1.29.2007
Cheap Drugs
The pharmaceutical company Novartis is testing India's new patent protection laws. India has a new law on patent protections in order to comply with World Trade Organizations regulations and Novartis is challenging the right of Indian companies to manufacture Gleevac, a drug for a rare form of leukemia.
Why should we care about legal maneuvering in India? Because Indian pharmaceutical companies are the primary source of generic drugs for countries in the developing world, from penicillin to antiretroviral drugs. Public health programs rely on these companies to produce affordable medicines for patients who can't afford them. Public pressure has prevented the WTO from cracking down on poor countries importing some of these drugs, but now working with India's national government it has imposed regulations that put millions of lives at risk.
Novartis is trotting out the same tired arguments that a) they need patent protections to ensure their ability to fund R&D and b) that it's not a matter of patient rights, but about "clarifying intellectual property rights ". a) is a half truth--companies benefit hugely from public funding and cheap drugs for the poor are clearly a public good, and these huge companies spend much more on marketing than they ever spend on R&D. b) is a semantic argument at best and a lie at worst. The companies want to protect their profits at the expense of sick people. If Novartis continues with the case, Indian judges will make a decision that could severely hamper public health in Africa. If you think they should drop it, you can sign an online petition here.
1.23.2007
Different worlds
The school of public health has six departments, each populated by people that look different from the others. In Epidemiology, they are casual and math-y; t-shirts, jeans and sneakers, all set off by an insulated lunch box. The Biostatisticians look like that, except more withdrawn and terrified. The Behavioral Sciences and Health Education crowd is mostly sorority girls, and a few guys that are secure enough in their masculinity to be the sensitive type. In Global Health, my department, we occasionally work our field clothes into daily wear--Chaco sandals, fleece zip-ups, knee-length skirts--but we also like to accessorize with trinkets and scarves from around the world. The Environmental Health types dress like they are ready to go clean out streambeds at any time. They carry enormous backpacks because they bring their lunches in tupperware, carry their nalgenes, and lug around their laptops so they never have to print anything out.
But the Health Policy and Management Department is my favorite, for looks. They all talk like they are from South Carolina and they dress either like JC Penney ads or like business school students. I've taken two classes in that department, and both times I thought I would develop allergies to blonde highlights and pearls. In my class with them today, we went around and said what we did over break. Several people had gone to college bowl games, others had gone to the beach in Mexico or the Carribean, one girl bragged about getting her mom drunk for the first time. For me, it was experiencing a new culture. When they are finished, most will enter the for-profit sector, where they will make comfortable livings in the "healthcare industry", enough to indulge their hobbies and college sports rivalries. I don't know where I'll be, but hopefully far from there.
But the Health Policy and Management Department is my favorite, for looks. They all talk like they are from South Carolina and they dress either like JC Penney ads or like business school students. I've taken two classes in that department, and both times I thought I would develop allergies to blonde highlights and pearls. In my class with them today, we went around and said what we did over break. Several people had gone to college bowl games, others had gone to the beach in Mexico or the Carribean, one girl bragged about getting her mom drunk for the first time. For me, it was experiencing a new culture. When they are finished, most will enter the for-profit sector, where they will make comfortable livings in the "healthcare industry", enough to indulge their hobbies and college sports rivalries. I don't know where I'll be, but hopefully far from there.
1.19.2007
Economics and AIDS
On the front page of the University of Chicago's website (my alma mater), there is a link to a New York Times about Emily Oster, a fellow at the University working on HIV in Africa. Intrigued about such a prominent Emily working on HIV at Chicago, I read further. Apparently, Ms. Oster is an economist, and according to the news article, her work has established that poor people in Africa;
...had less of an incentive to practice safe sex...because many of them could not expect to reach old age, whether or not they contracted H.I.V. Any attack on AIDS should therefore include an attack on poverty.
Oh really? Phillip Setel, in his ethnography of changing sexual relationships in Northern Tanzania talked to women who were not using condoms. They told him that they understood the risk of AIDS, that they thought it very possible that their husbands had extramarital relationships, and they knew that using condoms would protect them, but that they had no way to communicate about safe sex with their husbands. He found that teenagers in the region had received many messages about safe sex, but had a highly specific set of relationships and didn't see the messages as applying to all of these relationships. In some countries, a history of biomedical abuses by the government has caused HIV messages to be viewed as politically motivated and therefore ignored. And anyone who has been to a place where AIDS has hit hardest knows that people understand the unique nature of the threat, and would not choose to die a painful and prolonged death.
Granted, the article provides a basic summary of her work, but it's exactly the type of thing that drives me crazy about economists, and particularly those that economics is the best way to explain absolutely everything. Economics can't usefully describe power structures or traditions or history or human terror. Reducing complicated human actions down to the equation of a cost-benefit analysis is not illuminating and is usually offensive. Ms. Oster's work both assumes and implies that people view their low life-expectancies in value-neutral terms, but that's not true. If you ask them, the poor say that their misery is excessive, the result of structural injustice. From defining their behavior as a simple logical responses to a given situation, Ms. Oster resolves to fight poverty as a technical response. A better analysis asks why these people live in poverty, and asks them what their constraints on behavior are to inform a community-based response. Poor people are people, not thought-experiment decision machines.
...had less of an incentive to practice safe sex...because many of them could not expect to reach old age, whether or not they contracted H.I.V. Any attack on AIDS should therefore include an attack on poverty.
Oh really? Phillip Setel, in his ethnography of changing sexual relationships in Northern Tanzania talked to women who were not using condoms. They told him that they understood the risk of AIDS, that they thought it very possible that their husbands had extramarital relationships, and they knew that using condoms would protect them, but that they had no way to communicate about safe sex with their husbands. He found that teenagers in the region had received many messages about safe sex, but had a highly specific set of relationships and didn't see the messages as applying to all of these relationships. In some countries, a history of biomedical abuses by the government has caused HIV messages to be viewed as politically motivated and therefore ignored. And anyone who has been to a place where AIDS has hit hardest knows that people understand the unique nature of the threat, and would not choose to die a painful and prolonged death.
Granted, the article provides a basic summary of her work, but it's exactly the type of thing that drives me crazy about economists, and particularly those that economics is the best way to explain absolutely everything. Economics can't usefully describe power structures or traditions or history or human terror. Reducing complicated human actions down to the equation of a cost-benefit analysis is not illuminating and is usually offensive. Ms. Oster's work both assumes and implies that people view their low life-expectancies in value-neutral terms, but that's not true. If you ask them, the poor say that their misery is excessive, the result of structural injustice. From defining their behavior as a simple logical responses to a given situation, Ms. Oster resolves to fight poverty as a technical response. A better analysis asks why these people live in poverty, and asks them what their constraints on behavior are to inform a community-based response. Poor people are people, not thought-experiment decision machines.
1.13.2007
Where have I been?
One of the reasons (though not the primary one) for my long absence from the blog, has been job applications. Right, trying to be gainfully employed for once, as of May 2007. Anyway, I wanted to share this personal statement. It has been constructively torn apart by some good friends, and the statement I submit will be very different. But it was a useful exercise for me, and I think it summarizes how I got where I am pretty nicely.
--
I have had many teachers on the subjects of poverty and injustice. Growing up white and wealthy in the suburbs, I had never thought much about it except in the abstract. I spent the July before my senior year of high school at a French language academy in a small town in Virginia. During one class on Francophone Africa, the teacher explained in broad outlines the complex and intertwined challenges that Africa faces. Somehow, in the 17 years of my life to that point, I had never even heard about the cycles of poverty, hunger and illness that characterize the lives of a majority of people on the continent. I was riveted.
As a college student at the University of Chicago, I took every class on international development that I could find. I was exposed to the indifferent logic of Chicago-style development economics, but I was also introduced to powerful critiques of this approach from the fields of ethics, human rights and anthropology. When I co-founded the school’s chapter of the Student Global AIDS Campaign, I learned from other students already engaged in global AIDS advocacy. They taught me how to advocate against the outrageous and immoral public health policies that were denying treatment to millions of people dying from HIV-related illnesses in the developing world. In books by Paul Farmer, I learned that challenging the status quo and putting the needs of the poorest and sickest people at the center of policy is a strategy that can create change, even for people living in the harshest conditions.
During two summers in college, and for a year after I graduated, I went to Africa, where I found even more teachers. My neighbors in Tanzania showed me what it means to wake up in the morning without sugar for your tea, much less medicine for your fever and money for your child’s school fees. The leader of the organization I worked for let me take up some of her duties and so I learned what it feels like to have a steady stream of people knocking at your door, each person with a story more heartbreaking than the one before, and each one of them asking you for help. I felt outrage as people I knew died of HIV, the promised drugs not yet delivered to the public hospital, but the Tanzanians around me were resigned. I learned that injustice can come to seem acceptable when it becomes the grinding routine.
These days I spend my time at the school of public health. I am learning in the classroom about HIV programs and public health approaches that are successful, and about programs that fail. I am learning how to count and measure and speak the language of donors. My classes on human rights and anthropology have offered a moral framework for evaluating these, and I have been engaging in advocacy about public health together with other students. But I learn the most two mornings a week, when I board a city bus to a homeless outreach center in downtown Atlanta. There, our guests teach me about what brutal injustices can be found mere miles from the comfortable house I rent. One client’s face was scarred from an aggressive bacterial infection that attacked him after he progressed to AIDS. While he was hospitalized, he was evicted from his apartment, and all his belongings thrown away. Today he lives a basic existence in a program for people living with HIV and dealing with mental illness as well, another victim of the intertwined injustices of illness and poverty in the richest country in the world.
What all these teachers taught me about injustice, is that it is worth fighting. Working side by side with Tanzanians who ignored their own poverty to serve other people, and providing services to people who are not being served by an unjust world order, is worthy and necessary. But what I have also learned about injustice is that it will never be enough merely to manage its effects. It must also be challenged at its source, by people with influence in solidarity with people who have none. That is, the policy that affects the lives of people living with HIV should be formed to fulfill the rights of those people, and advocates are the ones who must call for the fulfillment of rights. I want to be engaged in this struggle. I want to be a part of advocating for change and engaging in service both. I believe that what I have learned and experienced so far will allow me to contribute in a substantial way to creating change. And at the same time, I know that I also have a great deal more to learn.
--
I have had many teachers on the subjects of poverty and injustice. Growing up white and wealthy in the suburbs, I had never thought much about it except in the abstract. I spent the July before my senior year of high school at a French language academy in a small town in Virginia. During one class on Francophone Africa, the teacher explained in broad outlines the complex and intertwined challenges that Africa faces. Somehow, in the 17 years of my life to that point, I had never even heard about the cycles of poverty, hunger and illness that characterize the lives of a majority of people on the continent. I was riveted.
As a college student at the University of Chicago, I took every class on international development that I could find. I was exposed to the indifferent logic of Chicago-style development economics, but I was also introduced to powerful critiques of this approach from the fields of ethics, human rights and anthropology. When I co-founded the school’s chapter of the Student Global AIDS Campaign, I learned from other students already engaged in global AIDS advocacy. They taught me how to advocate against the outrageous and immoral public health policies that were denying treatment to millions of people dying from HIV-related illnesses in the developing world. In books by Paul Farmer, I learned that challenging the status quo and putting the needs of the poorest and sickest people at the center of policy is a strategy that can create change, even for people living in the harshest conditions.
During two summers in college, and for a year after I graduated, I went to Africa, where I found even more teachers. My neighbors in Tanzania showed me what it means to wake up in the morning without sugar for your tea, much less medicine for your fever and money for your child’s school fees. The leader of the organization I worked for let me take up some of her duties and so I learned what it feels like to have a steady stream of people knocking at your door, each person with a story more heartbreaking than the one before, and each one of them asking you for help. I felt outrage as people I knew died of HIV, the promised drugs not yet delivered to the public hospital, but the Tanzanians around me were resigned. I learned that injustice can come to seem acceptable when it becomes the grinding routine.
These days I spend my time at the school of public health. I am learning in the classroom about HIV programs and public health approaches that are successful, and about programs that fail. I am learning how to count and measure and speak the language of donors. My classes on human rights and anthropology have offered a moral framework for evaluating these, and I have been engaging in advocacy about public health together with other students. But I learn the most two mornings a week, when I board a city bus to a homeless outreach center in downtown Atlanta. There, our guests teach me about what brutal injustices can be found mere miles from the comfortable house I rent. One client’s face was scarred from an aggressive bacterial infection that attacked him after he progressed to AIDS. While he was hospitalized, he was evicted from his apartment, and all his belongings thrown away. Today he lives a basic existence in a program for people living with HIV and dealing with mental illness as well, another victim of the intertwined injustices of illness and poverty in the richest country in the world.
What all these teachers taught me about injustice, is that it is worth fighting. Working side by side with Tanzanians who ignored their own poverty to serve other people, and providing services to people who are not being served by an unjust world order, is worthy and necessary. But what I have also learned about injustice is that it will never be enough merely to manage its effects. It must also be challenged at its source, by people with influence in solidarity with people who have none. That is, the policy that affects the lives of people living with HIV should be formed to fulfill the rights of those people, and advocates are the ones who must call for the fulfillment of rights. I want to be engaged in this struggle. I want to be a part of advocating for change and engaging in service both. I believe that what I have learned and experienced so far will allow me to contribute in a substantial way to creating change. And at the same time, I know that I also have a great deal more to learn.
1.09.2007
Somalia
Somalia has a window for peace, after 35+ years of civil war and rule by warlords. In recent years, a loose coalition of these warlords have received funding from the US as part of the War Against Terror, as this diverse group of brutal clan leaders portrayed itself as the enemy of Al Qaeda in Somalia. Of course, the daily terrors inflicted by these warlords on the Somali civilians who happened to cross their paths, were also being funded. And, not surprisingly, they didn't keep their promise to capture al Qaeda operatives, and bin Laden's associates have remained at large within Somalia's borders.
Somalia has an internationally recognized government which for most of the last year has ruled only its small capitol near the Kenyan border. It was a different group, the Islamic Courts, which swept the warlords out of the coastal city of Mogadishu and replaced daily chaos with peace. The allegiance of the Courts, and their stance on al Qaeda was unclear. But what was clear is that people in Mogadishu were glad to finally have peace in their streets.
The Islamic Courts are gone now. They were challenged by the recognized government, heavily supported by Ethiopian troops, and fled, the promised all-out war failing to erupt. Ethiopia has a large and advanced army, but its presence in Somalia is untenable, both for funding reasons and because Ethiopia is perceived as a Christian nation, and draws animosity in largely Muslim Somalia.
So what next? Donors and regional leaders are meeting to put together an African Union (AU) peacekeeping force, which would allow the Ethiopian troops to withdraw. Will the US under-fund this force, as it has the AU force in Darfur? Or will the US be a leader in stabilizing a country that is a former haven for terrorists and full of people desperate for stability and support from the outside world? The window is open, but it is small. Will peace come in?
Somalia has an internationally recognized government which for most of the last year has ruled only its small capitol near the Kenyan border. It was a different group, the Islamic Courts, which swept the warlords out of the coastal city of Mogadishu and replaced daily chaos with peace. The allegiance of the Courts, and their stance on al Qaeda was unclear. But what was clear is that people in Mogadishu were glad to finally have peace in their streets.
The Islamic Courts are gone now. They were challenged by the recognized government, heavily supported by Ethiopian troops, and fled, the promised all-out war failing to erupt. Ethiopia has a large and advanced army, but its presence in Somalia is untenable, both for funding reasons and because Ethiopia is perceived as a Christian nation, and draws animosity in largely Muslim Somalia.
So what next? Donors and regional leaders are meeting to put together an African Union (AU) peacekeeping force, which would allow the Ethiopian troops to withdraw. Will the US under-fund this force, as it has the AU force in Darfur? Or will the US be a leader in stabilizing a country that is a former haven for terrorists and full of people desperate for stability and support from the outside world? The window is open, but it is small. Will peace come in?
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