Wednesday, October 31, 2012

Changes once again...

After thinking through the papers I've read on communities, resilience, and systems, I've decided, once again, to change my paper topic.  I think it would be a valuable exercise to identify real health problems of a country or region and use the ideas of community, resilience, and systems to guide research about possible solutions.  I thought it would be best to switch focus from sub-Saharan Africa to Nicaragua, because my prior knowledge and experience there can better guide the research.

Here are my new objectives for the paper:
  • Identify key health problems in Nicaragua
    • Child mortality, maternal mortality, malnutrition, etc.
    • Focus on Atlantic region- consistently shows poorer health based on indicators
  • Explore the underlying causes
    • ethnic divide between Atlantic coast and Central/Pacific
    • Less densely populated
    • Political history
    • Infrastructure
    • loss of indigenous health knowledge
  • Examine innovative ways health problems have been addressed
    • community based approach
    • Food security
    • Millennium development villages
    • lentils for immunizations in India
    • Community health workers
  • Suggest possible policy solutions for the health issues in Nicaragua
The research will be guided by the ideas of resilience, community, and systems, so the literature review and background readings will serve the same purpose as in my last proposal.

It may seem late to change my topic now, but I already feel like I have a better grasp on this.  I originally picked an area of the world I'm not as familiar with, but decided my paper could go more in depth if I focus on an area I'm more familiar with.  I'm working on updated my abstract/literature review to reflect this change and have some background research done on Nicaragua's health status.

Friday, October 26, 2012

Missing Health Knowledge


Here is an updated abstract and outline for my paper.  I've switched focus a bit to focus more on health knowledge- collective knowledge- rather than just health professionals.

Abstract:
Health knowledge is a key element in ensuring that communities are resilient- meaning they have the ability to bounce back from a shock or perturbation.  Lack of health knowledge, both indigenous and western, in sub-Saharan Africa severely undermines the ability of African communities to respond to everyday health care needs, as well as during crisis.  This paper will examine health systems in sub-Saharan Africa to understand the underlying causes of the missing health, its cost, and explore innovative solutions to this issue.
Research Questions: 
How have health systems in sub-Saharan Africa evolved?  How can the issue of missing health knowledge be addressed?
Outline:
Introduction
·         Sustainable development needs to build resilience
·         Focus on health as important for ensuring resilience
·         Health knowledge as important factor
·         Lack of health knowledge and expertise undermines a community’s/nation’s ability to react to everyday health needs of a community as well as health needs during a crisis
Health Systems
·         History
·         How have health systems evolved?
Missing Health Knowledge
·         Indigenous vs. western
·         WHO recommendations for doctor-patient ratio
o   Loss of $ for developing countries
o   Lack of health care professionals
§  Poor health
§  Low resilience to health shocks at a household, community, and national level
§  Lack of health knowledge
·         What can be done?
o   Case studies of innovative interventions
o   Required in-country service
o   Local health training- community health workers, especially in rural areas

Tuesday, October 9, 2012

Resilience in EU Aid Programs


The EU has released a proposal, “EU Approach to Resilience: Learning from FoodSecurity Crises,” to integrate resilience more deeply in their development and humanitarian aid programs.  The proposal included four principles to guide EU in embedding resilience in their programs: align EU support with recipient country priorities, support the development of national resilience strategies, boost the flexibility of EU aid programs, and elevate resilience in the list of aid priorities in countries facing recurrent crises.  Although it is important to prioritize resilience in countries facing recurrent crises it is important to evaluate the national resilience strategies and recipient country priorities before jumping on board assuming they build resilience.
The proposal stresses that “building resilience is a long-term effort that needs to be firmly embedded in national policies and planning” and that sustainable development needs to focus on the root causes of crises rather than the results of crises.  This makes Food Security, Climate Change Adaptation, and Disaster Risk Reduction priority programs for strengthening resilience. 
The proposal defines resilience as “the ability of an individual, a household, a community, a country or a region to withstand, to adapt, and to quickly recover from stresses and shocks.”  The EU is building on their experience in addressing crises in the Horn of Africa and the Sahel.  The EU also stresses the need to incorporate women in building resilience in households and communities affected by crises.

Tuesday, October 2, 2012

Resilience and Brain Drain in Sub-Saharan Africa

This is my working abstract/outline for my research paper...


Abstract: There has been a recent emphasis in the development aid community towards building resilience, meaning increasing a community’s ability to bounce back from external shocks.  Health knowledge is a key element in ensuring resilience at a household, community, and national level.  The human capital flight (brain drain) of health care professionals in sub-Saharan Africa severely undermines the ability of African communities to respond to everyday health care needs, as well as during crisis, at a local and national level.  This paper will examine the underlying causes of brain drain, its cost (social and economic) to Africans, and what can be done at a local, national, and international level to discourage brain drain and to mitigate the negative effects of brain drain.

Research Questions:  How does the human capital flight (brain drain) of health care professionals in Africa affect the ability of Africans to respond to health problems at a local and national level? What steps can national and international actors take to mitigate the brain drain problem?

Outline:
Introduction
·         Sustainable development needs to build resilience
·         Focus on health as important for ensuring resilience
·         Health knowledge as important factor
·         Lack of health knowledge and expertise undermines a community’s/nation’s ability to react to everyday health needs of a community as well as health needs during a crisis
Brain Drain in Africa
·         Why does it happen?
o   Health care professionals seeking better wages, working conditions
o   Demand in developing countries
o   Training needed abroad
·         Why is this a problem?
o   WHO recommendations for doctor-patient ratio
o   Loss of $ for developing countries
o   Lack of health care professionals
§  Poor health
§  Low resilience to health shocks at a household, community, and national level
§  Lack of health knowledge
·         What can be done?
o   Increase wages/working conditions
o   Required in-country service
o   More & improved in-country training
o   Temporary visas
o   Training exchange
o   Local health training- community health workers, especially in rural areas

Wednesday, September 26, 2012

Resilience


Neil Thin, in his book Social Progress and Sustainable Design, asks why do we need to be reminded that human well-being is a top priority?  He illustrates this question with the first sentence of the first UN World Summit on Social Development:

For the first time in history, at the invitation of the United Nations, we gather as heads of State and Government to recognize the significance of social development and human well-being for all and to give to these goals the highest priority both now and into the twenty-first century.

In, Thinking in Systems, Donella Meadows pointed out that too much emphasis has been put on the quantifiable.  In terms of development, if we focus too much on what we can count and measure, then only what we can count and measure becomes important and we miss out on the true goal- human well-being.  Instead of focusing on the ends, we end up focusing on the means.  This holds true when too much emphasis is put on macro-economics.  An increase in GDP doesn’t necessarily mean an increase in human well-being.  In fact, it may lead to a decrease in absolute or relative well-being, especially because disparities between genders, regions, ethnicities, etc. are not taken into account in macro-economic measures.

There has been a recent shift in the development aid community towards resilience building.  This is especially true in the Sahel area of Africa where droughts and famines are common.  Aid in this region has focused on lessening the burden of shocks such as droughts and famines, rather than empowering households and communities to bounce back themselves.  In Ending the Everyday Emergency: Resilience and Children in the Sahel, Save the Children and World Vision emphasize that focus needs to be brought to the problems of food insecurity and malnourishment on a long-term basis, not just during crisis.  They propose the following ways to overcome the resilience deficit:

·         Make reduction of child under-nutrition central to resilience
·         Harness small-scale agriculture for resilience and improved nutrition
·         Invest in social protection and services for the poorest households
·         Develop a new plan for how the national governments, international donors, and agencies should work together to prevent hunger crisis

Wednesday, September 19, 2012

Community Learning & Regenerative Design


This post will discuss the concepts and ideas of community, community learning, and regenerative design discussed by David Eisenberg, Etienne Wenger, Frank Young, and Fritjof Capra.  In my attempt to synthesize their ideas, I try to include real world examples that relate to the concepts explained in the readings and attempt to connect their thinking.
In Communities of Practice and Social Learning Systems, Etienne Wenger introduces the idea of communities of practices- that communities reflect collective learning.  In communities of practice members are “bound together by their collectively developed understanding of what their community is about…members build their community through mutual engagement” and communities of practices have communal resources (i.e. language, routines, tools, styles, etc).  Wenger can also be tied to Capra’s thinking about communities.  Both view communities as living learning systems, but Wenger does so without a biology metaphor.  Communities of practice need to connect with other communities of learning in order to share knowledge to become a breathing, living, social learning system.
Wenger explains boundaries of communities of practice as fluid and come about from “different enterprises; different ways of engaging with one another; different histories; repertoires, ways of communicating, and capabilities.’  Wenger suggests there are four types of brokers between communities: boundary spanners, roamers, outposts, and pairs.  Many organizations recognize the benefits of having roamers, who go from place to place sharing knowledge and making connections, and create roamers through organizational policy.  For example, the United Nations and other large organizations require that staff move to a new post after a certain number of years.  This encourages knowledge sharing and boundary bridging at each country office.
With the widespread use of the internet, communities of practice can now be virtual and global.  The web represents a huge advantage for developing communities of practice as well as bridging across boundaries and linking similar communities that may be widespread globally. 
Frank Young and Keiko Minai’s structural approach to community ecology presented in Community Ecology: A New Theory and an Illustrative Test, view communities as units of evolutionary change uses ‘population health’ as the criterion for successful adaptation.  This moves away from the Darwinian idea of the strongest survive, which has no sense of community.  Essentially, Young and Minai believe that communities have a natural capacity for problem solving and without it communities would cease to exist.
Young and Minai describe structural differentiation as the “degree to which specialized knowledge is ‘stored’ in the diverse occupations and organizations of a community.”  This can be seen as how tightly knit a community of practice is.  Wenger would say that the higher the structural differentiation, the higher the need for brokers to connect communities of practice.
Regenerative design, as David Eisenberg explains in Regenerative Design: Toward the Re-Integration of Human Systems within Nature, goes beyond the popular term sustainable design, which Eisenberg criticizes as only going as far to slow down environmental degradation, to not only stop environmental degradation but to reverse it by integrating design with nature.  Human systems need to be designed to obey the laws of nature- gravity, thermodynamics, biology, and ecology- so that human systems can “co-evolve with and enhance the evolutionary capability of natural systems.”
The John T. Lyle Center for Regenerative Studies at California State Polytechnic University is an example of regenerative design; it incorporates the laws of thermodynamics into its design.  One of the buildings has south facing windows for heating in the winter and shading and evaporative cooling in the summer while another is built into a hill which helps regulate the temperature year-round.  The center also incorporates vegetable gardens, fish, compost, manure, on-site wastewater treatment, and bio-gas digesters into the compound.  The Center for Regenerative Studies is a hands on learning environment which brings Capra’s inner-city gardening project with elementary students to the university level.
Eisenberg says,
“We see that buildings and settlements are not ‘objects’ or assemblages of technologies and materials, but amalgamations and concentrations of many systems with energy and material flows, not unlike living organism with metabolisms (electric lines, solar resources, materials, prevailing winds, soil health, ground water, roadways, social network systems, etc.” 
Like Capra, Eisenberg employs interdisciplinary thinking by using biology as a metaphor for communities.  Both Capra and Eisenberg view communities as a living system; Capra uses the cell as a metaphor and Eisenberg describes electricity, water, materials, etc as the ‘metabolism’ of the community.
Eisenberg also relates design to the natural system by encouraging humans to recognize that “natural systems have the self organizing capability to health themselves- if we let them.”  He suggests that we need to realign our ideals and activities so that both human and natural systems have the ability to self heal.  We can view Eisenberg’s idea of regenerative design as going beyond the idea of community ecology presented by Young and Minai, which focuses on human systems, to integrate human and natural systems into one community.
Eisenberg disagrees with the human ecology view that the environment is everything outside of the community and stresses the need to include the environment and nature into the community.  Young recognizes that the exhaustion of resources and natural disasters are threats to human ecology and that “all current environmental threats reflect the past impact of community activity.”  Eisenberg’s solution to environmental threats is to design using the rules of nature to reduce those threats and to reverse the exhaustion of resources and environmental degradation that exacerbates those threats to communities.  

Tuesday, September 11, 2012

Networks

One  major theme I pulled out of Capra's book Hidden Connections, is the idea that all forms of life (at all levels from cells to communities) are comprised of networks and are defined by interactions.
Patricia Shields, a professor at Southwest Texas State University, in A Pragmatic Teaching Philosophy explains five different micro-conceptual frameworks for research which are focused around the type of research question (what, where, when, who, how, why).  Looking at her pragmatic teaching philosophy from  a network/interaction view point, the frameworks can be seen as different ways of dissecting networks/interactions to figure out the what, where, when, who, how, and why.  For example, the formal hypotheses framework is focused around the question 'why.'  The research method used in this framework is experimental or quasi-experimental; the researcher will observe the interactions within a specific community to find a correlation or cause-effect relationship.
Popular economist Steve Levitt uncovered some interesting correlations using the formal hypotheses framework.  In the reaction, A->B->C, he knows C and sets out to find what factors (A and B) cause C.  In his book Freakonomics, he attributed lower crime rates (C) in the early 90s to the legalization of abortion in the early 70s by arguing that unwanted children are more prone to crime and drug use (A) and after the legalization of abortion, a whole generation of unwanted births were averted (B) which lead to a drop in crime around twenty years later (C).  I'm not agreeing with Levitt's theory (it has been largely contested), but it does break down an issue into smaller components (or reactions) to try to explain a phenomena.

Tuesday, September 4, 2012

Eco-Literacy

The concept of ecological literacy (or eco-literacy) for short, pioneered by Fritjof Capra, means "our ability to understand the basic principles of ecology and to live accordingly."  In other words, to use ecological principles to build sustainable human communities.  By sustainable human communities, Capra means "social, cultural and physical environments in which we can satisfy our needs and aspirations without diminishing the chances of future generations."

Watch Capra explain ecological literacy on YouTube: http://www.youtube.com/watch?v=vohcled-kto

Capra stresses how eco-literacy should be brought into schools through gardening and cooking, but the ideas behind it need to be taken into account on a larger level as well.  One of the principles of ecology Capra stresses is that "diversity assures resilience."  The increasing presence of GMOs is a perfect example of how this simple principle is being ignored. GMOs have decreased biodiversity, making crops more vulnerable to climate change, pests, and diseases, not to mention the unknown side-effects of GMOs on the animals (including humans) that eat them.  "Diversity assures resilience" is a simple principle that has been ignored by the agricultural industry and food policy makers who have been more concerned about present crop yields than the future.

Read more on GMOs and biodiversity: http://gmo-journal.com/index.php/2011/06/17/loss-of-biodiversity-and-genetically-modified-crops/