September 14th, 2008
Posted by: oneillcristfulk
The role of Health in Poverty What role does health care and AIDS play in poverty and poverty alleviation?What does health care look like at the bottom of the pyramid?
The role of Health in Poverty What role does health care and AIDS play in poverty and poverty alleviation?What does health care look like at the bottom of the pyramid?
by: Tony Cox
How do we encourage more entrepreneurs to find creative ways to combat the ills caused by poverty? They must be incentivized. Knowing that they’re doing something good is one incentive, but obviously there needs to be more than that. And the incentives need to push them to develop sustainable solutions, rather than adopting charity-based methods. I say we get the government involved. Up until the past couple weeks, that might have seemed like a “liberal” idea, but it’s pretty clear by now that big government is a bipartisan idea. If we can find close to $1 trillion to help out ailing banks (without them giving up anything in return, mind you), then surely we can find some extra money to fight poverty.
What would this government program look like? Start with a pool of money. It can be relatively small at first, perhaps just a few billion dollars, then it could grow if the program is effective. Businesses and entrepreneurs could submit proposals detailing their projects, and, if approved, they would be eligible to borrow from the pool at a fair interest rate. These could either be new ventures or expansions of existing projects. There would be two requirements. One, the project must be designed to solve a specific social problem. There’s almost certainly a better way to phrase that, but I can’t think of one right now. Examples would be providing clean drinking water or health care to a population that cannot access them otherwise. Opening a plant in an impoverished area and staffing it with local workers might also qualify. The second requirement would be that the project must be self-sustaining. There would have to be some kind of grace period, perhaps 1 to 5 years depending on the circumstances, but eventually the business would have to support itself and the loan would have to be repaid. There would have to be strict oversight of the program. The government shouldn’t get involved in making decision for the businesses, but it would have to ensure that the money was being used for its intended purpose and that that it was on a track to sustainability.
by: David Lax
First of all, I really enjoyed reading the cases because they were actual examples of projects implemented to address a specific cause. This shift from broad general concepts to specific examples makes it easier to understand the multiple facets of poverty that we have been discussing. In addition, I find it easier to analyze and provide a critical perspective when dealing with specific facts. As I read each case I looked for the goal and the reward that was gained in place of profits. Also, I was interested in determining the details that were implemented to make the initiatives sustainable. In summary,in each of these cases the greater benefits were gained by the society and not the individuals and companies that administer their businesses. Which leaves me with my final question: If the gains are reaped by society, shouldn’t the society as a whole(including all people in the world) be responsible for bearing the costs? It just seems unsustainable and unfair to rely on a few individuals to be charitable and forego economic profits.
by: Laura Trott
Project Pyramid is everywhere I turn. Since the moment this class began, I’ve been unable to read a newspaper or watch CNN without finding something that pertains to our weekly discussions. Two weeks ago it was a New York Times editorial chastising the G-8 nations, all of which have fallen behind on their financial aid pledges to Africa. Last week it was on The Colbert Report where Stephen Colbert actually conducted his interview with ESPN’s Rick Reilly under a mosquito net. As a part of Nothing But Nets, Reilly works to provide families in Africa with quality mosquito nets in hopes of preventing the spread of malaria. This week I expect that something else will grab my attention which prior to this class- whether due to apathy or ignorance- would not have garnered the same interest. This week’s readings were particularly interesting because they focused on individuals who identified a singular problem and pursued its solution through creativity, economic utilitarianism, and a commitment to sustainable enterprise. As we move forward in our search for attainable business solutions, Owen students can look to Aravind Eye Care and BMVWW (the Jaipur Foot) as excellent guides, both of which are successfully operating in and making a difference within the bottom of the pyramid.
by: Carmen Wolfe
While the method of health care delivery may necessarily differ among countries, the universal need for medical attention is one of the most pressing concerns for those focusing on poverty alleviation. Health is often an important tool for measuring poverty levels of an area, such as the use of infant mortality rate as a prime metric for hunger. For a BoP nation to develop into a successful entrepreneurial state, it must have healthy people at its helm. Focusing on health needs in BoP communities will improve both longevity and quality of life, restoring functionality to many people groups and enabling them to be more productive.
Some diseases, such as HIV/AIDS disproportionately affect the BoP, with the highest rates in Africa. Nineteen of the twenty countries with the highest HIV prevalence are African nations. Other infectious diseases such as tuberculosis and malaria also share a similar profile. While HIV/AIDS has enjoyed a prominent profile in the realm of medical research, other important worldwide infectious diseases have fallen by the wayside as drug manufacturers have little interest in research and product development for consumers who are unable to afford high-priced therapies. More emphasis should be placed on research for effective vaccines for these diseases which target BoP nations.
It cannot be denied that developing nations often have different health needs than first-world nations, and these needs will change as an area moves forward with development. For developing health care in BoP communities, it is important to survey communities to determine the most important contributors to overall morbidity and mortality in an area. This will give an initial snapshot of the most pressing medical concerns that should be addressed, and will provide initial data so that the success of failure of future health interventions can be properly assessed. While infectious disease usually dominates the scene of traditional international health programs, it is important to keep in mind that as living standards rise, a shift can often be seen to non-communicable disease (NCD) as a significant contributor to overall mortality. Important NCDs to consider include heart disease, diabetes, and cancer. For example, according to WHO projections, by 2010 NCDs will be responsible for 59% of deaths in Bangladesh, a significant increase over rates of nearly 40% in 1990.
Prioritization is needed for providing health care in developing nations, though the ultimate goal should be for health care at the bottom of the pyramid to resemble available services in developed nations. By nature of the human experience, individuals in the BoP will have similar needs to individuals worldwide. It is necessary to look beyond infectious disease, and begin to consider how advanced medical technology such as specialized surgery can be brought to the developing world. The Jaipur Foot story demonstrates how innovative minds can adapt a product that costs several thousand dollars in the United States to the unique needs of Indians at a remarkably lower price. Other progressive medical minds have designed surgical implants for orthopaedic surgery that can be cheaply manufactured and used in developing nations, without sacrificing quality or efficacy. More innovations such as these need to be pioneered to continue to bring world-class health care to even the poorest nations.
by: Hana Crume
The readings this week further confirmed a theme that has been prevalent throughout all of the readings and class sessions we have had thus far. Every time I learn about a successful, sustainable business venture that has been able to lift a community or several individuals out of poverty, or that has at least been able to open up that possibility, I think of this saying: “Give a man a fish and he eats for a day. Teach a man to fish and he eats for a lifetime.” The idea that providing training, research, and resources necessary for impoverished communities to live more comfortably is more effective than simply giving the impoverished food or money has been consistent throughout the course. Kiva, Grameen Bank, the cases studied in this week’s reading, and several other organizations seem to provide a longer-lasting and wider-reaching service to the poor than do organizations who drop food and money, then leave.
by: Paul Dent
Paul Dent
Project Pyramid
I enjoyed Hans Rosling’s talk using statistics to illustrate quantitative differences between countries around the world- he spoke of the correlations between things such as family size and life expectancy, wealth distribution among the world’s population and the GDP in a particular country in relation to the child survival rate in that country. The interactive data that he displayed tracked changes over time to specific countries. With this data, he was able to draw some interesting thoughts.
I was particularly interested in the change in his data as he tracked it through history. For instance, he made fascinating remarks on how the life expectancy increased in Vietnam as social policies changed. As the social policies became more open, the life expectancy increased to almost the same level as Americans in the 1970’s. This idea of taking a big picture approach and realizing what else is at play in the countries we are talking about is something that will be helpful as we look to fight poverty from the bottom of the pyramid: what can we use to our advantage vs. need to be concerned about as a potential obstacle. Our classmate Joe has noted the place of the church in some of impoverished communities and how this institution can be leveraged. My point in mentioning this and relating it to the Vietnamese statistic is that it seems extremely important to be aware of what is going on in a country on the grassroots level and then use that information to create a contextual strategic approach to fighting poverty.
Rosling also discussed wealth distribution among the nations of the world and how years ago, there was more of a gap between the wealthiest and the poorest people. It now seems to be moving towards a mound shape distribution as the world’s wealth shifts in different directions and massive populations like the Asian nations become more and more developed.
Another thing that dawned on me as I watched this talk was the importance of not approaching poverty and the issues that are associated with poverty as a blanket problem with a blanket solution. Instead, it is important to recognize the enormous difference within countries and attempt to really understand exactly who you are trying to assist and the issues that are confronting them.
Speaking of data, Rosling puts great importance on the ability to access and manipulate statistical data that has been collected over the years with regards to development. With all of the many different groups working towards different goals in developing countries, it is important that they are equipped with the most helpful information out there. As the internet spreads throughout the world and people become aware of the influence that knowledge can have, it will become increasingly valuable information.
by: Mikael Jacobs
This week’s reading gave concrete evidence to support the idea that quality health care can be provided for low costs. Innovative and efficient approaches to delivery allow for sustainable development of organizations such as the Jaipur Foot and Aravind Eye Care System. It is easy to quantify the benefits to each organization, and more importantly, the enhancement of life in BoP nations. But although this creates endless possibilities for international poverty alleviation, it primarily makes me consider the impact these types of organizations could have on health care in America.
One of the biggest problems facing our country is the rising costs of health care. Hospitals are having difficulty surviving under their current operational structures, and government regulation makes it virtually impossible for an organization such as Aravind Eye Care System to operate in many states. What if, instead, government changed its legislation to promote competition and specialization? Would medical facilities actually be able to reduce costs to a fraction of current costs? This could revolutionize the delivery of health care in America and make it affordable to people of all income classifications, potentially alleviating poverty.
by: Virginia Francis
The means vs. the goal:
Although we focus on economic growth and GDP when we look at the bottom of the pyramid, do we really define improved economic growth as our end goal? This concept was addressed in the second video of Hans Rosling’s talk on how countries are pulling themselves out of poverty. I think this idea is important to note in any discussion of solutions to end poverty. Through his analysis of statistical data, Rosling was able to prove that economic growth is in fact the best means to improving global health (80% driven by economic standards of the country), but also pointed out that it is not the ultimate goal. Obviously this is up to personal opinion, and we have even debated our different definitions of poverty in class. But I would agree with Rosling that the most important goals for making a positive impact in developing areas of the world are for providing basic human rights and preserving culture because these are what bring joy and happiness to life. They are the value of living. This is something I have experienced myself while traveling to the underdeveloped areas of Cuba. Some of the poorest people I have ever met met were often the happiest and most joy filled. Their oppression didn’t come from being economically poor, but came from the underlying reasons for it. They were oppressed by the government and had basic human rights and freedoms taken away from them.
It was encouraging to listen to Rosling because he is so knowledgeable in the history of global health and economic growth. He presents the statistical information in a way that is educational and truthful. I liked his quote that “the seemingly impossible is possible.” He supported this idea by giving the example of how much Africa has developed over the last fifty years. The African countries have gone from a pre-medieval situation to a “one hundred year ago Europe” with a functioning national state. If you think about where Africa came from, he would conclude that it has done best in the world over the last fifty years.
by: Perry Still
One of the interesting things to me in the chapter of health alerts is the use of non-medical technologies to improve health care at the BOP. Prahalad describes how “the threat of rapid national, regional, and global spread of infectious disease poses a new challenge: early detection, and coordinated and rapid reaction by public-health authorities locally and globally. A basic surveillance system built on low-cost communications infrastructure is critical.” What’s interesting about this quote is the idea of approaching health issues from a communications standpoint. By thinking about health care in terms of bringing technology to the BOP that isn’t necessarily med tech. Instead of necessarily focusing on primary care, Prahalad notes that “early disease detection, clear and rapid communication, and coordinated action by health authorities can inhibit the spread of infectious diseases.” As opposed to focusing on health care personnel’s treatment of persons, but their communication. Most of us in the “business community” are not experts in health care treatment, infectious diseases, or any of these types of topics. However, we are trained in finding strategic solutions to organizational problems. By thinking about problems such as access to health care and other issues as organizational problems, we can improve health care at the BOP. As Prahalad notes “though these solutions might seem obvious for people who never leave home without a mobile phone, Voxiva looked beyond the U.S. borders to rural areas where 70 percent of the world’s poor live with limited access to telecommunications.” Rather than thinking of health care at the BOP in strictly traditional terms, if business leaders focus on things like efficiency and communication, we can have a great impact in areas outside of our expertise.
by: Allison Earnhart
Throughout our class and even throughout this blog, there have been several references to increasing government aid as a solution to ending poverty. While there is certainly a significant need to increase government aid to developing countries, this strategy must be approached with caution. How much government aid to developing countries is actually used for the purpose it was originally intended?
According to Eric Thurman, in the book, A Billion Bootstraps: Microcredit, Barefoot Banking, and the Business Solution for Ending Poverty, aid to developing nations since WWII has totaled $2.5 trillion. It is said that a majority of this aid is directed to the governments of developing nations. It makes me wonder why there are so many people still living in poverty if so much aid has been sent to developing nations in the last 50 years. There must be a significant amount of waste and/or the money is not being used as effectively as possible. Whatever the reason, the traditional definition of government aid to developing nations, cannot be the only solution to ending poverty.
Perhaps we need to rely more on the citizens of developing nations to ensure aid is being used effectively. This class has repeatedly emphasized that people living in poverty are capable of brilliant, sustainable business ideas. Can we begin to rely more heavily on these same people to ensure aid expenses are monitored? If people living in an impoverished village were alerted about the amount of aid sent for specific projects, is it possible that money has a better chance of being spent on the appropriate project?
by: Sapna Lathia
I firmly believe that a team that consists of people of a variety of different backgrounds, skills and expertise can be a powerful force. The team has the ability to cover a broad range of problems and it possesses the talent needed to approach problems from all angles. Each team member can give a different perspective on the issue at hand by leveraging his/her unique experience and knowledge base. This powerful team has the ability to overcome various obstacles in various environments.
I spent the last two and a half years working for Cisco Systems as a financial analyst for their Business Operations Finance team. Among my various responsibilities, I learned how to react to changes in the global economy, problem solve to counter market pressures, perform in depth analysis on how to increase profitability, and research about customer’s technology needs. I can use these same skills and expertise and apply them to the non-profit sector. Based on my past experience, I view problems in a different light than someone with a different background. In turn, my background combined with others’ skills and ideas can be a driving force for success. Through classroom discussions, I have learned that each individual has a different background and unique experiences that can all be utilized to reach our common goal.
Similarly, Professor Victor and Alfredo Vergara have the means to work together to really make an impact on the poverty stricken community in Mozambique. Professor Victor can use his business expertise to bring sustainability to Mr. Vergara’s ideas. He knows the importance of lending funds in order to empower borrowers and promote independence. He can use his business knowledge to learn about the market. What drives them? What motivates them? What are the environmental constraints? What are the legislative constraints? Professor Victor also knows the downside to simply handing out funds and the market inefficiencies attached to pure aid. Additionally, he can gather data needed to perform cost analysis. What are the transportation costs? What are the interest rates on nearby banks? What are the international taxation laws surrounding lending? How can the group optimize their inputs? Professor Victor can gather data and use it to work with investors in the United States to help create a model that benefits all.
Mr. Vergara has the medical background to determine the needs of the poverty stricken community? Do they have proper sanitary conditions? What immunizations/vaccines are necessary to prevent illnesses? What dosages do they need? What are the preventative measures that can be taken to improve the health of these unfortunate people?
Together, Professor Victor and Mr. Vergara have the skills and knowledge base to see the needs of the poverty stricken community from two different viewpoints. They should work together and leverage each others’ thoughts and ideas to develop a solution that is effective yet sustainable.
by: Vik Sidhu
An Empirical Investigation of the Relationship between Wealth and Health
Using the Survey of Consumer Finances
(source: http://www.irp.wisc.edu/publications/dps/pdfs/dp128704.pdf)
My natural tendency was to think that income and health are correlated. What I had never thought of was what this correlation meant – does a higher income lead a healthier life or does a healthier life lead to a higher income or are both true? It’s easy to see that a higher income will lead to a healthier life. I think that’s where the correlation between income and health ended but the reading I did this week and the videos I watched on TED.com have made me aware of other relations that make up this one correlation figure, which is all we see. If we consider the correlation to be true then as one gets healthier one should earn more. As I have seen through the thought provoking resources I mentioned above, it is not always so. Countries in developing and under developed nations have populations that are healthier than the populations of developed countries were not too long ago. But even then the developed countries were richer and developed. Even in the study by the Institute for Research on Poverty (IRP), I saw evidence of an income-health correlation but there are too many variables to conclusively admit to this correlation.
All this makes me want to step back and think if establishing such a correlation will help alleviate poverty? If lack of income causes ill health then what will happen if we took a sample of a thousand poverty inflicted individuals and checked them to see if they were medically fit and provide them with medical care wherever needed and say in two months leave them back, having ensured everyone was in a healthy state. If they are now as healthy as the average middle class man or woman will they be earning as much as them in say five or ten years? I think they will more likely be back to where they had started after having enjoyed short burst of increased productivity at best, when they were sampled and treated. Or let’s consider the United States. The richest nation in the world has no income shortages but then it still has its share of poverty. Sure poverty carries a different meaning in the United States but it still is poverty. Can we then say income and health are correlated? Can we say the world’s poor are overall unhealthy? Is bad health causing poverty across the world? I think not but there is compelling data available to support that income and health are correlated. Then again this might be deceptive and there might be data available to suggest there exists no such correlation. I think it’s too early to draw a conclusion. There are many underlying variables either waiting to be discovered or better explored. However this research we are conducting will be beneficial to us because we discover something new from it. We will either discover the limitations of our understanding or we will discover what we have been looking for – the critical factors that will lead us to the root causes of poverty worldwide. Till then we should not expect that providing medical aid to the needy will help them rise out of poverty.
by: Hana Crume
This is not relevant to the Health Care topic, but I wanted to go ahead and post on Week 7’s readings, as I won’t have access to a computer later tongiht…
Tupelo, Mississsippi went from being one of the poorest areas in the nation to right around the national average PCI as the result of a grassroots effort, spearheaded by a local Community Development Foundation.. They are using a three-step process to achieve their CDF goal of raising the standard of living; I think that this approach, coupled with forming only 10-year plans and then re-evaluating these plans, is crucial to Tupelo’s success. A thirty-year plan might be overwhelming to many key players in Tupelo’s transportation, and the enormous goal of immediately reaching the nation’s average per capita income might seem daunting to many. However, by breaking down the process in to manageable goals – namely, 10 years at a time and one step at a time – the community in the Tupelo area is given attainable and realistic goals to work towards. The clear goals of the CDF also contribute to its success. For example, instead of “create more jobs,” the CDF names “create 2,500 new jobs” as its specific goal. Clear measures of success are crucial to outlining a plan that is understandable to all who are involved – everyone in the community.
Another interesting point of this article was that the CDF provides not only grant money to help locals businesses get their feet off the ground, but also trainings and services to help these businesses grow. As I have mentioned with almost every other reading thus far, it is far more essential to provide support and a framework for growth for a developing community, rather than just dropping money and leaving. Again, like I have mentioned in almost every other reading, it goes back to the saying “Give a man a fish, feed him for a day. Teach him to fish, feed him for a lifetime.” The CDF is teaching this community to sustain itself and grow.
by: Heidi Wallenhorst
I have a personal anecdote regarding BOP health care that I find interesting… what happens when the resources are available but knowledge of how to implement them is not?
There are clearly many organizations working to chip at away at the global health care problem. Individual health professionals in the United States are working towards this end as well. I have two close friends who work as pediatric oncology nurses at Georgetown Medical Center. This past summer they raised money and took a medical mission trip to Ethiopia to work at a cancer clinic established by a well-known Ethiopian oncologist. Throughout their trip they were devastated by the conditions and treatment options provided to the child cancer patients in Ethiopia. The problems they encountered were not limited to lack of adequate funding of the cancer center, but were more centered on a general lack of knowledge for treating the patients. The children were being given chemotherapy to treat their cancers and were well supplied in this manner (based on donations to the organization). However, a big side effect of chemotherapy is extreme nausea, which at Georgetown, the girls simply treat with Benadryl. This concept was foreign to the caretakers in Ethiopia and made a huge difference in the comfort of the children. My friends left feeling they glad they made an actual impact, but devastated that a simple knowledge barrier proved to be the biggest problem they encountered. How can our medical care in the United States be as advanced as it is yet across the globe, very basic knowledge is lacking? And as we attempt to eradicate the resource problem (medicines, etc.), how can we bridge the seemingly more simple knowledge gap?
by: Emily Bowden
I couldn’t agree more with Hana’s comment: “I think of this saying: ‘Give a man a fish and he eats for a day. Teach a man to fish and he eats for a lifetime.’” This class reinforces for me the importance of education, training, and development of infrastructure. While donations to charity are noble, the creation of a sustainable community that can grow independently is far more valuable.
by: Tripp Shubert
It’s quite interesting to view Wall Street’s Financial “Crisis” within the context of extreme poverty throughout the world. Somehow I believe AIG’s and Lehman’s investors and employees will survive these hard times! Last Monday’s presentation that displayed the vast differences in health services, health funding per capita, infant mortalities and premature births, and even life expectancies between the wealthiest countries and the world’s developing countries was truly eye-opening. The greatest health funding continues to exist in countries where, some may argue, it is needed the least. Yet this reality continues while many Americans worry whether their pension plans will allow them to travel as extensively in retirement as they have hoped. But how do we solve this problem?
Many support the “top-down” approach to poverty alleviation in this way: they argue that these large corporations must be the ones supported in times of crisis (much as we have seen in recent days) SO THAT the “small fish” can continue to have health insurance, salaries, etc. Therefore, feed the rich, and watch the scraps trickle down to everyone else. The Wall Street Journal (Friday, September 26) merely glossed over the uncommon opinions of Robert Shapiro, “a former Clinton economic advisor and the chairman of the globalization program at NDN, a Washington think tank, [who] said the [proposed bailout] program outlined by the administration aimed at the wrong target. Rather than buying assets, he says, the government should provide money to people facing foreclosure, which would prevent the assets from going sour in the first place.” This idea reflects an unpopular principle of supporting the very people who struggle within an economy rather than the larger organizations whose books are affected by the poor. When applied to poverty alleviation around the world, this principle of “bottom-up” support is clearly the better policy. Yet all who are interested in combating world poverty must recognize this bias towards corporate support rather than individual support during a crisis. Hopefully the lessons from Tupelo and the success stories around the world with grass-roots efforts to alleviate poverty can convince future leaders to adjust their biases to provide the most efficient support to those in need.
by: Mohit Kumar
A vicious cycle (Poverty and Health) Facts: Poor people do not have access to basic health care; leave alone the advancement in health care with new technologies. E.g. in India even today, many children fall prey to Polio virus, even when the vaccine is readily available. Poverty alone is not responsible for such sufferings, because Polio vaccines are available for free of cost in India. The major cause lies in the fact that majority of these poor people do not even know that their children need to be vaccinated. AIDS is not spread in the red light areas of developing and under developed countries due to lack of preventive measures such as condoms, but is mainly due to the ignorance of people about AIDS. The inequalities in Health access to poor is another issue which needs a great attention.Studies have shown that poor children are five times more likely to die before reaching the age of 5 and 2.5 times more likely between the ages of 15 and 59, when compared to people of higher income group. The pregnancy mortality rate is extremely high in the absolute poverty segments of the society. Bad Health and poverty are highly correlated with each other. They act both as causes and consequences of each other. A ill person is not able to work, which in turn affects his income. On the other hand poor people are exposed to bad environmental conditions and do not get sufficient nourishment, which lead to malnutrition and deteriorating health. This is a very bad vicious cycle. A solution to poverty lies in good health for these people. Such solutions should be given more importance, as a healthy individual can work with full concentration and earn more to reduce his poverty. Healthy children can learn more efficiently and grow up to be educated and find better jobs, thus breaking this vicious cycle.
The vicious cycle can be broken by collaboration of agencies like World Health Organization (WHO), with the governments of under developed and developing countries. This collaboration can help in framing superior public policy, which can provide adequate health care access to the poor. ‘WHO’ can help these governments by providing guidelines and structures for developing affordable health care plans for the poor. One example of such a plan is the Polio eradication drive in India, where the government, NGO’s and the WHO have teamed up to penetrate the use of Polio vaccine in the remotest part of the country and educate people about the disease. This strategy needs to be custom designed as per the environmental factor in a given country. These factors can be influenced by the natural environment, religious sentiments and cultural beliefs of the people.
source: world health organization
by: Laura Trott
After reading “Lessons from Tupelo: A Case Study”, I went to the CDF’s website in order to learn more about this organization. I find that I am most impressed by the longevity of their success. From the 1940’s until today, their commitment to community and workforce development has taken what would have been a poor, rural Southern town and transformed it into a thriving, forward thinking city. The CDF’s latest victory will bring a highly coveted Toyota Prius plant to Wellspring, MS, just a few short miles outside of Tupelo.
As we look forward to Bangladesh and other BOP markets, we must ask ourselves what we can learn from Tupelo and what will be difficult to duplicate. Here are a couple of my thoughts around that subject:
•Tupelo had a remarkable leader who created this vision and then tirelessly shared it with the surrounding community. Outsiders can certainly make a difference, but does it takes a central leader from within the community to receive true buy-in and then spearhead such a broad initiative?
•The reading noted that Tupelo is looking for “givers, not takers.” This reminded me of previous classes when we’ve discussed whether a company is solely committed to its shareholder or if it can balance its commitment between shareholders and social initiatives. The Tupelo model seems to promote companies that can do both.
•The CDF is truly committed to high ethical standards. It prohibits its board members from voting on issues which could be considered a conflict of interest. It shuns direct citizen participation in luring industries and also avoids obligatory meetings with public officials. Such a commitment provides a challenge anywhere. However, this might especially be difficult in certain BOP markets where bribes are a routine part of the culture, where local governments will expect a certain amount of authority, etc. Overall, this particular item will most likely require the most adjustment depending upon the norms of that society.
by: Matthew Hancock
Throughout the entire class, we have been trying to define poor, i.e. who is poor, is one person poorer than another, and is a person that is poor in Africa poorer than a person in the U.S. I found it interesting that in the reading, Prahalad referenced The National Bank for Agriculture and Rural Development’s guidelines for determining poverty, and thus eligibility for Self Help Groups, or SHG’s. These were: “Is there only one source of income for the family; Are there any permanently ill members of the family; Do you regularly borrow from moneylenders; Do you live far from your drinking water source; (and) Do you belong to a scheduled caste or scheduled tribe?” (Prahalad 123). When considering my reflection from last week, where I communicated my view of poverty as absolute across the board and relative between geographies, I am pleased that the bank’s guidelines are somewhat similar to the view that I have developed. What struck me about the bank’s guidelines was the inclusion of healthcare, or asking a potential member of a SHG if there were any permanently ill members of the family. This was not included in my view of poverty as communicated last week, but since healthcare is so universal, and since people in both developing and developed countries often lack healthcare if they are truly poor, or are under the poverty line, I feel like I should now include it in my defined view.
by: Rachel Gore
During this week’s class, guest speaker Alfredo Vergara (from Vanderbilt’s Institute for Global Health) spoke to us about health issues facing developing countries. He described the effect their conditions have on population life expectancy, and on a nation’s livelihood and prospects for development. Professors Bart and Vergara posed a question to the class about how to stop the spread of HIV/AIDS in a small village in Mozambique, where the US government has allocated money for a clinic through the President’s Emergency Plan for AIDS Relief (PEPFAR) program. They suggested that a group of doctors, business experts and public health experts would be going down for a short period of time to analyze the needs of the community where only one doctor is available to several thousands of community members. They then asked what they should do during their time down there.
I was surprised that most of the comments in class focused around obtaining affordable treatment programs and less about prevention and education. My immediate thought went to condom distribution programs and sexual education. Many people have commended the Bush administration for its generous allocation of funds to the PEPFAR program as a real contribution to decreasing the spread of HIV/AIDS in the world. Yet, if you take a more critical look, one can observe that some of this money is contingent on furthering Bush administration policies, such as abstinence. When international health policies and aid are contingent upon promoting policies such as abstinence, then there is less money for programs with higher success rates on prevention, such as condom distribution. In fact, The Center for Reproductive Rights, a global legal advocacy group based in New York, has documented the effect of the US Mexico City Policy (also known as the “Global Gag Rule”, which effectively cuts off U.S. family planning assistance and funding to foreign Non-governmental Organizations (NGOs) that perform abortions (some exceptions for rape, incest and maternal health are allowed); provide counseling/referrals for abortions; or lobby to make abortion legal or more available in their country (for more information, visit http://www.globalgagrule.org/). The policy created during the Reagan administration, and reinstated by the Bush administration, is called the “gag” rule because it stifles debate about abortion-related issues, prevents the dissemination of information concerning essential health services, and may jeopardize the health of many women who turn to foreign NGOs which are dependent on US-based aid for contraceptive supplies. Furthermore, the Center works to challenge laws in other countries that try to promote this policy– Croatia has sponsored an extracurricular sex-education program Teen STAR (Sexuality Teaching in the context of Adult Responsibility) for a decade now promoting abstinence at the expense of other programs providing contraception (for more information, visit http://www.reproductiverights.org/pr_07_1010CroatiaSexEd.html). This is a classic example of the abuse of US governmental aid allocations because this group has now been awarded a U.S. government PEPFAR grant. The tie between the Bush administration’s coercion tactics to promote abstinence and the selection of NGOs for PEPFAR funds seems like a shotgun marriage. Its important to think about the complexity of the issue before commending Bush for taking a step in favor of global health because, in fact, it’s a step back for women worldwide.
by: Stephen Songy
My main take away from the reading on Tupelo is that changes can sometime be the most effective from the ground up, or a “grassroots” campaign. It seems as if the key may be to simply put those people in a position where they can make the changes that they see as the best fit.
Also, there seems to be a catalyst that sets that change into place. In the case of Tupelo, it was the efforts of McLean in uniting local community leaders and getting them all on the same sheet of music with respect to a strategic long term vision for the community.
From here I think we should ask ourselves, “what is the model for setting these changes into place?” Or, maybe a better question to ask is, “is there a model for setting these changes into place?” Is is possible that each community is different, and a set formula cannot be applied across the board? I think the right answer here is a mix. There are some general principles to the empowerment of other individuals, but not an explicit process to follow.
Specifically, I believe we should look at the project pyramid model village in this context. Is this village going to be the catalyst that sets this grassroots campaign in motion, or even a step in the right direction? Overall, I think the answer to that is “yes,” the initiative can make a difference if done correctly and fully focused on the needs of the citizens.
by: Brad Lindell
Markets and Health Care
We all know that people with more money have better health. Countries with more money also have better health. The converse is true for both. So, pretty clearly, better health and more money are correlated.
Thus, I present Brad’s doctrine of health:
Poor people are disempowered and unhealthy. This makes them sad.
Everyone has a theory for how this happens. I think that poor people are poor because they exist in a system that posits a group of poor to support a group of rich and successful. Given a world of limited resources, poverty exists because of unequal distribution of these resources.
Business students understand how the world works, and they benefit from the inequality that the system produces. Poverty and financial success are both positive feedback loops – poor people become stuck in a system where they are penalized for being poor and consistently restricted from upward mobility by their own poverty. Thus, poverty becomes intrinsic to a group of people because of the system in which they find themselves. Business students benefit from the converse cycle – as members of the leisure-focused middle-class, they have the opportunities to further their education and delay the immediate need to provide for themselves. By investing in their future, they ensure that they continue to control the resources of the world.
Health inequalities are secondary to resource inequalities. These resource inequalities are perpetuated by the current world economic system. Upward mobility is mostly destroyed, and those who live at the top of the economic food chain do so purely at the expense of those at the bottom. There’s a reason that a small population accounts for a large percentage of world consumption.
Unfortunately, health care innovations and international aid are nothing more than fingers in the dike. Do they produce results? Yes. But until we acknowledge that international “aid” is nothing more than an in-your-face demonstration of the positive-feedback economic opportunities created by our current system, all that we in the developed world can do is condescend.
by: Brad Lindell
As the PEPFAR program in Mozambique evolves, Dr. Vergara is wisely seeking the council of a multidisciplinary team. It is exciting to think that Dr. Victor is preparing for a trip where he can put markets to work for the bottom of the pyramid. But as we discussed in class last week, there are many ways to make markets work for the poor. As we kicked around possible themes for his trip, several important distinctions came up. I will try to delineate what I believe is the best focus for Bart’s trip below.
Integrated vs. Separate
Well, I sure hope an integrated program is ideal for the project in Mozambique, because if it’s not this will be nothing but a big misadventure. From a practical standpoint, an integrated approach to poverty alleviation and health programs eliminates a lot of overlapping administrative and overhead costs (and trades them for headaches). Additionally, if markets can promote health and wellness, integrated programs have the best chance to succeed in transforming a pocket of poverty.
Start Big vs. Start Small
Start Big! It’s very difficult to scale-up a venture, so why not start it at full-scale? Perhaps the best idea is the middle path – starting a less-ambitious project and a moderate scale. In truth, anything here is an overgeneralization. Anything that is started in this community should either be proven in very similar environments, or started as a pilot and then scaled-up.
Rich vs. Healthy
In his 1929 essay “The Function of Reason,” Alfred North Whitehead proposed that the art of life is “to live, to live well, to live better.” He goes on to explain how reason drives individuals to pursue that which furthers life. I happen to like Whiehead’s work, but this insight particularly informs our discussion of the goal of international development. In order to live well or better, we must build our lives on a foundation of health.
Markets vs. Aid
This now becomes the fundamental question of the course. Business people like to disparage aid and point to markets as the solution to everything. They become sheepish when markets give up a tenth of their value in a day, but they still like to believe in the power of free markets. Middle-class liberals like to believe in the power of aid and individuals. I must confess to be a part of that second group. Even after this class, I am quite unconvinced that markets can, on a widespread basis, do anything to alleviate poverty. For every example of a market helping the poor, I can give you five examples of markets being the source of income inequality. Capitalism is a system that rewards winners and creates efficiency. But you cannot have a winner without a loser, and with our current predominate economic system poverty will never be eliminated.
by: Anand Vankawala
There are many questions about healthcare that come to mind when thinking about care at the Bottom of the Pyramid. However, one of the specific ones that I would like to address is the following: What motivation does big pharma have to help those at the bottom of the pyramid?
We all know that novel pharmaceutical product development is a costly process. It can cost somewhere in the range of $800 million to $1 billion depending on the class of drug and level of understanding of the mechanism of action. With so much cost associated, what motivations could be provided in order to encourage the lowering of prices? Some methods that are already in use are negotiations with sovereign nations, subsidies through non-governmental organizations, and providing a certain quota of free medicine. However, these methods are far from solving the issue. There are further steps that need to be taken in order to further encourage cooperation.
The steps that can be taken are as follows:
1. Encourage the FDA to cooperate in the development process for medications designated for “orphan” diseases (diseases that pharmaceutical companies don’t think that they can benefit from). The costs of clinical trials keep rising, and make up a large portion of drug development costs. In addition, because this is a global problem, this cost could be spread out over the health and human services regulatory bodies of many countries.
2. Work with the holders of patents to encourage clauses to enable access of intellectual property by third party developers. In other words, allow for cheaper development of products to enable distribution to those in need in the developing world.
3. Reform the TRIPS agreement to encourage a collaborative effort to increase access to needed medicines worldwide
These are the grand steps that must be undertaken in order for medicines to reach those that need them. It will take the cooperation of corporations, universities, and governmental authorities, but in the end they are the people that have the ability to enact the change.
by: Andrea Lash
“Never in history have so many people had so much information, so many tools at their disposal, so many ways of making good ideas come to life. Yet at the same time, so many people, of all walks of life, could use so much help, in both little ways and big.
In the midst of this, new studies are reinforcing the simple wisdom that beyond a certain very basic level of material wealth, the only thing that increases individual happiness over time is helping other people.”
-Project 10 to the 100th
When I heard about this Google contest my immediate thought was that it would be a great tie-in for Project Pyramid, especially as everyone is wrapping up Mod 1 by writing papers on potential poverty solutions. The possibility to actually realize the ideas we come up with definitely changes the way I’m thinking about this final paper– with $10 million on the line, would it actually be possible to “solve” poverty?
http://www.project10tothe100.com/index.html
by: Perry Still
Here’s an article about new Owen professor Jim Schorr. He’s starting this spring and is a great addition to the Owen faculty.
October 2008
New Faculty: Jim Schorr
more features
Jim Schorr
Management professor believes business can play role in changing the world
by Amy Wolf
Business can and should be a catalyst for social and environmental change. That’s the philosophy Jim Schorr has been practicing and promoting across the country and the world for the last 15 years. Now he’ll be teaching this progressive business concept to future business leaders at the Vanderbilt Owen Graduate School of Management.
“Business and corporations have emerged as the dominant institution on the planet today, making business the most high-potential platform for effecting change in the world,” Schorr said. “There are important roles business must play in improving the conditions of society.”
Schorr is among the nation’s leading experts on social enterprise and entrepreneurship. In 1993, he co-founded Net Impact, an international non-profit dedicated to creating a network of MBAs and professionals committed to using the power of business to make a positive social, environmental and economic impact. The organization now has more than 25,000 alumni and members, with chapters at every major business school in the United States, including Vanderbilt, and on five continents.
Vanderbilt was chosen to host 1,300 MBAs from 120 business schools and 10 countries for the 2007 Net Impact Conference at the Owen School last November, with the theme “Building a Sustainable Future: What Will You Do Next?”
Schorr said in this day and age, the idea of social responsibility is not a tough sell to corporate America and no longer the fringe activity it was 20 years ago.
“Doing the right thing is not just good for society; it can be good for the corporation, for shareholders and for the bottom line,” Schorr said. “Business leaders are beginning to focus on social responsibility as an area of opportunity for the future.”
Along with teaching at the Owen School, Schorr is planning to develop a new academic center at Vanderbilt focused on the role of business in society. He said his goal is to collaborate with faculty, staff and students from across the university, as well as national organizations.
But there’s another big reason why Schorr is coming to Vanderbilt: his parents, three younger brothers and extended family. Schorr grew up in Tennessee and most of his family lives near Memphis where they run a true music mecca. Fifteen years ago, Schorr’s family took over the famous Sun Studio, where Elvis Presley, Johnny Cash and other music icons made history.
Most recently, Schorr worked at the Haas School of Business at the University of California-Berkeley. He said the new opportunity at Owen is an ideal fit for him, professionally and personally.
“This is definitely a homecoming for me, and I’m really excited for that,” he said.
Return to “The New Recruits” main page
by: Carmen Wolfe
In reply to comment 14 concerning health education:
Many NGO’s are turning their attention toward addressing the problems of health education in developing nations. In addition to providing short term service projects such as health screenings or health brigades, many of these organizations are instead planning for large scale health education programs. Manna Project International, a Vanderbilt-affiliated NGO hosted a group of physicians from Texas who came to Nicaragua for a short-term medical trip. These physicians provided pap screenings in a local clinic, and then subsequenty provided cryotherapy to destroy atypical cells with the potential to develop into cervical cancer. In addition to this field work, they also held educational conferences at local hospitals and clinics to train health care providers to provide these services on a continual basis. Medical equipment that was brought to Nicaragua to perform the field work was donated to these local institutions, creating a sustainable model for the detection and treatment of precancerous cervical lesions. This model provide an excellent example of how a short-term volunteer physician can make a lasting impact on a community by strengthening local institutions and empowering local health workers.
by: Laura Skibinski
Also commenting on Tupelo, Mississippi:
I enjoyed all of the papers on Tupelo, Mississippi this week. We have referenced the town several times in class, but never explored why they were successful in escaping poverty. It was interesting to learn that they focused on community development before economic development. It seems natural to provide the town with monetary stimulation and the community growth would follow, but maybe that really is putting the cart before the horse. By making the community responsible for their own economic stimulation, it pulls them together while improving the community.
Possibly, one of the reason’s an approach like this might often fail is that it requires varying levels of contributions from the residents. Many “better off” residents might object to having to contribute more money than poorer residents. It is a constant issue with taxes and politics and social programs. The people of Tupelo had to see the bigger future that they were not only helping the poor, but helping improve the entire community. That is a hard thing to achieve and undoubtedly required a strong leader.
Based on the articles, I would say strong leadership was exactly what Tupelo had. George McClean seemed to have his hat in everything Tupelo had to offer. He was able to convince business owners to contribute money while simultaneously advancing the farming practices of rural citizens. In a sense, this is like microlending. The business owner’s were able to make contributions that helped the farmers improve their output. In turn, this flooded the economy with unimaginable revenues.
All in all, I would say this was a brilliant business and community plan. Kudos to George McClean.
by: Scott O'Connell
This week’s readings from The Fortune at the Bottom of the Pyramid were especially interesting to me because health care is an industry that I would like to get into upon graduation. While past readings had focused on micro financing and the rise of banks and their involvement with micro financing, these readings focused more on the impact of affordable health care’s impact on a developing country, micro health care if you will.
The reading that I found most interesting was The Jaipur Foot Story, primarily because of the speed and effectiveness of the low cost prosthetics that people were being supplied with. I thought it was remarkable that a person could come in, have a custom fitted prosthetic developed for them and be on there often times in just three or four hours. I thought that the cost was shocking as well. First, the reading states that a prosthetic foot in the United States costs around $8,000, however the materials used to make the prosthetics in India cost only $7.68. I’m no doctor and know very little about prosthetics, but what makes a prosthetic in India so much cheaper? This is something I would love to know. Also, for those in the United States that are unable to afford the $8,000 prosthetic, do they have access to these cheaper prosthetics or is capitalism at its finest preventing them access to the cheaper things?
What this reading and the Jaipurfoot.org website failed to tell me though was how they are turning a profit. That is something I would like to find out more about.
by: Perry Still
An interesting report on social entrepreneurship from PBS.
http://www.pbs.org/newshour/indepth_coverage/social_issues/social_ent/
by: Gary Olsen
Over the course of this mod, we have discussed issues relating to the “Bottom of the Pyramid” ranging from possibly exploiting the poor for economic and business reasons to how society can eliminate poverty and the problems that come along with it. We have talked at high levels on what poverty is and how it is defined. Guest speakers were brought in to help illustrate difficult concepts regarding poverty. While no one will dispute the importance of talking about these matters at such a high level, the real change comes from the actual steps taken that are put into action. The following three steps I have decided to take into action and do my part in addressing this universal issue.
1) Researching the Issues
By simply looking up current events and keeping afloat of key topics surrounding poverty, we can become better informed and able to tell people about the problem at hand. It has been my experience that most people want to help others, but simply don’t have the information or know where to look. We can do our part by educating ourselves and can then help spread the word to others.
2) Finding the right organization
With the dramatic increase in the coverage of the internet over the past 20 years, we are truly becoming a connected world. Stories from the most remote places in the world are being told by reporters to all the nations. While the awareness of global issues is increasing, we are coincidentally seeing an increase in organizations willing to tackle these problems and doing something about it. There are literally thousands of organizations out there, so we need to find the one that resonates with us.
3) Tell just one person about your experiences
To help spread the word and the awareness of these issues, I’ve decided to tell just one person about the organization I have joined. It is a simple task that anyone can do and doesn’t require a lot of effort on our part. If everyone were to do this simple act, we can help raise the awareness of these issues.
by: Joe Boulier
In response to the first post, the US government is already a massive donor. I believe they are actually the biggest international development donor in the world. Having spent time working on US Gov’t development grants, the results are a mixed bag. For one, their incentives are very different then private donors. US Government aid comes with heavy compliance costs and is often political in nature. Food aid is given as a ways to support US farmers. If the US Govt really cared about tackling food insecurity in developing countries they would not be handing out bags of US farmed grain, rather investing more in the local farmers infrastructural needs to move from subsistence to producing food for export. I think social entrepreneurship should remain a private endeavor. It is easier to keep seperate from the aims of government foreign policy if it is not implemented by the man.
by: Burch Wood
Unfortunately, health care is in pretty poor shape at the bottom of the pyramid. The sad part is that many of the healthcare issues are some that we’ve already solved. They simply do not have access to drugs, procedures, or training - especially for prevention. As an aspiring healthcare administrator, I’d love to be able to figure out a way to help them receive the health care that I believe all humans deserve. I would love to encourage teaching of medicine or sending trained physicians into the area. I welcome any comments on how one could proceed on this project. I think it would excellent to build a healthcare system in these underserved areas… I just need to figure out how to control costs!