e., less of a financier and more of a provider and regulator) especially in secondary / tertiary care, and (2) it may regain the lost position of the public sector by increasing subsidy and focusing exclusively on better governance in service delivery at public facilities. The federal structure of the country does not allow the central government to be the sole player in exercising any one of them. However, it will be interesting to see whether and to what extent they could activate the state governments towards adopting one of these directions.
(i)See “Catastrophic health care payment: how much protected are the users of public hospitals?” by FHS-India. Read more
Monday, 18 May 2009
By HARRIET LE BRIS, STEPS Centre member
The ESRC STEPS Centre is pleased to be able to offer one-month postdoctoral fellowships, based here in Sussex.
The ESRC STEPS Centre (Social, Technological and Environmental Pathways to Sustainability) is a global research and policy engagement hub based in Sussex, drawing together researchers at the Institute of Development studies (IDS) and SPRU (Science and Technology Policy Research) with partners in Asia, Africa and Latin America. The STEPS Centre’s overall goal is to help link technology and environmental sustainability with poverty reduction and social justice, in ways that work amidst the complexity, diversity and dynamism of today’s world. The Centre works across three themes (dynamics, governance, designs) and three domains (food and agriculture, health and disease, water and sanitation), and through a variety of field-based projects.
We are pleased to offer the opportunity for postdoctoral researchers to engage with the STEPS Centre during a one month period based in Sussex. To apply, from any part of the world, you should have completed your doctorate within the last three years. You should have an original, exciting research interest, idea or plan which engages with some aspect of the Centre’s work. As a postdoctoral fellow, you will work closely with a mentor from the Centre to develop your interests and produce a paper to be published in the STEPS Working Paper series. STEPS will cover any necessary international travel costs, and you will receive a stipend of £1500 to cover local accommodation and subsistence in Sussex.
To apply, please send a one-page note outlining the topic you would focus on, a one-page CV and a letter of reference (e.g. from a PhD supervisor). Please also include an indication of the preferred dates of your fellowship between October 1st 2009 and 31st March 2010. Applications should reach the STEPS Centre Co-ordinator, Harriet Le Bris (email@example.com) by the closing date of 30 June 2009. Read more
By IAN SCOONES, STEPS Centre Co-director
A decade ago there was much hope – and even more hype – about the potentials of GM crops. GM crops were going to feed the world, solving issues of poverty and development, seemingly at a stroke. Technologies for dealing with drought or nutrient deficits were, it was claimed, in the pipeline. Even the pest-resistant Bt technologies that were already available offered the opportunity of reducing pesticide use and improving farmers’ incomes. GM crops were going to be of particular help, it was argued, to poorer farmers in the developing world, ushering in a new ‘gene revolution’ to succeed the ‘green revolution’ of previous decades.
A decade ago, of course, there were also those who predicted disaster and calamity – and still do. GM crops were going to result in all sorts of environmental and health catastrophes, and provide the basis for global domination of agriculture by a few large corporations. Just as the pro-GM lobby could be accused of excessive and unfounded hype, anti-GM campaigners often generated doomsday scenarios based on limited evidence.
Ian's full article is posted on the STEPS Centre website
By JULIA DAY, STEPS Centre member
On June 10 the STEPS Centre is launching a Biotechnology Research Archive and a new paper on Bt Cotton by Dominic Glover at a free event in London.
The STEPS Centre Biotechnology Research Archive will span over a decade of substantive, evidence-based research. A series of core projects, supported by DFID, the ESRC and the Rockefeller Foundation among others, provide the foundation of the archive. But there will be much else besides, with some early work stretching back to the early 1990s, and recent work focusing on contemporary experiences with GM crops across the world. The archive will go live on June 10 on the STEPS Centre website
On the same day, a new Working Paper by Dominic Glover, post-doctoral fellow at Wageningen University, on the Bt Cotton experience in India will be launched at an event in Parliament entitled GM Crops and the Global Food Crisis, part of the IDS Dangerous Ideas in Development series.
Speaking alongside Glover will be Erik Millstone, SPRU Science and Technology Policy Research, University of Sussex and STEPS Centre food and agriculture co-convenor and Peter Newell, University of East Anglia.
Entrance to the event is free - starting at 6pm in Committee Room 17, Palace of Westminster - and you can book a place by emailing Charlie Matthews at IDS on firstname.lastname@example.org
Monday, 11 May 2009
By IAN SCOONES, STEPS Co-Director
Read a short version of this piece, published in The Guardian.
The back-story of the swine flu outbreak is gradually seeping out. There are some vitally important lessons that can be learned. Here I outline five:
1. Risks, uncertainties and mortalities
A favourite media narrative in the face of a potential pandemic is the estimation of potential human mortalities. Huge numbers are bandied around, based on highly suspect data and assumptions. While the scientists concerned cover their articles with footnoted qualifications, these are stripped out for the media sound-bite. The result is often wild speculation and potential panic. The counter move is to keep quiet, cover up and assure the populace. Neither approach helps, as actually we don’t know what will happen, when and to whom. This acceptance of uncertainty and ignorance in a public debate is tough. But is also vital. Otherwise inappropriate public policy arises and misguided signals are given.
Preparing for a pandemic means preparing for surprises – and being ready to respond rapidly and flexibly under conditions of uncertainty requires a new set of skills, bureaucratic routines and incentive systems in the large public agencies charged with protecting the world from emerging infectious diseases.
Beyond a broader recognition of uncertainty and ignorance – features not easily captured in simple epidemiological modelling exercises or simple response plans – there is the need to improve overall system reliability. As Emery Roe and Paul Schulman argue in their recent book ‘High Reliability Management’, reliability must be a feature of any system operating in a complex, uncertain world. This requires, they argue, high reliability professionals who can track between local understandings of particular situations and unfolding scenarios and the macro situation.
These professionals are currently absent from the international effort – creating a missing middle, a vacuum at the heart of the response. In response to swine flu, these would be the people who would make sense of what was happening on the ground where the first outbreaks were spotted (the broader policy, liaising between agencies and across scales. This vital role is absent because authoritative knowledge, often codified in simple models and plans which do not accept uncertainty, ignorance or complexity, is created only at the top through particular types of accepted expertise. The problem, as the swine flu outbreaks are showing vividly, is that this is not enough.
2. Health inequalities and preparing for a pandemic
In a potentially global pandemic situation, it is all well and good offering a global assessment based on global statistics, but in reality major structural inequalities will affect the likely outcomes of rapid disease spread. We don’t know why so many more people have died in Mexico from swine flu than anywhere else. This may have a complex medical, virological cause. But it also may be to do with access to health care and effectiveness of response.
In the UK there is much brash talk of how we are ‘the best prepared’ country in the world. But being prepared means having resources – stockpiles of drugs, an effective surveillance system and a functioning national health system, for example. But in many places such conditions do not exist – and other diseases affect people’s health status and ability to resist new viruses. Poverty and inequality play a big part in the dynamics of diseases, and the highly differentiated social dimensions of disease control efforts should not be forgotten in the rush to construct a global public response to a potential pandemic.
Over the last few years, in response to avian influenza, there has been much emphasis on pandemic preparedness planning. According to the UN and the World Bank, there have been around 120 national plans produced, alongside numerous organisation-specific efforts in the UN, government departments and private businesses. Simulations have been developed, stockpiles of drugs secured and often highly detailed plans for response elaborated. It is on this basis that Alan Johnson, UK Health Minister, proudly asserts that Britain is ready.
But again this picture is not universal. Even among those countries which have spent time and money on preparing a national plan, there are huge variations. Some have been cut and pasted from standard templates and never done any rehearsals; others are so absurdly unrealistic that they could never be implemented. And beyond national plans, there are many, many organisations around the world – both public and private – that do not have a pandemic preparedness plan and would be caught unawares if something happened fast.
3. Local knowledge and disease surveillance
The swine flu story is showing how poor surveillance and reporting systems can mean an outbreak can soon get out of control and spread across the world. While diplomatic niceties prevent much criticism of the Mexican authorities, it is clear that there were big gaps in detection and reporting over the last months – dating back to February.
But it is also apparent that local people knew of the disease, and have some strong hypotheses about its origins. Anselma Amador from La Gloria, the village where the first known case of swine flu occurred commented to the Guardian newspaper: "We are not doctors, but it is hard for us not to think the pig farms around here don't have something to do with it….The flu has pig material in it and we are humans, not pigs." A large, industrial pig farm, owned by multinational company Smithfield Foods, is blamed. According to the Guardian, residents in La Gloria say the prevailing wind invariably blows the fetid air their way, where it gets stuck because of the hills that rise just behind the village.
These explanations are dismissed out of hand by the health minister and the company, but why are such leads not being tested and followed up? And why, perhaps more importantly, are such early-warning approaches, based on local knowledge about disease incidence and its dynamics, not part of the standard surveillance system. Why is such knowledge of the ‘not doctors’ so easily dismissed?
The lessons from the avian influenza outbreaks in south-east Asia and beyond point to the vital importance of local understandings of disease and its spread, as well as the significance of engaging with the ‘cultural logics’ of local people in its control. Medical doctors, epidemiologists, virologists, veterinarians and other specialists need to work hand-in-hand with local people in order for surveillance to be effective.
4. Naming, labelling and the politics of international organisations.
A fascinating debate has emerged about the naming of ‘swine flu’. This reveals much about the politics of a disease. An Israeli health minister has objected, so have a number of muslim groups on religious grounds. The World Animal Health Organisation, the OIE, has also argued that the flu should be relabelled ‘North American Influenza’, as the virus had not been isolated in animals, “no current information on influenza like animal disease…could support a link between human cases and possible animal cases including swine”.
While religious sensibilities might be understandable, the position of the OIE needs a bit more probing. Why has the veterinary establishment only belatedly engaged with the swine flu outbreaks, and why? Only on the 27th of April did the Chief Veterinarian of the FAO, Joseph Domenech, issue a statement, with experts dispatched to explore the links between the outbreaks of influenza in humans and animals. Domenech still insisted that “there is no evidence of a threat to the food chain; at this stage it is a human crisis and not an animal crisis.” The vets, it seems, have tried to distance themselves from the swine flu outbreaks: “this is a public health issue, animals have not (yet) been implicated” goes the storyline.
But what does this tell us about a coordinated international response? The integration of animal and human health efforts as part of the international avian influenza response has been much celebrated – and highlighted by the snazzy slogan ‘One World, One Health’ proclaimed by Bernard Vallat, the director general of the OIE, in a comment piece on the front page of their website as the way forward. But underlying the rhetoric, organisational competition and politics has handicapped many efforts, particularly at national level. As studies of the avian influenza response from across southeast Asia show, human and animal health efforts were often (although with some notable exceptions) poorly coordinated, lacking coherence and effectiveness.
The OIE is a membership organisation made up of Chief Veterinary Officers from around the world. As the WTO-recognised body dealing with trade in animals and their products, it has enormous influence on – and is enormously influenced by – the international livestock and meat trade. Pressures not to declare an animal disease outbreak can be immense, and slow reporting and a commitment to facilitating certain types of trade, for certain countries and certain business interests may sometimes be part of the political economy of decision-making. Who knows whether the reluctance of the veterinary authorities – in Mexico and internationally – to engage with the swine flu outbreak fulsomely is an indication of this.
5. The political economy of agriculture – and the impacts on global health.
A strong lesson from the avian influenza experience is that attention to the changing structure of the livestock industry is essential to understanding how diseases emerge and spread. While it is easy to blame big agribusiness and industrial farming techniques, it is often more complex than this. The rapid growth of industrial poultry production – particularly medium-sized units with poor bio-security – which is linked to informal trade patterns and unregulated marketing and located near fast-growing urban centres creates new health hazards, including the risk of outbreaks.
While the so-called ‘livestock revolution’ is much celebrated as a source of economic growth in the developing world, the rapid restructuring of the livestock sector has brought many downsides. Local back-yard production of poultry or pigs can be replaced by poorly regulated industrial units aimed at maximising returns but with little attention to safety, animal welfare, disease control or environmental pollution. Investors in such enterprises are often well connected in national political circles and are sometimes backed by internationally powerful individuals and companies who can pull the strings when needed.
This changing political economy of agriculture has major implications for how industries are regulated and diseases are managed. Poor reporting and lack of transparency often surrounds such businesses – public veterinarians may never get past the well-guarded fences, and whistle-blowing by employees (of companies or public services) is rigorously clamped down on. Independence, transparency and effective and timely information flows is essential for international efforts to control emerging diseases. Given the changing political economy of agriculture, this may be a call too far. As the details begin to emerge on the swine flu outbreaks, a more comprehensive assessment of the political economy of agriculture – and the pig industry in particular – in Mexico will be essential in learning lessons for the future. Read more
Wednesday, 6 May 2009
By JULIA DAY, STEPS Centre member
We are hoping to link up this lunchtime with the Innovation Asia-Pacific Symposium being held in Kathmandu, Nepal, for the first in a series of roundtables events for the STEPS Centre Innovation, Sustainability, Development: A New Manifesto project.
A group of delegates at the symposium in Kathamndu are gathering to discuss a series of questions around rethinking science, technology and development policies.
The New Manifesto project - 40 years after the original Sussex Manifesto was published - seeks to recommend new ways of linking science and innovation to development in order to address dynamic, uncertain global contexts and challenges of environmental sustainability, poverty reduction and social justice.
This event -organised in Nepal by David Grimshaw of Practical Action - is part of the process of bringing together cutting-edge ideas and diverse perspectives from around the world.
And, after a couple of minutes of anticipation, we are live and direct to Kathmandu's Everest Hotel, via the magic of video conferencing.
Adrian Ely, the convenor of the New Manifesto project and Professor Geoff Oldham, one of the authors of the original Sussex Manifesto, have just given opening addresses from here at SPRU on the Sussex University campus, followed by delegates in Nepal arranging themselves into small groups to discuss the roundtable questions (which I will endevour to make available on our website, so you can have a peak at what people are discussing).
Unfortunately I am unable to link you through to the Nepal event from this blog, but David's team is collecting video and audio material in Kathmandu, which we will also put on the website as soon as we can. And Practical Action's webpage for this event is here.
Tuesday, 5 May 2009
By HILARY STANDING, Fellow on Health in the IDS KNOTS Team and Director of Realising Rights
Living in Dhaka is a daily lesson in the extremes of human urban existence. This is a city of around 12 million packed into a surprisingly small area. It has huge slum populations and dense housing even in the “smart” areas. There is an uncountable population of domestic livestock of every description. One figure that grabbed my attention is that maximum desirable population density in urban areas is apparently 40,000 per sq kilometre. In old Dhaka it is 150,000.
The city is a serious environmental danger zone. The four rivers which surround and run through the city are so polluted that they are officially dead due to industrial and other toxic wastes. There is a picture in one of the daily papers of a stretch of dark blue river which probably reflects its proximity to a local dyeing factory. There is no functioning sewage system to speak of and the storm water drains are completely choked with garbage. The city’s water supply comes entirely from increasingly polluted groundwater and the top level aquifers are all exhausted. This year it hardly rained at all, a most unusual situation.
In April we experienced a severe heat wave for several weeks which only came to a halt a few days ago. One of the worst immediate results was that large areas of the city had either little or no water, or have been getting heavily polluted water which is too badly contaminated to be made fit for domestic consumption. As a consequence, there has been an epidemic of diarrhoea with significant numbers of deaths.
I am particularly aware of this on a daily basis as ICDDRB, where I am partly based and which is one of our partners, runs the only free hospital in Dhaka which treats acute diarrhoea cases. Since March, it has had double the daily number of admissions and I look out of my office onto what was the car park and which is now taken up with two large tents treating the overspill from the main hospital. And as the mortuary is in our building, it is distressing to see the ones who got there too late being wheeled over to the mortuary.
It is also the seasonal flu season here, with large numbers of people sick with a particularly nasty bug. So when swine flu started to make headlines in Bangladesh, it mainly provoked the wry comment of “how would we know if it hits Dhaka?” Avian flu is already widespread in every district of Bangladesh as poulty farming is such a major source of livelihood. It caused a few headlines at first, now it’s just something you live with. Meanwhile, today, I read in the paper that several children have died this week in a nearby village from pesticide poisoning due to exposure to the mountains of pesticides poured onto vegetable crops grown on local farmland for the urban market.
I have been reflecting on this a great deal lately as it challenges one’s sense of what constitutes “health” and appropriate research about it. This is a place where ill health is the norm. What are priorities when everything is a priority? Where can most difference be made when the numbers affected by infectious diseases, chronic diseases, toxic chemicals and vehicle emissions, climate emergencies, contaminated food and water supplies are all so staggeringly large?
There is a small attempt going on in the School of Public Health here to train government doctors in public health. But current public health curricula seem to reflect the narrowing of the concept of public health since the health economists have taken over the show. What happened to what we used to call “environmental health” or am I imagining a golden age of public health that in reality never existed, where safe and nutritious diet and public parks for exercise and fresh air were integral to our understanding of a healthy environment? Can we reinvent public health and how?
I sat in a WHO meeting a couple of weeks ago and was struck by the mismatch between what people from the countries were trying to talk about, what I see around me in Dhaka and the Geneva based expert talking about “patient centred care in the community with a dedicated family physician.” If this is a typical response to the challenges of global health, it seems neither realistic nor relevant. I see a bit more hope in the rising tide of demonstrations and awareness raising activities being organised by local environmentalists here. But they are puny compared to the interests stacked against them. Please, can anyone help me out on this one? Read more