NYTimes OpEd: How Brazil Fights Poverty

January 4, 2011

In follow-up to a (somewhat) recent post on income inequality in the United States:

There was a New York Times “Fixes” Op-Ed yesterday on how Brazil has drastically decreased income inequality over the past 7 years. Author Tina Rosenberg writes:

“Many countries display great wealth side by side with great poverty. But until recently, Brazil was the most unequal country in the world. Today, however, Brazil’s level of economic inequality is dropping at a faster rate than that of almost any other country. Between 2003 and 2009, the income of poor Brazilians has grown seven times as much as the income of rich Brazilians. Poverty has fallen during that time from 22 percent of the population to 7 percent.”

How did Brazil achieve such a feat? By giving money to the poor. Or, in more technical terms: conditional cash transfers.

“The idea is to give regular payments to poor families, in the form of cash or electronic transfers into their bank accounts, if they meet certain requirements.  The requirements vary, but many countries employ those used by Mexico: families must keep their children in school and go for regular medical checkups, and mom must attend workshops on subjects like nutrition or disease prevention.”

Brazil has been a progressive force in other ways. At the School of Public Health, we often hear of Brazil’s pioneer decision to offer free HIV drugs to all their citizens: a “controversial” policy that saved lives by ignoring intellectual property rights. Hundreds of thousands of lives were likely saved. The United States put Brazil on the “Special 301” watch list.

In this case, however, Brazil was not the first-mover. In 1997, Mexico created a social program called Progresa (now renamed and better known as Opportunidades) which has demonstrated the success of conditional cash transfers.   Positive results include increased school enrollment, retention and attainment; improved nutrition and other preventative health behaviors; and reduced maternal-infant mortality rates. (I always like “public health interventions” that are really just social economic programs).

The Oportunidades program has served as a model for similar programs in other locations including Brazil and even New York City. (Spoiler alert: The NYC program didn’t work.)


Top 5 Public Health Jobs (that have nothing to do with public health)

September 20, 2010

For a long time, I’ve had an idea for a post that I never fully developed. Finally, I’m going to post it. Perhaps some of the potential insights are only partially percolated in the post; regardless, we proceed.

To me, the question “How can I save the world?” always seemed to imply “How can I help the sick? How can I make people live longer, happier lives?” I’m not sure if this is a common association, but an enormous amount of impact can be made through broadly improving public health.

Almost all of the world’s greatest tragedies are issues of public health. While the discipline often focuses on disease epidemiology or health policy, other major events clearly affect the health of populations: war, climate change, mental stress, natural disasters. Objectively, public health is not just vaccinating children but bringing conflict resolution, preparing for hurricanes, improving family dynamics, paving roads, building bridges (physical and metaphorical), and improving the quality of life for large numbers of people.

Unfortunately, such a broad scope can’t really be covered in a Masters program. Instead, we learn biostatistics and memorize long lists of risk factors for cancer, infectious disease, and other behaviors that lead to sickness. (It turns out, being really poor makes being healthy really difficult).

All of these many health-related disciplines, however, need leaders. And since getting an MPH can slow people down for two years, I’ve compiled a personal list of the top five occupations that I believe achieve the most public health (i.e. save-the-world) impact.

1) Teachers
One of the most impressive correlations that exists (in my opinion) is the correlation between health and education. From a 2007 NY Times article:

The one social factor that researchers agree is consistently linked to longer lives in every country where it has been studied is education. It is more important than race; it obliterates any effects of income.

Education improves the economy, decreases risky behavior, and even cuts down smoking; not to mention the vocational training in finding stable employment and improving the economy.

2) Engineers
According to charity:water, unsafe water and lack of basic sanitation cause 80% of diseases and kill more people every year than all forms of violence, including war. The social consequences are equally destructive:

In Africa alone, people spend 40 billion hours every year just walking for water. Women and children usually bear the burden of water collection, walking miles to the nearest source, which is unprotected and likely to make them sick.

Time spent walking and resulting diseases keep them from school, work and taking care of their families. Along their long walk, they’re subjected to a greater risk of harassment and sexual assault.

In many places, water is hard to come by. There needs to be water infrastructure and to create this infrastructure we need innovative engineers. Plain and simple.

Engineers have done a lot to help the world. From the CBS Business Network:

Engineers have built more than 36,000 large dams around the globe to control floods and provide hydroelectric power, irrigation, industrial supplies, and drinking water to an expanding population and economy.

3) Politicians (kinda)
Poor governance in low-income countries ultimately causes A LOT of global health problems. Poverty becomes exacerbated. Public interventions fail due to corruption. Private markets cannot be efficiently regulated and open the door to exploitation.

Maybe Wycleaf Jean had the right idea on how to help the poor: become a politician.

Admittedly, although many problems are caused by governance, I don’t know that being a non-corrupt, intelligent, or even musically talented politican is the best way to overcome the problem. Bureaucracy, international relations, and other social, political, and economic dimensions discussed in a long list of Yale seminars aren’t easily solved by one Senator’s voice.

But hopefully there will always be people like Nelson Mandella, John Adams, Ellen Johnson Sirleaf and others to prove me wrong.

4) City Planners
There are more people in the world that face obesity than malnutrition. When I first heard that I was amazed. Now, admittedly, it makes sense.

Coined the “obesity epidemic,” a epidemiological transition has led to heart disease, cancer, diabetes, and other BMI-related chronic diseases to (appropriately) take the foreground in Western health policy. (In just about every public health class I have ever taken, obesity is one of the first issues that is discussed).

What can be done to prevent obesity? There are lots of alternative ideas being thrown around: sugar taxes, gym subsidies, improved health education, high quality healthy foods in low-income neighborhoods. All have potential, but one area that needs more emphasis is city planning.

To improve food security, encourage walking, and get people out of the BK breakfast->cubicle->episodes of Lost->bed routine, we need city designers.

In New Haven, I ride my bike or walk everywhere. I have access to nearby healthy foods and a gym. I have groceries delivered to me from a nearby grocery store. (Incidentally, grocery story delivery man could deserve an honorable mention for this list: finally, a way to maybe get produce and fruit to low-income neighborhoods).

By creating cities that can be navigated on foot (with efficient transportation) instead of relying on cars and highways, urban planning can create metropolitan hubs that have improved access to healthy foods while increasing exercise and even decreasing a reliance on (economically- and environmentally-) costly vehicles.

5) Journalists
I like to think I’m an idealist and an optimist. Yet, I get overwhelmed with global problems and discouraged trying to make an actual difference. It is during these times I consider dropping out of school, becoming a Park Ranger, and leading a content life in the wilderness. Or, investment banking.

Despite basically focusing on many of the world’s greatest tragedies, journalists like Nicholas Kristof inspire me and get me back on track. In order to truly address the plethora of public health issues (whether germs, genocide or gender inequality), we need to hear about them. Journalists bring these issues into the spotlight. They inspire. They mobilize. They tell people about the enormous disparity and they recruit the future leaders that will devote their lives to ending them.

Oprah can mobilize a social movement. Ben Franklin used journalism to influence the American Revolution. Glenn Beck can (unfortunately) get millions of people to hang on to his every word. This is a powerful tool to create enormous shifts in our world. Unfortunately, the economic future of journalism remains uncertain so it probably won’t pay that well.

At least there are always blogs.

SPOTLIGHT CHARITY: charity:water

October 22, 2009

Sad statistics get really boring after a while.

Half the world lives on less than $2 day. There are 10 new cases of malaria every second.  One in 12 people in the world are malnourished. We hear truly jaw-dropping facts all the time yet few individuals are truly motivated to rally for a cause.

So how can someone make a real difference? Inefficient aid bureaucracies, ubiquitous corruption, and ineffective organizations make sure that every donated dollar gets farther away from making any real impact.

Charity needs a re-branding phase and get ready, it’s starting to take form. The leading pioneer (and recipient of my Spotlight Charity award):  charity:water, an organization that brings clean water to people in developing nations. Charity:water does one thing, and it does it well: it tells a story.

Why charity:water Rocks
1) 100% of every donated dollar directly funds water projects
All administrative costs are already covered by a partnership with top donors (apparently known as “the well”). Every donated penny is directly outsourced to partnered programs that then build the pumps. Therefore, any donor’s qualms about overhead costs are straight-up bogus–you’ll have to come up with a new excuse not to donate.

2) They market like a successful business should.
Check out their website–it’s truly incredible and has some great visuals that get their message across:

They also have AMAZING videos.

New York Times columnist and personal hero, Nicholas Kristof went so far to say, “Any brand of toothpaste is peddled with far more sophistication than the life-saving work of aid groups.” And he’s right. One of the most significant problems of charities is an idea that a social mission absolves their organizations from managerial or marketing skills. It doesn’t!

3) They’re hip.
Charity:water utilizes social networking resources better than an emo high-schooler looking for new friends. The organization raised over $250,000 through the Twitter Twestival event and has well over a million Twitter followers. (In case you haven’t jumped on the Twitter bandwagon yet: that’s a lot of followers. To compare, the American Red Cross has around 26,000, or 2% of C:W).

5) They’re creative.
And not just in their graphic design. Check out their new community page that allows fans to run marathons, grow beards, and give up birthday presents to increase support for their organization. Their September birthday campaign raised over $1 million itself, providing clean water to more than 500,000 people.

4) Donors see the difference.
Every time charity:water funds a new well, the group takes photos and uploads them with GPS coordinates to a Google map so you can see your contribution at work.

Charity:water officially wins the inaugural *Berk Outstanding Achievement Award* for excellent marketing, efficient allocation of donor funds, and providing an effective solution to one of the world’s greatest public health crises. Congratulations to them.

And to readers: check out the SocialVibe banner to the right; watch a sponsor’s commercial and help support the C:W cause.  Any nominees for future award considerations?

What Zombie Movies Can Teach Us About Public Health

July 21, 2009

I’m going to commit a no-no. Bloggers are probably not supposed to re-post articles from the past, but that’s exactly how I’m going to start off.

As a public health student and a zombie enthusiast, this Op-Ed for the Yale Daily News combined two of things I love most. With an virulence rate of 1.00 and fatality rate of 1.00 (or 0, depending on how you look at it), zombism is a public health worker’s worst nightmare.

Originally printed in the April 8, 2009 Opinions section of the Yale Daily News.
( http://yaledailynews.com/articles/view/28543 )

Berk: Zombie movies can teach us

By Justin Berk

Is Yale prepared for a zombie attack?

After wasting hours of time studying for tests, writing senior essays or building Styrofoam dinosaur dioramas, many students forget to focus on the inevitable zombie apocalypse. Once the crisis hits, where will the unprepared student body turn? The political science majors are too soft, Directed Studies freshmen are too inexperienced and those math kids will probably just stay in the library working on problem sets. Who can possibly be our zombie saviors?

Enter public health enthusiasts.

If you’ve ever seen a zombie movie, you’ve seen an introductory guide to public health. The flesh-eating undead are an epidemiologist’s worst nightmare, but they can teach us a lot about public health crises and begin a philosophical discourse on the trade-offs between individual liberties and public safety.

Whether students learn them from an HIV surveillance internship or from watching “The Evil Dead 2,” there are four vital public health themes that everyone should know.

First, epidemics can strike at any time. Whether caused by medical experimentations of the rage virus (“28 Days Later”), pollution of 2-4-5 Trioxin (“The Return of the Living Dead”) or unusual moon alignment (“Night of the Living Dead”), a virus can appear quickly and spread rapidly. Without adequate resources, preparation or knowledge of the disaster, uninfected individuals face a heavy disadvantage compared to those who understand the risks of disease. Educational public health warnings are important. Pay attention next time: Get a flu vaccine.

Second, the medical model doesn’t have all the answers. In today’s health system, almost all health funding goes toward treatment of illness instead of prevention. This is an inefficient way to deal with cardiovascular disease, and an inefficient way to deal with proliferation of the undead. There’s no cure for zombie-ism, just as there is no absolute cure for diabetes or HIV (there are, however, life-saving treatments for both of these diseases). Prevention is key and must receive greater priority when looking at the health policy issues today.

Third, public health is an interdisciplinary field. Broad epidemic preparedness requires work from all academic disciplines from epidemiology to sociology, from medicine to economics. The economic efficiency of vaccine delivery, the morality of community quarantines, the anthropology of disease and the construction of wooden barricades are all important issues that come up during a health crisis such as a zombie attack. Disease — whether caused by a stomach bug, biological attack or brain-devouring syndrome — rarely has a magic-bullet cure. Instead, a coalition of experts must provide new perspectives to new problems. Going into the consulting industry after graduation? Public health experts can still use your help!

Fourth, disease is a global issue and affects everyone. Pathogens ignore national borders. They are able to cross the world in hours or days; no country is invulnerable to the importation of disease. Additionally, pathogens can adapt to changing ecological environments, creating strains resistant to basic treatments (the infected in “I Am Legend,” for example, began as allergic to sunlight, but by the end of the movie could venture into the dusk-time shadows). Around the world, the improper delivery of medications for tuberculosis and HIV has already created such resistance. All demographics — whether poor or rich, local or distant — must have access to effective health care treatment and prevention programs to prevent the global spread of these resistant “superbugs.”

Other important life lessons abound in zombie films: Always keep your doors locked; it’s a good idea to have some canned food around; in general, avoid malls; don’t bro out too long with your buddy who just got that zombie bite.

Is Yale prepared for a zombie attack? Probably not. But public health experts constantly fight to prevent such epidemics and, when they occur, work diligently to recognize, isolate and cure any infectious disease.

So how can you become one of these champions of global health? How can you better understand the epidemiological principles that serve as a foundation of a healthy population? How can you learn to protect yourself from outbreak, starvation, or your infected residential college master charging you while you’re cornered against a fence?

Go watch a zombie movie.